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Chen Y, Chen Z, Cao J, Lin L, Li J. Severe and continuous immunoparesis during induction or maintenance therapy in nontransplant patients with multiple myeloma is a sign of poor prognosis. Hematology 2024; 29:2329378. [PMID: 38470208 DOI: 10.1080/16078454.2024.2329378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/06/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE Multiple myeloma (MM) varies in clinical behavior, response to treatment and prognosis due to the heterogeneity of the disease. Data on the association between the immunoparesis status during treatment and prognosis in nontransplant MM patients are limited. METHODS In a retrospective analysis of 142 patients with MM, we examined the relationship between immunoparesis status and prognosis during treatment. All patients received novel agent-based therapy and did not undergo autologous stem cell transplantation. One, two, or three uninvolved immunoglobulins (Igs) below the lowest thresholds of normalcy were used to identify immunoparesis. RESULTS Patients with a greater degree of immunoparesis during treatment had shorter progression-free survival (PFS) and overall survival (OS). A total of 46.5% of the patients had severe and continuous immunoparesis (at least two uninvolved Igs suppressed continuously during treatment), representing a worse prognosis than those with complete or partial normalization of Igs during treatment. Among patients who achieved at least complete remission, PFS was poor in patients with severe and continuous immunoparesis. Furthermore, severe and continuous immunoparesis during treatment was a poor prognostic factor for PFS and OS according to multivariate analyses. CONCLUSION The degree of immunoparesis during treatment is a follow-up indicator for survival in nontransplant myeloma patients, and severe and continuous immunoparesis in nontransplant myeloma patients might be a sign of poor prognosis.
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Affiliation(s)
- Ying Chen
- Department of Central Laboratory, The Affiliated People's Hospital of Ningbo University, Ningbo, People's Republic of China
| | - Zhe Chen
- Department of Central Laboratory, The Affiliated People's Hospital of Ningbo University, Ningbo, People's Republic of China
| | - Junjie Cao
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, People's Republic of China
| | - Li Lin
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, People's Republic of China
| | - Jipeng Li
- Department of Central Laboratory, The Affiliated People's Hospital of Ningbo University, Ningbo, People's Republic of China
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2
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Mejia Saldarriaga M, Pan D, Unkenholz C, Mouhieddine TH, Velez-Hernandez JE, Engles K, Fein JA, Monge J, Rosenbaum C, Pearse R, Jayabalan D, Gordillo C, Chan HT, Yamshon S, Thibaud S, Mapara M, Inghirami G, Lentzsch S, Reshef R, Rossi A, Parekh S, Jagannath S, Richard S, Niesvizky R, Bustoros M. Absolute lymphocyte count after BCMA CAR-T therapy is a predictor of response and outcomes in relapsed multiple myeloma. Blood Adv 2024; 8:3859-3869. [PMID: 38776397 DOI: 10.1182/bloodadvances.2023012470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/29/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
ABSTRACT B-cell maturation antigen (BCMA)-targeting chimeric antigen receptor T cells (CAR-Ts) used in multiple myeloma (MM) are rapidly becoming a mainstay in the treatment of relapsed/refractory (R/R) disease, and CAR-T expansion after infusion has been shown to inform depth and duration of response (DoR), but measuring this process remains investigational. This multicenter study describes the kinetics and prognostic impact of absolute lymphocyte count (ALC) in the first 15 days after CAR-T infusion in 156 patients with relapsed MM treated with the BCMA-targeting agents ciltacabtagene autoleucel and idecabtagene vicleucel. Patients with higher maximum ALC (ALCmax) had better depth of response, progression-free survival (PFS), and DoR. Patients with ALCmax >1.0 × 103/μL had a superior PFS (30.5 months vs 6 months; P < .001) compared with those with ≤1.0 × 103/μL, whereas patients with ALCmax ≤0.5 × 103/μL represent a high-risk group with early disease progression and short PFS (hazard ratio, 3.4; 95% confidence interval, 2-5.8; P < .001). In multivariate analysis, ALCmax >1.0 × 103/μL and nonparaskeletal extramedullary disease were the only independent predictors of PFS and DoR after accounting for international staging systemic staging, age, CAR-T product, high-risk cytogenetics, and the number of previous lines. Moreover, our flow cytometry data suggest that ALC is a surrogate for BCMA CAR-T expansion and can be used as an accessible prognostic marker. We report, to our knowledge, for the first time the association of ALC after BCMA CAR-T infusion with clinical outcomes and its utility in predicting response in patients with R/R MM.
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Affiliation(s)
- Mateo Mejia Saldarriaga
- Division of Hematology & Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine, New York, NY
| | - Darren Pan
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Caitlin Unkenholz
- Division of Hematology & Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine, New York, NY
| | - Tarek H Mouhieddine
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juan Esteban Velez-Hernandez
- Division of Hematology & Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine, New York, NY
- Department of Internal Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Katherine Engles
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua A Fein
- Division of Hematology & Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine, New York, NY
| | - Jorge Monge
- Division of Hematology & Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine, New York, NY
| | - Cara Rosenbaum
- Division of Hematology & Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine, New York, NY
| | - Roger Pearse
- Division of Hematology & Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine, New York, NY
| | - David Jayabalan
- Department of Internal Medicine, Universidad de Antioquia, Medellin, Colombia
| | - Christian Gordillo
- Division of Hematology & Oncology, Columbia University Irving Cancer Center, New York, NY
| | - Hei Ton Chan
- Division of Hematology & Oncology, Columbia University Irving Cancer Center, New York, NY
| | - Samuel Yamshon
- Division of Hematology & Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine, New York, NY
| | - Santiago Thibaud
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Markus Mapara
- Division of Hematology & Oncology, Columbia University Irving Cancer Center, New York, NY
| | | | - Suzanne Lentzsch
- Division of Hematology & Oncology, Columbia University Irving Cancer Center, New York, NY
| | - Ran Reshef
- Division of Hematology & Oncology, Columbia University Irving Cancer Center, New York, NY
| | - Adriana Rossi
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samir Parekh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sundar Jagannath
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shambavi Richard
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ruben Niesvizky
- Division of Hematology & Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine, New York, NY
| | - Mark Bustoros
- Division of Hematology & Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine, New York, NY
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3
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Hsu TL, Tsai CK, Liu CY, Yeh CM, Lin FL, Hsiao LT, Liu YC, Chien SH, Wang HY, Ko PS, Lin TA, Chen WC, Chen PM, Liu JH, Gau JP, Liu CJ. Risk factors of early disease progression and decreased survival for multiple myeloma patients after upfront autologous stem cell transplantation. Ann Hematol 2024; 103:2893-2904. [PMID: 38472362 DOI: 10.1007/s00277-024-05641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/19/2024] [Indexed: 03/14/2024]
Abstract
Multiple myeloma (MM) stands as the second most prevalent hematological malignancy, constituting approximately 10% of all hematological malignancies. Current guidelines recommend upfront autologous stem cell transplantation (ASCT) for transplant-eligible MM patients. This study seeks to delineate factors influencing post-ASCT outcomes in MM patients. Our cohort comprised 150 MM patients from Taipei Veterans General Hospital, with progression-free survival (PFS) as the primary endpoint and overall survival (OS) as the secondary endpoint. A Cox proportional hazards model was employed to discern potential predictive factors for survival. ASCT age ≥ 65 (hazard ratio [HR] 1.94, 95% confidence interval [CI] 1.08-3.47) and the presence of extramedullary disease (HR 2.53, 95% CI 1.53-4.19) negatively impacted PFS. Conversely, treatment response ≥ VGPR before ASCT (HR 0.52, 95% CI 0.31-0.87) and total CD34+ cells collected ≥ 4 × 106 cells/kg on the first stem cell harvesting (HR 0.52, 95% CI 0.32-0.87) were positively associated with PFS. For OS, patients with ISS stage III (HR 2.06, 95% CI 1.05-4.04), the presence of extramedullary disease (HR 3.92, 95% CI 2.03-7.58), light chain ratio ≥ 100 before ASCT (HR 7.08, 95% CI 1.45-34.59), post-ASCT cytomegalovirus infection (HR 9.43, 95% CI 3.09-28.84), and a lower conditioning melphalan dose (< 140 mg/m2; HR 2.75, 95% CI 1.23-6.17) experienced shorter OS. In contrast, post-ASCT day + 15 absolute monocyte counts (D15 AMC) > 500/µl (HR 0.36, 95% CI 0.17-0.79) and post-ASCT day + 15 platelet counts (D15 PLT) > 80,000/µl (HR 0.48, 95% CI 0.24-0.94) were correlated with improved OS. Significantly, early PLT and AMC recovery on day + 15 predicting longer OS represents a novel finding not previously reported. Other factors also align with previous studies. Our study provides real-world insights for post-ASCT outcome prediction beyond clinical trials.
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Affiliation(s)
- Te-Lin Hsu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Kuang Tsai
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Yu Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fen-Lan Lin
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yao-Chung Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Hsuan Chien
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Yuan Wang
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Shen Ko
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-An Lin
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Chun Chen
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Min Chen
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jin-Hwang Liu
- Section of Hematology and Oncology, Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
- Institute of Biopharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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4
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Cheng H, Sun Y, Zhang X, Chen Z, Shao L, Liu J, Wang D, Chen Y, Wang X, Chen W, Sang W, Qi K, Li Z, Sun C, Shi M, Qiao J, Wu Q, Zeng L, Zheng J, Xu K, Cao J. Complex association of body mass index and outcomes in patients with relapsed and refractory multiple myeloma treated with CAR-T cell immunotherapy. Cytotherapy 2024; 26:832-841. [PMID: 38625072 DOI: 10.1016/j.jcyt.2024.03.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/07/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND AIMS Chimeric antigen receptor-T (CAR-T) cells have exhibited remarkable efficacy in treating refractory or relapsed multiple myeloma (R/R MM). Although obesity has a favorable value in enhancing the response to immunotherapy, less is known about its predictive value regarding the efficacy and prognosis of CAR-T cell immunotherapy. METHODS We conducted a retrospective study of 111 patients with R/R MM who underwent CAR-T cell treatment. Using the body mass index (BMI) classification, the patients were divided into a normal-weight group (73/111) and an overweight group (38/111). We investigated the effect of BMI on CAR-T cell therapy outcomes in patients with R/R MM. RESULTS The objective remission rates after CAR-T cell infusion were 94.7% and 89.0% in the overweight and normal-weight groups, respectively. The duration of response and overall survival were not significant difference between BMI groups. Compared to normal-weight patients, overweight patients had an improved median progression-free survival. There was no significant difference in cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome between the subgroups. In terms of hematological toxicity, the erythrocyte, hemoglobin, platelet, leukocyte and neutrophil recovery was accelerated in the overweight group. Fewer patients in the overweight group displayed moderate percent CD4 and CD4/CD8 ratios compared to the normal-weight group. Furthermore, the percent CD4 ratios were positively correlated with the levels of cytokines [interleukin-2 (IL-2) (day 14), interferon gamma (IFN-γ) (day 7) and tumor necrosis factor alpha (TNF-α) (days 14 and 21)] after cells infusion. On the other hand, BMI was positively associated with the levels of IFN-γ (day 7) and TNF-α (days 14 and 21) after CAR-T cells infusion. CONCLUSIONS Overall, this study highlights the potential beneficial effect of a higher BMI on CAR-T cell therapy outcomes.
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Affiliation(s)
- Hai Cheng
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yingjun Sun
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xiaoxue Zhang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zihan Chen
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lingyan Shao
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jiaying Liu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Dandan Wang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yegan Chen
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xue Wang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wei Chen
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wei Sang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Kunming Qi
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhenyu Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Cai Sun
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ming Shi
- Cancer Institute, Xuzhou Medical University, Xuzhou, China
| | - Jianlin Qiao
- Jiangsu Bone Marrow Stem Cell Institute, Xuzhou, China
| | - Qingyun Wu
- Jiangsu Bone Marrow Stem Cell Institute, Xuzhou, China
| | - Lingyu Zeng
- Jiangsu Bone Marrow Stem Cell Institute, Xuzhou, China
| | - Junnian Zheng
- Cancer Institute, Xuzhou Medical University, Xuzhou, China
| | - Kailin Xu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
| | - Jiang Cao
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
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5
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Firestone RS, Socci ND, Shekarkhand T, Zhu M, Qin WG, Hultcrantz M, Mailankody S, Tan CR, Korde N, Lesokhin AM, Hassoun H, Shah U, Maclachlan KH, Rajeeve S, Landau HJ, Scordo M, Shah GL, Lahoud OB, Giralt S, Murata K, Usmani SZ, Chung DJ. Antigen escape as a shared mechanism of resistance to BCMA-directed therapies in multiple myeloma. Blood 2024; 144:402-407. [PMID: 38728378 DOI: 10.1182/blood.2023023557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
ABSTRACT B-cell maturation antigen (BCMA)-targeting therapeutics have dramatically improved outcomes in relapsed/refractory multiple myeloma (RRMM). However, whether the mechanisms of resistance between these therapies are shared and how the identification of such mechanisms before therapy initiation could refine clinical decision-making remains undefined. We analyzed outcomes for 72 RRMM patients treated with teclistamab, a CD3 × BCMA bispecific antibody, 42% (30/72) of whom had prior BCMA-directed therapy exposure. Malignant plasma cell BCMA expression was present in all BCMA therapy-naïve patients. Prior therapy-mediated loss of plasma cell BCMA expression before teclistamab treatment, measured by immunohistochemistry, was observed in 3 patients, none of whom responded to teclistamab, and 1 of whom also did not respond to ciltacabtagene autoleucel. Whole exome sequencing of tumor DNA from 1 patient revealed biallelic loss of TNFRSF17 following treatment with belantamab mafodotin. Low-to-undetectable peripheral blood soluble BCMA levels correlated with the absence of BCMA expression by bone marrow plasma cells. Thus, although rare, loss of BCMA expression following TNFRSF17 gene deletions can occur following any BCMA-directed therapy and prevents response to subsequent anti-BCMA-directed treatments, underscoring the importance of verifying the presence of a target antigen.
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Affiliation(s)
- Ross S Firestone
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicholas D Socci
- Department of Engineering and Bioinformatics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tala Shekarkhand
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Menglei Zhu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wei Ge Qin
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carlyn Rose Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Alexander M Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Urvi Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Kylee H Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Sridevi Rajeeve
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heather J Landau
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Scordo
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gunjan L Shah
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oscar B Lahoud
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kazunori Murata
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Saad Z Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J Chung
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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6
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Qiang W, Lu J, Jia Y, Liu J, Liu J, He H, Wang X, Fan X, Jin L, Ruan Q, Zhang Q, Shen L, Weng L, Cao W, Li W, Du J. B-Cell Maturation Antigen/CD19 Dual-Targeting Immunotherapy in Newly Diagnosed Multiple Myeloma. JAMA Oncol 2024:2821602. [PMID: 39052306 DOI: 10.1001/jamaoncol.2024.2172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Importance Patients with high-risk newly diagnosed multiple myeloma (NDMM) often have poor outcomes with standard treatments, necessitating novel effective frontline therapies to enhance clinical outcomes. GC012F, a B-cell maturation antigen/CD19 dual-targeting chimeric antigen receptor (CAR) T-cell therapy, has been developed on the novel FasTCAR platform. Notably, its use as a frontline therapy for patients with high-risk NDMM who are eligible for transplant has not been thoroughly explored. Objective To examine the safety, pharmacokinetics, and patient health and survival outcomes associated with GC012F in individuals with NDMM. Design, Setting, and Participants Patients were enrolled in this single-arm, open-label phase 1 cohort study between June 28, 2021, and June 1, 2023 (the data cutoff date). All patients included in this study were treated at a single center, Shanghai Changzheng Hospital. The patients in the efficacy evaluation were followed up for a minimum period of 3 months. Intervention Patients underwent 2 cycles of induction therapy, followed by GC012F infusion (at 1 × 105 cells/kg, 2 × 105 cells/kg, or 3 × 105 cells/kg). Main Outcomes and Measures The primary goals were to assess the safety, efficacy, and pharmacokinetics of GC012F at various dose levels. Results Of 22 patients receiving GC012F treatment, 6 experienced mild to moderate cytokine release syndrome (grade 1-2) and none experienced neurotoxic effects. Nineteen patients were included in the efficacy evaluation, and all 19 patients showed stringent complete responses and achieved minimal residual disease negativity. The treatment's effectiveness was consistent across different dose levels. GC012F demonstrated a rapid response, with a median time to first stringent complete response of 84 days (range, 26-267 days) and achieving minimal residual disease negativity within 28 days (range, 23-135 days). The CAR T-cell expansion was robust, with a median peak copy number of 60 652 copies/μg genomic DNA (range, 8754-331 159 copies/μg genomic DNA), and the median time to median peak copy number was 10 days (range, 9-14 days). Conclusions and Relevance The findings of this single-arm, open-label phase 1 cohort study suggest that GC012F may be a safe treatment associated with positive health and survival outcomes for patients with high-risk NDMM eligible for transplant. Owing to the small sample size, further studies with larger cohorts and longer follow-up durations are needed.
