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Paludo J, Mikhael JR, LaPlant BR, Halvorson AE, Kumar S, Gertz MA, Hayman SR, Buadi FK, Dispenzieri A, Lust JA, Kapoor P, Leung N, Russell SJ, Dingli D, Go RS, Lin Y, Gonsalves WI, Fonseca R, Bergsagel PL, Roy V, Sher T, Chanan-Khan AA, Ailawadhi S, Stewart AK, Reeder CB, Richardson PG, Rajkumar SV, Lacy MQ. Pomalidomide, bortezomib, and dexamethasone for patients with relapsed lenalidomide-refractory multiple myeloma. Blood 2017; 130:1198-1204. [PMID: 28684537 PMCID: PMC5606008 DOI: 10.1182/blood-2017-05-782961] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/21/2017] [Indexed: 01/09/2023] Open
Abstract
This phase 1/2 trial evaluated the maximum tolerated doses, safety, and efficacy of pomalidomide, bortezomib, and dexamethasone (PVD) combination in patients with relapsed lenalidomide-refractory multiple myeloma (MM). In phase 1, dose level 1 consisted of pomalidomide (4 mg by mouth on days 1 to 21), IV or subcutaneous bortezomib (1.0 mg/m2 on days 1, 8, 15, and 22), and dexamethasone (40 mg by mouth on days 1, 8, 15, and 22) given every 28 days. Bortezomib was increased to 1.3 mg/m2 for dose level 2 and adopted in the phase 2 expansion cohort. We describe the results of 50 patients. Objective response rate was 86% (95% confidence interval [CI], 73-94) among all evaluable patients (stringent complete response, 12%; complete response, 10%; very good partial response, 28%; and partial response, 36%) and 100% among high-risk patients. Within a median follow-up of 42 months, 20% remain progression free, 66% are alive, and 4% remain on treatment. Median progression-free survival was 13.7 months (95% CI, 9.6-17.7). The most common toxicities were neutropenia (96%), leukopenia (84%), thrombocytopenia (82%), anemia (74%), and fatigue (72%); however, the majority of these were grade 1 or 2. The most common grade ≥3 toxicities included neutropenia (70%), leukopenia (36%), and lymphopenia (20%). Deep vein thrombosis occurred in 5 patients. In conclusion, PVD is a highly effective combination in lenalidomide-refractory MM patients. Weekly administration of bortezomib enhanced tolerability and convenience. Toxicities are manageable, mostly consisting of mild cytopenias with no significant neuropathy. This trial was registered at www.clinicaltrials.gov as #NCT01212952.
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Affiliation(s)
- Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Betsy R LaPlant
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Alese E Halvorson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - John A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Vivek Roy
- Mayo Clinic Florida, Jacksonville, FL; and
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102
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Dimopoulos MA, Lonial S, White D, Moreau P, Palumbo A, San‐Miguel J, Shpilberg O, Anderson K, Grosicki S, Spicka I, Walter‐Croneck A, Magen H, Mateos M, Belch A, Reece D, Beksac M, Bleickardt E, Poulart V, Sheng J, Sy O, Katz J, Singhal A, Richardson P. Elotuzumab plus lenalidomide/dexamethasone for relapsed or refractory multiple myeloma: ELOQUENT-2 follow-up and post-hoc analyses on progression-free survival and tumour growth. Br J Haematol 2017; 178:896-905. [PMID: 28677826 PMCID: PMC6084289 DOI: 10.1111/bjh.14787] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/29/2017] [Indexed: 01/26/2023]
Abstract
The randomized phase III ELOQUENT-2 study (NCT01239797) evaluated the efficacy and safety of elotuzumab + lenalidomide/dexamethasone (ELd) versus lenalidomide/dexamethasone (Ld) in relapsed/refractory multiple myeloma. ELd reduced the risk of disease progression/death by 30% versus Ld (hazard ratio [HR] 0·70). Median time from diagnosis was 3·5 years. We present extended 3-year follow-up data. Endpoints included progression-free survival (PFS), overall response rate (ORR) and interim overall survival (OS). Exploratory post-hoc analyses included impact of time from diagnosis and prior lines of therapy on PFS, and serum M-protein dynamic modelling. ORR was 79% (ELd) and 66% (Ld) (P = 0·0002). ELd reduced the risk of disease progression/death by 27% versus Ld (HR 0·73; P = 0·0014). Interim OS demonstrated a trend in favour of ELd (P = 0·0257); 1-, 2- and 3-year rates with ELd versus Ld were: 91% versus 83%, 73% versus 69% and 60% versus 53%. In patients with ≥ median time from diagnosis and one prior therapy, ELd resulted in a 53% reduction in the risk of progression/death versus Ld (HR 0·47). Serum M-protein dynamic modelling showed slower tumour regrowth with ELd. Adverse events were comparable between arms. ELd provided a durable and clinically relevant improvement in efficacy, with minimal incremental toxicity.
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Affiliation(s)
- Meletios A. Dimopoulos
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Sagar Lonial
- Department of Hematology and Medical OncologyWinship Cancer InstituteEmory University School of MedicineAtlantaGAUSA
| | - Darrell White
- Division of HematologyQueen Elizabeth II Health Sciences Centre and Dalhousie UniversityHalifaxNSCanada
| | | | - Antonio Palumbo
- Myeloma UnitDivision of HaematologyUniversity of TorinoAzienda Ospedaliero‐Universitaria Città della Salute e della Scienza di TorinoTorinoItaly
| | - Jesus San‐Miguel
- Clinica Universidad de NavarraInvestigación Médica AplicadaIDISNACIBERONCPamplonaSpain
| | - Ofer Shpilberg
- Institute of HaematologyAssuta Medical CentersTel AvivIsrael
| | - Kenneth Anderson
- Division of Hematologic OncologyDana‐Farber Cancer InstituteBostonMAUSA
| | - Sebastian Grosicki
- Department of Cancer PreventionMedical University of SilesiaKatowicePoland
| | - Ivan Spicka
- 1st Department of Medicine – Department of HaematologyFirst Faculty of MedicineCharles University and General Teaching Hospital in PraguePragueCzech Republic
| | - Adam Walter‐Croneck
- Department of Haemato‐oncology and Bone Marrow TransplantationMedical University of LublinLublinPoland
| | - Hila Magen
- Davidoff Cancer CenterRabin Medical CenterPetah TikvaIsrael
| | - Maria‐Victoria Mateos
- Haematology DepartmentUniversity Hospital of Salamanca–Instituto de Investigación Biomédica de Salamanca (IBSAL)SalamancaSpain
| | - Andrew Belch
- Department of OncologyCross Cancer Institute and University of AlbertaEdmontonABCanada
| | - Donna Reece
- Department of Medical Oncology and HaematologyPrincess Margaret Cancer CentreTorontoONCanada
| | - Meral Beksac
- Department of HaematologyAnkara UniversityAnkaraTurkey
| | - Eric Bleickardt
- Oncology Clinical DevelopmentBristol‐Myers SquibbLawrencevilleNJUSA
| | | | - Jennifer Sheng
- Clinical Pharmacology & PharmacometricsBristol‐Myers SquibbLawrencevilleNJUSA
| | - Oumar Sy
- Global Biometric SciencesBristol‐Myers SquibbLawrencevilleNJUSA
| | - Jessica Katz
- Global Clinical Research (Research and Development Oncology)Bristol‐Myers SquibbLawrencevilleNJUSA
| | - Anil Singhal
- AbbVie Biotherapeutics Inc. (ABR)Redwood CityCAUSA
| | - Paul Richardson
- Department of Medical OncologyDana‐Farber Cancer InstituteBostonMAUSA
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103
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Fracchiolla NS, Iurlo A, Ferla V, Fattizzo B, Freyrie A, Reda G, Cortelezzi A. Concomitant Occurrence of Blastic Plasmacytoid Dendritic Cell Neoplasm and Acute Myeloid Leukaemia after Lenalidomide Treatment for. Clin Lab 2017; 63:1513-1517. [PMID: 28879716 DOI: 10.7754/clin.lab.2017.170322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Myelodysplastic syndromes with chromosome 5 long arm deletion (5q-mds) may benefit from lenalidomide treatment. However, unresponsive patients have a high risk for clonal evolution and progression to acute myeloid leukemia. Case: We describe a 5q-patient treated with lenalidomide, who concomitantly developed acute myeloid leukemia and blastic plasmacytoid dendritic cell neoplasm, a rare and highly aggressive lymphoma. CONCLUSIONS Evolution of 5q- syndrome to acute myeloid leukemia and blastic plasmacytoid dendritic cell neoplasm may have occurred through various mechanisms, including persistence of neoplastic lenalidomide-resistant stem cells and selection of a more aggressive clone via lenalidomide augmentation of the ARPC1B gene, or because of lenalidomide stimulation on dendritic cells. Further studies are needed to clarify lenalidomide oncogenic potential.
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104
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Abstract
Lenalidomide has emerged as an effective therapeutic alternative for the management of anemia in lower-risk myelodysplastic syndromes (MDS). Compelling results from phase I and phase II clinical studies prompted the US Food and Drug Administration to approve lenalidomide for the treatment of transfusion-dependent MDS patients with interstitial deletion of chromosome 5q [del(5q)]. Subsequently, the National Comprehensive Cancer Network (NCCN) has incorporated lenalidomide into their current treatment algorithm for the treatment of lower-risk del(5q) patients. This discussion examines the current NCCN guidelines for the treatment of these patients, including the management of anemia in lower-risk MDS, and discusses the potential future therapeutic applications of lenalidomide in this disease.
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Affiliation(s)
- Alan F List
- Malignant Hematology Program, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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105
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Abstract
Lenalidomide, an IMiD drug (a novel type of immunomodulating drug) was recently approved by the US Food and Drug Administration for the treatment of transfusion-dependent anemia in patients with myelodysplastic syndromes (MDS) and interstitial deletions of chromosome 5q [del(5q)]. This review examines the clinical experience from the MDS-001 and MDS-003 clinical trials that led to this approval, the results of biological correlates supporting the targets of drug action, and the results from a non-del(5q) multicenter study (MDS-002). Lenalidomide treatment resulted in both erythroid and cytogenetic responses in the majority of patients with del(5q), accompanied by reductions in inflammatory cytokine generation and marrow microvessel density and improvement in primitive hematopoietic progenitor recovery. Central pathology review showed that resolution of cytologic dysplasia was common in patients with del(5q) but was infrequent in erythroid-responding patients without the chromosome 5 deletion. These findings indicate that lenalidomide promotes erythropoiesis in lower-risk MDS, with two apparently distinct mechanisms of action: suppression of the ineffective del(5q) clone and promotion of effective erythropoiesis in non-del(5q) MDS progenitors. These studies identified lenalidomide as a highly active erythropoietic- and cytogenetic-remitting agent in lower-risk MDS patients who otherwise would not be expected to benefit from recombinant erythropoietin therapy. The most common adverse reactions include dose-dependent neutropenia and thrombocytopenia that are more pronounced in patients with del(5q) in whom early suppression of the clone is expected.
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Affiliation(s)
- Alan F List
- Malignant Hematology Program, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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106
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Holstein SA, Jung SH, Richardson PG, Hofmeister CC, Hurd DD, Hassoun H, Giralt S, Stadtmauer EA, Weisdorf DJ, Vij R, Moreb JS, Callander NS, van Besien K, Gentile TG, Isola L, Maziarz RT, Bashey A, Landau H, Martin T, Qazilbash MH, Rodriguez C, McClune B, Schlossman RL, Smith SE, Hars V, Owzar K, Jiang C, Boyd M, Schultz C, Wilson M, Hari P, Pasquini MC, Horowitz MM, Shea TC, Devine SM, Linker C, Anderson KC, McCarthy PL. Updated analysis of CALGB (Alliance) 100104 assessing lenalidomide versus placebo maintenance after single autologous stem-cell transplantation for multiple myeloma: a randomised, double-blind, phase 3 trial. Lancet Haematol 2017; 4:e431-e442. [PMID: 28826616 PMCID: PMC5718627 DOI: 10.1016/s2352-3026(17)30140-0] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 02/01/2023]
Abstract
Background CALGB 100104 (Alliance) studied lenalidomide vs. placebo following autologous stem cell transplant (ASCT) for newly diagnosed myeloma patients, demonstrating improved time to progression (TTP) and overall survival (OS), and an increase in second primary malignancies (SPM) for lenalidomide at 34-months median follow-up. Here we report an updated intent-to-treat analysis at 91-months median follow-up. Methods Patients were eligible if they had active myeloma, had received at most two induction regimens and had achieved stable disease or better in the first 100 days after ASCT. In this phase 3 study, 460 patients were randomised in a double-blind manner to either lenalidomide (n=231) or placebo (n=229) utilizing a permutated-block randomisation with fixed block size. Randomisation was stratified by three factors: normal or elevated β2-microglobulin level at registration (≤2·5 mg/L vs > 2·5 mg/L), prior use or nonuse of thalidomide during induction therapy, and prior use or nonuse of lenalidomide during induction therapy. The starting dose was 10 mg daily, escalated to 15 mg daily after three months. The primary endpoint was TTP (time of progressive disease or death from any cause) using intent-to-treat analysis. After three interim analyses, the study was unblinded at median follow-up of 18 months and 86/128 placebo patients without progressive disease chose to cross over to lenalidomide. This study is registered with ClinicalTrials.gov identifier NCT00114101; new patients are no longer being recruited, but some patients remain on treatment and in follow-up. Findings The median TTP for lenalidomide is 57·3 months (95% CI 44·2–73·3) and 28·9 months (95% CI 23·0–36·3) for placebo (hazard ratio (HR): 0·57, 95% CI 0·46–0·71, p<0·0001). The TTP benefit with lenalidomide was observed regardless of whether patients were in a complete response at time of randomisation or whether they had received thalidomide or lenalidomide induction therapy. The most common grade 3–4 adverse events were neutropenia (116 (50%) of 231 patients in the lenalidomide arm and 37 (16%) of 229 patients in the placebo arm) and thrombocytopenia (34 patients (15%) in the lenalidomide arm and 11 patients (4·8%) in the placebo arm. Eighteen haematological (7·8%) and 14 solid tumour (6·1%) SPMs have been diagnosed following randomisation and prior to disease progression in the lenalidomide arm vs. three haematological (1·3%) and nine solid tumour (3·9%) SPMs in the placebo arm. Of the placebo SPMs, three haematological and five of nine solid tumour SPMs were in the crossover subgroup. Interpretation Despite an increase in haematological adverse events and SPMs, lenalidomide maintenance therapy following ASCT significantly improves TTP and can be considered a standard of care.
