This site uses cookies to deliver our services and to show you relevant ads and presentations. By clicking on "Accept", you acknowledge that you have read and understand our Cookie Policy , Privacy Policy , and our Terms of Use.
X

Download Multiple Myeloma Case studies PowerPoint Presentation


Login   OR  Register
X


Iframe embed code :



Presentation url :

X

Description :

Available Multiple Myeloma Case studies powerpoint presentation for free download which is uploaded by search an active user in belonging ppt presentation Health & Wellness category.

Tags :

Multiple Myeloma Case studies

Home / Health & Wellness / Health & Wellness Presentations / Multiple Myeloma Case studies PowerPoint Presentation

Multiple Myeloma Case studies PowerPoint Presentation

Ppt Presentation Embed Code   Zoom Ppt Presentation

About This Presentation


Description : Available Multiple Myeloma Case studies powerpoint presentation for free download which is uploaded ... Read More

Tags : Multiple Myeloma Case studies

Published on : Feb 24, 2014
Views : 683 | Downloads : 0


Download Now

Share on Social Media

             

PowerPoint is the world's most popular presentation software which can let you create professional Multiple Myeloma Case studies powerpoint presentation easily and in no time. This helps you give your presentation on Multiple Myeloma Case studies in a conference, a school lecture, a business proposal, in a webinar and business and professional representations.

The uploader spent his/her valuable time to create this Multiple Myeloma Case studies powerpoint presentation slides, to share his/her useful content with the world. This ppt presentation uploaded by onlinesearch in this Health & Wellness category is available for free download,and can be used according to your industries like finance, marketing, education, health and many more.

SlidesFinder.com provides a platform to marketers, presenters and educationists along with being the preferred search engine for professional PowerPoint presentations on the Internet to upload their Multiple Myeloma Case studies ppt presentation slides to help them BUILD THEIR CROWD!!