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Affiliation(s)
- Wanting Qiang
- Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, Shanghai, China
| | - Jing Lu
- Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, Shanghai, China
| | - Yanchun Jia
- Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, Shanghai, China
| | - Jia Liu
- Gracell Biotechnologies Ltd, Shanghai, China
| | - Jin Liu
- Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, Shanghai, China
| | - Haiyan He
- Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, Shanghai, China
| | - Xiaoxiang Wang
- Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, Shanghai, China
| | - Xiaoqiang Fan
- Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, Shanghai, China
| | - Lina Jin
- Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, Shanghai, China
| | - Qianqi Ruan
- Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, Shanghai, China
| | - Qi Zhang
- Gracell Biotechnologies Ltd, Shanghai, China
| | | | - Lihong Weng
- Gracell Biotechnologies Ltd, Shanghai, China
| | - Wei Cao
- Gracell Biotechnologies Ltd, Shanghai, China
| | - Wenling Li
- Gracell Biotechnologies Ltd, Shanghai, China
| | - Juan Du
- Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, Shanghai, China
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7
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Landgren O, Prior TJ, Masterson T, Heuck C, Bueno OF, Dash AB, Einsele H, Goldschmidt H, Knop S, Li C, Mellqvist UH, McFadden I, Oprea C, Ross JA, Talpes M, Hydren JR, Ahlstrom JM, Kazandjian D, Weinhold N, Zhang R, Stetler-Stevenson M, Marti G, Devlin SM. EVIDENCE meta-analysis: evaluating minimal residual disease as an intermediate clinical end point for multiple myeloma. Blood 2024; 144:359-367. [PMID: 38768337 DOI: 10.1182/blood.2024024371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024] Open
Abstract
ABSTRACT Estimating progression-free survival (PFS) and overall survival superiority during clinical trials of multiple myeloma (MM) has become increasingly challenging as novel therapeutics have improved patient outcomes. Thus, it is imperative to identify earlier end point surrogates that are predictive of long-term clinical benefit. Minimal residual disease (MRD)-negativity is a common intermediate end point that has shown prognostic value for clinical benefit in MM. This meta-analysis was based on the US Food and Drug Administration guidance for considerations for a meta-analysis of MRD as a clinical end point and evaluates MRD-negativity as an early end point reasonably likely to predict long-term clinical benefit. Eligible studies were phase 2 or 3 randomized controlled clinical trials measuring MRD-negativity as an end point in patients with MM, with follow-up of ≥6 months following an a priori-defined time point of 12 ± 3 months after randomization. Eight newly diagnosed MM studies evaluating 4907 patients were included. Trial-level associations between MRD-negativity and PFS were R2WLSiv, 0.67 (95% confidence interval [CI], 0.43-0.91) and R2copula 0.84 (0.64 to >0.99) at the 12-month time point. The individual-level association between 12-month MRD-negativity and PFS resulted in a global odds ratio (OR) of 4.02 (95% CI, 2.57-5.46). For relapse/refractory MM, there were 4 studies included, and the individual-level association between 12-month MRD-negativity and PFS resulted in a global OR of 7.67 (4.24-11.10). A clinical trial demonstrating a treatment effect on MRD is reasonably likely to eventually demonstrate a treatment effect on PFS, suggesting that MRD may be an early clinical end point reasonably likely to predict clinical benefit in MM, that may be used to support accelerated approval and thereby, expedite the availability of new drugs to patients with MM.
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Affiliation(s)
- Ola Landgren
- Division of Myeloma, Department of Medicine, Sylvester Myeloma Research Institute, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | | | | | | | | | | | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Knop
- Nuremberg General Hospital and Paracelsus Medical School, Nuremberg, Germany
| | | | | | | | | | | | | | | | | | - Dickran Kazandjian
- Division of Myeloma, Department of Medicine, Sylvester Myeloma Research Institute, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Niels Weinhold
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Gerald Marti
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Sean M Devlin
- Memorial Sloan Kettering Cancer Center, New York, NY
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8
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Costa LJ. MRD accelerating myeloma drug development. Blood 2024; 144:345-347. [PMID: 39052265 DOI: 10.1182/blood.2024025421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
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9
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Mollee P, Reynolds J, Janowski W, Quach H, Campbell P, Gibbs S, Lee S, Lee E, Taylor K, Cochrane T, Wallington-Gates C, Kwok F, Weber N, Kerridge I, Weston H, Ho PJ, Leahy MF, Horvath N, Spencer A. Daratumumab, cyclophosphamide, bortezomib, and dexamethasone for transplant-ineligible myeloma: AMaRC 03-16. Blood Adv 2024; 8:3721-3730. [PMID: 38739707 DOI: 10.1182/bloodadvances.2023012539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/04/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
ABSTRACT In newly diagnosed transplant-ineligible patients with myeloma, daratumumab has improved outcomes when added to the standard-of-care regimens. In a randomized trial, we tested whether similar improvements would be observed when daratumumab was added to the bortezomib, cyclophosphamide, and dexamethasone (VCD) regimen. Transplant-ineligible patients with untreated myeloma were randomized to receive VCD or VCD plus daratumumab (VCDD). A total of 121 patients were randomized: 57 in the VCD arm and 64 in the VCDD arm. Baseline characteristics were balanced between the 2 arms. The median progression-free survival (PFS) was 16.8 months (95% confidence interval [CI], 15.3-21.7) and 25.8 months (95% CI, 19.9-33.5) in the VCD and VCDD arms, respectively (hazard ratio, 0.67; log-rank test P = .066). In a preplanned analysis, it was demonstrated that the daratumumab-containing arm showed a significant improvement in PFS from 18 months onward, based on estimates at fixed time points after randomization. The proportions of patients who were progression-free at the following time points were: 18 months, 48% vs 68% (P = .0002); 24 months, 36% vs 52% (P = .0001); and 30 months, 27% vs 41% (P < .0001) in the VCD and VCDD arms, respectively. The best overall response and very good partial response rate were significantly higher in the daratumumab arm compared with the VCD and VCDD arms, respectively (65% vs 86%, P = .007; and 28% vs 52%, P = .009). Seventy-two percent of the VCDD patients completed the 9 cycles of induction therapy with no grade 3 or 4 peripheral neuropathy adverse events. This study supports VCDD as an option for the initial treatment of transplant-ineligible patients with myeloma. This trial was registered at the Australian New Zealand Clinical Trials Registry (ACTRN12617000202369).
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Affiliation(s)
- Peter Mollee
- Haematology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - John Reynolds
- Haematology Department, Alfred Hospital, Melbourne, VIC, Australia
- Haematology Department, Monash University, Melbourne, VIC, Australia
| | - Wojt Janowski
- Haematology Department, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Hang Quach
- Haematology Department, University of Melbourne and St Vincent's Hospital, Melbourne, VIC, Australia
| | - Philip Campbell
- Haematology Department, University Hospital Geelong - Barwon Health, Geelong, VIC, Australia
| | - Simon Gibbs
- Haematology Department, Eastern Health, Box Hill, VIC, Australia
| | - Sophie Lee
- Haematology Department, Western Health, Melbourne, VIC, Australia
| | - Edwin Lee
- Haematology Department, Canberra Hospital, Canberra, ACT, Australia
| | | | - Tara Cochrane
- Haematology Department, Gold Coast University Hospital and Griffith University, Gold Coast, QLD, Australia
| | - Craig Wallington-Gates
- Haematology Department, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia
| | - Fiona Kwok
- Haematology Department, Westmead Hospital, Sydney, NSW, Australia
| | - Nicholas Weber
- Haematology Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Ian Kerridge
- Haematology Department, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Helen Weston
- Haematology Department, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia
| | - P Joy Ho
- Haematology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Noemi Horvath
- Haematology Department, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Andrew Spencer
- Haematology Department, Alfred Hospital, Melbourne, VIC, Australia
- Haematology Department, Monash University, Melbourne, VIC, Australia
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10
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Yates SJ, Cursio JF, Artz A, Kordas K, Bishop MR, Derman BA, Kosuri S, Riedell PA, Kline J, Jakubowiak A, Mortel M, Johnson S, Nawas MT. Optimization of older adults by a geriatric assessment-guided multidisciplinary clinic before CAR T-cell therapy. Blood Adv 2024; 8:3785-3797. [PMID: 38810262 DOI: 10.1182/bloodadvances.2024012727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024] Open
Abstract
ABSTRACT The optimal means of assessing candidacy of older adults (≥65 years) for chimeric antigen receptor T-cell (CAR-T) therapy are unknown. We explored the role of a geriatric assessment (GA)-guided multidisciplinary clinic (GA-MDC) in selecting and optimizing older adults for CAR-T. Sixty-one patients were evaluated in a GA-MDC (median age, 73 years; range, 58-83). A nonbinding recommendation ("proceed" or "decline") regarding suitability for CAR-T was provided for each patient based on GA results. Fifty-three patients ultimately received CAR-T (proceed, n = 47; decline, n = 6). Among patients who received B-cell maturation antigen (BCMA)-directed (n = 11) and CD19-directed CAR-T (n = 42), the median overall survival (OS) was 14.2 months and 16.6 months, respectively. GA uncovered high rates of geriatric impairment among patients proceeding to CAR-T therapy, with fewer impairments in those recommended "proceed." Patients recommended "proceed" had shorter median length of stay (17 vs 31 days; P = .05) and lower rates of intensive care unit admission (6% vs 50%; P = .01) than those recommended "decline." In patients receiving CD19- and BCMA-directed CAR-T therapy, a "proceed" recommendation was associated with superior OS compared with "decline" (median, 16.6 vs 11.4 months [P = .02]; and median, 16.4 vs 4.2 months [P = .03], respectively). When controlling for Karnofsky performance status, C-reactive protein, and lactate dehydrogenase at time of lymphodepletion, the GA-MDC treatment recommendation remained prognostic for OS (hazard ratio, 3.26; P = .04). Patients optimized via the GA-MDC without serious vulnerabilities achieved promising outcomes, whereas patients with high vulnerability experienced high toxicity and poor outcomes after CAR-T therapy.
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Affiliation(s)
- Samuel J Yates
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - John F Cursio
- Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, IL
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Keriann Kordas
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Michael R Bishop
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
| | - Benjamin A Derman
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Satyajit Kosuri
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Peter A Riedell
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Justin Kline
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Andrzej Jakubowiak
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Mylove Mortel
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Shalitha Johnson
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Mariam T Nawas
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
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11
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Mateos MV, Martínez-López J, Rodriguez Otero P, González-Calle V, Gonzalez MS, Oriol A, Gutiérrez NC, Ríos-Tamayo R, Rosiñol L, Alvarez Rivas MA, Bargay J, Gonzalez-Rodriguez AP, Alegre A, Escalante F, Iñigo Rodríguez MB, De La Rubia J, Teruel AI, de Arriba F, Palomera L, Hernández MT, Lopez Jiménez J, Reinoso-Segura M, García Mateo A, Ocio EM, Paiva B, Puig N, Cedena MT, Bladé J, Lahuerta JJ, San-Miguel JF. Curative Strategy for High-Risk Smoldering Myeloma: Carfilzomib, Lenalidomide, and Dexamethasone (KRd) Followed by Transplant, KRd Consolidation, and Rd Maintenance. J Clin Oncol 2024:JCO2302771. [PMID: 39038268 DOI: 10.1200/jco.23.02771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/29/2024] [Accepted: 04/17/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE Early treatment of high-risk smoldering myeloma has been shown to delay progression to multiple myeloma (MM). We conducted this trial with curative intention using a treatment approach employed for newly diagnosed patients with MM. METHODS Patients with high-risk smoldering myeloma (>50% progression risk at 2 years) and transplant candidates were included and received induction therapy with carfilzomib, lenalidomide, and dexamethasone (KRd), six cycles, followed by high-dose melphalan (200 mg/m2) autologous stem-cell transplantation (HDM-ASCT), two KRd consolidation cycles, and Rd maintenance for 2 years. The primary end point was undetectable measurable residual disease (uMRD) rate by next-generation flow after ASCT. Sustained uMRD 4 years after ASCT was the secondary end point. RESULTS Between June 2015 and June 2017, 90 patients were included, and 31% met at least one SixtyLightchain MRI (SLiM)-hypercalcemia, renal impairment, anemia, bone disease (CRAB) criterion. After a median follow-up of 70.1 months, 3 months after ASCT, in the intention-to-treat population, 56 (62%) of 90 patients had uMRD, and 4 years later, it was sustained in 29 patients (31%). Five patients progressed to MM, and the 70-month progression rate was 94% (95% CI, 84 to 89). The presence of any SLiM CRAB criteria predicted progression to MM (four of the five patients; hazard ratio, 0.12; 95% CI, 0.14 to 1.13; P = .03). Thirty-six patients showed biochemical progression, and failure to achieve uMRD at the end of treatment predicted it. The 70-month overall survival was 92% (95% CI, 82 to 89). Neutropenia and infections were the most frequent adverse events during treatment, resulting in one treatment-related death. Three second primary malignancies have been reported. CONCLUSION Although a longer follow-up is needed, this curative approach is encouraging and more effective than active MM, with 31% of the patients maintaining the uMRD 4 years after HDM-ASCT.