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Affiliation(s)
| | - Sin-Ho Jung
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | | | - Craig C Hofmeister
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - David D Hurd
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Hani Hassoun
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Ravi Vij
- Washington University School of Medicine, St Louis, MO, USA
| | - Jan S Moreb
- University of Florida Health, Gainesville, FL, USA
| | | | - Koen van Besien
- Weill Medical College of Cornell University, New York, NY, USA
| | - Teresa G Gentile
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Luis Isola
- Mount Sinai School of Medicine, New York, NY, USA
| | | | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Heather Landau
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas Martin
- University of California at San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Scott E Smith
- Alliance for Clinical Trials in Oncology, Chicago, IL, USA; Loyola University, Chicago, IL, USA
| | - Vera Hars
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | - Kouros Owzar
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | - Chen Jiang
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | - Molly Boyd
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Chelsea Schultz
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Marcia Wilson
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | | | | | - Mary M Horowitz
- Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant Clinical Trials Network, Rockville, MD, USA
| | - Thomas C Shea
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Steven M Devine
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Charles Linker
- University of California at San Francisco, San Francisco, CA, USA
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107
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Czuczman MS, Trněný M, Davies A, Rule S, Linton KM, Wagner-Johnston N, Gascoyne RD, Slack GW, Brousset P, Eberhard DA, Hernandez-Ilizaliturri FJ, Salles G, Witzig TE, Zinzani PL, Wright GW, Staudt LM, Yang Y, Williams PM, Lih CJ, Russo J, Thakurta A, Hagner P, Fustier P, Song D, Lewis ID. A Phase 2/3 Multicenter, Randomized, Open-Label Study to Compare the Efficacy and Safety of Lenalidomide Versus Investigator's Choice in Patients with Relapsed or Refractory Diffuse Large B-Cell Lymphoma. Clin Cancer Res 2017; 23:4127-4137. [PMID: 28381416 PMCID: PMC8171498 DOI: 10.1158/1078-0432.ccr-16-2818] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/16/2016] [Accepted: 03/31/2017] [Indexed: 12/19/2022]
Abstract
Purpose: Randomized, multicenter, open-label, phase 2/3 trial investigating lenalidomide versus investigator's choice (IC) in relapsed/refractory diffuse large B-cell lymphoma (DLBCL).Experimental Design: Patients with DLBCL who received ≥2 prior therapies were stratified by DLBCL subtype [germinal center B-cell (GCB) vs. non-GCB; determined by immunohistochemistry (IHC)] and then randomized 1:1 to lenalidomide (25 mg/day, 21 days of 28-day cycle) or IC (gemcitabine, rituximab, etoposide, or oxaliplatin). Crossover to lenalidomide was permitted for IC-treated patients with radiologically confirmed progressive disease. The primary endpoint was overall response rate (ORR). Progression-free survival (PFS), overall survival, and subtype analysis [GCB vs. activated B-cell (ABC)] using gene expression profiling (GEP) were exploratory endpoints.Results: Stage 1: 102 DLBCL patients (by IHC: non-GCB, n = 54; GCB, n = 48) received ≥1 dose of lenalidomide or IC. Hematologic treatment-emergent adverse events with lenalidomide versus IC included neutropenia (42.6%; 36.4%), anemia (33.3%; 47.3%), thrombocytopenia (24.1%; 43.6%), and leukopenia (5.6%; 12.7%), respectively. Overall, lenalidomide-treated patients had an ORR of 27.5% versus 11.8% in IC (ORRs were similar regardless of IHC-defined DLBCL subtype). Median PFS was increased in patients receiving lenalidomide (13.6 weeks) versus IC (7.9 weeks; P = 0.041), with greater improvements in non-GCB patients (15.1 vs. 7.1 weeks, respectively; P = 0.021) compared with GCB (10.1 vs. 9.0 weeks, respectively; P = 0.550).Conclusions: The clinical benefit of lenalidomide monotherapy in DLBCL patients was more evident in the non-GCB subtype. Exploratory analyses suggest that this preferential benefit was more pronounced in the GEP-defined ABC population, demonstrating a need for additional studies of lenalidomide in DLBCL using GEP subtyping. Clin Cancer Res; 23(15); 4127-37. ©2017 AACR.
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Affiliation(s)
| | - Marek Trněný
- Department of Hematology, Charles University Hospital, Prague, Czech Republic
| | - Andrew Davies
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Simon Rule
- Department of Haematology, Derriford Hospital, Plymouth, United Kingdom
| | - Kim M Linton
- Division of Molecular and Clinical Cancer Sciences, The Christie Foundation Trust, Manchester, United Kingdom
| | - Nina Wagner-Johnston
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Randy D Gascoyne
- Centre for Lymphoid Cancers, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Graham W Slack
- Centre for Lymphoid Cancers, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Pierre Brousset
- Laboratoire D'Anatomie Pathologique, Centre Hospitalier Universitaire Purpan, Toulouse, France
| | - David A Eberhard
- Department of Pathology/Laboratory Medicine and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | | | - Gilles Salles
- Hematology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Thomas E Witzig
- Departments of Laboratory Medicine and Pathology and Hematology, Mayo Clinic, Rochester, Minnesota
| | - Pier Luigi Zinzani
- Institute of Hematology and Medical Oncology, University of Bologna, Bologna, Italy
| | - George W Wright
- Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Louis M Staudt
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Yandan Yang
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - P Mickey Williams
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, Maryland
| | - Chih-Jian Lih
- Molecular Characterization and Clinical Assay Development Laboratory, Leidos Biomedical Research Inc. and Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | | | | | | | | | - Dale Song
- Celgene Corporation, Summit, New Jersey
| | - Ian D Lewis
- Divison of Haematology, Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia
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108
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Miura S, Kuroda H, Yamada M, Sato K, Ameda S, Sakano H, Shibata T, Uemura N, Abe T, Fujii S, Maeda M, Kobune M, Kato J. [Effective BiRd Therapy after the Addition of Clarithromycin for Lenalidomide and Dexamethasone Resistant Multiple Myeloma Ineligible for Stem Cell Transplantation]. Gan To Kagaku Ryoho 2017; 44:689-693. [PMID: 28860442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BiRd combination therapy, which comprises clarithromycin(CAM: Biaxin®), lenalidomide(LEN: Revlimid®), and dexamethasone( DEX), is a highly effective treatment for newly diagnosed symptomatic multiple myeloma(MM). However, its efficacy against recurrent myeloma refractory to LEN and DEX combination therapy(Rd therapy)remains unclear. In this study, we retrospectively analyzed the data of 7 patients(4 men and 3 women, median age of 76 years)with MM, who had clarithromycin added to their Rd regimen. In all patients, the starting dose of clarithromycin was 400 mg daily and the median number of prior therapies was 3(range, 1-4). Patients received a median of 9 cycles of Rd(range, 6-27 cycles)for a median duration of 8 months. Then, patients received a median of 14 cycles of BiRd(range 2-36 cycles). One patient showed partial response(PR), which was the best response, while the others showed stable disease(SD). Our results demonstrated that the addition of clarithromycin to Rd could overcome resistance to Rd and lead to durable responses, without exacerbating hematological or non-hematological toxicities. Thus, BiRd therapy may represent a therapeutic option for symptomatic MM resist- ant to Rd therapy.
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Affiliation(s)
- Shogo Miura
- Dept. of Gastroenterology and Hematology/Clinical Oncology, Internal Medicine, Steel Memorial Muroran Hospital
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109
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Nakaya A, Fujita S, Satake A, Nakanishi T, Azuma Y, Tsubokura Y, Hotta M, Yoshimura H, Ishii K, Ito T, Nomura S. Realistic Lenalidomide Dose Adjustment Strategy for Transplant-Ineligible Elderly Patients with Relapsed/Refractory Multiple Myeloma: Japanese Real-World Experience. Acta Haematol 2017; 138:55-60. [PMID: 28728162 DOI: 10.1159/000477792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/27/2017] [Indexed: 12/20/2022]
Abstract
Lenalidomide is an immunomodulatory drug administered orally in the treatment of multiple myeloma. Some elderly patients require a reduced lenalidomide dose because of comorbidities and/or adverse events. This study investigated the actual dose of lenalidomide in elderly patients, finding that most received reduced (5-10 mg) doses. The most common reasons for dose reduction were renal dysfunction (54% of patients), fatigue (grade ≥3; 20%), hematologic disorder (grade ≥3; 14%), and rash (grade ≥3; 9%). Their median time to progression was 11.8 months and their median overall survival was 39.2 months. The overall response rate was 73%, including 17% with a complete response, 19% with a very good partial response, and 37% with a partial response. These results showed that, contrary to western countries, most patients were treated with a reduced dose of lenalidomide in Japan. However, it is suggested that continued treatment with a tolerable dose may yield favorable outcomes.
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Affiliation(s)
- Aya Nakaya
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
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110
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Minagawa K, Falcon CP, Matsui T. Very-Low-Dose Lenalidomide for Elderly and/or Frail Multiple Myeloma Patients: Lower Might Be Better. Acta Haematol 2017; 138:52-54. [PMID: 28723683 DOI: 10.1159/000478691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Kentaro Minagawa
- Bone Marrow Transplantation and Cell Therapy Unit, Department of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
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Wang GM, Yang GZ, Huang ZX, Zhong YP, Jin FY, Liao AJ, Wang XM, Fu ZZ, Liu H, Li XL, Zhou JF, Zhang X, Hu Y, Meng FY, Huang XJ, Chen WM, Lu J. [A prospective multi-center trial of non-interventional and observational study of lenalidomide in Chinese patients with multiple myeloma]. Zhonghua Nei Ke Za Zhi 2017; 56:500-506. [PMID: 28693058 DOI: 10.3760/cma.j.issn.0578-1426.2017.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: To evaluate the efficacy and safety of lenalidomide in a real-world clinical practice in Chinese patients with multiple myeloma (MM). Methods: It was a prospective, multi-center, observational study. A total of 165 consecutive patients with MM treated with lenalidomide-based regimens were enrolled in 12 hospitals from June 2013 to November 2015. Relevant information was recorded, such as baseline clinical data, cytogenetic abnormalities, treatment regimens, and duration of treatment, safety, and survival. Results: (1)There were 126 relapsed and refractory MM (RRMM) patients, 25 newly diagnosed patients and 19 maintenance patients. The evaluable RRMM patients accounted for 120 cases, among which 74 cases(61.7%) reached the partial response (PR) or above, and a very good partial response (VGPR) in 16 patients (13.3%), a complete response (CR) in 14 cases (11.7%), a strictly complete response (sCR) in 4 cases (3.3%). Thus, a VGPR or above in 34 patients accounted for 28.3%. (2)The median follow-up was 13 months, the median time to progression 12 months. The median survival after receiving lenalidomide was 19 months, and the median overall survival (OS) was 62 months. (3) The univariate analysis in 120 RRMM patients suggested that prognostic factors for significant improvement in PFS included normal karyotype, international staging system (ISS) Ⅰ-Ⅱ, t(4; 14) negative (detected by fluorescence in situ hybridization), non-bortezomib resistance and response to previous regimens. As to OS, non-bortezomib resistance, response to previous regimens and non-primary refractoriness were positive factors. Multivariate analysis showed that the response to previous regimens (PR or better) was an independent good prognostic factor for progress-free survival(PFS), non-bortezomib resistance and non-primary refractoriness for OS. (4) Grade 3 or 4 adverse events that occurred in more than 10% of all enrolled patients were neutropenia (12.7%), leukocytosis(11.5%) and thrombocytopenia (12.7%). Owing to intolerance of toxic side effects, 7 cases withdrew lenalidomide. Conclusions: No matter what combination, regimens containing lenalidomide are effective to RRMM patients with overall response rate 61.7%, a time to progression 12 months and an overall survival 62 months.The toxicity is quite tolerable and manageable. In addition, the response to previous treatment (reached PR or above) is the independent good prognostic factor for PFS, non-bortezomib resistance and non-primary refractoriness for OS. Clinical trail registration: Clinicaltrials.gov, NCT01947309.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - W M Chen
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - J Lu
- Department of Hematology, Peking University People's Hospital, Beijing 100044, China
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112
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Maly JJ, Christian BA, Zhu X, Wei L, Sexton JL, Jaglowski SM, Devine SM, Fehniger TA, Wagner-Johnston ND, Phelps MA, Bartlett NL, Blum KA. A Phase I/II Trial of Panobinostat in Combination With Lenalidomide in Patients With Relapsed or Refractory Hodgkin Lymphoma. Clin Lymphoma Myeloma Leuk 2017; 17:347-353. [PMID: 28622959 PMCID: PMC6033275 DOI: 10.1016/j.clml.2017.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/10/2017] [Accepted: 05/04/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lenalidomide and panobinostat have shown single-agent efficacy of 14% to 50% and 27% to 58%, respectively, in Hodgkin lymphoma (HL). This phase I/II study was conducted to determine the maximum tolerated dose (MTD), safety, and efficacy of lenalidomide combined with panobinostat in relapsed/refractory HL. PATIENTS AND METHODS In the phase I trial, previously treated patients with classical or lymphocyte-predominant HL received escalating doses of lenalidomide on days 1 to 21 and panobinostat 3 times a week (TIW) every 28 days. Dose-limiting toxicity (DLT) was defined during cycle 1. When the MTD was determined, a phase II study was conducted to determine overall response (OR). RESULTS Twenty-four patients enrolled; 11 in the phase I and 13 in phase II portions. No DLTs were observed but 2 patients who received 25 mg lenalidomide and 20 mg panobinostat experienced neutropenia and thrombocytopenia > 14 days in cycle 2, leading to selection of 25 mg lenalidomide on days 1 to 21 and 15 mg panobinostat TIW for the phase II dose. In all 24 patients, Grade 3 to 4 toxicities consisted of neutropenia (58%), thrombocytopenia (42%), lymphopenia (25%), and febrile neutropenia (25%). OR was 16.7% (2 complete response [CR] and 2 partial response). One patient with CR had lymphocyte-predominant HL and received 22 cycles. Median progression-free survival and overall survival were 3.8 and 16.4 months, respectively. CONCLUSION Although the combination of panobinostat and lenalidomide appears safe in patients with relapsed/refractory HL, the limited efficacy and significant rates of neutropenia and febrile neutropenia observed do not support further evaluation of this combination in HL.
