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William I. Bensinger

The treatment of multiple myeloma has dramatically improved in the past 10 years. The availability of new drugs has broadened chemotherapy options; however, complete remissions (CR) are infrequent, and cure is still rare. High-dose therapy followed by autologous or allogeneic stem cell transplant has emerged as a promising means to increase remission rates and improve survival. Autologous transplants have not always shown survival benefits in randomized studies because the majority of patients who undergo transplant relapse, and patients given conventional therapy can receive salvage transplants at the time of relapse. CR has been found to reliably predict survival and thus the efforts to improve remission rates using autologous transplant include tandem transplants, targeted radiation, cytoprotective agents, or posttransplant immunotherapy. Only allogeneic hematopoietic stem cell transplantation is potentially curative, because of an immunologic graft-versus-myeloma effect. High transplant-related mortality associated with allogeneic stem cell transplantation is currently the major limitation to wider use of this modality. Although patients who receive either allogeneic or autologous stem cell transplants for multiple myeloma have similar 3- to 5-year survivals, only allograft recipients appear to enjoy long-term disease-free survival. Promising approaches designed to improve the therapeutic index of allografts include the use of nonablative conditioning regimens, peripheral blood cells rather than bone marrow, graft engineering, and targeted conditioning therapies such as bone-seeking radioisotopes.

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Sarah P. Hammond, Sankar Swaminathan, William I. Bensinger and Lindsey R. Baden

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Kenneth C. Anderson, Melissa Alsina, William Bensinger, J. Sybil Biermann, Asher Chanan-Khan, Adam D. Cohen, Steven Devine, Benjamin Djulbegovic, Cristina Gasparetto, Carol Ann Huff, Madan Jagasia, Bruno C. Medeiros, Ruby Meredith, Noopur Raje, Jeffrey Schriber, Seema Singhal, George Somlo, Keith Stockerl-Goldstein, Guido Tricot, Julie M. Vose, Donna Weber, Joachim Yahalom and Furhan Yunus

Multiple Myeloma Clinical Practice Guidelines in Oncology NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Overview Multiple myeloma (MM) is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. The American Cancer Society estimates that 20,580 new cases of MM will occur in the United States in 2009, including 11,680 in men and 8900 in women, with an estimated 10,580 deaths.1 The mean age of affected individuals is 62 years for men (75% > 70 years) and 61 years for women (79% > 70 years). The treatment of MM has dramatically improved over the past decade. The 5-year survival rate reported in the Surveillance Epidemiology and End Results database has increased from 25% in 1975 to 34% in 2003 because of the availability of newer and more effective treatment options.2,3 MM is typically sensitive to various cytotoxic drugs, both as initial treatment...
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Lindsey Robert Baden, William Bensinger, Michael Angarone, Corey Casper, Erik R. Dubberke, Alison G. Freifeld, Ramiro Garzon, John N. Greene, John P. Greer, James I. Ito, Judith E. Karp, Daniel R. Kaul, Earl King, Emily Mackler, Kieren A. Marr, Jose G. Montoya, Ashley Morris-Engemann, Peter G. Pappas, Ken Rolston, Brahm Segal, Susan K. Seo, Sankar Swaminathan, Maoko Naganuma and Dorothy A. Shead

Patients with cancer are at increased risk for developing infectious complications during the course of their disease and treatment. The following sections of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Prevention and Treatment of Cancer-Related Infections provide an overview of the risk factors for infectious complications, recommendations for infectious risk categorization, and strategies for prevention of infections in high-risk patient populations with cancer. Individualized risk evaluation for infections and incorporation of preventative measures are essential components of the overall spectrum of cancer care, and may contribute to optimizing treatment outcomes for patients.

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Kenneth C. Anderson, Melissa Alsina, William Bensinger, J. Sybil Biermann, Asher Chanan-Khan, Adam D. Cohen, Steven Devine, Benjamin Djulbegovic, Edward A. Faber Jr., Cristina Gasparetto, Carol Ann Huff, Adetola Kassim, Bruno C. Medeiros, Ruby Meredith, Noopur Raje, Jeffrey Schriber, Seema Singhal, George Somlo, Keith Stockerl-Goldstein, Steven P. Treon, Guido Tricot, Donna M. Weber, Joachim Yahalom and Furhan Yunus

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Kenneth C. Anderson, Melissa Alsina, William Bensinger, J. Sybil Biermann, Adam D. Cohen, Steven Devine, Benjamin Djulbegovic, Edward A. Faber Jr, Christine Gasparetto, Francisco Hernandez-Ilizaliturri, Carol Ann Huff, Adetola Kassim, Amrita Y. Krishnan, Bruno C. Medeiros, Ruby Meredith, Noopur Raje, Jeffrey Schriber, Seema Singhal, George Somlo, Keith Stockerl-Goldstein, Steven P. Treon, Guido Tricot, Donna M. Weber, Joachim Yahalom, Furhan Yunus, Rashmi Kumar and Dorothy A. Shead

These NCCN Guidelines Insights highlight the important updates/changes specific to the management of Waldenström’s Macroglobulinemia/Lymphoplasmacytic Lymphoma. These include the addition of regimens containing novel agents as primary and salvage therapy options, inclusion of the updated summary of response categories and criteria from the sixth international workshop on Waldenström’s Macroglobulinemia, and a section on management of peripheral neuropathy in the accompanying discussion.

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Kenneth C. Anderson, Melissa Alsina, William Bensinger, J. Sybil Biermann, Adam D. Cohen, Steven Devine, Benjamin Djulbegovic, Edward A. Faber Jr, Cristina Gasparetto, Francisco Hernandez-Illizaliturri, Carol Ann Huff, Adetola Kassim, Amrita Y. Krishnan, Michael Liedtke, Ruby Meredith, Noopur Raje, Jeffrey Schriber, Seema Singhal, George Somlo, Keith Stockerl-Goldstein, Steven P. Treon, Donna Weber, Joachim Yahalom, Furhan Yunus, Dorothy A. Shead and Rashmi Kumar

These NCCN Guidelines Insights highlight the important updates/changes specific to the management of relapsed or progressive disease in the 2013 version of the NCCN Clinical Practice Guidelines in Oncology for Multiple Myeloma. These changes include the addition of new regimens as options for salvage therapy and strategies to mitigate the adverse effects and risks associated with newer regimens for the treatment of multiple myeloma.