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Affiliation(s)
- María-Victoria Mateos
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC and Centro de Investigación del Cáncer, IBMCC (USAL-CSIC), Salamanca, Spain
| | - Joaquin Martínez-López
- Hematology Department, Hospital 12 de Octubre, Medicine Department, Medicine School of Complutense University, I+12. CNIO, Madrid, Spain
| | - Paula Rodriguez Otero
- Hematology Department, Cancer Center Clinica Universidad de Navarra (CCUN), Cima, CIBERONC, Pamplona, Spain
| | - Verónica González-Calle
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Salamanca, Spain
- Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Marta Sonia Gonzalez
- Hematology Department, Hospital Clinico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Albert Oriol
- Clinical Hematology, Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias I Pujol, Badalona, Spain
| | - Norma C Gutiérrez
- Hematology Department, University Hospital of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Rafael Ríos-Tamayo
- Unidad de Gammapatías Monoclonales, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Laura Rosiñol
- Hematology Department, Hospital Clinic, Barcelona, Spain
| | | | - Joan Bargay
- Hematology Department, Hospital Universitario Son Llatzer, IdISBa (Institut d'Investigació Sanitaria Illes Balears), Palma, Spain
| | | | - Adrián Alegre
- Hematology Department, University Hospital La Princesa & University Hospital QuironSalud, Autonoma-University, Madrid, Spain
| | - Fernando Escalante
- Servicio de Hematología, Unidad i+i, Complejo Asistencial Universitario de León, León, Spain
| | | | - Javier De La Rubia
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Universidad Católica de Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, CIBERONC CB16/12/00284, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Isabel Teruel
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Felipe de Arriba
- Servicio de Hematologia, Hospital Universitario Morales Meseguer, IMIB-Pascual Parrilla, Universidad de Murcia, Murcia, Spain
| | - Luis Palomera
- Hematology Department, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Miguel T Hernández
- Hematology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | - Marta Reinoso-Segura
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | | | - Enrique M Ocio
- Hematology Department, Hospital Universitario Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| | - Bruno Paiva
- Hematology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Noemi Puig
- Hematology Department, Hospital Universitario de Salamanca (HUSAL), IBSAL, IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - M Teresa Cedena
- Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Madrid, Spain
| | - Joan Bladé
- Hematology Department, Hospital Clinic, IDIBARS, Barcelona, Spain
| | - Juan Jose Lahuerta
- Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jesus F San-Miguel
- Cancer Center Clinica Universidad de Navarra (CCUN), CIMA, IDISNA, CIBERONC, Pamplona, Spain
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12
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Drozd-Sokołowska J, Waszczuk-Gajda A, Topczewska M, Maciejewska M, Dutka M, Zaucha JM, Szmigielska-Kapłon A, Nowicki M, Olszewska-Szopa M, Szeremet A, Czyż A, Kozioł M, Hus M, Mańko J, Hus I, Romejko-Jarosińska J, Kopińska A, Helbig G, Mądry K, Boguradzki P, Król M, Snarski E, Hayden PJ, Jamroziak K, Dwilewicz-Trojaczek J, Basak GW. Stem Cell Mobilization Performed with Different Doses of Cytarabine in Plasma Cell Myeloma Patients Relapsing after Previous Autologous Hematopoietic Cell Transplantation-A Multicenter Report by the Polish Myeloma Study Group. Cancers (Basel) 2024; 16:2588. [PMID: 39061226 DOI: 10.3390/cancers16142588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Salvage autologous hematopoietic cell transplantation (auto-HCT) may be used to treat relapse of plasma cell myeloma occurring after previous auto-HCT. When an insufficient number of hematopoietic stem cells have been stored from the initial harvest, remobilization is necessary. Here, we aimed to analyze the efficacy and safety of different doses of cytarabine (total 800 vs. 1600 vs. 2400 mg/m2) for remobilization. Sixty-five patients, 55% male, with a median age at remobilization 63 years, were included. Remobilization was performed with cytarabine_800 in 7, cytarabine_1600 in 36, and cytarabine_2400 in 22 patients. Plerixafor rescue was used in 25% of patients receiving cytarabine_1600 and 27% of those receiving cytarabine_2400. Patients administered cytarabine_800 were not rescued with plerixafor. Remobilization was successful in 80% of patients (57% cytarabine_800; 86% cytarabine_1600; 77% cytarabine_2400; p = 0.199). The yield of collected CD34+ cells did not differ between the different cytarabine doses (p = 0.495). Patients receiving cytarabine_2400 were at the highest risk of developing severe cytopenias, requiring blood product support, or having blood-stream infections. One patient died of septic shock after cytarabine_2400. In summary, remobilization with cytarabine is feasible in most patients. All doses of cytarabine allow for successful remobilization. Cytarabine_2400 is associated with higher toxicity; therefore, lower doses (800 or 1600 mg/m2) seem to be preferable.
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Affiliation(s)
- Joanna Drozd-Sokołowska
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Magdalena Topczewska
- Faculty of Computer Science, Bialystok University of Technology, 15-351 Bialystok, Poland
| | - Martyna Maciejewska
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Magdalena Dutka
- Department of Hematology and Transplantology, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Jan Maciej Zaucha
- Department of Hematology and Transplantology, Medical University of Gdansk, 80-214 Gdansk, Poland
| | | | - Mateusz Nowicki
- Department of Hematology, Medical University of Lodz, 93-513 Lodz, Poland
| | | | - Agnieszka Szeremet
- Department of Hematology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Anna Czyż
- Department of Hematology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Magdalena Kozioł
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
| | - Marek Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
| | - Joanna Mańko
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Iwona Hus
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
- Department of Hematology, National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Joanna Romejko-Jarosińska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Anna Kopińska
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, 40-032 Katowice, Poland
| | - Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, 40-032 Katowice, Poland
| | - Krzysztof Mądry
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Piotr Boguradzki
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Małgorzata Król
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Emilian Snarski
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
- Faculty of Medicine and Health Science, University of Zielona Góra, 65-046 Zielona Góra, Poland
| | - Patrick J Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, D08 NHY1 Dublin, Ireland
| | - Krzysztof Jamroziak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Jadwiga Dwilewicz-Trojaczek
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Grzegorz Władysław Basak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
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13
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Sagar S, Khan D, Sivasankar KV, Kumar R. New PET Tracers for Symptomatic Myeloma. PET Clin 2024:S1556-8598(24)00056-7. [PMID: 39025753 DOI: 10.1016/j.cpet.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Multiple myeloma (MM) is a hematologic malignancy characterized by the clonal proliferation of plasma cells within the bone marrow. Accurate staging and monitoring of disease progression are crucial for effective management. PET imaging has emerged as a powerful tool in the diagnosis and management of MM, with radiotracers like 18F-fluorodeoxyglucose and novel agents playing a pivotal role. This review explores the current state of PET imaging in multiple myeloma, focusing on its role in initial staging, response assessment, and prognosis prediction, with an emphasis on recent advancements.
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Affiliation(s)
- Sambit Sagar
- Diagnostic Nuclear Medicine Division, Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Dikhra Khan
- Diagnostic Nuclear Medicine Division, Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Rakesh Kumar
- Diagnostic Nuclear Medicine Division, Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India.
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14
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Tantawy M, Langaee T, Wang D, Rubinstein SM, Cornell RF, Lenihan D, Fradley MG, Gong Y. Differential Expression of Circulating miRNAs and Carfilzomib-Related Cardiovascular Adverse Events in Patients with Multiple Myeloma. Int J Mol Sci 2024; 25:7795. [PMID: 39063038 DOI: 10.3390/ijms25147795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
This study investigates the association between circulating microRNA (miRNA) expression and cardiovascular adverse events (CVAE) in multiple myeloma (MM) patients treated with a carfilzomib (CFZ)-based regimen. A cohort of 60 MM patients from the Prospective Observation of Cardiac Safety with Proteasome Inhibitor (PROTECT) study was analyzed. Among these, 31 patients (51.6%) developed CVAE post-CFZ treatment. The Taqman OpenArray Human microRNA panels were used for miRNA profiling. We identified 13 differentially expressed miRNAs at baseline, with higher expressions of miR-125a-5p, miR-15a-5p, miR-18a-3p, and miR-152-3p and lower expression of miR-140-3p in patients who later developed CVAE compared to those free of CVAE, adjusting for age, gender, race, and higher B-type natriuretic peptide levels. We also identified three miRNAs, including miR-150-5p, that were differentially expressed in patients with and without CVAE post-treatment. Additionally, five miRNAs responded differently to CFZ treatment in CVAE vs. non-CVAE patients, including significantly elevated post-treatment expression of miR-140-3p and lower expressions of miR-598, miR-152, miR-21, and miR-323a in CVAE patients. Pathway enrichment analysis highlighted the involvement of these miRNAs in cardiovascular diseases and vascular processes. These findings suggest that specific miRNAs could serve as predictive biomarkers for CVAE and provide insights into the underlying mechanisms of CFZ-CVAE. Further investigation is warranted before these findings can be applied in clinical settings.
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Affiliation(s)
- Marwa Tantawy
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Taimour Langaee
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Danxin Wang
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Samuel M Rubinstein
- Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Robert F Cornell
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Daniel Lenihan
- Cape Cardiology Group, Saint Francis Medical Center, Cape Girardeau, MO 63703, USA
| | - Michael G Fradley
- Thalheimer Center for Cardio-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Cardio-Oncology Working Group, UF Health Cancer Center, Gainesville, FL 32610, USA
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15
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Guo YH, Liu AJ, Huang JW, Wang L, Yang MF. Prognostic value of 18F-FDG PET/CT in patients with relapsed multiple myeloma. Ann Hematol 2024:10.1007/s00277-024-05888-5. [PMID: 39012517 DOI: 10.1007/s00277-024-05888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024]
Abstract
This study aimed to assess the prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computer tomography (18F-FDG PET/CT) in patients with relapsed multiple myeloma (MM). Fifty-one consecutive patients with relapsed MM were enrolled in this retrospective study. 18F-FDG parameters based on the Italian Myeloma Criteria for PET Use (IMPeTUs) and clinical data were analyzed for overall survival (OS) and progression-free survival (PFS). The Cox proportional risk model was used for univariate and multivariate analysis, and Kaplan-Meier survival curves were used for survival analysis. The median length of follow-up was 20 months (IQR, 5-29 months), the median PFS for the entire cohort was 8 months (IQR, 3-17 months) and the median OS was 21 months (IQR, 8-49 months). Multivariate survival analysis demonstrated that the Deauville score of BM > 3 [HR 2.900, 95% CI (1.011, 8.319), P = 0.048] and the presence of EMD [HR 3.134, 95% CI (1.245, 7.891), P = 0.015] were independent predictors of poor PFS. The presence of EMD [HR 12.777, 95% CI (1.825, 89.461), P = 0.010] and the reduced platelets count [HR 7.948, 95% CI (1.236, 51.099), P = 0.029] were adversely associated with OS. 18F-FDG PET/CT parameters based on IMPeTUs have prognostic significance in patients with relapsed MM.
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Affiliation(s)
- Yue-Hong Guo
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Road, Chaoyang District, Beijing, 100020, China
| | - Ai-Jun Liu
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Road, Chaoyang District, Beijing, 100020, China
| | - Jing-Wei Huang
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Road, Chaoyang District, Beijing, 100020, China
| | - Li Wang
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Road, Chaoyang District, Beijing, 100020, China
| | - Min-Fu Yang
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Road, Chaoyang District, Beijing, 100020, China.
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16
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Natrajan K, Kaushal M, George B, Kanapuru B, Theoret MR. FDA Approval Summary: Ciltacabtagene Autoleucel for Relapsed or Refractory Multiple Myeloma. Clin Cancer Res 2024; 30:2865-2871. [PMID: 38713595 PMCID: PMC11249607 DOI: 10.1158/1078-0432.ccr-24-0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/20/2024] [Accepted: 05/07/2024] [Indexed: 05/09/2024]
Abstract
In February 2022, the FDA approved ciltacabtagene autoleucel, a chimeric antigen receptor (CAR) T-cell therapy targeting the B-cell maturation antigen, for adult patients with relapsed/refractory multiple myeloma after ≥4 lines of therapy, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody. Approval was based on overall response rate (ORR), complete response (CR) rate, and duration of response (DoR) in 97 adult patients in a single-arm, open-label, multicenter phase 2 trial (CARTITUDE-1 [NCT03548207]). Patients received a single infusion of ciltacabtagene autoleucel, preceded by lymphodepleting chemotherapy. Of the 97 patients evaluable, ORR was 97.9% [95% confidence interval (CI), 92.7-99.7] with a stringent CR rate of 78.4% (95% CI, 68.8-86.1). After median follow-up of 18 months, the median DoR was 21.8 months (95% CI, 21.8-not estimable [NE]) in responders (PR or better) and NE (95% CI, 21.8 months-NE) in patients who achieved stringent CR. Serious adverse reactions occurred in 55% of the 97 patients evaluated for safety. Grade 3 or higher cytokine release syndrome (CRS) and neurologic toxicities occurred in 5% and 11% of the patients, respectively, leading to a Risk Evaluation and Mitigation Strategy. Neurologic toxicities included immune effector cell-associated neurologic syndrome, typically seen with CAR-T products, parkinsonism, peripheral neuropathy, cranial nerve palsies, and Guillain-Barré syndrome. One fatal case of hemophagocytic lymphohistiocytosis/macrophage activation syndrome occurred. Prolonged and recurrent grade 3 or 4 cytopenias occurred; a single patient required hematopoietic stem-cell rescue.
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Affiliation(s)
- Kavita Natrajan
- Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Megha Kaushal
- Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Bindu George
- Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Bindu Kanapuru
- Center for Drug Evaluation and Research, Silver Spring, MD, USA
- Oncology Center of Excellence, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Marc R. Theoret
- Center for Drug Evaluation and Research, Silver Spring, MD, USA
- Oncology Center of Excellence, U.S. Food and Drug Administration, Silver Spring, MD, USA
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17
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Puertas B, Fernández-Sánchez A, Alejo E, Rey-Búa B, Martín-López AA, Pérez-López E, López-Parra M, López-Corral L, Gutiérrez-Gutiérrez NC, García-Sanz R, Puig N, González-Calle V, Mateos MV. A research center's experience of T-cell-redirecting therapies in triple-class refractory multiple myeloma. Blood Adv 2024; 8:3478-3487. [PMID: 38717869 PMCID: PMC11260841 DOI: 10.1182/bloodadvances.2024012773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/18/2024] [Indexed: 06/29/2024] Open
Abstract
ABSTRACT The efficacies of chimeric antigen receptor T cells (CAR-Ts) and bispecific monoclonal antibodies (BiAbs) for triple-class refractory (TCR) myeloma have not previously been compared, and clinical data on how to rescue patients after relapse from these immunotherapies are limited. A retrospective study of 73 TCR patients included in trials was conducted: 36 received CAR-Ts and 37 received BiAbs. CAR-Ts produced a higher overall response rate (ORR) than BiAbs (97.1% vs 56.8%, P = .002). After a median of follow-up of 18.7 months, no significant difference in progression-free survival (PFS) was observed between the CAR-T and BiAbs groups (16.6 vs 10.8 months; P = .090), whereas overall survival (OS) was significantly longer in the CAR-T than in the BiAbs group (49.2 vs 22.6 months; P = .021). BiAbs after CAR-Ts yielded a higher ORR and longer PFS2 than did nonredirecting T-cell therapies after CAR-Ts (ORR: 87.5% vs 50.0%; PFS2: 22.9 vs 12.4 months). By contrast, BiAbs after BiAbs resulted in an ORR of 33% and PFS2 of 8.4 months, which was similar to that produced by the nonredirecting T-cell therapies (ORR: 28.6%; PFS2: 8.1 months). Although this is a pooled analysis of different trials with different products and the patient profile is different for CAR-Ts and BiAbs, both were effective therapies for TCR myeloma. However, in our experience, although the PFS was similar with the 2 approaches, CAR-T therapy resulted in better OS, mainly because of the efficacy of BiAbs as rescue therapy. Our results highlight the importance of treatment sequence in real-word experience.