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Affiliation(s)
- Joseph J Maly
- The Ohio State University, James Cancer Center, Columbus, OH.
| | | | - Xiaohua Zhu
- The Ohio State University, James Cancer Center, Columbus, OH
| | - Lai Wei
- The Ohio State University, James Cancer Center, Columbus, OH
| | | | | | - Steven M Devine
- The Ohio State University, James Cancer Center, Columbus, OH
| | | | | | - Mitch A Phelps
- The Ohio State University, James Cancer Center, Columbus, OH
| | | | - Kristie A Blum
- The Ohio State University, James Cancer Center, Columbus, OH
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113
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Khouri MR, Jabbour EJ, Gulbis AM, Turturro F, Ledesma C, Korbling M, Samuels BI, Ahmed S, Alousi AM, Ciurea SO, Marin D, Patel KK, Popat UR, Bueso-Ramos CE, Bassett RL, Khouri IF. Feasibility of Lenalidomide Therapy for Persistent Chronic Lymphocytic Leukemia after Allogeneic Transplantation. Biol Blood Marrow Transplant 2017; 23:1405-1410. [PMID: 28495642 DOI: 10.1016/j.bbmt.2017.04.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 04/29/2017] [Indexed: 12/30/2022]
Abstract
In patients with chronic lymphocytic leukemia (CLL), persistence of disease after allogeneic stem cell transplantation (alloSCT) can result in poor outcomes. In an effort to improve these outcomes, patients with persistent CLL who were 90 to 100 days beyond alloSCT with no evidence of graft-versus-host-disease (GVHD) were randomized to receive lenalidomide or standard care (withdrawal of immunosuppression followed by donor lymphocyte infusion). Lenalidomide was initiated at 5 mg every other day and increased to 10 mg daily, if tolerated, in each patient. Of 38 patients enrolled, 17 (45%) met the eligibility criteria for randomization. Of these 17 patients, 8 were randomized to undergo lenalidomide therapy. Five (62%) patients had to stop taking the drug because of toxicity. The main reason for drug discontinuation was acute GVHD in 43% of patients. This incidence was 11% in the patients who were randomized to not receive lenalidomide. With a median follow-up of 2.6 years, the median survival was 3.4 years for those receiving lenalidomide. This was not reached in patients randomized to not receive lenalidomide and in patients in complete remission who were not randomized. These results suggested that treatments other than lenalidomide are needed for persistent CLL after alloSCT.
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Affiliation(s)
- Maria R Khouri
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alison M Gulbis
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Francesco Turturro
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Celina Ledesma
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Martin Korbling
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Barry I Samuels
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sairah Ahmed
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amin M Alousi
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stefan O Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Marin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Krina K Patel
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos E Bueso-Ramos
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Issa F Khouri
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Dimopoulos MA, Stewart AK, Masszi T, Špička I, Oriol A, Hájek R, Rosiñol L, Siegel D, Mihaylov GG, Goranova‐Marinova V, Rajnics P, Suvorov A, Niesvizky R, Jakubowiak A, San‐Miguel J, Ludwig H, Palumbo A, Obreja M, Aggarwal S, Moreau P. Carfilzomib, lenalidomide, and dexamethasone in patients with relapsed multiple myeloma categorised by age: secondary analysis from the phase 3 ASPIRE study. Br J Haematol 2017; 177:404-413. [PMID: 28211560 PMCID: PMC5412871 DOI: 10.1111/bjh.14549] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/01/2016] [Indexed: 01/08/2023]
Abstract
A primary analysis of the ASPIRE study found that the addition of carfilzomib to lenalidomide and dexamethasone (carfilzomib group) significantly improved progression-free survival (PFS) compared with lenalidomide and dexamethasone alone (control group) in patients with relapsed multiple myeloma (RMM). This post hoc analysis examined outcomes from ASPIRE in patients categorised by age. In the carfilzomib group, 103/396 patients were ≥70 years old, and in the control group, 115/396 patients were ≥70 years old. Median PFS for patients <70 years old was 28·6 months for the carfilzomib group versus 17·6 months for the control group [hazard ratio (HR), 0·701]. Median PFS for patients ≥70 years old was 23·8 months for the carfilzomib group versus 16·0 months for the control group (HR, 0·753). For patients <70 years the overall response rate (ORR) was 86·0% (carfilzomib group) and 66·9% (control group); for patients ≥70 years old the ORR was 90·3% (carfilzomib group) and 66·1% (control group). Within the carfilzomib group, grade ≥3 cardiovascular adverse events occurred more frequently among patients ≥70 years old compared with patients <70 years old. Carfilzomib-lenalidomide-dexamethasone has a favourable benefit-risk profile for patients with RMM, including elderly patients ≥70 years old. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT01080391.
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Affiliation(s)
| | | | - Tamás Masszi
- St István and St Laszlo Hospital3rd Dept. of Internal MedicineSemmelweis UniversityBudapestHungary
| | - Ivan Špička
- First Faculty of MedicineCharles University in PraguePragueCzech Republic
| | - Albert Oriol
- Institut Català d'OncologiaHospital Germans Trias i PujolBarcelonaSpain
| | - Roman Hájek
- University Hospital Ostrava and Faculty of MedicineUniversity of OstravaOstravaCzech Republic
| | | | - David Siegel
- John Theurer Cancer Center at Hackensack UniversityHackensackNJUSA
| | | | | | - Péter Rajnics
- Department of HaematologyMór Kaposi Teaching HospitalKaposvárHungary
| | - Aleksandr Suvorov
- Haematological DepartmentFirst Republican Clinical Hospital of UdmurtiaIzhevskRussia
| | | | | | | | - Heinz Ludwig
- Wilhelminen Cancer Research InstituteWilhelminenspitalViennaAustria
| | | | - Mihaela Obreja
- Onyx Pharmaceuticals, Inc. an Amgen subsidiarySouth San FranciscoCAUSA
| | - Sanjay Aggarwal
- Onyx Pharmaceuticals, Inc. an Amgen subsidiarySouth San FranciscoCAUSA
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115
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Fennira F, Chasset F, Soubrier M, Cordel N, Petit A, Francès C. Lenalidomide for refractory chronic and subacute cutaneous lupus erythematosus: 16 patients. J Am Acad Dermatol 2017; 74:1248-51. [PMID: 27185425 DOI: 10.1016/j.jaad.2016.01.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Feriel Fennira
- Université Paris 6, AP-HP, Service de Dermatologie-Allergologie, Hôpital Tenon, France
| | - François Chasset
- Université Paris 6, AP-HP, Service de Dermatologie-Allergologie, Hôpital Tenon, France
| | - Martin Soubrier
- Université de Clermont-Ferrand, Service de Rhumatologie, Hôpital G-Montpied, France
| | - Nadège Cordel
- Unité de Dermatologie et Médicine Interne, CHU de Pointe à Pitre, Université des Antilles, Guadeloupe
| | - Antoine Petit
- Université Paris VII, APHP, Service de Dermatologie, Hôpital Saint Louis, France
| | - Camille Francès
- Université Paris 6, AP-HP, Service de Dermatologie-Allergologie, Hôpital Tenon, France.
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116
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Attal M, Lauwers-Cances V, Hulin C, Leleu X, Caillot D, Escoffre M, Arnulf B, Macro M, Belhadj K, Garderet L, Roussel M, Payen C, Mathiot C, Fermand JP, Meuleman N, Rollet S, Maglio ME, Zeytoonjian AA, Weller EA, Munshi N, Anderson KC, Richardson PG, Facon T, Avet-Loiseau H, Harousseau JL, Moreau P. Lenalidomide, Bortezomib, and Dexamethasone with Transplantation for Myeloma. N Engl J Med 2017; 376:1311-1320. [PMID: 28379796 PMCID: PMC6201242 DOI: 10.1056/nejmoa1611750] [Citation(s) in RCA: 803] [Impact Index Per Article: 114.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND High-dose chemotherapy plus autologous stem-cell transplantation has been the standard treatment for newly diagnosed multiple myeloma in adults up to 65 years of age. However, promising data on the use of combination therapy with lenalidomide, bortezomib, and dexamethasone (RVD) in this population have raised questions about the role and timing of transplantation. METHODS We randomly assigned 700 patients with multiple myeloma to receive induction therapy with three cycles of RVD and then consolidation therapy with either five additional cycles of RVD (350 patients) or high-dose melphalan plus stem-cell transplantation followed by two additional cycles of RVD (350 patients). Patients in both groups received maintenance therapy with lenalidomide for 1 year. The primary end point was progression-free survival. RESULTS Median progression-free survival was significantly longer in the group that underwent transplantation than in the group that received RVD alone (50 months vs. 36 months; adjusted hazard ratio for disease progression or death, 0.65; P<0.001). This benefit was observed across all patient subgroups, including those stratified according to International Staging System stage and cytogenetic risk. The percentage of patients with a complete response was higher in the transplantation group than in the RVD-alone group (59% vs. 48%, P=0.03), as was the percentage of patients in whom minimal residual disease was not detected (79% vs. 65%, P<0.001). Overall survival at 4 years did not differ significantly between the transplantation group and the RVD-alone group (81% and 82%, respectively). The rate of grade 3 or 4 neutropenia was significantly higher in the transplantation group than in the RVD-alone group (92% vs. 47%), as were the rates of grade 3 or 4 gastrointestinal disorders (28% vs. 7%) and infections (20% vs. 9%). No significant between-group differences were observed in the rates of treatment-related deaths, second primary cancers, thromboembolic events, and peripheral neuropathy. CONCLUSIONS Among adults with multiple myeloma, RVD therapy plus transplantation was associated with significantly longer progression-free survival than RVD therapy alone, but overall survival did not differ significantly between the two approaches. (Supported by Celgene and others; IFM 2009 Study ClinicalTrials.gov number, NCT01191060 .).
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Affiliation(s)
- Michel Attal
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Valerie Lauwers-Cances
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Cyrille Hulin
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Xavier Leleu
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Denis Caillot
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Martine Escoffre
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Bertrand Arnulf
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Margaret Macro
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Karim Belhadj
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Laurent Garderet
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Murielle Roussel
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Catherine Payen
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Claire Mathiot
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Jean P Fermand
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Nathalie Meuleman
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Sandrine Rollet
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Michelle E Maglio
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Andrea A Zeytoonjian
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Edie A Weller
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Nikhil Munshi
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Kenneth C Anderson
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Paul G Richardson
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Thierry Facon
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Hervé Avet-Loiseau
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Jean-Luc Harousseau
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
| | - Philippe Moreau
- From the Institut Universitaire du Cancer de Toulouse-Oncopole (M.A., M.R., C.P., S.R., H.A.-L.) and Service d'Epidémiologie, Centre Hospitalier et Universitaire de Toulouse (V.L.-C.), Toulouse, Hôpital Haut-Lévêque, Bordeaux Pessac (C.H.), Centre Hospitalier et Universitaire la Miletrie, Poitiers (X.L.), Centre Hospitalier Le Bocage, Dijon (D.C.), Centre Hospitalier et Universitaire de Rennes, Rennes (M.E.), Hôpital St.-Louis (B.A., J.P.F.), Centre Hospitalier Universitaire, Hôpital St.-Antoine (L.G.), Institut Curie (C.M.), and Haute Autorité de Santé (J.-L.H.), Paris, Institut d'Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen (M.M.), Centre Hospitalier et Universitaire Henri Mondor, Creteil (K.B.), Hôpital Claude Huriez, Lille (T.F.), and Hôtel Dieu, Nantes (P.M.) - all in France; Institut Jules Bordet, Brussels (N. Meuleman); and Dana-Farber Cancer Institute, Boston (M.E.M., A.A.Z., E.A.W., N. Munshi, K.C.A., P.G.R.)