User Presentation
Related Presentation
Free PowerPoint Templates
Slide 1 - Multiple Myeloma Case studiesUKMF Education Day November 2011 Kwee Yong Cancer Institute University College London
Slide 2 - Case 1 : Lynne 36 year old business manager June 2010: fatigue & nosebleeds Hb 8.8g/dL, WBC 2.8 x 109/L, Neuts 0.9, plts 198 IgG 79g/L, pp = 61 Creatinine 109umol/L, normal Ca++ Albumin 33g/L, b2m 3.7mg/L (ISS Stage 2) BMT: 80% plasma cells, CD56+, cyclin D1+ FISH: t(11;14) SS: no lytic lesions, MRI spine: no focal lesions
Slide 3 - Several karytopic abnormalities Case 1: Lynne
Slide 4 - July 2010: CTD & zometa (sibling match) Neutropenia after one dose Cyclo Thal/Dex Poor tolerance: dizziness, bradycardia (45-50/min) Pp 46, then 53 Case 1: Lynne What would you do now?
Slide 5 - Case 1: Decision point 1 Continue with Dexamethasone alone Switch to Velcade and Dexamethasone Continue with Cyclophosphamide and dexamethasone with growth factor support Stop treatment to allow bone marrow recovery
Slide 6 - July 2010: CTD & zometa (sibling match) Neutropenia after one dose Cyclo Thal/Dex Poor tolerance: dizziness, bradycardia (45-50/min) Pp 46, then 53 Case 1: Lynne August 2010: Velcade/Dex 3 cycles Stable disease Grade 1 PN What would you do now?
Slide 7 - Case 1: Decision point 2 Continue with Velcade and Dexamethasone for further 2-3 cycles as tolerated Switch to Revlimid and Dexamethasone Add Revlimid to Velcade and Dexamethasone Arrange mobilisation and PBSCH
Slide 8 - Revlimid 10mg od days 1-14, with velcade 1.3g/m2 and dex After 14 days, neutrophils 0.6 Prolonged neutropenia Transfusions Case 1 : Lynne What would you do now?
Slide 9 - Case 1: Decision point 3 Wait for bone marrow recovery and try again with RVD Switch to Revlimid and Dexamethasone ESHAP with PBSCH Proceed to allogeneic transplant
Slide 10 - Case 1: Lynne What would you do now?
Slide 11 - Case 1: Decision point 4 Salvage regimen prior to ASCT Proceed to allogeneic transplant Proceed to ASCT Clinical trial of new agent
Slide 12 - ASCT Jan 2011 (27 weeks after diagnosis): pp 42 ASCT 14.01.2011 5 week admission Fever day -1 Grade 3/4 mucositis: diarrhoea++, nausea, dehydrated Hypokalaemia induced DI: polyuria, polydipsia Neut engraftment day +12 Discharged day +33 Case 1: Lynne
Slide 13 - Case 1: Lynne BM 3% PC VGPR What would you do now?
Slide 14 - Case 1: Decision point 5 Nothing Reduced intensity sibling allograft (LenaRIC study) Maintenance with lenalidomide Maintenance with thalidomide
Slide 15 - Case 1: issues Primary refractory MM Discordance in prognostic information between FISH and karyotype Sibling match – when to allograft? Case for tandem sib RIC allo? Poor tolerance of chemotherapy Toxicity of conditioning
Slide 16 - Case 2: Joanna 49 year old charity worker June 2010 ‘blocked ear’ for 2 mo Sudden onset diplopia and numbness R face 4 days Right 6th nerve palsy MRI head: large irregular tumour arising from clivus and R sphenoid, invading cavernous sinus CT scan: rib lesions, T5 lesion invading canal, large sacral mass, sternal mass, L iliac lesion, breast lump
Slide 17 - R L Case 2: Joanna
Slide 18 - Immune paresis Urine protein: 2g/24 hr SFLC: kappa 4720mg/L BMT: 80% plasma cells, cyclin D1+, CD56- FISH: IgH split, 17p loss in all cells CT-PET: FDG avid lesions manubrium, R iliac bone, R base of skull, T5 Case 2: Joanna Case 2: Joanna
Slide 19 - Case 2 : Decision point 1How would you manage this patient? Urgent DXT to base of skull Treat with CTD Use high grade NHL protocol with CNS treatment Velcade and dexamethasone
Slide 20 - LP: no cells, methotrexate High dose dexamethasone Velcade, Idarubicin & Ara-C (June 2010) Clinical response, MRI improvement, KLC 79mg/L July 2010: Ida-Ara-C no.2 with Velcade/dex Neutropenic fever, klebsiella septicaemia Hypoxia, severe mucositis Case 1: Joanna Case 2: Joanna Case 2: Joanna
Slide 21 - Velcade / dexamethasone no.3 Re-staging MRI: good response to treatment PET-CT scan: new FDG-avid lesions in liver and spleen, previous lesions resolved BM: CR, KLC 1.7mg/L, urine: IF neg for BJP Case 2: Joanna
Slide 22 - Biopsy liver lesions x 3!! Fibrosis with inflammatory cells Rx: posaconazole 3 mo Velcade / Dexamethasone no.4 Cyclo-G-CSF prime and PBSC harvest Repeat CT scan: lesions unchanged Case 2: Joanna What would you do now?
Slide 23 - Case 2: Decision point 2 Assume liver lesions disease and treat with Revlimid and dexamethasone Attempt further biopsy of liver Continue posaconazole and re-scan Proceed with ASCT
Slide 24 - 25 Feb 2011: Melphalan 140 / TBI 12 Gy in 6 fractions ASCT in ambulatory care Fever day +8, resistant E Coli, PICC line out Engrafted day +12, discharged day +15 May 2011: BM clear, SFLC normal, CT abdo: lesions smaller MRI head Case 2: Joanna Case 2: Joanna
Slide 25 - Case 2: repeat imaging What would you do now?
Slide 26 - Case 2: Decision point 3 Consolidation DXT to base of skull Do nothing Maintenance with thalidomide (lenalidomide) Search for donor (MUD RIC-allo, -LenaRIC?) Case 2: Joanna 30 Gy DXT to base of skull in 15 fractions Watch and wait