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Affiliation(s)
- Borja Puertas
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
| | - Adolfo Fernández-Sánchez
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
| | - Elena Alejo
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
| | - Beatriz Rey-Búa
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
| | - Ana A. Martín-López
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
| | - Estefanía Pérez-López
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
| | - Miriam López-Parra
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
| | - Lucía López-Corral
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
| | - Norma C. Gutiérrez-Gutiérrez
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
| | - Ramón García-Sanz
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
| | - Noemi Puig
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
| | - Verónica González-Calle
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
| | - María-Victoria Mateos
- Hematology Department, University Hospital of Salamanca/ Instituto de Investigación Biomédica de Salamanca/Cancer Research Center IBMCC, Centro de Investigación Biomédica en Red del Cáncer, Salamanca, Spain
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18
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Chari A, Kaufman JL, Laubach J, Sborov DW, Reeves B, Rodriguez C, Silbermann R, Costa LJ, Anderson LD, Nathwani N, Shah N, Bumma N, Holstein SA, Costello C, Jakubowiak A, Wildes TM, Orlowski RZ, Shain KH, Cowan AJ, Pei H, Cortoos A, Patel S, Lin TS, Voorhees PM, Usmani SZ, Richardson PG. Daratumumab in transplant-eligible patients with newly diagnosed multiple myeloma: final analysis of clinically relevant subgroups in GRIFFIN. Blood Cancer J 2024; 14:107. [PMID: 38977707 PMCID: PMC11231363 DOI: 10.1038/s41408-024-01088-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024] Open
Abstract
The randomized, phase 2 GRIFFIN study (NCT02874742) evaluated daratumumab plus lenalidomide/bortezomib/dexamethasone (D-RVd) in transplant-eligible newly diagnosed multiple myeloma (NDMM). We present final post hoc analyses (median follow-up, 49.6 months) of clinically relevant subgroups, including patients with high-risk cytogenetic abnormalities (HRCAs) per revised definition (del[17p], t[4;14], t[14;16], t[14;20], and/or gain/amp[1q21]). Patients received 4 induction cycles (D-RVd/RVd), high-dose therapy/transplant, 2 consolidation cycles (D-RVd/RVd), and lenalidomide±daratumumab maintenance (≤ 2 years). Minimal residual disease-negativity (10-5) rates were higher for D-RVd versus RVd in patients ≥ 65 years (67.9% vs 17.9%), with HRCAs (54.8% vs 32.4%), and with gain/amp(1q21) (61.8% vs 28.6%). D-RVd showed a trend toward improved progression-free survival versus RVd (hazard ratio [95% confidence interval]) in patients ≥ 65 years (0.29 [0.06-1.48]), with HRCAs (0.38 [0.14-1.01]), and with gain/amp(1q21) (0.42 [0.14-1.27]). In the functional high-risk subgroup (not MRD negative at the end of consolidation), the hazard ratio was 0.82 (0.35-1.89). Among patients ≥ 65 years, grade 3/4 treatment-emergent adverse event (TEAE) rates were higher for D-RVd versus RVd (88.9% vs 77.8%), as were TEAEs leading to discontinuation of ≥ 1 treatment component (37.0% vs 25.9%). One D-RVd patient died due to an unrelated TEAE. These results support the addition of daratumumab to RVd in transplant-eligible patients with high-risk NDMM. Video Abstract.
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Affiliation(s)
- Ajai Chari
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - Jacob Laubach
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Douglas W Sborov
- Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brandi Reeves
- University of North Carolina-Department of Medicine-Chapel Hill, Chapel Hill, NC, USA
| | | | - Rebecca Silbermann
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Larry D Anderson
- Myeloma, Waldenstrӧm's and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nitya Nathwani
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Nina Shah
- University of California San Francisco, San Francisco, CA, USA
| | - Naresh Bumma
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Sarah A Holstein
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Caitlin Costello
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | | | - Tanya M Wildes
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert Z Orlowski
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kenneth H Shain
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Andrew J Cowan
- Clinical Research Division, Fred Hutch Cancer Center, Seattle, WA, USA
| | - Huiling Pei
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | | | - Thomas S Lin
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Peter M Voorhees
- Levine Cancer Institute, Atrium Health Wake Forest University School of Medicine, Charlotte, NC, USA.
| | - Saad Z Usmani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Paul G Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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19
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Ho PJ, Moore E, Wellard C, Quach H, Blacklock H, Harrrison SJ, MacDonald EJ, McQuilten ZK, Wood EM, Mollee P, Spencer A. The impact of biomarkers of malignancy (IMWG SLiM criteria) in myeloma in a real-world population: Clinical characteristics, therapy and outcomes from the Australian and New Zealand Myeloma and Related Diseases Registry (ANZ MRDR). Br J Haematol 2024. [PMID: 38965706 DOI: 10.1111/bjh.19624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
A decade after International Myeloma Working Group (IMWG) biomarkers (SLiM criteria) were introduced, this real-world study examined their impact on diagnosis, therapy and outcomes in myeloma. Using the ANZ MRDR, 3489 newly diagnosed patients from 2013 to 2023, comprising 3232 diagnosed by CRAB ('CRAB patients', including 1758 who also satisfied ≥1 SLiM criteria) and 257 by SLiM ('SLiM patients') criteria were analysed. CRAB patients had higher R-ISS and lower performance status, with no difference in cytogenetic risk. SLiM patients had improved progression-free survival (PFS, 37.5 vs. 32.2 months, hazard ratio [HR] 1.31 [1.08-1.59], p = 0.003), overall survival (80.9 vs. 73.2 months, HR 1.64 [1.26-2.13], p < 0.001) and PFS2 (54.6 vs. 40.3 months, HR 1.51 [1.22-1.86], p < 0.001) compared with CRAB patients, partially explained by earlier diagnosis, with no differential impact between the plasma cell and light-chain criteria on PFS. However, 34% of CRAB patients did not manifest SLiM characteristics, raising the possibility that SLiM features are associated with different biological behaviours contributing to a better prognosis, for example, improved PFS2 in SLiM patients suggested less disease resistance at first relapse. These data support earlier initiation of therapy by SLiM. The superior survival outcomes of SLiM versus CRAB patients highlight the importance of defining these subgroups when interpreting therapeutic outcomes at induction and first relapse.
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Affiliation(s)
- P Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Elizabeth Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hang Quach
- St. Vincent's Hospital, Melbourne and University of Melbourne, Melbourne, Australia
| | | | - Simon J Harrrison
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | | | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Mollee
- Princess Alexandra Hospital and University of Queensland, Brisbane, Australia
| | - Andrew Spencer
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, Australia
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20
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Rossi A, Cattabriga A, Bezzi D. Symptomatic Myeloma: PET, Whole-Body MR Imaging with Diffusion-Weighted Imaging or Both. PET Clin 2024:S1556-8598(24)00050-6. [PMID: 38969566 DOI: 10.1016/j.cpet.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
According to international guidelines, patients with suspected myeloma should primarily undergo low-dose whole-body computed tomography (CT) for diagnostic purposes. To optimize sensitivity and specificity and enable treatment response assessment, whole-body MR (WB-MR) imaging should include diffusion-weighted imaging with apparent diffusion coefficient maps and T1-weighted Dixon sequences with bone marrow Fat Fraction Quantification. At baseline WB-MR imaging shows greater sensitivity for the detecting focal lesions and diffuse bone marrow infiltration pattern than 18F-fluorodeoxyglucose PET-CT, which is considered of choice for evaluating response to treatment and minimal residual disease and imaging of extramedullary disease.
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Affiliation(s)
- Alice Rossi
- Struttura Complessa Radiologia - Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Via Piero Maroncelli, 40 - 47014 Meldola (FC), Italy
| | - Arrigo Cattabriga
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Dipartimento di Scienze Mediche e Chirurgiche, Via Massarenti 9, 40138 Bologna, Italy
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21
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Bommier C, Maurer MJ, Lambert J. What clinicians should know about surrogate end points in hematologic malignancies. Blood 2024; 144:11-20. [PMID: 38603637 DOI: 10.1182/blood.2023022269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/14/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
ABSTRACT Use of surrogates as primary end points is commonplace in hematology/oncology clinical trials. As opposed to prognostic markers, surrogates are end points that can be measured early and yet can still capture the full effect of treatment, because it would be captured by the true outcome (eg, overall survival). We discuss the level of evidence of the most commonly used end points in hematology and share recommendations on how to apply and evaluate surrogate end points in research and clinical practice. Based on the statistical literature, this clinician-friendly review intends to build a bridge between clinicians and surrogacy specialists.
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Affiliation(s)
- Côme Bommier
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
- Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments Team, INSERM, U1153, Assistance Publique-Hôpitaux de Paris Hôpital St Louis, Université Paris Cité, Paris, France
| | - Matthew John Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Jerome Lambert
- Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments Team, INSERM, U1153, Assistance Publique-Hôpitaux de Paris Hôpital St Louis, Université Paris Cité, Paris, France
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22
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Venner CP, Duggan P, Song K, Reece D, Sharma S, Su J, Jimenez-Zepeda VH, McCurdy A, Louzada M, Mian H, Sebag M, White D, Stakiw J, Kotb R, Aslam M, Reiman A, Gul E, Chu MP, Bergstrom D, LeBlanc R. Tandem Autologous Stem Cell Transplantation Does Not Benefit High-Risk Myeloma Patients in the Maintenance Era: Real-World Results from The Canadian Myeloma Research Group Database. Transplant Cell Ther 2024:S2666-6367(24)00490-1. [PMID: 38971462 DOI: 10.1016/j.jtct.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 07/08/2024]
Abstract
In patients with multiple myeloma (MM), the presence of high-risk cytogenetic abnormalities is associated with worse disease control and survival. Autologous stem cell transplant (ASCT) does benefit these patients. Tandem transplantation has been explored as a means to deepen responses and further improve survival however, its role remains controversial. This is particularly true in the era of novel agent induction and post-transplant maintenance therapy. The aim of this study was to use the Canadian Myeloma Research Group database and examine a large cohort of real-world patients comparing the outcomes of tandem versus single ASCT specifically in high-risk patients receiving novel agent-based induction and post-transplant maintenance. The data for this study was derived retrospectively from a comprehensive national-level database of Canadian patients with MM. High-risk cytogenetics was defined as presence of del17p, t(4;14), or t(14;16). Those receiving allogeneic transplant were excluded. Tandem transplantation was defined as a second ASCT performed consecutively without interim relapse or progression after first ASCT. Those with relapse or progressive disease within 3 months of completing a first transplant were excluded. We compared response depth, progression-free, and overall survival (OS) based on single or tandem transplantation procedures. The impact of covariates of interest was also assessed. A total of 381 patients with high-risk cytogenetics were identified. A total of 242 received single and 139 patients received tandem transplants. All received post-transplant maintenance. The most common induction regimen for these patients was cyclophosphamide, bortezomib, and steroids (CyBorD, 87%). Forty-one patients (10.8%) required reinduction prior to first ASCT. The best overall responses at any time were 98.3% (90.5% ≥ very good partial response [VGPR]) and 98.6% (89.9% ≥ VGPR) in the single and tandem ASCT groups, respectively. Survival outcomes were similar with the median progression-free survival for single or tandem ASCT of 35.2 and 35.3 months (P = .88) and the median OS were 92.6 and 88.9 months, respectively (P = .72). No statistically significant differences were seen based on type of cytogenetic abnormality or type of maintenance. This was confirmed on multivariate analysis. In the real-world setting, tandem ASCT does not improve outcomes for MM patients with high-risk cytogenetics. This may be driven by the use of effective pre- and post-ASCT therapies. The development of more potent induction and consolidation along with current nearly ubiquitous continuous maintenance therapies until disease progression does not support the use of a second high-dose procedure.
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Affiliation(s)
| | - Peter Duggan
- Department of Hematology, Tom Baker Cancer Center, University of Calgary, Calgary, Canada
| | - Kevin Song
- BC Cancer Agency, University of British Columbia, Vancouver, Canada
| | - Donna Reece
- Princess Margaret Cancer Centre, Toronto, Canada; Canadian Myeloma Research Group, Vaughan, Ontario, Canada
| | - Smriti Sharma
- Canadian Myeloma Research Group, Vaughan, Ontario, Canada
| | - Jiandong Su
- Canadian Myeloma Research Group, Vaughan, Ontario, Canada
| | | | | | | | - Hira Mian
- Juravinski Cancer Center, Hamilton, Ontario, Canada
| | | | - Darrell White
- Queen Elizabeth II Health Sciences Centre. Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julie Stakiw
- Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rami Kotb
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | | | - Anthony Reiman
- Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Engin Gul
- Canadian Myeloma Research Group, Vaughan, Ontario, Canada
| | - Michael P Chu
- Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Debra Bergstrom
- Division of Hematology, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, St John's, Newfoundland, Canada
| | - Richard LeBlanc
- Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
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23
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Jia Z, Xia J, Lu Q. Urine immunofixation electrophoresis and serum free light chain analyses benefit diagnosis of multiple myeloma in orthopedic patients with normal serum total proteins, creatinine, calcium, and hemoglobin. Lab Med 2024; 55:454-459. [PMID: 38141202 DOI: 10.1093/labmed/lmad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND A substantial number of patients with multiple myeloma (MM) who have bone destruction are initially admitted into the orthopedic service at the hospital. However, routine laboratory testing usually fails to identify these patients, thus delaying optimal therapy. Therefore, there is a clear medical need for early diagnosis of MM in these patients. METHODS Between 2019 and 2021, 42 patients receiving treatment for orthopedic conditions had normal hemoglobin (Hb), total protein (TP), albumin (ALB), creatinine (CREA), and blood calcium (Ca) levels before their surgical procedure(s) but were subsequently pathologically confirmed to have MM, based on their presenting orthopedic symptoms. During the same period, 52 patients with orthopedic conditions were pathologically excluded from the diagnosis of MM and were recruited into our control group. Serum free light chain (sFLC) testing was performed in 94 consecutive patients in the orthopedic service using Siemens N Latex FLC kits. The levels of Hb, TP, ALB, CREA, and Ca were also measured. All 42 patients with MM were divided into group A (n = 25: κ proliferation) and group B (n = 17: λ proliferation) by the pathology department. RESULTS There were no significant differences in levels of Hb, TP, ALB, CREA, and Ca between group A and group B and the control group. However, the sFLC κ/λ ratio of group A and B was also significantly different from that of the control group (P < .001). The results of serum immunofixation electrophoresis (IFE) testing demonstrated negative results in 14 cases (58.3%) in group A and 4 cases (25.0%) in group B. CONCLUSIONS Some patients with orthopedic conditions who do not have typical MM laboratory results, such as those with abnormal Hb, TP, ALB, CREA, and Ca levels before their operation(s), actually have MM. MM should be highly suspected in patients with unexplained bone lesions and with an abnormal sFLC κ/λ ratio. Further tissue or bone marrow biopsy is needed in these patients even if serum and urine IFE results are negative and light chain ratio is normal.
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Affiliation(s)
- Zhongwei Jia
- Clinical Laboratory Department, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jinxing Xia
- Clinical Laboratory Department, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qiong Lu
- Clinical Laboratory Department, First Affiliated Hospital of Anhui Medical University, Hefei, China
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24
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Chu B, Wang YT, Gao S, Shi L, Lu MQ, Fang LJ, Xiang QQ, Chen Y, Wang MZ, Wang LF, Sun K, Yang J, Duan F, Bao L. R2-ISS staging combined with circulating plasma cells improves risk stratification for newly diagnosed multiple myeloma: a single-center real-world study. Ann Hematol 2024:10.1007/s00277-024-05806-9. [PMID: 38955826 DOI: 10.1007/s00277-024-05806-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/14/2024] [Indexed: 07/04/2024]
Abstract
We aimed to evaluate if circulating plasma cells (CPC) detected by flow cytometry could add prognostic value of R2-ISS staging. We collected the electronic medical records of 336 newly diagnosed MM patients (NDMM) in our hospital from January 2017 to June 2023. The median overall survival (OS) for patients and R2-ISS stage I-IV were not reached (NR), NR, 58 months and 53 months, respectively. There was no significant difference in OS between patients with stage I and patients with stage II (P = 0.309) or between patients with stage III and patients with stage IV (P = 0.391). All the cases were re-classified according to R2-ISS stage and CPC numbers ≥ 0.05% (CPC high) or<0.05% (CPC low) into four new risk groups: Group 1: R2-ISS stage I + R2-ISS stage II and CPC low, Group 2: R2-ISS stage II and CPC high + R2-ISS stage III and CPC low, Group 3: R2-ISS stage III and CPC high + R2-ISS stage IV and CPC low, Group 4: R2-ISS stage IV and CPC high. The median OS were NR, NR, 57 months and 32 months. OS of Group 1 was significantly longer than that of Group 2 (P = 0.033). OS in Group 2 was significantly longer than that of Group 3 (P = 0.007). OS in Group 3 was significantly longer than that of Group 4 (P = 0.041). R2-ISS staging combined with CPC can improve risk stratification for NDMM patients.