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Abstract
RATIONALE Crystalglobulinemia is a rare disease caused by monoclonal immunoglobulins, characterized by irreversible crystallization on refrigeration. It causes systemic symptoms including purpura, arthralgia, and vessel occlusive conditions to be exacerbated by exposure to cold. We report a patient with crystalglobulinemia associated with monoclonal gammopathy of undetermined significance (MGUS) manifesting as chronic arthralgia and recurrent acute arterial occlusion. PRESENTING CONCERNS A 61-year-old man, who had been diagnosed with MGUS and who had arthralgia of unknown origin, presented with recurrent acute limb ischemia after surgical thromboembolectomy. Refrigeration of his serum formed precipitates that looked like needle-shaped crystals. These crystals did not dissolve with warming, which is not a characteristic of cryoglobulins. Skin biopsy results showed crystal-liked eosinophilic bodies in small vessels and we diagnosed crystalglobulinemia. INTERVENTION AND OUTCOMES Although he underwent above-knee amputation, he was treated with a bortezomib and dexamethasone-based chemotherapeutic regimen, following lenalidomide maintenance therapy. Finally, he achieved complete remission and serum crystalglobulins diminished. LESSONS Monoclonal gammopathy, previously diagnosed as MGUS, can cause systemic symptoms and thrombotic conditions by producing pathologic immunoglobulins, such as crystalglobulins. In such situations, MGUS, even when it has not progressed to multiple myeloma, can be a target of aggressive chemotherapy. Crystalglobulinemia should be considered for patients with monoclonal gammopathy manifesting as systemic and thrombotic symptoms exacerbated by cooling.
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Kootte RS, Faber LM. Hepatitis E during lenalidomide treatment for multiple myeloma in complete remission. Neth J Med 2017; 75:117-121. [PMID: 28469048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Lenalidomide has a central role in the treatment of multiple myeloma and results in improved survival. As with other chemotherapeutics, it can cause several serious side effects. This is the first reported case of hepatitis E during lenalidomide treatment for multiple myeloma in complete remission. In case of liver chemistry abnormalities during lenalidomide treatment, the differential diagnosis should include hepatitis E infection.
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Affiliation(s)
- R S Kootte
- Department of Internal Medicine, Rode Kruis Hospital, Beverwijk, the Netherlands
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The Lancet Haematology. Phase 1 clinical trials and toxicity. Lancet Haematol 2017; 4:e147. [PMID: 28363338 DOI: 10.1016/s2352-3026(17)30041-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Lázaro Sierra J, Carrasco V, Cases E, Gómez Gonzalez C. Two cases of permanent indwelling catheter for long-term administration of intrapleural chemotherapy. Arch Bronconeumol 2017; 53:590-591. [PMID: 28359605 DOI: 10.1016/j.arbres.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Vicente Carrasco
- Servicio de Hematología, Hospital Royo Villanova, Zaragoza, España
| | - Enrique Cases
- Servicio de Neumología, Hospital La Fe, Valencia, España
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Abstract
Over the last two decades, the outcomes for patients with multiple myeloma, a plasma cell malignancy, have dramatically improved. The development of the immunomodulatory drugs (IMiDs), which include thalidomide, lenalidomide, and pomalidomide, has contributed significantly to these improved outcomes. While thalidomide is now less commonly prescribed, lenalidomide is widely used in the treatment of newly diagnosed transplant-eligible and transplant-ineligible patients, in the maintenance setting post-transplant and in the relapsed/refractory setting, while pomalidomide is currently utilized in the relapsed/refractory setting. The IMiDs have been reported to have a multitude of activities, including anti-angiogenic, cytotoxic, and immunomodulatory. However, the more recent discoveries that the IMiDs bind to cereblon and thus regulate the ubiquitination of key transcription factors including IKZF1 and IKZF3 have provided greater insight into their mechanism of action. Here, the clinical efficacy of these agents in myeloma is reviewed and the structure-function relationship, the molecular mechanisms of action, and the association of IMiDs with second primary malignancies and thrombosis are discussed.
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Affiliation(s)
- Sarah A Holstein
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Philip L McCarthy
- Department of Medicine, Blood and Marrow Transplant Center, Roswell Park Cancer Institute, Buffalo, NY, USA.
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Holmberg LA, Becker PS, Bensinger W. Results from Two Consecutive Studies of Consolidation Therapy after Autologous Transplant for Multiple Myeloma: Thalidomide, Dexamethasone, and Clarithromycin or Lenalidomide, Dexamethasone, and Clarithromycin. Acta Haematol 2017; 137:123-131. [PMID: 28355602 DOI: 10.1159/000455937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/10/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In multiple myeloma (MM), relapse is a problem after autologous hematopoietic stem cell transplantation (ASCT). In the nontransplant setting, thalidomide/dexamethasone/clarithromycin (BLT-D) and lenalidomide/dexamethasone/clarithromycin (BiRd) achieve responses with acceptable toxicity. Both regimens are reasonable objects of study in the post-ASCT setting. PATIENTS AND METHODS We report on BLT-D and BiRd given post-ASCT. Studies were conducted consecutively. After recovery from ASCT, therapy was started. All 3 drugs were given for 1 year, and then immunomodulatory drugs alone were given as long as tolerated or until disease progression. RESULTS For BLT-D, the most common toxicity was peripheral neuropathy (PN). For BiRd, infection, PN, and neutropenia were the most common adverse events. BiRd was associated with a higher frequency of secondary cancers. The median follow-up for BLT-D was 10.2 years (range 8.6-10.7) and for BiRd it was 7.5 years (range 6.4-8.4). After BLT-D, 18 patients (67%) were alive and 10 (37%) were alive without disease progression, and after BiRd, 18 patients (58%) were alive and 10 (32%) were alive without disease progression. CONCLUSIONS BLT-D and BiRd can be given post-ASCT with different toxicity profiles and comparable disease-free and overall survival rates. A randomized study comparing these regimens to single-agent lenalidomide is needed to determine which approach is superior. Key Message: Relapse of MM is a major problem after ASCT. Strategies are needed post-ASCT to improve outcomes. In the nontransplant setting, thalidomide or lenalidomide/dexamethasone/clarithromycin treat MM with acceptable toxicity. We, thus, studied both regimens post- ASCT. They can be given with different toxicity profiles and result in good disease control.
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Affiliation(s)
- Leona A Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, and Department of Medicine, University of Washington, Seattle, WA, USA
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Lu J, Lee JH, Huang S, Qiu L, Lee J, Liu T, Yoon S, Kim K, Shen ZX, Eom HS, Chen WM, Min CK, Kim HJ, Lee JO, Kwak JY, Yiu W, Chen G, Ervin‐Haynes A, Hulin C, Facon T. Continuous treatment with lenalidomide and low-dose dexamethasone in transplant-ineligible patients with newly diagnosed multiple myeloma in Asia: subanalysis of the FIRST trial. Br J Haematol 2017; 176:743-749. [PMID: 28106903 PMCID: PMC5324608 DOI: 10.1111/bjh.14465] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/20/2016] [Indexed: 02/05/2023]
Abstract
The phase 3 FIRST (Frontline Investigation of REVLIMID + Dexamethasone Versus Standard Thalidomide) trial demonstrated that lenalidomide plus low-dose dexamethasone (Rd) until disease progression (Rd continuous) is an effective treatment option for transplant-ineligible patients with newly diagnosed multiple myeloma (NDMM). Given genetic differences between Asian and Western populations, this subanalysis of the FIRST trial examined the safety and efficacy of Rd (given continuously or for 18 cycles [Rd18]) and MPT (melphalan, prednisone, thalidomide) in 114 Asian patients from Mainland China, South Korea and Taiwan. Efficacy and safety with Rd continuous in Asian patients were consistent with those in the overall study population. The overall response rates were 77·8% for Rd continuous, 57·5% for MPT and 65·8% for Rd18. The risk of progression or death was reduced by 39% with Rd continuous versus MPT and by 35% with Rd continuous versus Rd18. Rd continuous improved the 3-year survival rate compared with MPT (70·2% vs. 56·4%) and Rd18 (58·1%). Common grade 3/4 adverse events in the Rd continuous and MPT arms were neutropenia (25·0% vs. 43·6%), infection (19·4% vs. 28·2%) and anaemia (19·4% vs. 15·4%), respectively. Thromboembolic event rates were low, and no second primary malignancies were observed. Rd continuous is safe and effective in transplant-ineligible Asian patients with NDMM.
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Affiliation(s)
- Jin Lu
- Peking University People's HospitalBeijingChina
| | - Jae H. Lee
- Gachon University Gil HospitalIncheonKorea
| | | | - Lugui Qiu
- Institute of Haematology and Blood Diseases HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
| | - Je‐Jung Lee
- Chonnam National University Hwasun HospitalHwasun‐gunJeonnamKorea
| | - Ting Liu
- West China Hospital of Sichuan UniversityChengduChina
| | | | - Kihyun Kim
- Sungkyunkwan UniversitySamsung Medical CentreSeoulKorea
| | - Zhi X. Shen
- Ruijin HospitalShanghai Jiaotong UniversityShanghaiChina
| | | | | | | | - Hyo J. Kim
- Hallym University Sacred Heart HospitalAnyangKorea
| | - Jeong O. Lee
- Seoul National University Bundang HospitalSeongnamKorea
| | - Jae Y. Kwak
- Chonbuk National University HospitalJeonjuKorea
| | - Wai Yiu
- Celgene CorporationSummitNJUSA
| | | | | | | | - Thierry Facon
- Service des Maladies du SangHôpital Claude HuriezLilleFrance
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Sulek JE, Robinson SP, Petrossian AA, Zhou S, Goliadze E, Manjili MH, Toor A, Guruli G. Role of Epigenetic Modification and Immunomodulation in a Murine Prostate Cancer Model. Prostate 2017; 77:361-373. [PMID: 27862100 DOI: 10.1002/pros.23275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/21/2016] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Decreased expression of highly immunogenic cancer-testis antigens (CTA) might help tumor to achieve low immunogenicity, escape immune surveillance and grow unimpeded. Our aim was to evaluate CTA expression in tumor and normal tissues and to investigate possible means of improving the immune response in a murine prostate cancer (CaP) model by using the combination of epigenetic modifier 5-azacitidine (5-AzaC) and immunomodulator lenalidomide. No study to date has examined the effect of this combination on the prostate cancer or its impact on antigen-presenting cells (APC). MATERIALS AND METHODS Gene microarrays were performed to compare expression of several CTA in murine prostate cancer (RM-1 cells) and normal prostate. RM-1 cells were treated with 5-AzaC and real-time PCR was performed to investigate the expression of several CTA. Western blotting was used to determine whether expression of CTA-specific mRNA induced by 5-AzaC resulted in increase in the corresponding protein. Effect of the epigenetic agents and immunomodulators was assessed on dendritic cells (DC) using flow cytometry, ELISA and T-cell proliferation assay. RESULTS Gene arrays demonstrated decreased expression of 35 CTA in CaP tissue compared to normal prostate. 5-AzaC treatment of RM-1 prostate cancer cells upregulated the expression of all 13 CTA tested in a dose-dependent fashion. DC were treated with 5-AzaC and lenalidomide and the expression of surface markers MHC Class I, MHC Class II, CD80, CD86, CD 205, and CD40 was increased. Combination of 5-AzaC and lenalidomide enhances the ability of DC to stimulate T-cell proliferation in mixed leukocyte reaction. Secretion of IL-12 and IL-15 by DC increased significantly with addition of 5-AzaC or 5-AzaC and lenalidomide. CONCLUSIONS Decreased expression of CTA by prostate cancer may be a means of escaping immune monitoring. Combination of epigenetic modifications and immunomodulation by 5-AzaC and lenalidomide increased tumor immunogenicity and enhanced DC function and may be used in the treatment of advanced prostate cancer. Prostate 77: 361-373, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jay E Sulek
- Division of Urology, Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Samuel P Robinson
- Division of Urology, Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Albert A Petrossian
- Division of Urology, Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Shaoqing Zhou
- Division of Urology, Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Ekaterine Goliadze
- Division of Urology, Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
- Massey Cancer Center, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Masoud H Manjili
- Massey Cancer Center, Virginia Commonwealth University Medical Center, Richmond, Virginia
- Department of Microbiology and Immunology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Amir Toor
- Massey Cancer Center, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Georgi Guruli
- Division of Urology, Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
- Massey Cancer Center, Virginia Commonwealth University Medical Center, Richmond, Virginia
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125
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Durie BGM, Hoering A, Abidi MH, Rajkumar SV, Epstein J, Kahanic SP, Thakuri M, Reu F, Reynolds CM, Sexton R, Orlowski RZ, Barlogie B, Dispenzieri A. Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trial. Lancet 2017; 389:519-527. [PMID: 28017406 PMCID: PMC5546834 DOI: 10.1016/s0140-6736(16)31594-x] [Citation(s) in RCA: 601] [Impact Index Per Article: 85.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/09/2016] [Accepted: 08/26/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Lenalidomide plus dexamethasone is a reference treatment for patients with newly diagnosed myeloma. The combination of the proteasome inhibitor bortezomib with lenalidomide and dexamethasone has shown significant efficacy in the setting of newly diagnosed myeloma. We aimed to study whether the addition of bortezomib to lenalidomide and dexamethasone would improve progression-free survival and provide better response rates in patients with previously untreated multiple myeloma who were not planned for immediate autologous stem-cell transplant. METHODS In this randomised, open-label, phase 3 trial, we recruited patients with newly diagnosed multiple myeloma aged 18 years and older from participating Southwest Oncology Group (SWOG) and National Clinical Trial Network (NCTN) institutions (both inpatient and outpatient settings). Key inclusion criteria were presence of CRAB (C=calcium elevation; R=renal impairment; A=anaemia; B=bone involvement) criteria with measurable disease (measured by assessment of free light chains), Eastern Cooperative Oncology Group (ECOG) performance status of 0-3, haemoglobin concentration 9 g/dL or higher, absolute neutrophil count 1 × 103 cells per mm3 or higher, and a platelet count of 80 000/mm3 or higher. We randomly assigned (1:1) patients to receive either an initial treatment of bortezomib with lenalidomide and dexamethasone (VRd group) or lenalidomide and dexamethasone alone (Rd group). Randomisation was stratified based on International Staging System stage (I, II, or III) and intent to transplant (yes vs no). The VRd regimen was given as eight 21-day cycles. Bortezomib was given at 1·3 mg/m2 intravenously on days 1, 4, 8, and 11, combined with oral lenalidomide 25 mg daily on days 1-14 plus oral dexamethasone 20 mg daily on days 1, 2, 4, 5, 8, 9, 11, and 12. The Rd regimen was given as six 28-day cycles. The standard Rd regimen consisted of 25 mg oral lenalidomide once a day for days 1-21 plus 40 mg oral dexamethasone once a day on days 1, 8, 15, and 22. The primary endpoint was progression-free survival using a prespecified one-sided stratified log rank test at a significance level of 0·02. Analyses were intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00644228. FINDINGS Between April, 2008, and February, 2012, we randomly assigned 525 patients at 139 participating institutions (264 to VRd and 261 to Rd). In the randomly assigned patients, 21 patients in the VRd group and 31 in the Rd group were deemed ineligible based mainly on missing, insufficient, or early or late baseline laboratory data. Median progression-free survival was significantly improved in the VRd group (43 months vs 30 months in the Rd group; stratified hazard ratio [HR] 0·712, 96% CI 0·56-0·906; one-sided p value 0·0018). The median overall survival was also significantly improved in the VRd group (75 months vs 64 months in the Rd group, HR 0·709, 95% CI 0·524-0·959; two-sided p value 0·025). The rates of overall response (partial response or better) were 82% (176/216) in the VRd group and 72% (153/214) in the Rd group, and 16% (34/216) and 8% (18/214) of patients who were assessable for response in these respective groups had a complete response or better. Adverse events of grade 3 or higher were reported in 198 (82%) of 241 patients in the VRd group and 169 (75%) of 226 patients in the Rd group; 55 (23%) and 22 (10%) patients discontinued induction treatment because of adverse events, respectively. There were no treatment-related deaths in the Rd group, and two in the VRd group. INTERPRETATION In patients with newly diagnosed myeloma, the addition of bortezomib to lenalidomide and dexamethasone resulted in significantly improved progression-free and overall survival and had an acceptable risk-benefit profile. FUNDING NIH, NCI, NCTN, Millennium Pharmaceuticals, Takeda Oncology Company, and Celgene Corporation.