Slide 27 - Case 3: Lenny 45 yr old warehouse supervisor Aug 2011: Back pain since Dec 2010 Anorexia and weight loss Unsteady walking “Numb balls” Sluggish bowels, urinary hesitancy Pain radiating down legs, walking with sticks Case 3: Lenny
Slide 28 - Case 3: Lenny
Slide 29 - Case 3: Lenny MRI: extensive paravertebral mass T11-L2, extending into soft tissues, and into the spinal canal at L1 compressing the conus Biopsy at Stanmore: Plasma cell tumour
Slide 30 - Dexamethasone 4mg qds BM clear FBC normal, renal function normal SEP small IgAk pp, total IgA 9.8g/L SFLC SS, MRI spine: no other lesions Solitary plasmacytoma Case 3: Lenny Case 3: Lenny
Slide 31 - Case 3: Decision point 1How would you manage this patient? Surgery and decompression Radiotherapy Treat with CTD Treat with velcade and dexamethasone Case 3: Lenny
Slide 32 - Velcade, cyclophosphamide & dexamethasone started within 24 hours Radiotherapy review – on hold Pain decreased, improved mobility Postural drop beginning of cycle 2 Lying 130/75, standing 107/70 asymptomatic Delay 1 week Case 3: Lenny Case 3: Lenny
Slide 33 - MRI after 2 cycles CVD, marked improvement Sensation in groins now normal, perineal parasthesiae persists but better Bowels : grade 1 constipation Bladder function normal IgA reduced from 9.8 to 1.7g/L Case 3: Lenny What would you do now?
Slide 34 - Case 3: Decision point 2 Stop CVD and give radical DXT Continue with CVD Switch to CTD Surgery to stabilise spine Case 3: Lenny
Slide 35 - Spinal plasmacytoma:Radiotherapy, surgical decompression/fixation or systemic treatment? Level of tumour Cervical, thoracic, T-L jn, lumbo-sacral Spinal cord issues: bony or tumour Spinal stability: (bracing?) Presence of disease elsewhere Stage of disease (diagnosis, relapse) Access (clinical oncologists, surgical colleagues)
Slide 36 - Solitary bone plasmacytoma Most (>70%) progress to MM, majority within 2-4 years Risk of progression assoc with persistence of M-band, abnormal SFLC ratio PET-CT scanning may be useful to identify occult disease Relatively indolent disease even after progression, OS 5-10 years
Slide 37 - 55 yr old schoolteacher March 2010: back pain (previous L4/5 vertebrectomy) Hb 6.6g/dl, WBC 2.4, neuts 1.2, Plats 34 SEP: pp 2 g/L, UTP 9 g/L b2microglobulin 9.3mg/L SFLC lambda 5270mg/L Calcium and Renal function normal Case 4: Michael
Slide 38 - BM 90% cyclin D1+ PC, FISH ? Partial p53 loss MRI: diffuse abn BM signal, extraosseus tumour left 6th rib, paravertebral mass at T11/12 No spinal cord issues, neurologically intact Case 4: Michael
Slide 39 - Case 4: Decision point 1How would you treat this patient? CTD Velcade and dexamethasone Urgent radiotherapy to paravertebral mass VAD/Idarubicin & Dex (Myeloma XI, PADIMAC)
Slide 40 - Case 4: Michael What would you do now? FISH: t(11;14) single fusion TP53: deleted in 88% BM
Slide 41 - Case 4: Decision point 2 Add Cyclophosphamide to Revlimid /Dex Proceed with mobilising stem cells ESHAP-type regimen Palliate
Slide 42 - Case 4: Michael What would you do now?
Slide 43 - Case 4: Decision point 3 Do nothing Search for donor for RIC allo Maintenance with thalidomide Consolidation - ? VTD consolidation
Slide 44 - VAD TD VD RD TAD PAD VTD Summary of novel agent induction trials (randomized studies) Post-induction Post-transplant ≥ VGPR rates post-induction and post-transplant Harousseau et al. ASH/ASCO symposium during ASH 2008 Rajkumar et al. ASCO 2008 (Abstract 8504); ASH/ASCO symposium during ASH 2008 Lokhorst et al. Haematologica 2008;93:124–7 Sonneveld et al. ASH 2008 (abstract 653); IMW (abstract 152) Cavo et al. ASH 2008 (abstract 158); IMW 2009 (abstract 451) *Post-transplant data not available 15-16% 30- 35% 39% 33% 45% 62% 42%
Slide 45 - 17p- disease in MM 9-10% at presentation Progression event Associated with Light chain only disease, high ISS stage Prognostic only if in ≥50% plasma cells Very poor outlook IFM study of Vel/Dex, EFS 14 mo vs 36mo
Slide 46 - (A) Event-free survival (EFS) and (B) overall survival (OS) in patients with del(17p) (n = 54) or without del(17p) (n = 453) treated with bortezomib-dexamethasone induction (EFS and OS in years; P < .001 for EFS and OS). Avet-Loiseau H et al. JCO 2010;28:4630-4634 ©2010 by American Society of Clinical Oncology
Slide 47 - Case 5: John 63 year old aircraft engineer Presented with anaemia Diagnosed with IgGk MM Initial treatment with VAMP, minor response CDT x 5 ASCT
Slide 48 - Case 5: John ?
Slide 49 - Case 5: Decision point 1 Palliate Cyclophosphamide and dexamethasone Thalidomide regimen Re-treat with velcade on NHS
Slide 50 - Case 5: John
Slide 51 - Case 5: Decision point 2 Palliate Thalidomide Cyclophosphamide and dexamethasone Clinical trial
Slide 52 - Clinical trials for relapsed MM Bortezomib trials (± HDACi, ±hsp90i, ±mAb) Usually IV velcade 1-3 prior lines Lenalidomide trials (±carfilzomib, ±CS1 mAb) Pomalidomide trials MUK Clinical Trials Network early phase studies Less restriction in no of prior lines Other, eg carfilzomib