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Affiliation(s)
- Bin Chu
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, No. 31 East Xinjiekou Street, Xicheng District, Beijing, 100035, China
| | - Yu-Tong Wang
- Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Shan Gao
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, No. 31 East Xinjiekou Street, Xicheng District, Beijing, 100035, China
| | - Lei Shi
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, No. 31 East Xinjiekou Street, Xicheng District, Beijing, 100035, China
| | - Min-Qiu Lu
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, No. 31 East Xinjiekou Street, Xicheng District, Beijing, 100035, China
| | - Li-Juan Fang
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, No. 31 East Xinjiekou Street, Xicheng District, Beijing, 100035, China
| | - Qiu-Qing Xiang
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, No. 31 East Xinjiekou Street, Xicheng District, Beijing, 100035, China
| | - Yuan Chen
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, No. 31 East Xinjiekou Street, Xicheng District, Beijing, 100035, China
| | - Meng-Zhen Wang
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, No. 31 East Xinjiekou Street, Xicheng District, Beijing, 100035, China
| | - Li-Fang Wang
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Kai Sun
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, No. 31 East Xinjiekou Street, Xicheng District, Beijing, 100035, China
| | - Jing Yang
- Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Fangfang Duan
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Li Bao
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, No. 31 East Xinjiekou Street, Xicheng District, Beijing, 100035, China.
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25
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Khan MK, Nasti TH, Qian JY, Kleber TJ, Switchenko JM, Kaufman JL, Nooka AJ, Dhodapkar MV, Buchwald ZS, Obiekwe D, Lonial S, Ahmed R. Pembrolizumab and low-dose, single-fraction radiotherapy for patients with relapsed or refractory multiple myeloma: a prospective, single-centre, single-group, open-label, phase 2 pilot trial in the USA. Lancet Haematol 2024; 11:e510-e520. [PMID: 38797190 DOI: 10.1016/s2352-3026(24)00105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Currently, the use of radiotherapy alone for people with multiple myeloma is limited to palliation of pain, pending fracture, and control of spinal-cord compression. Single immune-checkpoint inhibitors, such as anti-programmed death-1 (anti-PD1), have not been successful. We aimed to evaluate the activity and safety of the combination of pembrolizumab and low-dose, single-fraction, hypofractionated radiotherapy to treat patients with relapsed or refractory multiple myeloma. METHODS For this prospective, single-centre, single-group, open-label, phase 2 trial, we recruited patients with relapsed or refractory multiple myeloma from the Winship Cancer Institute (Emory University, Atlanta, GA, USA). Key inclusion criteria were aged 18 years or older, Eastern Cooperative Oncology Group (ECOG) performance score of 0 or 1, relapsed or refractory multiple myeloma as indicated by progression under International Myeloma Working Group (IMWG) criteria, and adequate candidacy for both pembrolizumab and radiotherapy. Baseline and post-treatment assessments were serial bone-marrow biopsy, peripheral blood collections, staging, serial serum and urine paraprotein analysis, serial PET-CT imaging, and a physical examination. On day 1, patients received hypofractionated 8 gray in 1 fraction (8 Gy/1 fx) radiotherapy to either symptomatic or progressing extra-osseous or osseous myeloma sites. Patients also received pembrolizumab (200 mg/kg intravenously) on day 2 or 3, then once every 3 weeks (±7 days) for 2 years or until progressive disease, unacceptable toxicity, withdrawal of consent, loss to follow-up, or death. Dose reduction and interruptions were not allowed. The primary outcome was acute toxicity defined as grade 3 or worse toxicity at 3 months within the radiated site when used in combination with pembrolizumab. All patients were analysed per protocol and included in safety analyses. This trial is registered on ClinicalTrials.gov (NCT03267888); it is completed and closed to accrual. FINDINGS 32 patients were screened between June 1, 2018, and Sept 2, 2022, and 25 were enrolled in the trial and treated on protocol. Of the 25 treated patients, 11 (44%) were female and 14 (56%) were male. 19 (76%) patients were White and six (24%) were Black or African American. Toxicity, as the primary outcome, was deemed to be acceptable as no grade 4 or 5 adverse events were observed. At 3-month follow-up, eight (32%) of 25 patients had treatment benefit (one had stable disease, three had partial response, two had very good partial response, and two had complete response). There was no grade 3 or worse radiation-related toxicity within irradiated volumes. One (4%) patient of the 25 who received combination treatment had a grade 3 pembrolizumab-related adverse event. There were no treatment-related deaths. INTERPRETATION Combination treatment of low-dose, single-fraction radiotherapy with pembrolizumab was safe, with early promise of response activity. Our approach could be an option for patients with relapsed or refractory multiple myeloma who have not responded to previous treatment. Larger trials to substantiate our findings are needed. FUNDING Merck Sharp & Dohme.
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Affiliation(s)
- Mohammad K Khan
- Winship Cancer Institute and Department of Radiation Oncology, Emory University, Atlanta, GA, USA.
| | - Tahseen H Nasti
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, USA
| | - Joshua Y Qian
- School of Medicine, Emory University, Atlanta, GA, USA
| | - Troy J Kleber
- School of Medicine, Emory University, Atlanta, GA, USA; MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Jonathan L Kaufman
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Ajay J Nooka
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Madhav V Dhodapkar
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Zachary S Buchwald
- Winship Cancer Institute and Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Daby Obiekwe
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Rafi Ahmed
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, USA; Vaccine Center, Emory University, Atlanta, GA, USA
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26
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Tang W, Li Y, Zhang L, Zhong X, Liang Q, Zheng Y, Liu Y, Wang Y, Wang X, Zeng Y, Fang B, Zheng L, Niu T. Phase I study of TQB3602, an oral proteasome inhibitor, in relapsed and refractory multiple myeloma. Cancer Med 2024; 13:e7435. [PMID: 39031941 PMCID: PMC11259557 DOI: 10.1002/cam4.7435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/26/2024] [Accepted: 06/16/2024] [Indexed: 07/22/2024] Open
Abstract
OBJECTIVE TQB3602 is a novel orally bioavailable proteasome inhibitor. This study is the first-in-human phase I clinical trial to evaluate the safety, tolerability, pharmacokinetics, and preliminary efficacy of TQB3602 in relapsed/refractory multiple myeloma (RRMM). METHODS This is a multicenter phase I clinical trial consisting of the 3+3 dose-escalation phase and dose expansion phase. Patients with MM who have received ≥2 prior antimyeloma therapies were enrolled. TQB3602 is administered at a dose of 0.5~7mg on days 1, 8, 15 in 28-day cycle. RESULTS Twenty-five RRMM patients who relapsed or failed ≥2 lines of therapies were enrolled in the dose escalation phase. Two patients in the 7.0 mg dose group developed dose-limiting toxicity events (one with grade 2 peripheral neuropathy [PN] complicated by pain and one with diarrhea and abdominal pain), leading to a maximum tolerated dose of 6.0 mg. Any-grade adverse events (AEs) occurred in 24 (96.0%) patients, while grade ≥3 AEs occurred in 13 (52.0%). The most common grade ≥3 AEs was anemia (6, 24.0%). The incidence rate of PN was 16% with no grade ≥3 PN occurred. TQB3602 was rapidly absorbed, resulting in a time-to-plasma peak concentration of 0.8-1.5 h. The mean half-life was approximately 82 h. The AUClast and Cmax were approximately 1.9 times higher on day 15 than on day 1. Among 22 response-evaluable patients, 63.7% achieved stable disease or better. CONCLUSIONS TQB3602 is well tolerated, with a favorable neurotoxicity profile, and has shown preliminary efficacy in patients with RRMM. The anticipated therapeutic dose was 6 mg and was adopted for an ongoing dose-expansion phase.
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Affiliation(s)
- Wenjiao Tang
- Department of Hematology, West China HospitalSichuan UniversityChengduChina
| | - Yan Li
- Department of Hematology, West China HospitalSichuan UniversityChengduChina
| | - Li Zhang
- Department of Hematology, West China HospitalSichuan UniversityChengduChina
| | - Xushu Zhong
- Department of Hematology, West China HospitalSichuan UniversityChengduChina
| | - Qiushi Liang
- Department of Hematology, West China HospitalSichuan UniversityChengduChina
| | - Yuhuan Zheng
- Department of Hematology, West China HospitalSichuan UniversityChengduChina
| | - Yuzhang Liu
- Department of HematologyHenan Cancer HospitalZhengzhouChina
| | - Yafei Wang
- Chia Tai Tianqing Pharmaceutical Group Co., LTD.NanjingJiangsuChina
| | - Xunqiang Wang
- Chia Tai Tianqing Pharmaceutical Group Co., LTD.NanjingJiangsuChina
| | - Yun Zeng
- Department of HematologyThe First Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Baijun Fang
- Department of HematologyHenan Cancer HospitalZhengzhouChina
| | - Li Zheng
- Department of CTC Laboratory, West China HospitalSichuan UniversityChengduChina
| | - Ting Niu
- Department of Hematology, West China HospitalSichuan UniversityChengduChina
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27
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Tagliari de Oliveira S, Binato R, Ellen Broto G, Tomie Takakura E, Navarro Gordan Ferreira Martins L, Abdelhay E, Panis C. Transcriptome of bone marrow-Derived stem cells reveals new inflammatory mediators related to increased survival in patients with multiple myeloma. Cytokine 2024; 179:156613. [PMID: 38643632 DOI: 10.1016/j.cyto.2024.156613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/28/2024] [Accepted: 04/09/2024] [Indexed: 04/23/2024]
Abstract
Although multiple myeloma (MM) is a neoplasm that leads affected individuals to death, little is known about why some patients survive much longer than others. In this context, we investigated the transcriptomic profile of bone marrow hematopoietic stem cells obtained from MM patients and compared the clinical outcomes of death and survival six months after bone marrow transplantation. The leukapheresis products of 39 patients with MM eligible for autologous transplantation were collected and analyzed. After extraction, the RNA was analyzed using the GeneChip Human Exon 1.0 Array method. The transcriptome profile was analyzed in silico, and the differentially expressed signaling pathways of interest were validated. The results showed a difference in the expression of inflammation-related genes, immune response processes, and the oxidative stress pathway. The in silico study also pointed out the involvement of the NFκB transcription factor in the possible modulation of these genes. We chose to validate molecules participating in these processes, including the cytokines TNF-α, IFN-γ, and TGF-β1; in addition, we measured the levels of oxidative stress mediators (pro-oxidant profile and the total antioxidant capacity). TNF-α levels were significantly reduced in patients who died and were over 50 years old at diagnosis, as well as in patients with plasmacytoma. Increased TNF-α was detected in patients with very high levels of β2-microglobulin. IFN-γ reduction was observed in patients with a complete response to treatment compared to those with a very good response. Patients with plasmacytoma who died also had an increased pro-oxidant profile. These data show the profile of inflammatory response markers that are altered in patients with MM who die quickly and serve as a basis for the development of future studies of markers to predict better survival in this disease.
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Affiliation(s)
- Stefania Tagliari de Oliveira
- Laboratório de Biologia de Tumores, Universidade Estadual do Oeste do Paraná, Unioeste - Francisco Beltrão - Paraná, Brazil; Rede de Assistência a Saúde Metropolitana de Sarandi - Programa de Residência Médica em Clínica Médica - Sarandi - Paraná, Brazil
| | - Renata Binato
- Instituto Nacional de Câncer, Centro de Transplante de Medula Óssea, Rio de Janeiro, Brazil
| | - Geise Ellen Broto
- Laboratório de Biologia de Tumores, Universidade Estadual do Oeste do Paraná, Unioeste - Francisco Beltrão - Paraná, Brazil
| | - Erika Tomie Takakura
- Laboratório de Biologia de Tumores, Universidade Estadual do Oeste do Paraná, Unioeste - Francisco Beltrão - Paraná, Brazil
| | | | - Eliana Abdelhay
- Instituto Nacional de Câncer, Centro de Transplante de Medula Óssea, Rio de Janeiro, Brazil
| | - Carolina Panis
- Laboratório de Biologia de Tumores, Universidade Estadual do Oeste do Paraná, Unioeste - Francisco Beltrão - Paraná, Brazil.
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28
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Thoren K, Menad S, Nouadje G, Macé S. Isatuximab-Specific Immunofixation Electrophoresis Assay to Remove Interference in Serum M-Protein Measurement in Patients with Multiple Myeloma. J Appl Lab Med 2024; 9:661-671. [PMID: 38573925 DOI: 10.1093/jalm/jfae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/26/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Isatuximab, an IgG-kappa (IgGκ) anti-cluster of differentiation 38 (CD38) monoclonal antibody approved for use in patients with relapsed or refractory multiple myeloma (MM), can potentially interfere with the visualization of endogenous monoclonal protein (M-protein) on standard immunofixation electrophoresis (IFE) and lead to inaccurate classification of a patient's response to therapy. The Hydrashift 2/4 isatuximab IFE assay (Hydrashift isatuximab assay) removes isatuximab interference from IFE. Using samples from patients enrolled in clinical trials of isatuximab-based therapy for MM, we demonstrate how the Hydrashift isatuximab assay improves the ability to detect residual M-protein and offer recommendations for when the assay is most useful. METHODS Samples from 141 patients with a variety of known M-protein isotypes were selected and analyzed by standard IFE and the Hydrashift isatuximab assay. A positive control containing isatuximab was run on every standard IFE and Hydrashift gel. RESULTS The Hydrashift isatuximab assay reliably shifted the migration of isatuximab in patient samples. Standard IFE was adequate for determining 104 patients' M-protein status, and the Hydrashift isatuximab assay confirmed these results. In samples from 37 patients with a history of IgGκ MM and a single IgGκ band visible on standard IFE near the isatuximab migration site, the Hydrashift isatuximab assay was able to separate isatuximab from endogenous M-protein, identifying residual M-protein in 17 samples and preventing false-positive interpretations of standard IFE in 20 samples. CONCLUSIONS The Hydrashift isatuximab assay is most useful in patients with known IgGκ MM when a single IgGκ band appears near the isatuximab migration site on standard IFE during isatuximab-based therapy. CLINICALTRIALS.GOV REGISTRATION NUMBERS NCT03275285 and NCT03319667.
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Affiliation(s)
- Katie Thoren
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
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29
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An G, Ge Z, Jing H, Liu J, Yang G, Feng R, Xu Z, Qi M, Wang J, Song J, Zhou W, Sun B, Zhu D, Chen X, Cui C, Qiu L. Subcutaneous daratumumab in Chinese patients with relapsed or refractory multiple myeloma: an open-label, multicenter, phase 1 study (MMY1010). BLOOD SCIENCE 2024; 6:e00193. [PMID: 38832105 PMCID: PMC11146469 DOI: 10.1097/bs9.0000000000000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/26/2024] [Indexed: 06/05/2024] Open
Abstract
Despite recent progress in multiple myeloma (MM) treatments, most patients will relapse and require additional treatment. Intravenous daratumumab, a human IgGκ monoclonal antibody targeting CD38, has shown good efficacy in the treatment of MM. A subcutaneous version of daratumumab was formulated to reduce the burden of intravenous infusions. We aimed to investigate the efficacy and safety of subcutaneous daratumumab in Chinese patients with relapsed/refractory MM based on the demonstrated noninferiority of subcutaneous daratumumab to intravenous daratumumab, with a shorter administration time and reduced infusion-related reaction rate in global studies. This phase 1, multicenter study (MMY1010; ClinicalTrials.gov Identifier: NCT04121260) evaluated subcutaneous daratumumab in Chinese patients with relapsed/refractory MM after 1 prior line (n = 1) or ≥2 prior lines (n = 20) of therapy, including a proteasome inhibitor and an immunomodulatory drug. Primary endpoints were pharmacokinetics and safety. Mean (standard deviation) maximum trough concentration of daratumumab was 826 (335) μg/mL, which was consistent with prior studies of subcutaneous daratumumab and intravenous daratumumab. Safety was consistent with safety profiles observed in other daratumumab studies, with no new safety concerns identified. Incidences of infusion-related reactions and injection-site reactions were low and consistent with other subcutaneous daratumumab studies. At a median follow-up of 7.5 months, the overall response rate was 57.1%, with a very good partial response or better rate of 38.1% and complete response or better rate of 19.0%. Our results demonstrate a favorable benefit/risk profile of subcutaneous daratumumab in Chinese patients with relapsed/refractory MM, potentially impacting clinical administration of daratumumab in this population.