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Affiliation(s)
- Brian G M Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, CA, USA.
| | | | - Muneer H Abidi
- Spectrum Health Cancer Center, Michigan State University, Grand Rapids, MI, USA
| | | | - Joshua Epstein
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stephen P Kahanic
- Siouxland Regional Cancer Center, Sanford NCORP of the Northern Central Plains, Sioux City, IA, USA
| | - Mohan Thakuri
- Southeast Clinical Oncology Research Consortium NCORP, Cancer Care of Western North Carolina, Asheville, NC, USA
| | - Frederic Reu
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | | | | | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bart Barlogie
- Myeloma Program, Mount Sinai School of Medicine, New York, NY, USA
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Abstract
Lenalidomide is a lead therapeutic in multiple myeloma and deletion 5q myelodysplastic syndromes and shows promising activities in other hematologic malignancies. This article presents a comprehensive review of the clinical pharmacokinetics and pharmacodynamics of lenalidomide. Oral lenalidomide is rapidly and highly absorbed (>90 % of dose) under fasting conditions. Food affects oral absorption, reducing area under the concentration-time curve (AUC) by 20 % and maximum concentration (C max) by 50 %. The increase in AUC and C max is dose proportional, and interindividual variability in plasma exposure is low to moderate. Lenalidomide distributes into semen but is undetectable 3 days after stopping treatment. Biotransformation of lenalidomide in humans includes chiral inversion, trivial hydroxylation, and slow non-enzymatic hydrolysis. Approximately 82 % of an oral dose is excreted as lenalidomide in urine within 24 h. Lenalidomide has a short half-life (3-4 h) and does not accumulate in plasma upon repeated dosing. Its pharmacokinetics are consistent across patient populations, regardless of the type of hematologic malignancy. Renal function is the only important factor affecting lenalidomide plasma exposure. Lenalidomide has no QT prolongation risk at approved doses, and higher plasma exposure to lenalidomide is associated with increased risk of neutropenia and thrombocytopenia. Despite being a weak substrate of P-glycoprotein (P-gp) in vitro, lenalidomide does not have clinically significant pharmacokinetic interactions with P-gp substrates/inhibitors in controlled studies. The AUC-matched dose adjustment is recommended for patients with renal impairment at the start of therapy. No dose adjustment for lenalidomide is needed on the basis of age, ethnicity, mild hepatic impairment, or drug-drug interactions.
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Affiliation(s)
- Nianhang Chen
- Department of Clinical Pharmacology, Celgene Corporation, 86 Morris Avenue, Summit, NJ, 07901, USA.
| | - Simon Zhou
- Department of Clinical Pharmacology, Celgene Corporation, 86 Morris Avenue, Summit, NJ, 07901, USA
| | - Maria Palmisano
- Department of Clinical Pharmacology, Celgene Corporation, 86 Morris Avenue, Summit, NJ, 07901, USA
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Majer I, van de Wetering G, Polanyi Z, Krishna A, Gray E, Roy A. Panobinostat Plus Bortezomib Versus Lenalidomide in Patients with Relapsed and/or Refractory Multiple Myeloma: A Matching-Adjusted Indirect Treatment Comparison of Survival Outcomes using Patient-level Data. Appl Health Econ Health Policy 2017; 15:45-55. [PMID: 27550239 DOI: 10.1007/s40258-016-0271-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND In the UK, the standard of care for patients with multiple myeloma who received ≥2 prior treatments is lenalidomide plus dexamethasone (LEN + DEX) and pomalidomide plus DEX (POM + DEX) (in Wales only). Recently, panobinostat plus bortezomib and DEX (PAN + BTZ + DEX) was licensed in this setting. The current study assessed the progression-free survival (PFS) and overall survival (OS) outcomes with PAN + BTZ + DEX versus LEN + DEX (primary comparator) and POM + DEX (exploratory comparator). METHODS Since an anchor-based indirect treatment comparison was not feasible, the matching-adjusted indirect treatment comparison approach was used. To compare the survival outcomes, patient-level data were generated for the comparators utilizing published Kaplan-Meier survival estimates. The use of approximated patient-level data and matched data for PAN + BTZ + DEX allowed the use of Cox proportional hazards models and the assessment of the proportional hazards assumption. In cases where there was evidence that the proportional hazards assumption was violated, time-dependent hazard ratios (HRs) were estimated. Median and mean values for PFS and OS were predicted. RESULTS For both PFS and OS, the proportional hazards assumption was not satisfied, therefore time-dependent HRs were estimated. Using time-dependent HRs, the mean PFS was estimated to be 11.83 months for PAN + BTZ + DEX and 10.96 months for LEN + DEX. The corresponding mean OS estimates were 30.73 and 27.76 months, respectively. Comparisons with POM + DEX were affected by large uncertainty and did not allow making robust inferences. CONCLUSIONS To our knowledge, this is the first study that combined matching-adjusted indirect treatment comparison with time-dependent HRs to address changing patterns in the HR. The results suggest that treatment with PAN + BTZ + DEX and LEN + DEX are associated with similar mean PFS and OS in the third-line treatment setting of multiple myeloma.
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Affiliation(s)
- Istvan Majer
- Pharmerit International, Health Economics and Outcomes Research, Marten Meesweg 107, 3068 AV, Rotterdam, The Netherlands
| | - Gijs van de Wetering
- Pharmerit International, Health Economics and Outcomes Research, Marten Meesweg 107, 3068 AV, Rotterdam, The Netherlands.
| | | | | | | | - Anuja Roy
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Schmit JM, DeLaune J, Norkin M, Grosbach A. A Case of Plasmablastic Lymphoma Achieving Complete Response and Durable Remission after Lenalidomide-Based Therapy. Oncol Res Treat 2017; 40:46-48. [PMID: 28095384 DOI: 10.1159/000455146] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Plasmablastic lymphoma (PBL) is an uncommon variant of diffuse large B-cell lymphoma that is characterized by its plasmacytoid features, aggressive tendencies, and frequent association with human immunodeficiency virus (HIV) infection or other immunocompromised states. Multi-agent, intensive chemotherapy regimens are recommended as first-line treatment by the National Comprehensive Cancer Network. However, the toxicity of these regimens is high and prognosis remains poor. CASE REPORT We report a patient with HIV-negative PBL who achieved complete response and durable remission using a lenalidomide-based chemotherapy regimen as first-line therapy. CONCLUSION Cyclophosphamide, lenalidomide, dexamethasone (CRD) may provide an alternative initial therapeutic option for patients with PBL who cannot tolerate the intensive chemotherapy regimens currently recommended.
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Wanchoo R, Abudayyeh A, Doshi M, Edeani A, Glezerman IG, Monga D, Rosner M, Jhaveri KD. Renal Toxicities of Novel Agents Used for Treatment of Multiple Myeloma. Clin J Am Soc Nephrol 2017; 12:176-189. [PMID: 27654928 PMCID: PMC5220662 DOI: 10.2215/cjn.06100616] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Survival for patients with multiple myeloma has significantly improved in the last decade in large part due to the development of proteasome inhibitors and immunomodulatory drugs. These next generation agents with novel mechanisms of action as well as targeted therapies are being used both in the preclinical and clinical settings for patients with myeloma. These agents include monoclonal antibodies, deacetylase inhibitors, kinase inhibitors, agents affecting various signaling pathways, immune check point inhibitors, and other targeted therapies. In some cases, off target effects of these therapies can lead to unanticipated effects on the kidney that can range from electrolyte disorders to AKI. In this review, we discuss the nephrotoxicities of novel agents currently in practice as well as in development for the treatment of myeloma.
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Affiliation(s)
- Rimda Wanchoo
- Division of Nephrology, Hofstra Northwell School of Medicine, Great Neck, New York
| | - Ala Abudayyeh
- Division of Internal Medicine, Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mona Doshi
- Division of Nephrology, Wayne State University School of Medicine, Detroit, Michigan
| | - Amaka Edeani
- Kidney Diseases Branch, National Institute of Diabetes, Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland
| | - Ilya G. Glezerman
- Department of Medicine, Renal Service, Memorial Sloan Kettering Cancer Center and Department of Medicine, Weill Cornell Medical Center, New York, New York
| | - Divya Monga
- Nephrology Division, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Mitchell Rosner
- Division of Nephrology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Kenar D. Jhaveri
- Division of Nephrology, Hofstra Northwell School of Medicine, Great Neck, New York
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Zuo W, Zhu X, Yang J, Mei Z, Deng M, Lin Q, Song Y, Yin Q. Bortezomib combined with lenalidomide as the first-line treatment for the rare synchronous occurrence of multiple myeloma and pulmonary adenocarcinoma: A case report. Medicine (Baltimore) 2017; 96:e5787. [PMID: 28072730 PMCID: PMC5228690 DOI: 10.1097/md.0000000000005787] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Simultaneous multiple myeloma (MM) and pulmonary adenocarcinoma is a rare occurrence, and thus, treatment is a challenge. This study reports on 1 such case of MM with concurrent lung cancer, where an accurate diagnosis was made and the patient underwent treatment for both cancers. CASE SUMMARY A 68-year-old man presented with 2 months of progressive lower back pain. Visualization with magnetic resonance imaging (MRI) revealed multiple collapsed vertebrae from T12 to S3, as well as an altered signal intensity at the T3 vertebra. The patient was diagnosed with MM upon examination. A chest computed tomography (CT) scan revealed a round mass in the left lower lobe of the lungs, and a CT-guided needle biopsy uncovered a moderately differentiated adenocarcinoma. There were no additional notable findings in the left lung using positron emission tomography computed tomography (PET-CT). Therefore, a diagnosis of MM with pulmonary adenocarcinoma was made. Surgery was performed to excise the lung cancer. Bortezomib was used as first-line induction therapy against both tumors and lenalidomide was used for maintenance. The patient went into complete remission. Using this combined chemotherapy, the patient has survived for over 3 years since a diagnosis was made despite relapsing twice after the first year. CONCLUSION This report clearly delineates the diagnosis and treatment of a rare case of synchronous MM and pulmonary adenocarcinoma, as well as depicts a potentially positive outcome for the patient. It also overviews some diagnostic and therapeutic implications for clinicians.
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Eddou H, Zinebi A, Maaroufi HE, Moudden MK, Doghmi K, Mikdame M, Baaj ME. Traitement des amyloses AL systémiques: à propos de 25 cas. Pan Afr Med J 2017. [PMID: 29541306 PMCID: PMC5847059 DOI: 10.11604/pamj.2017.28.160.11885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
L'amylose AL systémique primitive est un désordre hématologique rare. La plupart des recommandations thérapeutiques sont basées sur des études de phase II ou des comparaisons rétrospectives et des séries de cas. Le but de cette étude était de décrire les cas d'amylose primitive AL et de faire une comparaison entre le protocole standard Melphlan-Dexamethasone et les nouveaux agents dans le traitement de première ligne de ces patients. Il s'agissait d'une étude rétrospective, descriptive et multicentrique, portant sur l'ensemble des cas d'amyloses AL colligées durant une période s'étalant de juillet 2009 à juin 2016 au sein de 2 centres hospitaliers militaires. Vingt cinq patients ont été colligés dans notre série (12 traités par le Melphalan-Dexamethasone et 13 par des protocoles contenant au moins du Bortézomib ou du Lénalidomide). Il n'y avait pas de différence significative entre les 2 groupes en termes de caractéristiques épidémiologiques, cliniques ou pronostiques. Après un suivi médian de 40 mois, la survie globale médiane était de 54 mois dans le groupe melphalan-Dexamethasone et de 60 mois dans le groupe nouvelles thérapeutiques (P = 0,98). Concernant la survie sans progression, elle était de 18 mois pour le groupe traitement standard contre 11 mois pour le 2ème groupe (P = 0,08). Dans notre petite série nous n'avons pas trouvé une supériorité des nouvelles thérapeutiques par rapport au protocole classique. Ce résultat doit être confirmé par la réalisation d'une vraie étude prospective surtout en raison du coûtde ces nouvelles molécules qui ne sont pas toujours accessibles surtout dans les pays en voie de développement.
