Some of the divergences observed may be explained by the fact tha

Some of the divergences observed may be explained by the fact that various eveniences may influence the serum IGF-I levels: age and gender [47], inflammatory processes [48], other concomitant diseases [49, 50], endocrine diseases [47], nutrition [47], drug administration and liver toxicity. Furthermore, melphalan therapy, which is hepatotoxic and therefore

should reduce IGF-I synthesis, has been reported to increase IGF-I molecules after the 4th course [40], possibly when it was effective in restoring the peripheral blood IGF-I amounts. It is also possible to speculate that the cytotoxic effect of therapy should release a great amount of endocellular molecules from necrotic cells with induction of inflammatory processes and IGF-I drop. In conclusion, as previously reported for other neoplastic diseases [42, 51], serum IGF-I BKM120 clinical trial concentrations are clearly reduced in case of open disease. Therefore, a clinical use of serum determinations of this molecule should be made very carefully since this substance does not show a clear specificity for MM. A possible role of IGF-I as putative monitoring marker of malignant disease seems to emerge by our study, even though specific clinical trials need to be planned and the possible interference of other factors in serum

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