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Affiliation(s)
- Gang An
- National Clinical Research Center for Hematological Disorders, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China
| | - Zheng Ge
- Department of Hematology, Zhongda Hospital Southeast University, Nanjing 210009, China
| | - Hongmei Jing
- Peking University Third Hospital, Beijing 100191, China
| | - Jing Liu
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Guoping Yang
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Ru Feng
- Department of Hematology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China
| | - Zhongyuan Xu
- Phase 1 Clinical Trial Department, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China
| | - Ming Qi
- Janssen Research & Development, LLC, Spring House, PA 19477, USA
| | - Jianping Wang
- Janssen Research & Development, LLC, Spring House, PA 19477, USA
| | - Juanjuan Song
- Janssen Research & Development, LLC, Beijing 100025, China
| | - Wei Zhou
- Janssen Research & Development, LLC, Beijing 100025, China
| | - Binbin Sun
- Janssen Research & Development, LLC, Shanghai 200231, China
| | - Dian Zhu
- Janssen Research & Development, LLC, Shanghai 200231, China
| | - Xi Chen
- Janssen Research & Development, LLC, Shanghai 200231, China
| | - Canchan Cui
- Janssen Research & Development, LLC, Beijing 100025, China
| | - Lugui Qiu
- National Clinical Research Center for Hematological Disorders, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China
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30
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Ladbury C, Sanchez J, Chowdhury A, Palmer J, Liu A, Stein A, Htut M, Farol L, Cai JL, Somlo G, Rosenzweig M, Wong JC, Sahebi F. Phase 1 Study of Bortezomib, Fludarabine, and Melphalan, With or Without Total Marrow Irradiation, as Allogeneic Hematopoietic Stem Cell Transplant Conditioning for High-risk or Relapsed/Refractory Multiple Myeloma. Am J Clin Oncol 2024; 47:325-332. [PMID: 38483213 DOI: 10.1097/coc.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
OBJECTIVE We conducted a phase 1 study of a conditioning regimen with or without total marrow irradiation (TMI) before allogeneic hematopoietic stem cell transplantation for patients with high-risk or refractory multiple myeloma. METHODS Eighteen patients were enrolled on one of 2 strata. Patients with no prior radiation received TMI (900 cGy), fludarabine (FLU), and melphalan (MEL) conditioning, with bortezomib added in the second cohort (stratum I). Patients with prior radiation received FLU, MEL, and bortezomib, without TMI (stratum II). RESULTS Eight patients were enrolled in the TMI arm (stratum I). One of 3 patients in cohort 1 experienced dose-limiting toxicity (DLT), which led to the expansion to 3 more patients with no DLT. Cohort 2 enrolled only 2 patients due to low accrual, with bortezomib, added at 0.5 mg/m 2 ; neither experienced DLT. Nine patients were enrolled in the non-TMI arm (stratum II). Three patients were enrolled in cohort 1 (bortezomib 0.5 mg/m 2 ) and none experienced DLT. Three were enrolled in cohort 2 (bortezomib 0.7 mg/m 2 ), and 1 experienced DLT; therefore, the cohort expanded to 3 more patients. One more patient experienced DLT. Median overall survival on strata I and II was 44.5 months (95% CI: 1.73-not reached) and 21.6 months (95% CI: 4.1-72.7), respectively. Median progression-free survival on strata I and II was 18.1 months (95% CI: 1.73-not reached) and 8.9 months (95% CI: 2.7-24.4), respectively. CONCLUSION TMI 900 cGy, FLU, and MEL are considered feasible as conditioning for allogeneic stem cell transplantation and may warrant further investigation due to favorable response rates and survival.
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Affiliation(s)
- Colton Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte
| | - James Sanchez
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte
| | - Arnab Chowdhury
- Division of Biostatistics, Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte
| | - Joycelynne Palmer
- Division of Biostatistics, Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte
| | - An Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte
| | - Anthony Stein
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte
| | - Myo Htut
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte
| | - Leonardo Farol
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte
- Department of Hematology and Hematopoietic Cell Transplantation, Southern California Kaiser Permanente Medical Group, Los Angeles, CA
| | - Ji-Lian Cai
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte
- Department of Hematology and Hematopoietic Cell Transplantation, Southern California Kaiser Permanente Medical Group, Los Angeles, CA
| | - George Somlo
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte
| | - Michael Rosenzweig
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte
| | - Jeffrey C Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte
| | - Firoozeh Sahebi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte
- Department of Hematology and Hematopoietic Cell Transplantation, Southern California Kaiser Permanente Medical Group, Los Angeles, CA
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Yi JH, Park SS, Min CK, Eom HS, Byun JM, Koh Y, Yoon SS, Lee JH, Jung SH, Lee JJ, Yoon SE, Woo SY, Kim K. Real-world outcome of patients with extensively pretreated multiple myeloma who were treated with selinexor and dexamethasone: a Korean multicenter retrospective analysis. Ann Hematol 2024; 103:2365-2372. [PMID: 38267559 DOI: 10.1007/s00277-024-05615-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/02/2024] [Indexed: 01/26/2024]
Abstract
The outcomes of patients with myeloma after exposed to penta-classes are extremely poor. Selinexor is the first approved exportin inhibitor for those patients, but intractable toxicities may limit its use. This retrospective study evaluated the real-world efficacy and safety of selinexor plus dexamethasone (XD) and involved 48 patients with multiple myeloma, who were treated from November 2020 to October 2022. Their median age was 64 years, and the median number of prior lines of therapy was 6. The overall response rate was 25%, and the median progression-free survival (PFS) was 2.1 months (95% confidence interval (CI), 1.7-2.5). Patients on a reduced initial dose, delayed treatment, and dose reduction had better PFS. After XD treatment failure, 17 patients received subsequent therapy and had a median PFS of 2.4 months. The median overall survival was 4.6 months (95% CI, 2.3-6.9). Among the patients, 12 (25%) and 17 (35%) experienced dose reduction and delayed treatment, respectively. Our data show that the real-world efficacy of XD treatment in heavily pretreated patients was modest and that improving treatment adherence through reducing initial doses or delaying treatments may improve patient outcomes.
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Affiliation(s)
- Jun Ho Yi
- Division of Hematology-Oncology, Department of Medicine, Chung-Ang University, Seoul, Korea
| | - Sung-Soo Park
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, Catholic University, Seoul, Korea
| | - Chang-Ki Min
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, Catholic University, Seoul, Korea
| | - Hyeon-Seok Eom
- Department of Internal Medicine, National Cancer Center, Goyang, Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Hoon Lee
- Department of Hematology, Gachon University College of Medicine, Incheon, Korea
| | - Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, Korea
| | - Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Sook-Young Woo
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea.
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Kiesel B, Osawa M, Masilamani M, Bar M, Hsu K, Godwin C, Burgess M, Lamba M, Gaudy A. Informing the Recommended Phase III Dose of Alnuctamab, a CD3 × BCMA T-Cell Engager, Using Population Pharmacokinetics and Exposure-Response Analysis. Clin Pharmacol Ther 2024. [PMID: 38938115 DOI: 10.1002/cpt.3353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024]
Abstract
Alnuctamab, a B-cell maturation antigen (BCMA)-targeting T-cell engager, has demonstrated encouraging antitumor activity in the phase I study CC-93269-MM-001 treating patients with relapsed or refractory multiple myeloma. Identification of a recommended Phase III dose (RP3D) was a key objective, as such population pharmacokinetic (PopPK) and exposure-response analysis was critical. Intravenous (IV) alnuctamab was administered in fixed doses (0.15-10 mg) or in step-up doses to a maximum 10-mg target dose. Subcutaneous (SC) step-up doses of 3 and 6 mg were followed by a target dose range of 10-60 mg. Concentration data from IV and SC alnuctamab administration was pooled and was well described by a two-compartment PopPK model with first-order absorption and elimination. Covariate analysis determined that the inclusion of baseline soluble BCMA (sBCMA) on clearance significantly improved model fitting. Individual exposure parameters were estimated from the final model to characterize exposure-response relationships. Switching from IV to SC administration improved the safety profile of alnuctamab by limiting the frequency of grade ≥2 CRS events. A significant exposure-CRS relationship was observed after the first SC dose, but not subsequent dose administrations. Exposure-safety analysis did not find a statistically significant relationship between increasing exposure and the probability of key safety events of interest. Logistic regression analysis for patients administered SC alnuctamab identified that increased exposure significantly increased the probability of response, although the additional benefit was minimal at exposures above 30 mg target dose. Considering the totality of exposure-response data, the clinical pharmacology assessment supported a SC RP3D of 3/6/30 mg.
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Affiliation(s)
- Brian Kiesel
- Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Mayu Osawa
- Bristol-Myers Squibb, Princeton, New Jersey, USA
| | | | - Merav Bar
- Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Kevin Hsu
- Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Colin Godwin
- Bristol-Myers Squibb, Princeton, New Jersey, USA
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Malard F, Neri P, Bahlis NJ, Terpos E, Moukalled N, Hungria VTM, Manier S, Mohty M. Multiple myeloma. Nat Rev Dis Primers 2024; 10:45. [PMID: 38937492 DOI: 10.1038/s41572-024-00529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/29/2024]
Abstract
Multiple myeloma (MM) is a haematological lymphoid malignancy involving tumoural plasma cells and is usually characterized by the presence of a monoclonal immunoglobulin protein. MM is the second most common haematological malignancy, with an increasing global incidence. It remains incurable because most patients relapse or become refractory to treatments. MM is a genetically complex disease with high heterogeneity that develops as a multistep process, involving acquisition of genetic alterations in the tumour cells and changes in the bone marrow microenvironment. Symptomatic MM is diagnosed using the International Myeloma Working Group criteria as a bone marrow infiltration of ≥10% clonal plasma cells, and the presence of at least one myeloma-defining event, either standard CRAB features (hypercalcaemia, renal failure, anaemia and/or lytic bone lesions) or biomarkers of imminent organ damage. Younger and fit patients are considered eligible for transplant. They receive an induction, followed by consolidation with high-dose melphalan and autologous haematopoietic cell transplantation, and maintenance therapy. In older adults (ineligible for transplant), the combination of daratumumab, lenalidomide and dexamethasone is the preferred option. If relapse occurs and requires further therapy, the choice of therapy will be based on previous treatment and response and now includes immunotherapies, such as bi-specific monoclonal antibodies and chimeric antigen receptor T cell therapy.
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Affiliation(s)
- Florent Malard
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
| | - Paola Neri
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada
| | - Nizar J Bahlis
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada
| | - Evangelos Terpos
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nour Moukalled
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Salomon Manier
- Department of Hematology, Lille University Hospital and INSERM UMR-S1277 and CNRS UMR9020, Lille, France
| | - Mohamad Mohty
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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Howard AJ, Concepcion I, Wang AX, Hamadeh IS, Hultcrantz M, Mailankody S, Tan C, Korde N, Lesokhin AM, Hassoun H, Shah UA, Maclachlan KH, Rajeeve S, Landau HJ, Scordo M, Shah GL, Lahoud OB, Chung DJ, Giralt S, Usmani SZ, Firestone RS. Unscheduled health care interactions in patients with multiple myeloma receiving T-cell redirection therapies. Blood Adv 2024; 8:3246-3253. [PMID: 38621239 PMCID: PMC11226971 DOI: 10.1182/bloodadvances.2024012871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
ABSTRACT Outcomes for patients with relapsed/refractory multiple myeloma (R/RMM) have dramatically improved after the development and now growing utilization of B-cell maturation antigen-targeted chimeric antigen receptor (CAR) T-cell therapy and bispecific antibody (BsAb) therapy. However, health care utilization as a quality-of-life metric in these growing populations has not been thoroughly evaluated. We performed a retrospective cohort study evaluating the frequency and cause of unscheduled health care interactions (UHIs) among patients with R/RMM responding to B-cell maturation antigen-targeted BsAb and CAR T-cell therapies (N = 46). This included the analysis of remote UHIs including calls to physicians' offices and messages sent through an online patient portal. Our results showed that nearly all patients with R/RMM (89%) receiving these therapies required a UHI during the first 125 days of treatment, with a mean of 3.7 UHIs per patient. Patients with R/RMM responding to BsAbs were significantly more likely to remotely contact their physicians' offices (1.8-fold increase; P = .038) or visit an urgent care center (more than threefold increase; P = .012) than patients with R/RMM responding to CAR T-cell therapies. This was largely due to increased reports of mild upper respiratory tract infections in BsAb patients. Our results underscore the need to develop preemptive management strategies for commonly reported symptoms that patients with R/RMM experience while receiving CAR T-cell or BsAb therapies. This preemptive management may significantly reduce unnecessary health care utilization in this vulnerable patient population.
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Affiliation(s)
- Anna J. Howard
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Isabel Concepcion
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alice X. Wang
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Issam S. Hamadeh
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Malin Hultcrantz
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sham Mailankody
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carlyn Tan
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neha Korde
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexander M. Lesokhin
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hani Hassoun
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Urvi A. Shah
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kylee H. Maclachlan
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sridevi Rajeeve
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heather J. Landau
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Scordo
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gunjan L. Shah
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oscar B. Lahoud
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J. Chung
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Saad Z. Usmani
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ross S. Firestone
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY
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Bayani DB, Lin YC, Nagarajan C, Ooi MG, Tso ACY, Cairns J, Wee HL. Modeling First-Line Daratumumab Use for Newly Diagnosed, Transplant-Ineligible, Multiple Myeloma: A Cost-Effectiveness and Risk Analysis for Healthcare Payers. PHARMACOECONOMICS - OPEN 2024:10.1007/s41669-024-00503-9. [PMID: 38900407 DOI: 10.1007/s41669-024-00503-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND AND OBJECTIVE This study aimed to assess the cost-effectiveness of two regimens regarded as the standard of care for the treatment of newly diagnosed, transplant-ineligible multiple myeloma in Singapore: (1) daratumumab, lenalidomide, and dexamethasone and (2) bortezomib, lenalidomide, and dexamethasone. Additionally, it aimed to explore potential strategies to manage decision uncertainty and mitigate financial risk. METHODS A cost-effectiveness analysis from the healthcare system perspective was conducted using a partitioned survival model to estimate lifetime costs and quality-adjusted life years (QALYs) associated with daratumumab-based treatment and the bortezomib-based regimen. The analysis used data from the MAIA and SWOG S0777 trials and incorporated local real-world data where available. Sensitivity analyses were performed to evaluate the robustness of the findings, and a risk analysis was conducted to analyze various payer strategies in terms of their payer strategy and uncertainty burden (P-SUB), which account for the decision uncertainty and the additional cost of choosing a suboptimal intervention. RESULTS The incremental cost-effectiveness ratio (ICER) for daratumumab, lenalidomide, and dexamethasone (DRd) compared with bortezomib, lenalidomide, and dexamethasone (VRd) was US $90,364 per QALY gained. The results were sensitive to variations in survival for DRd, postprogression treatment costs, cost of hospice care, and hazard ratio for progression-free survival. The scenarios explored indicated that structural assumptions, such as the time horizon of the analysis, significantly influenced the results due to uncertainties arising from immature trial data and treatment efficacy over time. Among the various payer strategies compared, an upfront price discount for daratumumab emerged as the best approach with the lowest P-SUB at US $14,708. CONCLUSION In conclusion, this study finds that daratumumab as a first-line treatment for myeloma exceeds the cost-effectiveness threshold considered in this evaluation. An upfront price reduction is the recommended strategy to manage uncertainties and mitigate financial risks. These findings highlight the importance of targeted payer strategies to address specific types and sources of uncertainty.