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Affiliation(s)
- Hicham Eddou
- Service de Médecine Interne, Hôpital Militaire Moulay Ismail Méknes, Maroc
| | - Ali Zinebi
- Service de Médecine Interne, Hôpital Militaire Moulay Ismail Méknes, Maroc
| | - Hicham El Maaroufi
- Service d'Hématologie Clinique, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | | | - Kamal Doghmi
- Service d'Hématologie Clinique, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Mohammed Mikdame
- Service d'Hématologie Clinique, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
| | - Mohammed El Baaj
- Service de Médecine Interne, Hôpital Militaire Moulay Ismail Méknes, Maroc
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Matsuoka S, Hosono N, Matsuda Y, Oiwa K, Ookura M, Tai K, Anzai M, Nemoto T, Ishizuka T, Nakamoto Y, Yamauchi T. [Recurrent multiple lung lesions synchronizing with the disease activity of multiple myeloma]. Rinsho Ketsueki 2017; 58:2406-2410. [PMID: 29332875 DOI: 10.11406/rinketsu.58.2406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 68-year-old male patient, who was diagnosed with MGUS (IgG-λ) 11 years ago, was referred to our hospital because of a progressing pancytopenia. He was diagnosed with multiple myeloma (MM) and was hospitalized because of fever and pneumonia. Although empiric antibiotic and antifungal therapies were promptly initiated, his pneumonia worsened. Chest CT images revealed diffuse interstitial pneumonia. Although bortezomib/dexamethasone therapy was initiated as a treatment for MM and pneumonia, he showed little response. His pneumonia worsened and progressed to acute respiratory distress syndrome. Using mPSL (500 mg/day), sivelestat, and MM treatment switching to lenalidomide/dexamethasone (Rd), his respiratory status and CT findings rapidly improved. He received Rd therapy as an outpatient; however, after the completion of six cycles of therapy, his MM progressed, with a recurrence of pneumonia and high fever again. The onset of pneumonia was closely associated with MM progression. His pneumonia improved by treatment with mPSL half-pulse and MM treatment switching to carfilzomib/Rd. In the present study, we report the case of a patient with myeloma, who presented with multiple interstitial pneumonia, resulting in respiratory failure twice in concordance with myeloma progression.
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Affiliation(s)
- Sae Matsuoka
- Department of Hematology and Oncology, University of Fukui
| | - Naoko Hosono
- Department of Hematology and Oncology, University of Fukui
| | | | - Kana Oiwa
- Department of Hematology and Oncology, University of Fukui
| | - Miyuki Ookura
- Department of Hematology and Oncology, University of Fukui
| | - Katsunori Tai
- Department of Hematology and Oncology, University of Fukui
| | - Masaki Anzai
- Division of Respiratory Medicine, University of Fukui
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Dao K, Lu Y, Peer CJ, Figg WD, Stadelmann R, Burnier M, Buclin T, Kissling S. Pharmacokinetics of lenalidomide during high cut-off dialysis in a patient with multiple myeloma and renal failure. Cancer Chemother Pharmacol 2016; 79:215-218. [PMID: 27988790 DOI: 10.1007/s00280-016-3219-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/07/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION High cut-off dialysis, increasingly used in multiple myeloma patients, is susceptible to influence anticancer drug elimination. We report about lenalidomide disposition in a patient on high cut-off dialysis for renal failure secondary to myeloma cast nephropathy. METHODS The patient received a higher dosage of lenalidomide (5 mg b.i.d.), owing to concerns about a potential decrease in lenalidomide exposure during dialysis sessions. A set of blood samples was taken in order to develop a pharmacokinetic model accounting for lenalidomide concentrations in this setting. RESULTS According to our model, the area under the curve was 3273 µg h/L, i.e., 60% higher than expected under usual dosage (25 mg q.d.) with normal renal function. Despite this, the patient did not develop major hematological toxicity. CONCLUSIONS Lenalidomide doses of 5 mg b.i.d. led to high exposure in a patient with renal failure undergoing high cut-off dialysis. Yet, the dosage of 5 mg q.d. recommended in conventional dialysis would probably be adequate in such patients.
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Affiliation(s)
- Kim Dao
- Division of Clinical Pharmacology, Biomedicine, Department of Laboratories, CHUV, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland.
| | - Yimin Lu
- Service of Nephrology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cody J Peer
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - William D Figg
- Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Raphael Stadelmann
- Division of Hematology, Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michel Burnier
- Service of Nephrology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thierry Buclin
- Division of Clinical Pharmacology, Biomedicine, Department of Laboratories, CHUV, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 17, 1011, Lausanne, Switzerland
| | - Sebastien Kissling
- Service of Nephrology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Berenson A, Vardanyan S, David M, Wang J, Harutyunyan NM, Gottlieb J, Halleluyan R, Spektor TM, Udd KA, Eshaghian S, Nassir Y, Eades B, Swift R, Berenson JR. Outcomes of multiple myeloma patients receiving bortezomib, lenalidomide, and carfilzomib. Ann Hematol 2016; 96:449-459. [PMID: 27933373 DOI: 10.1007/s00277-016-2889-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 11/27/2016] [Indexed: 12/13/2022]
Abstract
New classes of drugs including the proteasome inhibitors (PI) bortezomib and, more recently, carfilzomib and the immunomodulatory agent lenalidomide have shown improved outcomes for multiple myeloma (MM) patients during the past decade. However, most of the studies reporting outcomes for patients receiving these drugs have relied on older data sets derived from large institutions that included patients not receiving their treatment at those facilities and represented only those eligible for clinical trials or were from sites where treatment options were limited. We have analyzed data from 258 MM patients who have received treatment with at least one of three agents: bortezomib, carfilzomib, and lenalidomide in a single clinic specializing in MM with respect to their responses and other outcomes to treatment regimens including these agents. Response rates were similar between these three drugs when used for the first time and again during subsequent treatment regimens. As expected, the clinical benefit rates (CBRs) were better for patients receiving their first treatment when compared to their use in subsequent treatment regimens. The CBRs were similar during their 2nd, 3rd, and 4th treatments containing these agents. Many patients refractory to these agents showed responses to regimens containing these same drugs when used in different combinations. In addition, patients refractory to one PI often responded to the other PI. The results of this study demonstrate that novel agents can be used repeatedly in novel combinations with significant clinical benefit for patients with MM.
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Affiliation(s)
- Ariana Berenson
- Institute for Myeloma & Bone Cancer Research, 9201 W. Sunset Blvd., Suite 300, West Hollywood, CA, 90069, USA
| | - Suzie Vardanyan
- Institute for Myeloma & Bone Cancer Research, 9201 W. Sunset Blvd., Suite 300, West Hollywood, CA, 90069, USA
| | - Michael David
- Institute for Myeloma & Bone Cancer Research, 9201 W. Sunset Blvd., Suite 300, West Hollywood, CA, 90069, USA
| | - James Wang
- Institute for Myeloma & Bone Cancer Research, 9201 W. Sunset Blvd., Suite 300, West Hollywood, CA, 90069, USA
- James R. Berenson, MD, Inc., 9201 W. Sunset Blvd., Suite 310, West Hollywood, CA, USA
| | - Nika Manik Harutyunyan
- Institute for Myeloma & Bone Cancer Research, 9201 W. Sunset Blvd., Suite 300, West Hollywood, CA, 90069, USA
| | - Jillian Gottlieb
- Institute for Myeloma & Bone Cancer Research, 9201 W. Sunset Blvd., Suite 300, West Hollywood, CA, 90069, USA
| | - Ran Halleluyan
- Institute for Myeloma & Bone Cancer Research, 9201 W. Sunset Blvd., Suite 300, West Hollywood, CA, 90069, USA
| | - Tanya M Spektor
- Oncotherapeutic, 9201 W. Sunset Blvd., Suite 317, West Hollywood, CA, USA
| | - Kyle A Udd
- Institute for Myeloma & Bone Cancer Research, 9201 W. Sunset Blvd., Suite 300, West Hollywood, CA, 90069, USA
- James R. Berenson, MD, Inc., 9201 W. Sunset Blvd., Suite 310, West Hollywood, CA, USA
| | - Shahrooz Eshaghian
- Institute for Myeloma & Bone Cancer Research, 9201 W. Sunset Blvd., Suite 300, West Hollywood, CA, 90069, USA
| | - Youram Nassir
- James R. Berenson, MD, Inc., 9201 W. Sunset Blvd., Suite 310, West Hollywood, CA, USA
| | - Benjamin Eades
- James R. Berenson, MD, Inc., 9201 W. Sunset Blvd., Suite 310, West Hollywood, CA, USA
| | - Regina Swift
- James R. Berenson, MD, Inc., 9201 W. Sunset Blvd., Suite 310, West Hollywood, CA, USA
| | - James R Berenson
- Institute for Myeloma & Bone Cancer Research, 9201 W. Sunset Blvd., Suite 300, West Hollywood, CA, 90069, USA.
- James R. Berenson, MD, Inc., 9201 W. Sunset Blvd., Suite 310, West Hollywood, CA, USA.
- Oncotherapeutic, 9201 W. Sunset Blvd., Suite 317, West Hollywood, CA, USA.
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Abstract
Objective: To evaluate lenalidomide in the treatment of multiple myeloma and myelodysplastic syndrome (MDS). Data Sources: Clinical literature was accessed through MEDLINE (1966–August 2005), Science Citation Index (1980–August 2005), and Proceedings of the American Society of Hematology (2000–2004). Data Synthesis: New analogs of thalidomide have been synthesized that are more potent and less toxic. Lenalidomide (CC-5013) is currently in Phase III trials for the treatment of multiple myeloma and MDS. Phase II trials demonstrated lenalidomide's efficacy in patients refractory to thalidomide. The full potential of this agent has yet to be proven, but preliminary data seem promising. Conclusions: Lenalidomide is a potent immunomodulating drug that offers different mechanisms of action and therapeutic potential for the treatment of multiple myeloma, MDS, and other malignancies.
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Affiliation(s)
- Sara K Maier
- Department of Pharmacy, Duke University Medical Center, Durham, NC 27710-3089, USA.
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136
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Ureshino H, Kizuka H, Kusaba K, Sano H, Nishioka A, Shindo T, Kubota Y, Ando T, Kojima K, Kimura S. 5q- syndrome-like features as the first manifestation of myelodysplastic syndrome in a patient with an unbalanced whole-arm translocation der(5;19)(p10;q10). Int J Hematol 2016; 105:692-696. [PMID: 27914067 DOI: 10.1007/s12185-016-2160-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
Abstract
Derivative (5;19)(p10;q10) [der(5;19)(p10;q10)] is a rare chromosomal abnormality in myelodysplastic syndrome (MDS), and is genetically similar to deletion 5q [del(5q)]. However, MDS with der(5;19)(p10;q10) and 5q- syndrome are generally characterized as distinct subtypes. Here, we report a case of a patient with 5q- syndrome-like features as the first manifestation of MDS with der(5; 19)(p10;q10). A 59-year-old woman was admitted to our hospital for anemia without leukopenia and thrombocytopenia. She had received chemotherapy comprising carboplatin and docetaxel for endometrial cancer eight years before. Bone marrow aspirate (BM) revealed low blast counts with trilineage dysplastic cells, and fluorescent in situ hybridization revealed the loss of colony-stimulating factor 1 receptor (CSF1R) signals at 5q33-34. Although the initial manifestation was 5q- syndrome, G-banded metaphase analysis and spectral karyotyping analysis revealed der(5;19)(p10;q10). Consequently, a diagnosis of therapy-related MDS (t-MDS) was made. She failed to respond to azacitidine and lenalidomide therapy. Consequently, transfusion-dependent anemia and thrombocytopenia developed with increasing myeloblasts. Cytarabine, aclarubicin, and granulocyte colony-stimulating factor therapy also failed, and unfortunately the patient died. Thus, MDS with der(5;19)(p10;q10) may represent a platinum agent-related t-MDS that is highly resistant to chemotherapy.
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Affiliation(s)
- Hiroshi Ureshino
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Haruna Kizuka
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kana Kusaba
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Haruhiko Sano
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Atsujiro Nishioka
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Takero Shindo
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Yasushi Kubota
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Toshihiko Ando
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kensuke Kojima
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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137
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Abstract
The treatment of patients with myelodysplastic syndromes (MDSs) has hinged primarily on supportive care (ie, blood transfusions, colony stimulating agents, iron chelation, etc.) and the US Food and Drug Administration-approved agents, including 5-azacytidine, deoxyazacytidine, and lenalidomide. For patients no longer benefitting from these agents, there is a paucity of effective therapies. The challenges at this time include our limited understanding of the mechanisms of resistance to these therapies and the variables employed to select next best therapies for patients based on: (1) their performance status and medical comorbidities; (2) the molecular feature(s) of their MDS; (3) the prior treatments they have received; and (4) the long-term goal(s)/possibilities for their future treatment (ie, transplant vs no transplant).
