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Int. J. Mol. Sci. 2016, 17(10), 1760;

Towards Stratified Medicine in Plasma Cell Myeloma

Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, Ulster University, C-TRIC Building, Altnagelvin Area Hospital, Glenshane Road, Derry/Londonderry BT47 6SB, Northern Ireland
Author to whom correspondence should be addressed.
Academic Editor: William Chi-shing Cho
Received: 24 July 2016 / Revised: 26 September 2016 / Accepted: 5 October 2016 / Published: 21 October 2016
(This article belongs to the Special Issue Precision Medicine—From Bench to Bedside)
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Plasma cell myeloma is a clinically heterogeneous malignancy accounting for approximately one to 2% of newly diagnosed cases of cancer worldwide. Treatment options, in addition to long-established cytotoxic drugs, include autologous stem cell transplant, immune modulators, proteasome inhibitors and monoclonal antibodies, plus further targeted therapies currently in clinical trials. Whilst treatment decisions are mostly based on a patient’s age, fitness, including the presence of co-morbidities, and tumour burden, significant scope exists for better risk stratification, sub-classification of disease, and predictors of response to specific therapies. Clinical staging, recurring acquired cytogenetic aberrations, and serum biomarkers such as β-2 microglobulin, and free light chains are in widespread use but often fail to predict the disease progression or inform treatment decision making. Recent scientific advances have provided considerable insight into the biology of myeloma. For example, gene expression profiling is already making a contribution to enhanced understanding of the biology of the disease whilst Next Generation Sequencing has revealed great genomic complexity and heterogeneity. Pathways involved in the oncogenesis, proliferation of the tumour and its resistance to apoptosis are being unravelled. Furthermore, knowledge of the tumour cell surface and its interactions with bystander cells and the bone marrow stroma enhance this understanding and provide novel targets for cell and antibody-based therapies. This review will discuss the development in understanding of the biology of the tumour cell and its environment in the bone marrow, the implementation of new therapeutic options contributing to significantly improved outcomes, and the progression towards more personalised medicine in this disorder. View Full-Text
Keywords: plasma cell myeloma; multiple myeloma; plasma cell dyscrasias; personalised medicine; flow cytometry; Next Generation Sequencing; proteasome inhibitors; immunomodulatory drugs; microRNAs plasma cell myeloma; multiple myeloma; plasma cell dyscrasias; personalised medicine; flow cytometry; Next Generation Sequencing; proteasome inhibitors; immunomodulatory drugs; microRNAs

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Egan, P.; Drain, S.; Conway, C.; Bjourson, A.J.; Alexander, H.D. Towards Stratified Medicine in Plasma Cell Myeloma. Int. J. Mol. Sci. 2016, 17, 1760.

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