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Affiliation(s)
- Diana Beatriz Bayani
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Singapore, 117549, Republic of Singapore.
| | - Yihao Clement Lin
- Department of Hematology, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Melissa G Ooi
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | | | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, Department of Pharmacy, National University of Singapore, Singapore, Singapore
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Morè S, Corvatta L, Manieri VM, Morsia E, Offidani M. The Challenging Approach to Multiple Myeloma: From Disease Diagnosis and Monitoring to Complications Management. Cancers (Basel) 2024; 16:2263. [PMID: 38927968 PMCID: PMC11202048 DOI: 10.3390/cancers16122263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
The outcome of multiple myeloma (MM) has significantly improved in the last few decades due to several factors such as new biological discoveries allowing to better stratify disease risk, development of more effective therapies and better management of side effects related to them. However, handling all these aspects requires an interdisciplinary approach involving multiple knowledge and collaboration of different specialists. The hematologist, faced with a patient with MM, must not only choose a treatment according to patient and disease characteristics but must also know when therapy needs to be started and how to monitor it during and after treatment. Moreover, he must deal not only with organ issues related to MM such as bone disease, renal failure or neurological disease but also with adverse events, often very serious, related to novel therapies, particularly new generation immunotherapies such as CAR T cell therapy and bispecific antibodies. In this review, we provide an overview on the newer MM diagnostic and monitoring strategies and on the main side effects of MM therapies, focusing on adverse events occurring during treatment with CAR T cells and bispecific antibodies.
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Affiliation(s)
- Sonia Morè
- Clinica di Ematologia Azienda Ospedaliero, Universitaria delle Marche, 60126 Ancona, Italy; (S.M.); (V.M.M.); (E.M.)
| | - Laura Corvatta
- U.O.C. Medicina, Ospedale Profili, 60044 Fabriano, Italy;
| | - Valentina Maria Manieri
- Clinica di Ematologia Azienda Ospedaliero, Universitaria delle Marche, 60126 Ancona, Italy; (S.M.); (V.M.M.); (E.M.)
| | - Erika Morsia
- Clinica di Ematologia Azienda Ospedaliero, Universitaria delle Marche, 60126 Ancona, Italy; (S.M.); (V.M.M.); (E.M.)
| | - Massimo Offidani
- Clinica di Ematologia Azienda Ospedaliero, Universitaria delle Marche, 60126 Ancona, Italy; (S.M.); (V.M.M.); (E.M.)
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Ortiz de Landazuri I, Oliver-Caldés A, Español-Rego M, Agulló C, Contreras MT, Zabaleta A, Puig N, Cabañas V, González-Calle V, Zugasti I, Inogés S, Rodríguez Otero P, Martin-Antonio B, Reguera JL, López-Diaz de Cerio A, Aróstegui JI, Uribe-Herranz M, Benítez-Ribas D, Rodríguez-Lobato LG, González EA, Tovar N, Charry P, Navarro S, Rosiñol L, Tréboles K, Mora G, Yagüe J, Moraleda JM, Urbano-Ispizua Á, Mateos MV, Pascal M, Paiva B, Juan M, Fernández de Larrea C. Serum mass spectrometry for treatment monitoring in patients with multiple myeloma receiving ARI0002h CAR T-cells. Br J Haematol 2024. [PMID: 38894496 DOI: 10.1111/bjh.19589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024]
Abstract
Chimeric antigen receptor (CAR) T-cell therapies have increased the patients with relapsed/refractory multiple myeloma (RRMM) in whom standard electrophoretic techniques fail to detect the M-protein. Quantitative immunoprecipitation mass spectrometry (QIP-MS) can accurately measure serum M-protein with high sensitivity, and identify interferences caused by therapeutic monoclonal antibodies. Here, we investigate the outcome of QIP-MS in 33 patients treated with the academic BCMA-directed CAR T-cell ARI0002h (Cesnicabtagene Autoleucel). QIP-MS offered more detailed insights than serum immunofixation (sIFE), identifying glycosylated M-proteins and minor additional peaks. Moreover, the potential interferences owing to daratumumab or tocilizumab treatments were successfully detected. When analysing different assay platforms during patient's monitoring after ARI0002h administration, we observed that QIP-MS showed a high global concordance (78.8%) with sIFE, whereas it was only moderate (55.6%) with bone marrow (BM)-based next-generation flow cytometry (NGF). Furthermore, QIP-MS consistently demonstrated the lowest negativity rate across the different timepoints (27.3% vs. 60.0% in months 1 and 12, respectively). Patients with QIP-MS(+)/BM-based NGF(-) showed a non-significant shorter median progression free survival than those with QIP-MS(-)/BM-based NGF(-). In summary, we show the first experience to our knowledge demonstrating that QIP-MS could be particularly useful as a non-invasive technique when evaluating response after CAR T-cell treatment in MM.
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Affiliation(s)
- Iñaki Ortiz de Landazuri
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Aina Oliver-Caldés
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
- Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Marta Español-Rego
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Cristina Agulló
- Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Instituto Universitario de Biología Molecular y Celular del Cáncer (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - María Teresa Contreras
- Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Instituto Universitario de Biología Molecular y Celular del Cáncer (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Aintzane Zabaleta
- Cancer Center Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - Noemí Puig
- Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Instituto Universitario de Biología Molecular y Celular del Cáncer (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Valentín Cabañas
- Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Pascual Parrilla), Universidad de Murcia, Murcia, Spain
| | - Verónica González-Calle
- Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Instituto Universitario de Biología Molecular y Celular del Cáncer (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Inés Zugasti
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Susana Inogés
- Cancer Center Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - Paula Rodríguez Otero
- Cancer Center Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | | | - Juan Luis Reguera
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Sevilla, Spain
| | - Ascensión López-Diaz de Cerio
- Cancer Center Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - Juan Ignacio Aróstegui
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Mireia Uribe-Herranz
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Daniel Benítez-Ribas
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Europa Azucena González
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Natalia Tovar
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Paola Charry
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Sergio Navarro
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Karen Tréboles
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Génesis Mora
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Jordi Yagüe
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - José María Moraleda
- Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Pascual Parrilla), Universidad de Murcia, Murcia, Spain
| | - Álvaro Urbano-Ispizua
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - María Victoria Mateos
- Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Instituto Universitario de Biología Molecular y Celular del Cáncer (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Mariona Pascal
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Bruno Paiva
- Cancer Center Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - Manel Juan
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Carlos Fernández de Larrea
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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Wijnands C, Armony G, Noori S, Gloerich J, Bonifay V, Caillon H, Luider TM, Brehmer S, Pfennig L, Srikumar T, Trede D, Kruppa G, Dejoie T, van Duijn MM, van Gool AJ, Jacobs JFM, Wessels HJCT. An automated workflow based on data independent acquisition for practical and high-throughput personalized assay development and minimal residual disease monitoring in multiple myeloma patients. Clin Chem Lab Med 2024; 0:cclm-2024-0306. [PMID: 38872409 DOI: 10.1515/cclm-2024-0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Minimal residual disease (MRD) status in multiple myeloma (MM) is an important prognostic biomarker. Personalized blood-based targeted mass spectrometry detecting M-proteins (MS-MRD) was shown to provide a sensitive and minimally invasive alternative to MRD-assessment in bone marrow. However, MS-MRD still comprises of manual steps that hamper upscaling of MS-MRD testing. Here, we introduce a proof-of-concept for a novel workflow using data independent acquisition-parallel accumulation and serial fragmentation (dia-PASEF) and automated data processing. METHODS Using automated data processing of dia-PASEF measurements, we developed a workflow that identified unique targets from MM patient sera and personalized protein sequence databases. We generated patient-specific libraries linked to dia-PASEF methods and subsequently quantitated and reported M-protein concentrations in MM patient follow-up samples. Assay performance of parallel reaction monitoring (prm)-PASEF and dia-PASEF workflows were compared and we tested mixing patient intake sera for multiplexed target selection. RESULTS No significant differences were observed in lowest detectable concentration, linearity, and slope coefficient when comparing prm-PASEF and dia-PASEF measurements of serial dilutions of patient sera. To improve assay development times, we tested multiplexing patient intake sera for target selection which resulted in the selection of identical clonotypic peptides for both simplex and multiplex dia-PASEF. Furthermore, assay development times improved up to 25× when measuring multiplexed samples for peptide selection compared to simplex. CONCLUSIONS Dia-PASEF technology combined with automated data processing and multiplexed target selection facilitated the development of a faster MS-MRD workflow which benefits upscaling and is an important step towards the clinical implementation of MS-MRD.
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Affiliation(s)
- Charissa Wijnands
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gad Armony
- Translational Metabolic Laboratory, Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Somayya Noori
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jolein Gloerich
- Translational Metabolic Laboratory, Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Hélène Caillon
- Biochemistry Laboratory, Hospital of Nantes, Nantes, France
| | - Theo M Luider
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | - Thomas Dejoie
- Biochemistry Laboratory, Hospital of Nantes, Nantes, France
| | - Martijn M van Duijn
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Alain J van Gool
- Translational Metabolic Laboratory, Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joannes F M Jacobs
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans J C T Wessels
- Translational Metabolic Laboratory, Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
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Bumma N, Richter J, Jagannath S, Lee HC, Hoffman JE, Suvannasankha A, Zonder JA, Shah MR, Lentzsch S, Baz R, Maly JJ, Namburi S, Pianko MJ, Ye JC, Wu KL, Silbermann R, Min CK, Vekemans MC, Munder M, Byun JM, Martínez-Lopez J, Cassady K, DeVeaux M, Chokshi D, Boyapati A, Hazra A, Yancopoulos GD, Sirulnik LA, Rodriguez Lorenc K, Kroog GS, Houvras Y, Dhodapkar MV. Linvoseltamab for Treatment of Relapsed/Refractory Multiple Myeloma. J Clin Oncol 2024; 42:JCO2401008. [PMID: 38879802 PMCID: PMC11272139 DOI: 10.1200/jco.24.01008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/17/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE We present a phase I/II first-in-human trial evaluating the safety and efficacy of 50 mg and 200 mg doses of linvoseltamab, a B-cell maturation antigen × CD3 bispecific antibody in relapsed/refractory multiple myeloma (RRMM). METHODS Phase II eligible patients had RRMM that either progressed on/after ≥three lines of therapy including a proteasome inhibitor (PI), an immunomodulatory drug (IMiD), and an anti-CD38 antibody or was triple-class (PI/IMiD/anti-CD38) refractory. Phase II treatment was once a week through week 14 and then once every 2 weeks. Phase II 200 mg patients who achieved a ≥very good partial response by week 24 received linvoseltamab once every 4 weeks. The primary end point in phase II was overall response rate (ORR). RESULTS Among the 117 patients treated with 200 mg, the median age was 70 years, 39% had high-risk cytogenetics, and 28% had penta-refractory disease. At a median follow-up of 14.3 months, the ORR was 71%, with 50% achieving ≥complete response (CR). In 104 patients treated with 50 mg at a median follow-up of 7.4 months, the ORR was 48%, with 21% achieving ≥CR. The median duration of response (DOR) for 200 mg patients (n = 83) was 29.4 months (95% CI, 19.2 to not evaluable). Among 200 mg patients, the most common adverse events included cytokine release syndrome (35.0% Gr1, 10.3% Gr2, 0.9% Gr3), neutropenia (0.9% Gr2, 18.8% Gr3, 23.1% Gr4), and anemia (3.4% Gr1, 4.3% Gr2, 30.8% Gr3). Immune effector cell-associated neurotoxicity syndrome occurred in 7.7% of patients (2.6% each Gr1, Gr2, Gr3). Infections were reported in 74.4% of patients (33.3% Gr3, 2.6% Gr4); infection frequency and severity declined over time. CONCLUSION Linvoseltamab 200 mg induced deep and durable responses, with a median DOR of 29.4 months, in patients with RRMM with an acceptable safety profile.
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Affiliation(s)
- Naresh Bumma
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | - Hans C. Lee
- The University of Texas MD Anderson Cancer Centre, Houston, TX
| | | | | | | | - Mansi R. Shah
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Rachid Baz
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | | | | | - Matthew J. Pianko
- Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, MI
| | - Jing Christine Ye
- Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, MI
| | - Ka Lung Wu
- Ziekenhuis Netwerk Antwerpen Stuivenberg, Antwerp, Belgium
| | - Rebecca Silbermann
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Chang-Ki Min
- Department of Hematology, College of Medicine, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Marie-Christiane Vekemans
- Department of Hematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Markus Munder
- Department of Internal Medicine III, University Medical Center Mainz, Mainz, Germany
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joaquín Martínez-Lopez
- Hospital 12 de Octubre, i+12, School of Medicine Universidad Complutense, CNIO, Madrid, Spain
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40
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Pasvolsky O, Marcoux C, Dai J, Milton DR, Tanner MR, Syed N, Bashir Q, Srour S, Saini N, Lin P, Ramdial J, Nieto Y, Tang G, Aljawai Y, Lee HC, Gaballa MR, Patel KK, Kebriaei P, Thomas SK, Orlowski RZ, Shpall EJ, Champlin RE, Qazilbash MH. Trends in Outcomes After Upfront Autologous Transplant for Multiple Myeloma Over Three Decades. Transplant Cell Ther 2024:S2666-6367(24)00438-X. [PMID: 38852784 DOI: 10.1016/j.jtct.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/28/2024] [Accepted: 06/01/2024] [Indexed: 06/11/2024]
Abstract
Upfront autologous stem cell transplantation (auto-SCT) remains standard of care for eligible patients with newly diagnosed multiple myeloma (NDMM), although recently its role has been questioned. The aim of the study was to evaluate trends in patient characteristics, treatment, and outcomes of NDMM who underwent upfront auto-SCT over three decades. We conducted a single-center retrospective analysis of patients with NDMM who underwent upfront auto-SCT at MD Anderson Cancer Center between 1988 to 2021. Primary end points were progression-free survival (PFS) and overall survival (OS). Patients were grouped by the year of auto-SCT: 1988-2000 (n = 249), 2001-2005 (n = 373), 2006-2010 (n = 568), 2011-2015 (n = 815) and 2016-2021 (n = 1036). High-risk cytogenetic abnormalities were defined as del (17p), t (4;14), t (14;16), and 1q21 gain or amplification by fluorescence in situ hybridization. We included 3041 MM patients in the analysis. Median age at auto-SCT increased from 52 years (1988-2000) to 62 years (2016-2021), as did the incidence of high-risk cytogenetics from 15% to 40% (P < .001). Comorbidity burden, as measured by a Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) of >3, increased from 17% (1988-2000) to 28% (2016-2021) (P < .001). Induction regimens evolved from predominantly chemotherapy to immunomodulatory drug (IMiD) and proteasome inhibitor (PI) based regimens, with 74% of patients receiving IMiD-PI triplets in 2016-2021 (39% bortezomib, lenalidomide and dexamethasone (VRD) and 35% carfilzomib, lenalidomide and dexamethasone [KRD]). Response rates prior to auto-SCT steadily increased, with 4% and 10% achieving a ≥CR and ≥VGPR compared to 19% and 65% between 1988-2000 and 2016-2021, respectively. Day 100 response rates post auto-SCT improved from 24% and 49% achieving ≥CR and ≥VGPR between 1988-2000 to 41% and 81% between 2016-2021, respectively. Median PFS improved from 22.3 months between 1988-2000 to 58.6 months between 2016-2021 (HR 0.42, P < .001). Among patients with high-risk cytogenetics, median PFS increased from 13.7 months to 36.8 months (HR 0.32, P < .001). Patients aged ≥65 years also had an improvement in median PFS from 33.6 months between 2001 and 2005 to 52.8 months between 2016-2021 (HR 0.56, P = .001). Median OS improved from 55.1 months between 1988-2000 to not reached (HR 0.41, P < .001). Patients with high-risk cytogenetics had an improvement in median OS from 32.9 months to 66.5 months between 2016-2021 (HR 0.39, P < .001). Day 100 non-relapse mortality from 2001 onwards was ≤1%. Age-adjust rates of second primary malignancies were similar in patients transplanted in different time periods. Despite increasing patient age and comorbidity burden, this large real-world study demonstrated significant improvements in the depth of response and survival outcomes in patients with NDMM undergoing upfront auto-SCT over the past three decades, including those with high-risk disease.
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Affiliation(s)
- Oren Pasvolsky
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Curtis Marcoux
- Division of Hematology, Dalhousie University, Halifax, Canada
| | - Jianliang Dai
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark R Tanner
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Naureen Syed
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samer Srour
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neeraj Saini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul Lin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeremy Ramdial
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yosra Aljawai
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hans C Lee
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mahmoud R Gaballa
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Krina K Patel
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sheeba K Thomas
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Zanwar S, Sidana S, Shune L, Puglianini OC, Pasvolsky O, Gonzalez R, Dima D, Afrough A, Kaur G, Davis JA, Herr M, Hashmi H, Forsberg P, Sborov D, Anderson LD, McGuirk JP, Wagner C, Lieberman-Cribbin A, Rossi A, Freeman CL, Locke FL, Richard S, Khouri J, Lin Y, Patel KK, Kumar SK, Hansen DK. Impact of extramedullary multiple myeloma on outcomes with idecabtagene vicleucel. J Hematol Oncol 2024; 17:42. [PMID: 38845015 PMCID: PMC11157748 DOI: 10.1186/s13045-024-01555-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
Idecabtagene vicleucel (Ide-cel) has demonstrated excellent efficacy and durable responses in patients with relapsed/refractory multiple myeloma (RRMM). However, the outcomes with ide-cel in patients with extramedullary disease (EMD) remain incompletely characterized. We included patients with RRMM treated with ide-cel between May 2021 and April 2023 across 11 US academic institutions. Visceral or soft tissue lesions non-contiguous from bone was classified as EMD. Time-to-event analyses were performed from date of ide-cel infusion. Among 351 patients, 84 (24%) had EMD prior to infusion. The median follow-up from ide-cel infusion was 18.2 months (95% CI: 17-19.3). The day 90 overall response rates (ORR) were 52% vs. 82% for the EMD and non-EMD cohorts, respectively (p < 0.001). The median progression-free survival (PFS) was 5.3 months (95% CI: 4.1-6.9) for the EMD cohort vs. 11.1 months (95% CI: 9.2-12.6; p < 0.0001) for the non-EMD cohort. In a multivariable analysis, EMD was an independent predictor of inferior PFS [hazard ratio 1.5 (1.1-2.2), p = 0.02]. The median overall survival was 14.8 months [95% CI: 9-Not reached (NR)] vs. 26.9 months (26.3 vs. NR, p = 0.006) for the EMD and non-EMD cohorts, respectively. Extramedullary disease represents an independent predictor of inferior day 90 ORR and PFS among patients treated with ide-cel.
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Affiliation(s)
- Saurabh Zanwar
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Surbhi Sidana
- Stanford University School of Medicine, Stanford, CA, USA
| | - Leyla Shune
- The University of Kansas Medical Center, Kansas City, KS, USA
| | - Omar Castaneda Puglianini
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Oren Pasvolsky
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca Gonzalez
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Danai Dima
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | - Aimaz Afrough
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Gurbakhash Kaur
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - James A Davis
- Medical University of South Carolina, Charleston, SC, USA
| | - Megan Herr
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hamza Hashmi
- Medical University of South Carolina, Charleston, SC, USA
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Forsberg
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Douglas Sborov
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Larry D Anderson
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | | | - Charlotte Wagner
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Alex Lieberman-Cribbin
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriana Rossi
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ciara L Freeman
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Frederick L Locke
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Shambavi Richard
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jack Khouri
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | - Yi Lin
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Krina K Patel
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Shaji K Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
| | - Doris K Hansen
- Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
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42
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Kogure Y, Handa H, Ito Y, Ri M, Horigome Y, Iino M, Harazaki Y, Kobayashi T, Abe M, Ishida T, Ito S, Iwasaki H, Kuroda J, Shibayama H, Sunami K, Takamatsu H, Tamura H, Hayashi T, Akagi K, Shinozaki T, Yoshida T, Mori I, Iida S, Maeda T, Kataoka K. ctDNA improves prognostic prediction for patients with relapsed/refractory MM receiving ixazomib, lenalidomide, and dexamethasone. Blood 2024; 143:2401-2413. [PMID: 38427753 DOI: 10.1182/blood.2023022540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
ABSTRACT It remains elusive how driver mutations, including those detected in circulating tumor DNA (ctDNA), affect prognosis in relapsed/refractory multiple myeloma (RRMM). Here, we performed targeted-capture sequencing using bone marrow plasma cells (BMPCs) and ctDNA of 261 RRMM cases uniformly treated with ixazomib, lenalidomide, and dexamethasone in a multicenter, prospective, observational study. We detected 24 and 47 recurrently mutated genes in BMPC and ctDNA, respectively. In addition to clonal hematopoiesis-associated mutations, varying proportion of driver mutations, particularly TP53 mutations (59.2% of mutated cases), were present in only ctDNA, suggesting their subclonal origin. In univariable analyses, ctDNA mutations of KRAS, TP53, DIS3, BRAF, NRAS, and ATM were associated with worse progression-free survival (PFS). BMPC mutations of TP53 and KRAS were associated with inferior PFS, whereas KRAS mutations were prognostically relevant only when detected in both BMPC and ctDNA. A total number of ctDNA mutations in the 6 relevant genes was a strong prognostic predictor (2-year PFS rates: 57.3%, 22.7%, and 0% for 0, 1, and ≥2 mutations, respectively) and independent of clinical factors and plasma DNA concentration. Using the number of ctDNA mutations, plasma DNA concentration, and clinical factors, we developed a prognostic index, classifying patients into 3 categories with 2-year PFS rates of 57.9%, 28.6%, and 0%. Serial analysis of ctDNA mutations in 94 cases revealed that TP53 and KRAS mutations frequently emerge after therapy. Thus, we clarify the genetic characteristics and clonal architecture of ctDNA mutations and demonstrate their superiority over BMPC mutations for prognostic prediction in RRMM. This study is a part of the C16042 study, which is registered at www.clinicaltrials.gov as #NCT03433001.
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Affiliation(s)
- Yasunori Kogure
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuta Ito
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masaki Ri
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuichi Horigome
- Department of Hematology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaki Iino
- Department of Hematology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Yoriko Harazaki
- Department of Hematology, Miyagi Cancer Center, Natori, Japan
| | - Takahiro Kobayashi
- Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Masahiro Abe
- Department of Hematology, Kawashima Hospital, Tokushima, Japan
| | - Tadao Ishida
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shigeki Ito
- Department of Hematology and Oncology, Iwate Medical University Hospital, Iwate, Japan
| | - Hiromi Iwasaki
- Department of Hematology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirohiko Shibayama
- Department of Hematology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | | | - Hideto Tamura
- Department of Hematology, Nippon Medical School, Tokyo, Japan
| | - Toshiaki Hayashi
- Department of Hematology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kiwamu Akagi
- Division of Molecular Diagnosis and Cancer Prevention, Saitama Cancer Center, Saitama, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | | | - Ikuo Mori
- Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Maeda
- Division of Precision Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Keisuke Kataoka
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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Facon T, Dimopoulos MA, Leleu XP, Beksac M, Pour L, Hájek R, Liu Z, Minarik J, Moreau P, Romejko-Jarosinska J, Spicka I, Vorobyev VI, Besemer B, Ishida T, Janowski W, Kalayoglu-Besisik S, Parmar G, Robak P, Zamagni E, Goldschmidt H, Martin TG, Manier S, Mohty M, Oprea C, Brégeault MF, Macé S, Berthou C, Bregman D, Klippel Z, Orlowski RZ. Isatuximab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple Myeloma. N Engl J Med 2024. [PMID: 38832972 DOI: 10.1056/nejmoa2400712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND Bortezomib, lenalidomide, and dexamethasone (VRd) is a preferred first-line treatment option for patients with newly diagnosed multiple myeloma. Whether the addition of the anti-CD38 monoclonal antibody isatuximab to the VRd regimen would reduce the risk of disease progression or death among patients ineligible to undergo transplantation is unclear. METHODS In an international, open-label, phase 3 trial, we randomly assigned, in a 3:2 ratio, patients 18 to 80 years of age with newly diagnosed multiple myeloma who were ineligible to undergo transplantation to receive either isatuximab plus VRd or VRd alone. The primary efficacy end point was progression-free survival. Key secondary end points included a complete response or better and minimal residual disease (MRD)-negative status in patients with a complete response. RESULTS A total of 446 patients underwent randomization. At a median follow-up of 59.7 months, the estimated progression-free survival at 60 months was 63.2% in the isatuximab-VRd group, as compared with 45.2% in the VRd group (hazard ratio for disease progression or death, 0.60; 98.5% confidence interval, 0.41 to 0.88; P<0.001). The percentage of patients with a complete response or better was significantly higher in the isatuximab-VRd group than in the VRd group (74.7% vs. 64.1%, P = 0.01), as was the percentage of patients with MRD-negative status and a complete response (55.5% vs. 40.9%, P = 0.003). No new safety signals were observed with the isatuximab-VRd regimen. The incidence of serious adverse events during treatment and the incidence of adverse events leading to discontinuation were similar in the two groups. CONCLUSIONS Isatuximab-VRd was more effective than VRd as initial therapy in patients 18 to 80 years of age with newly diagnosed multiple myeloma who were ineligible to undergo transplantation. (Funded by Sanofi and a Cancer Center Support Grant; IMROZ ClinicalTrials.gov number, NCT03319667.).
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Affiliation(s)
- Thierry Facon
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Meletios-Athanasios Dimopoulos
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Xavier P Leleu
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Meral Beksac
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Ludek Pour
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Roman Hájek
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Zhuogang Liu
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Jiri Minarik
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Philippe Moreau
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Joanna Romejko-Jarosinska
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Ivan Spicka
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Vladimir I Vorobyev
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Britta Besemer
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Tadao Ishida
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Wojciech Janowski
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Sevgi Kalayoglu-Besisik
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Gurdeep Parmar
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Pawel Robak
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Elena Zamagni
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Hartmut Goldschmidt
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Thomas G Martin
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Salomon Manier
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Mohamad Mohty
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Corina Oprea
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Marie-France Brégeault
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Sandrine Macé
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Christelle Berthou
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - David Bregman
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Zandra Klippel
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Robert Z Orlowski
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
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Khouri J, Dima D, Li H, Hansen D, Sidana S, Shune L, Anwer F, Sborov D, Wagner C, Kocoglu MH, Atrash S, Voorhees P, Peres L, Hovanky V, Simmons G, Williams L, Raza S, Afrough A, Anderson LD, Ferreri C, Hashmi H, Davis J, McGuirk J, Goldsmith S, Borogovac A, Lin Y, Midha S, Nadeem O, Locke FL, Baz R, Hamilton B, Alsina M, Sauter C, Patel K, Kaur G. Absolute Lymphocyte Count and Outcomes of Multiple Myeloma Patients Treated with Idecabtagene Vicleucel: The US Myeloma Immunotherapy Consortium Real- World Experience. Transplant Cell Ther 2024:S2666-6367(24)00437-8. [PMID: 38834151 DOI: 10.1016/j.jtct.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/14/2024] [Accepted: 05/29/2024] [Indexed: 06/06/2024]
Abstract
Idecabtagene vicleucel (ide-cel) has shown impressive efficacy in relapsed/refractory multiple myeloma (RRMM). This study aimed to investigate the impact of absolute lymphocyte count (ALC) on the survival outcomes of RRMM patients treated with standard of care (SOC) ide-cel. Data were collected retrospectively from 11 institutions in the U.S. Impact of ALC parameters including pre-apheresis (pre-A), pre-lymphodepletion (pre-LD), absolute and percent difference from pre-A to pre-LD on clinical outcomes after ide-cel were examined using survival analysis. A new ALC profile was created based on univariate analysis that comprises 3 groups: normal (≥1 × 109/L) pre-LD ALC (LDN), low (<1 × 109/L) pre-LD ALC (LDL) + percent reduction <37.5 (%RL), and LDL ALC + percent reduction ≥37.5 (%RH). A total of 214 SOC ide-cel recipients were included in this analysis. The median patient age was 64 years (interquartile range [IQR], 57 to 69 years), median number of prior therapies was 6 (IQR, 5 to 9), and median duration of follow-up was 5.4 months (IQR, 2.1 to 8.3 months). Most patients had both low pre-A ALC (75.3%) and pre-LD ALC (77.2%), and the reduction from pre-A to pre-LD (median, .65 to .55 × 109/L) was statistically significant. Univariate analysis showed that the LDL + %RH group had significantly worse progression-free survival (PFS) and overall survival (OS) compared to the LDL + %RL and LDN ALC groups (6-month PFS: 40% versus 67.6% and 60.9%; 6-month OS: 69.5% versus 87% and 94.3%). In multivariable analysis, after adjusting for age, performance status, cytogenetic risk, use of bridging therapy, and extramedullary disease, PFS did not maintain its statistical significance; however, OS remained significantly worse for LDL + %RH group compared to the LDN ALC group (hazard ratio [HR], 4.3; 95% confidence interval [CI], 1.1 to 17), but the difference between the LDL + %RH versus %RL groups was not statistically significant (HR, 1.7; 95% CI, .8 to 4.0). Our findings indicate that low pre-LD ALC with high %R from pre-A to pre-LD was associated with inferior survival outcomes, particularly OS, in patients who received SOC ide-cel.
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Affiliation(s)
- Jack Khouri
- Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Danai Dima
- Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio.
| | - Hong Li
- Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Doris Hansen
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Surbhi Sidana
- Stanford University School of Medicine, Stanford, California
| | - Leyla Shune
- University of Kansas Medical Center, Kansas City, Kansas
| | - Faiz Anwer
- Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Douglas Sborov
- University of Utah Huntsman Cancer Institute, Salt Lake City, Utah
| | - Charlotte Wagner
- University of Utah Huntsman Cancer Institute, Salt Lake City, Utah
| | - Mehmet H Kocoglu
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | | | | | - Lauren Peres
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Vanna Hovanky
- Stanford University School of Medicine, Stanford, California
| | - Gary Simmons
- Virginia Commonwealth University Massey Cancer Center, Richmond, Virginia
| | | | - Shahzad Raza
- Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Aimaz Afrough
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Larry D Anderson
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | | | - Hamza Hashmi
- Medical University of South Carolina, Charleston, South Carolina
| | - James Davis
- Medical University of South Carolina, Charleston, South Carolina
| | - Joseph McGuirk
- University of Kansas Medical Center, Kansas City, Kansas
| | | | | | - Yi Lin
- Mayo Clinic Cancer Center, