MULTIPLE MYELOMA and other monoclonal gammopathies
Monoclonal gammopathies and multiple myeloma are a group of diseases where tumor plasma cells grow abnormally in the bone marrow and a monoclonal protein increases in the blood and/or urine.
Multiple myeloma is the second most frequent blood tumor after lymphomas. Treatment for this disease has changed dramatically in the recent years thanks to the development of new therapies, such as the approval of 5 new drugs that have doubled the survival rate of patients with myeloma.
We are a reference center of the Spanish Myeloma Group; we receive and diagnose 3 to 4 cases a day.
Also, we are a reference center for pre-clinical research for new treatments, collaborating with different pharmaceutical companies and offering a training facility for over 100 foreign physicians that come to train in our hospital every year.
At the Clinica Universidad de Navarra we offer personalized treatment and follow-up for our patients. The drugs we administer and their intensity are individualized according to the particular characteristics of each patient.
There are three types:
1. Monoclonal gammopathy of undetermined significance (MGUS): the most frequent type. It is a “benign” condition, with presence of a monoclonal protein in the blood or urine due to a slight increase of plasma cells, with no other alterations. Eleven percent of these cases evolve into multiple myeloma.
2. Asymptomatic / smoldering myeloma: in this case there is a larger amount of tumor cells in the bone marrow and a larger amount of monoclonal protein in the blood and/or urine, but no symptoms are present. The evolution is uncertain; some cases behave like a “benign” monoclonal gammopathy and others evolve into an active myeloma, becoming high-risk patients.
3. Multiple myeloma: this type shows symptoms such as anemia, bone damage, kidney failure of increase of calcium in the blood, and other analytic or radiological alterations that require immediate treatment.
Multiple myeloma and monoclonal gammopathy medical care and research team of the Clinica Universidad de Navarra and CIMA (Center for Applied Medical Research)
WE PROVIDE PRECISE DIAGNOSES AND THE MOST ADVANCED TREATMENT WITH HIGHLY DEDICATED PROFESSIONALS TO FIGHT AGAINST THE DISEASE
INTERNATIONAL REFERENCE CENTER
Dr. Jesus San Miguel is a world reference regarding this disease. Dr. San Miguel is currently the Chair of the International Myeloma Society.
We have led the changes in the diagnosis and response criteria for this disease. Our team has over 20 professionals researching on myeloma.
Currently, we have over 30 open clinical trials to offer new opportunities to our patients.
- Dr. Jesus San Miguel is a world reference on this disease and Chair of the International Myeloma Society.
- Our professional team has led the changes in the diagnosis and response criteria for myeloma in the International Myeloma Working Group
- Reference center of the Spanish Myeloma Group for diagnosis: each day we receive 3-4 cases for evaluation.
- Reference center for pre-clinical research in collaboration with different pharmaceutical companies to speed-up the step between the laboratory and the patient.
- Over 20 professionals researching on myeloma
- Over 30 open clinical trials in our center
- Over 25 scientific publications in first level international journals
- Training center for foreign physicians. Over 100 foreign hematologists come every year to train in our service.
Our professional team has contributed to:
- The approval of at least, 5 drugs: Bortezomib (New England Journal of Medicine 2008, Lancet Oncology 2010), Lenalidomide (New England Journal of Medicine 2003), Pomalidomide (Lacet Oncology 2013), Panobinostat (Lancet Oncology 2014) y Daratumumab (New England Journal of Medicine 2015, New England Journal of Medicine 2017).
- The construction of the current prognosis classification of myeloma in stages (ISS) (Journal of Clinical Oncology 2005).
- The improvement of diagnosis criteria (Lancet Oncology 2014) and the assessment of the response to treatment (Lancet Oncology 2016), as part of the International Myeloma Working Group.
- Predicting the risks of transformation of the pre-malignant forms to malignant (New England Journal of Medicine 2013, Lancet Oncology 2016).
