Panminerva medica
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The treatment of patients with multiple myeloma has changed in the last decades, with an improved median survival of 8-10 years. The current treatment for newly diagnosed multiple myeloma patients eligible for autologous transplantation consists of 4 phases: pretransplant, induction, transplant, post-transplant consolidation and maintenance. Even today, a long-term disease control is the goal of multiple myeloma treatment in current clinical practice. ⋯ Careful patient selection based on overall health status is crucial to ensure a balance between risks and benefits. In the era of induction regimens with new agents, upfront autologous transplantation remains the standard of care for young patients with newly diagnosed multiple myeloma due to the longer progression-free survival showed in randomized clinical studies. With the currently available data, the tandem transplantation in multiple myeloma may be considered in patients with high-risk cytogenetics, in particular, those who did not receive a new triplet combination or those with a lower response than very good partial response following their first transplantation.
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Over the last two decades, the outcomes of patients with multiple myeloma (MM), a malignant plasma cells dyscrasia, have dramatically improved. The development and the introduction of the immunomodulatory drugs (IMiDs) which include thalidomide, lenalidomide, and pomalidomide, have contributed significantly to these improvements. ⋯ Here the mechanisms of action, the clinical efficacy and the management of side effects are reviewed as well as the new classes of cereblon E3 ligase modulator (CELMoD) and their promising clinical data are described.
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Strong epidemiologic evidence has highlighted the role of pollution, on top of adverse climate features, as a novel cardiovascular risk factor. However, mechanistic proof that reducing pollution may be beneficial to prevent atherothrombotic events is limited. We aimed at appraising the impact of temporary traffic bans in a large metropolitan area on the risk of acute coronary syndromes. ⋯ Temporary traffic ban may favorably reduce coronary atherothrombotic events, and in particular NSTEMI, even if not globally and immediately impacting on environmental pollution. Further controlled studies are required to confirm and expand this hypothesis-generating results.