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138
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Abstract
The majority of myelodysplastic syndrome (MDS) patients belong to the International Prognostic Scoring System (IPSS) and IPSS-revised (IPSS-R) lower-risk categories. Their precise diagnostics and prognostic stratification is often a challenge, but may ensure the optimization of therapy. The availability of diverse treatment options has significantly improved the quality of life and survival of this group of patients. Anemia is the most relevant cytopenia in terms of frequency and symptoms in lower-risk MDS, and may be treated successfully with erythropoietic stimulating agents, provided a careful selection is performed on the basis of IPSS-R, endogenous erythropoietin levels, and transfusion independence. Doses and duration of therapy of erythropoietic-stimulating agents (ESAs) are critical to determine efficacy. In case a patient fails ESA treatment, the available options may include lenalidomide (approved for del5q positive cases), hypomethylating agents, and a rather large number of experimental agents, whose clinical trials should be offered to a larger number of MDS patients. The choice for second-line treatment must take into account biologic, cytogenetic, and molecular-identified characteristics of individual patients, as well as frailty and comorbidities. Other cytopenias are less frequently presenting as isolated. Specific therapy for thrombocytopenia has been proposed in experimental clinical trials with thrombomimetic agents that have shown good efficacy, but raised some safety concern. Although neutropenia is targeted symptomatically with growth factor supportive care, the immunosuppressive treatments are indicated mainly for pancytopenic, hypoplastic lower-risk MDS; they are not widely used because of their toxicity, despite the fact that they may induce responses. Finally, hematopoietic stem cell transplant is the curative option also for lower-risk MDS and timing should be carefully evaluated, balancing toxicity and the possibility of survival advantage. Finally, even when considered suitable for lower-risk MDS, transplant application is limited to the rarer fit and younger MDS patient.
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Affiliation(s)
- Valeria Santini
- SODc Hematology, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
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139
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Ujjani CS, Jung SH, Pitcher B, Martin P, Park SI, Blum KA, Smith SM, Czuczman M, Davids MS, Levine E, Lewis LD, Smith SE, Bartlett NL, Leonard JP, Cheson BD. Phase 1 trial of rituximab, lenalidomide, and ibrutinib in previously untreated follicular lymphoma: Alliance A051103. Blood 2016; 128:2510-2516. [PMID: 27697771 PMCID: PMC5123195 DOI: 10.1182/blood-2016-06-718106] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/23/2016] [Indexed: 11/20/2022] Open
Abstract
Chemoimmunotherapy in follicular lymphoma is associated with significant toxicity. Targeted therapies are being investigated as potentially more efficacious and tolerable alternatives for this multiply-relapsing disease. Based on promising activity with rituximab and lenalidomide in previously untreated follicular lymphoma (overall response rate [ORR] 90%-96%) and ibrutinib in relapsed disease (ORR 30%-55%), the Alliance for Clinical Trials in Oncology conducted a phase 1 trial of rituximab, lenalidomide, and ibrutinib. Previously untreated patients with follicular lymphoma received rituximab 375 mg/m2 on days 1, 8, 15, and 22 of cycle 1 and day 1 of cycles 4, 6, 8, and 10; lenalidomide as per cohort dose on days 1 to 21 of 28 for 18 cycles; and ibrutinib as per cohort dose daily until progression. Dose escalation used a 3+3 design from a starting dose level (DL) of lenalidomide 15 mg and ibrutinib 420 mg (DL0) to DL2 (lenalidomide 20 mg, ibrutinib 560 mg). Twenty-two patients were enrolled; DL2 was determined to be the recommended phase II dose. Although no protocol-defined dose-limiting toxicities were reported, a high incidence of rash was observed (all grades 82%, grade 3 36%). Eleven patients (50%) required dose reduction, 7 because of rash. The ORR for the entire cohort was 95%, and the 12-month progression-free survival was 80% (95% confidence interval, 57%-92%). Five patients developed new malignancies; 3 had known risk factors before enrollment. Given the increased toxicity and required dose modifications, as well as the apparent lack of additional clinical benefit to the rituximab-lenalidomide doublet, further investigation of the regimen in this setting seems unwarranted. The study was registered with www.ClinicalTrials.gov as #NCT01829568.
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Affiliation(s)
- Chaitra S Ujjani
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC
| | - Sin-Ho Jung
- Alliance Statistics and Data Center, Duke University, Durham, NC
| | | | - Peter Martin
- Meyer Cancer Center, Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, NY
| | - Steven I Park
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kristie A Blum
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Sonali M Smith
- University of Chicago Medicine Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Myron Czuczman
- Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY
| | | | - Ellis Levine
- Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY
| | - Lionel D Lewis
- Norris Cotton Cancer Center, The Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Scott E Smith
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL; and
| | - Nancy L Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - John P Leonard
- Meyer Cancer Center, Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, NY
| | - Bruce D Cheson
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC
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140
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Kwong YL. Radiologic and molecular remission of follicular T cell lymphoma treated with lenalidomide. Ann Hematol 2016; 96:513-515. [PMID: 27838774 DOI: 10.1007/s00277-016-2873-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/28/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Yok-Lam Kwong
- Department of Medicine, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.
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141
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Lian XY, Zhang ZH, Deng ZQ, He PF, Yao DM, Xu ZJ, Wen XM, Yang L, Lin J, Qian J. Efficacy and Safety of Lenalidomide for Treatment of Low-/Intermediate-1-Risk Myelodysplastic Syndromes with or without 5q Deletion: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0165948. [PMID: 27824902 PMCID: PMC5100926 DOI: 10.1371/journal.pone.0165948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/20/2016] [Indexed: 01/22/2023] Open
Abstract
Background Lenalidomide could effectively induce red blood cell (RBC) transfusion independence (TI) in patients with lower-risk (Low/Intermediate-1) myelodysplastic syndrome (MDS) with or without 5q deletion. However whether lenalidomide ultimately improves the overall survival (OS) of lower-risk MDS patients and reduces the progression to AML remains controversial. Method A meta-analysis was conducted to examine the efficacy and safety of lenalidomide in the treatment of lower-risk MDS. Efficacy was assessed according to erythroid hematologic response (HI-E), cytogenetic response (CyR), OS and AML progression. Safety was evaluated based on the occurrence rates of grades 3–4 adverse events (AEs). Results Seventeen studies were included consisting of a total of 2160 patients. The analysis indicated that the overall rate of HI-E was 58% with 95% confidence interval (CI) of 43–74%. The pooled estimates for the rates of CyR, complete CyR, and partial CyR were 44% (95% CI 19–68%), 21% (95% CI 13–30%) and 23% (95% CI 15–32%), respectively. The patients with 5q deletion had significantly higher rate of HI-E and CyR than those without 5q deletion (P = 0.002 and 0.001, respectively). The incidences of grades 3–4 neutropenia, thrombocytopenia, leukopenia, anemia, deep vein thrombosis, diarrhea, fatigue and rash were 51% (95% CI 30–73%), 31% (95% CI 20–42%), 9% (95% CI 5–13%), 7% (95% CI 2–12%), 3% (95% CI 2–5%), 3% (95% CI 1–5%), 2% (95% CI 1–4%) and 2% (95% CI 1–3%), respectively. Lenalidomide significantly improved OS (HR: 0.62, 95% CI 0.47–0.83, P = 0.001) and lowered the risk of AML progression in del(5q) patients (RR: 0.61, 95% CI 0.41–0.91, P = 0.014). Conclusions In spite of the AEs, lenalidomide could be effectively and safely used for the treatment of lower-risk MDS patients with or without 5q deletion.
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Affiliation(s)
- Xin-yue Lian
- Department of Hematology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Zhi-hui Zhang
- Department of Hematology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Zhao-qun Deng
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Pin-fang He
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Dong-ming Yao
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Zi-jun Xu
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Xiang-mei Wen
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Lei Yang
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Jiang Lin
- Laboratory Center, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
- * E-mail: (JQ); (JL)
| | - Jun Qian
- Department of Hematology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
- * E-mail: (JQ); (JL)
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142
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Jakubowiak AJ, Campioni M, Benedict Á, Houisse I, Tichy E, Giannopoulou A, Aggarwal SK, Barber BL, Panjabi S. Cost-effectiveness of adding carfilzomib to lenalidomide and dexamethasone in relapsed multiple myeloma from a US perspective. J Med Econ 2016; 19:1061-1074. [PMID: 27224006 DOI: 10.1080/13696998.2016.1194278] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the economic value of carfilzomib (Kyprolis), this study developed the Kyprolis Global Economic Model (K-GEM), which examined from a United States (US) payer perspective the cost-effectiveness of carfilzomib-lenalidomide-dexamethasone (KRd) versus lenalidomide-dexamethasone (Rd) in relapsed multiple myeloma (RMM; 1-3 prior therapies) based on results from the phase III ASPIRE trial that directly compared these regimens. METHODS A partitioned survival model that included three health states of progression-free (on or off treatment), post-progression, and death was developed. Using ASPIRE data, the effect of treatment regimens as administered in the trial was assessed for progression-free survival and overall survival (OS). Treatment effects were estimated with parametric regression models adjusting for baseline patient characteristics and applied over a lifetime horizon. US Surveillance, Epidemiology and End Results (1984-2014) registry data were matched to ASPIRE patients to extrapolate OS beyond the trial. Estimated survival was adjusted to account for utilities across health states. The K-GEM considered the total direct costs (pharmacy/medical) of care for patients treated with KRd and Rd. RESULTS KRd was estimated to be more effective compared to Rd, providing 1.99 life year and 1.67 quality-adjusted life year (QALY) gains over the modeled horizon. KRd-treated patients incurred $179,393 in total additional costs. The incremental cost-effectiveness ratio (ICER) was $107,520 per QALY. LIMITATIONS Extrapolated survival functions present the greatest uncertainty in the modeled results. Utilities were derived from a combination of sources and assumed to reflect how US patients value their health state. CONCLUSIONS The K-GEM showed KRd is cost-effective, with an ICER of $107,520 per QALY gained against Rd for the treatment of patients with RMM (1-3 prior therapies) at a willingness-to-pay threshold of $150,000. Reimbursement of KRd for patients with RMM may represent an efficient allocation of the healthcare budget.
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Affiliation(s)
| | - Marco Campioni
- b Global Health Economics , Amgen (Europe) GmbH, Zug , Switzerland
| | | | - Ivan Houisse
- c Modeling and Simulation , Evidera, Budapest , Hungary
| | - Eszter Tichy
- c Modeling and Simulation , Evidera, Budapest , Hungary
| | | | | | - Beth L Barber
- d Global Development , Amgen Inc., Thousand Oaks , CA , USA
| | - Sumeet Panjabi
- e Global Health Economics , Amgen Inc. San Francisco , CA , USA
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143
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Ibata S, Sato T, Kuroda H, Nagamachi Y, Iyama S, Fujimi A, Kamihara Y, Konuma Y, Yoshida M, Tatekoshi A, Hashimoto A, Horiguchi H, Ono K, Murase K, Takada K, Miyanishi K, Kobune M, Hirayama Y, Kato J. A phase II trial of small-dose bortezomib, lenalidomide and dexamethasone (sVRD) as consolidation/maintenance therapy in patients with multiple myeloma. Cancer Chemother Pharmacol 2016; 78:1041-1049. [PMID: 27738809 PMCID: PMC5083756 DOI: 10.1007/s00280-016-3163-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 10/06/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Consolidation/maintenance therapy induces deep remission in patients with multiple myeloma (MM); however, the most suitable regimen has been under investigation. The combination therapy with bortezomib, lenalidomide and dexamethasone (VRD) is a powerful regimen for relapsed/refractory as well as newly diagnosed MM as an induction therapy. However, severe adverse events (AEs) may become a problem when VRD is introduced without dose reduction as a consolidation/maintenance therapy. METHODS In this single-arm phase II study, we evaluated the efficacy of small-dose VRD regimen (sVRD) in the consolidation/maintenance setting. Sixteen patients who had partial response (PR) or better after any induction therapy were enrolled. Patients received at least six 28-day cycles of subcutaneous bortezomib (1.3 mg/m2 on days 1 and 15), lenalidomide (10 mg on days 1-21) and dexamethasone (40 mg on days 1, 8, 15 and 22). RESULTS The overall response rate and the complete response (CR) rate were 100 and 43.8 %, respectively. In particular, one patient with CR and two patients with very good PR at enrollment achieved stringent CR during 6 courses of sVRD. With a median follow-up time of 29.4 months, the median progression-free survival (PFS) and overall survival (OS) were not reached, while the PFS and OS rates at 2.5 years were 66.6 and 77.3 %, respectively. Univariate analysis demonstrated that disease progression as a reason for discontinuation of sVRD had a negative impact on OS. There were no grade 3 or 4 hematologic or nonhematologic AEs. CONCLUSION Our sVRD regimen as a consolidation/maintenance therapy was highly effective and well tolerable.
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Affiliation(s)
- Soushi Ibata
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
| | - Tsutomu Sato
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan.
| | - Hiroyuki Kuroda
- Gastroenterology and Hematology/Clinical Oncology, Internal Medicine, Steel Memorial Muroran Hospital, Muroran, Japan
| | | | - Satoshi Iyama
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
| | - Akihito Fujimi
- Department of Hematology and Oncology, Oji General Hospital, Tomakomai, Japan
| | - Yusuke Kamihara
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
| | - Yuichi Konuma
- Department of Hematology and Oncology, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Masahiro Yoshida
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
| | - Ayumi Tatekoshi
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
| | - Akari Hashimoto
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
| | - Hiroto Horiguchi
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
| | - Kaoru Ono
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
| | - Kazuyuki Murase
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
| | - Kohichi Takada
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
| | - Koji Miyanishi
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
| | - Masayoshi Kobune
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
| | - Yasuo Hirayama
- Division of Internal Medicine, Higashi Sapporo Hospital, Sapporo, Japan
| | - Junji Kato
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku, Sapporo, Japan
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144
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Dimopoulos MA, Oriol A, Nahi H, San-Miguel J, Bahlis NJ, Usmani SZ, Rabin N, Orlowski RZ, Komarnicki M, Suzuki K, Plesner T, Yoon SS, Ben Yehuda D, Richardson PG, Goldschmidt H, Reece D, Lisby S, Khokhar NZ, O'Rourke L, Chiu C, Qin X, Guckert M, Ahmadi T, Moreau P. Daratumumab, Lenalidomide, and Dexamethasone for Multiple Myeloma. N Engl J Med 2016; 375:1319-1331. [PMID: 27705267 DOI: 10.1056/nejmoa1607751] [Citation(s) in RCA: 1043] [Impact Index Per Article: 130.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Daratumumab showed promising efficacy alone and with lenalidomide and dexamethasone in a phase 1-2 study involving patients with relapsed or refractory multiple myeloma. METHODS In this phase 3 trial, we randomly assigned 569 patients with multiple myeloma who had received one or more previous lines of therapy to receive lenalidomide and dexamethasone either alone (control group) or in combination with daratumumab (daratumumab group). The primary end point was progression-free survival. RESULTS At a median follow-up of 13.5 months in a protocol-specified interim analysis, 169 events of disease progression or death were observed (in 53 of 286 patients [18.5%] in the daratumumab group vs. 116 of 283 [41.0%] in the control group; hazard ratio, 0.37; 95% confidence interval [CI], 0.27 to 0.52; P<0.001 by stratified log-rank test). The Kaplan-Meier rate of progression-free survival at 12 months was 83.2% (95% CI, 78.3 to 87.2) in the daratumumab group, as compared with 60.1% (95% CI, 54.0 to 65.7) in the control group. A significantly higher rate of overall response was observed in the daratumumab group than in the control group (92.9% vs. 76.4%, P<0.001), as was a higher rate of complete response or better (43.1% vs. 19.2%, P<0.001). In the daratumumab group, 22.4% of the patients had results below the threshold for minimal residual disease (1 tumor cell per 105 white cells), as compared with 4.6% of those in the control group (P<0.001); results below the threshold for minimal residual disease were associated with improved outcomes. The most common adverse events of grade 3 or 4 during treatment were neutropenia (in 51.9% of the patients in the daratumumab group vs. 37.0% of those in the control group), thrombocytopenia (in 12.7% vs. 13.5%), and anemia (in 12.4% vs. 19.6%). Daratumumab-associated infusion-related reactions occurred in 47.7% of the patients and were mostly of grade 1 or 2. CONCLUSIONS The addition of daratumumab to lenalidomide and dexamethasone significantly lengthened progression-free survival among patients with relapsed or refractory multiple myeloma. Daratumumab was associated with infusion-related reactions and a higher rate of neutropenia than the control therapy. (Funded by Janssen Research and Development; POLLUX ClinicalTrials.gov number, NCT02076009 .).
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Affiliation(s)
- Meletios A Dimopoulos
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Albert Oriol
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Hareth Nahi
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Jesus San-Miguel
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Nizar J Bahlis
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Saad Z Usmani
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Neil Rabin
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Robert Z Orlowski
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Mieczyslaw Komarnicki
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Kenshi Suzuki
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Torben Plesner
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Sung-Soo Yoon
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Dina Ben Yehuda
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Paul G Richardson
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Hartmut Goldschmidt
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Donna Reece
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Steen Lisby
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Nushmia Z Khokhar
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Lisa O'Rourke
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Christopher Chiu
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Xiang Qin
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Mary Guckert
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Tahamtan Ahmadi
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
| | - Philippe Moreau
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias I Pujol, Barcelona (A.O.), and Clínica Universidad de Navarra-Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.S.-M.) - both in Spain; Karolinska Institute and the Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm (H.N.); Tom Baker Cancer Centre, University of Calgary, Calgary, AB (N.J.B.), and the Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto (D.R.) - both in Canada; Levine Cancer Institute-Carolinas HealthCare System, Charlotte, NC (S.Z.U.); the Department of Haematology, University College London Hospitals NHS Trust, London (N.R.); the Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.); the Department of Hematology and Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland (M.K.); the Department of Hematology, Japanese Red Cross Medical Center, Tokyo (K.S.); Vejle Hospital and University of Southern Denmark, Vejle (T.P.), and Genmab, Copenhagen (S.L.) - both in Denmark; the Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (S.-S.Y.); the Hematology Department, Hadassah-Hebrew University Medical Center, Jerusalem (D.B.Y.); Dana-Farber Cancer Institute, Harvard Medical School, Boston (P.G.R.); University Hospital Heidelberg and the German Cancer Research Center, Heidelberg, Germany (H.G.); Janssen Research and Development, Spring House, PA (N.Z.K., L.O., C.C., X.Q., M.G., T.A.); and the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France (P.M.)
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Madan RA, Karzai FH, Ning YM, Adesunloye BA, Huang X, Harold N, Couvillon A, Chun G, Cordes L, Sissung T, Beedie SL, Dawson NA, Theoret MR, McLeod DG, Rosner I, Trepel JB, Lee MJ, Tomita Y, Lee S, Chen C, Steinberg SM, Arlen PM, Gulley JL, Figg WD, Dahut WL. Phase II trial of docetaxel, bevacizumab, lenalidomide and prednisone in patients with metastatic castration-resistant prostate cancer. BJU Int 2016; 118:590-7. [PMID: 26780387 PMCID: PMC6387685 DOI: 10.1111/bju.13412] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the safety and clinical efficacy of two anti-angiogenic agents, bevacizumab and lenalidomide, with docetaxel and prednisone. PATIENTS AND METHODS Eligible patients with metastatic castration-resistant prostate cancer enrolled in this open-label, phase II study of lenalidomide with bevacizumab (15 mg/kg), docetaxel (75 mg/m(2) ) and prednisone (10 mg daily). Docetaxel and bevacizumab were administered on day 1 of a 3-week treatment cycle. To establish safety, lenalidomide dosing in this combination was escalated in a conventional 3 + 3 design (15, 20 and 25 mg daily for 2 weeks followed by 1 week off). Patients received supportive measures including prophylactic pegfilgrastim and enoxaparin. The primary endpoints were safety and clinical efficacy. RESULTS A total of 63 patients enrolled in this trial. Toxicities were manageable with most common adverse events (AEs) being haematological, and were ascertained by weekly blood counts. Twenty-nine patients (46%) had grade 4 neutropenia, 20 (32%) had grade 3 anaemia and seven (11%) had grade 3 thrombocytopenia. Despite frequent neutropenia, serious infections were rare. Other common non-haematological grade 3 AEs included fatigue (10%) and diarrhoea (10%). Grade 2 AEs in >10% of patients included anorexia, weight loss, constipation, osteonecrosis of the jaw, rash and dyspnoea. Of 61 evaluable patients, 57 (93%), 55 (90%) and 33 (54%) had PSA declines of >30, >50 and >90%, respectively. Of the 29 evaluable patients, 24 (86%) had a confirmed radiographic partial response. The median times to progression and overall survival were 18.2 and 24.6 months, respectively. CONCLUSIONS With appropriate supportive measures, combination angiogenesis inhibition can be safely administered and potentially provide clinical benefit. These hypothesis-generating data would require randomized trials to confirm the findings.
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Affiliation(s)
- Ravi A Madan
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Fatima H Karzai
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Yang-Min Ning
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Bamidele A Adesunloye
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Xuan Huang
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Nancy Harold
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Anna Couvillon
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Guinevere Chun
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Lisa Cordes
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Tristan Sissung
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Shaunna L Beedie
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Nancy A Dawson
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C., USA
| | - Marc R Theoret
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - David G McLeod
- Center for Prostate Disease Research, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Inger Rosner
- Center for Prostate Disease Research, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jane B Trepel
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Min-Jung Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Yusuke Tomita
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Sunmin Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Clara Chen
- Radiology and Imaging Sciences, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Seth M Steinberg
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Philip M Arlen
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - James L Gulley
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - William D Figg
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
| | - William L Dahut
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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146
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Abstract
The monoclonal gammopathies of renal significance (MGRS) are a group of disorders characterized by monoclonal Ig deposition in the kidney, but are not associated with systemic lymphoma or overt multiple myeloma. The prevailing hypothesis is that the pathogenic paraproteins in MGRS are produced by underlying B cell or plasma cell clones. However, in the MGRS literature, the yield of detecting a clone has been variable, and progression to ESRD is common. Here, we present an "onco-nephrologic" approach to the MGRS disorders by highlighting recent advances in lymphoma and multiple myeloma that can be used in the evaluation and management of these patients.
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Affiliation(s)
| | - Brendan M Weiss
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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147
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Abstract
Multiple myeloma is an incurable malignant plasma cell-originating cancer. Although its treatment outcomes have improved with the use of glucocorticoids, alkylating drugs, and novel agents, including proteasome inhibitors (bortezomib and carfilzomib) and immunomodulatory drugs (thalidomide, lenalidomide, and pomalidomide), relapse remains a serious problem. Strategies to improve outcomes following autologous stem cell transplantation and frontline treatments in non-transplant patients include consolidation to intensify therapy and improve the depth of response and maintenance therapy to achieve long-term disease control. Many clinical trials have reported increased progression-free and overall survival rates after consolidation and maintenance therapy. The role of consolidation/maintenance therapy has been assessed in patients eligible and ineligible for transplantation and is a valuable option in clinical trial settings. However, the decision to use consolidation and/or maintenance therapy needs to be guided by the individual patient situation in actual clinical practice. This review analyzes the currently available evidence from several reported clinical trials to determine the optimal consolidation and maintenance therapy in clinical practice.
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Affiliation(s)
- Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Chang-Ki Min
- Division of Hematology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- Correspondence to Chang-Ki Min, M.D. Division of Hematology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6053 Fax: +82-2-599-3589 E-mail:
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148
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Petukhova TA, Tartar DM, Mayo K, Fung MA, Tuscano J, Jagdeo J. Erythema Nodosum-like Septal Panniculitis Secondary to Lenalidomide Therapy in a Patient With Janus Kinase 2-Positive Myelofibrosis. J Drugs Dermatol 2016; 15:1024-1025. [PMID: 27538006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Erythema nodosum (EN) is a panniculitis frequently encountered secondary to medical therapy. We present a case of a 66-year-old gentleman with JAK2-positive myelofibrosis who developed transient EN-like lesions on his trunk and upper and lower extremities approximately three weeks after starting lenalidomide therapy. The subcutaneous nodules improved with intralesional triamcinolone and topical clobetasol without discontinuation of lenalidomide.<br /><br /> <em>J Drugs Dermatol</em>. 2016;15(8):1024-1025.
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149
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Lee SE, Lim JY, Ryu DB, Kim TW, Yoon JH, Cho BS, Eom KS, Kim YJ, Kim HJ, Lee S, Cho SG, Kim DW, Lee JW, Min WS, Kim M, Min CK. Circulating immune cell phenotype can predict the outcome of lenalidomide plus low-dose dexamethasone treatment in patients with refractory/relapsed multiple myeloma. Cancer Immunol Immunother 2016; 65:983-94. [PMID: 27342591 PMCID: PMC11029332 DOI: 10.1007/s00262-016-1861-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 06/15/2016] [Indexed: 12/19/2022]
Abstract
Although the antimyeloma effect of lenalidomide is associated with activation of the immune system, the exact in vivo immunomodulatory mechanisms of lenalidomide combined with low-dose dexamethasone (Len-dex) in refractory/relapsed multiple myeloma (RRMM) patients remain unclear. In this study, we analyzed the association between immune cell populations and clinical outcomes in patients receiving Len-dex for the treatment of RRMM. Peripheral blood samples from 90 RRMM patients were taken on day 1 of cycles 1 (baseline), 2, 3, and 4 of Len-dex therapy. Peripheral blood CD3(+), CD4(+), and CD8(+) cell frequencies were significantly decreased by 3 cycles of therapy, whereas NK cell frequency was significantly increased after the 3rd cycle. For the myeloid-derived suppressor cell (MDSC) subset, the frequency of granulocytic MDSCs transiently increased after the 1st cycle, whereas there was an increase in monocytic MDSC (M-MDSC) frequency after the 1st and 3rd cycles. Among 81 evaluable patients, failure to achieve a response of VGPR or greater was associated with a decrease in CD8(+) cell frequency and increase in M-MDSC frequency after 3 cycles of Len-dex treatment. A high proportion of natural killer T (NKT)-like cells (CD3(+)/CD56(+)) prior to Len-dex treatment might predict a longer time to progression. In addition, patients with a smaller decrease in the frequency of both CD3(+) cells and CD8(+) cells by 3 cycles exhibited a longer time to the next treatment. These results demonstrated that early changes in immune cell subsets are useful immunologic indicators of the efficacy of Len-dex treatment in RRMM.
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Affiliation(s)
- Sung-Eun Lee
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Ji-Young Lim
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Da-Bin Ryu
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Tae Woo Kim
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Jae-Ho Yoon
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Byung-Sik Cho
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Ki-Seong Eom
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Yoo-Jin Kim
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Hee-Je Kim
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Seok Lee
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Seok-Goo Cho
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Dong-Wook Kim
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Jong-Wook Lee
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Woo-Sung Min
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Ki Min
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, #222 Banpodaero, Seocho-Gu, Seoul, 06591, Korea.
- Catholic Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea.
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150
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Jacobus SJ, Rajkumar SV, Weiss M, Stewart AK, Stadtmauer EA, Callander NS, Dreosti LM, Lacy MQ, Fonseca R. Randomized phase III trial of consolidation therapy with bortezomib- lenalidomide-Dexamethasone (VRd) vs bortezomib-dexamethasone (Vd) for patients with multiple myeloma who have completed a dexamethasone based induction regimen. Blood Cancer J 2016; 6:e448. [PMID: 27471864 PMCID: PMC5030380 DOI: 10.1038/bcj.2016.55] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S J Jacobus
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | | | - M Weiss
- ThedaCare, Appleton, WI, USA
| | - A K Stewart
- Mayo Clinic in Arizona, Scottsdale, AZ, South Africa
| | | | | | - L M Dreosti
- University of Pretoria, Pretoria, South Africa
| | | | - R Fonseca
- Mayo Clinic in Arizona, Scottsdale, AZ, South Africa
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