We are conducting over 30 open clinical trials in all stages of the disease and all drugs under evaluation for myeloma, and also all types of autologous and allogeneic transplants
CAR cells anti BCMA
- Bispecific antibodies targeting BCMA
New generation proteasome inhibitors:
- CELMODs, 3rd generation immunomodulator drugs
Other drugs (selective inhibitors)
COMPREHENSIVE AND PRECISE DIAGNOSES WITH CUTTING EDGE TECHNOLOGY
Flow cytometry is a key instrument for diagnosis and prognosis valuations of monoclonal gammopathies. It allows precise characterizing of markers in plasma cells of a myeloma to guide diagnosis and prognosis.
We have led the most sensitive methods to detect the minimal residual disease in order to obtain higher precision when monitoring the efficiency of treatments.
Flow cytometry has been key when modifying the latest response classification of myeloma and establishing the negative prognosis of the persistence of the negative minimal residual disease".
DR. BRUNO PAIVA
Deputy Scientific Director of CIMA LAB Diagnostics
The genetic classification of myeloma is fundamental to establish an adequate prognosis.
Studies on mutations and sequencing have allowed finding unfavorable mutations among patients where others tests result normal. These studies guide the use of certain treatments.
- FISH in selected plasma cells
- Mutation panel
- Massive sequencing studies
We count on all the genetic and genomic techniques to diagnose hereditary diseases (monogenic pathology, syndromes and hereditary cancer), as well as diagnostic, predictive and prognostic markers in solid tumors and hematologic neoplasias".
DR. Ma. JOSÉ CALASANZ
Deputy Scientific Director of CIMA LAB Diagnostics
Positron Emission Tomography (PET): with glucose and methionine. The latter radiopharmaceutical has a wider diagnostic sensitivity for myeloma.
Full-body CAT with low doses of radiation: allows obtaining high-quality images with higher sensitivity than conventional X-rays.
3-Tesla MRI: the most potent resonance that obtains higher precision diagnoses of images.
access theMOST ADVANCED TREATMENT
The symptoms of the disease are derived from the uncontrolled proliferation of plasma cells in the bone marrow. These cells displace normal cells, resulting in a picture of anemia with its associated symptoms: fatigue, pallor, tachycardia, hot flushes, etc.
There is also bone destruction that can cause more or less intense bone pain and even spontaneous fractures or fractures to minimal trauma.
In addition, atypical cells produce and secrete an abnormal immunoglobulin to the blood (component or monoclonal band) that when filtered by the kidney can cause renal failure.
In the recent years, new progress has been made regarding this disease, increasing significantly these patients’ survival rate.
In patients under 70 that fulfill the criteria, the ideal treatment is the bone marrow self-transplant.
4-5 induction treatment cycles with new drugs (bortezomib, thalidomide, lenalidomide, etc.) and then self-transplant. After, new drugs can be administered to consolidate and maintain the response to the disease.
If the patient is not a candidate for bone marrow self-transplant, the indicated treatment is to administer alkylation agents: melphalan, prednisone, etc, previously the classic treatment, but adding these new drugs:
- Monoclonal antibodies such as daratumumab, isatuximab, bispecific antibodies anti BCMA.
- New immunomodulators: Pomalidomide, lenalidomide, etc.
- New generation proteosome inhibitors: oprozomib, carfilzomib, etc.
- Other selective inhibitor drugs: venetoclax, selinexor, panobinostat, etc.
The Clinica Universidad de Navarra currently has 45 open clinical trials about multiple myeloma that provide a therapeutic opportunity for our patients as they can have access to these new drugs.
Thanks to these clinical trials we have contributed to the approval of at least 5 new drugs to fight against this disease: Bortezomib (New England Journal of Medicine 2008, Lancet Oncology 2010), Lenalidomide (New England Journal of Medicine 2003), Pomalidomide (Lacet Oncology 2013), Panobinostat (Lancet Oncology 2014) y Daratumumab (New England Journal of Medicine 2015, New England Journal of Medicine 2017).
We have the most sophisticated developments, such as molecular biology studies, to assess the multiple prognostic factors that are essential for selecting the most appropriate treatment for each patient.”
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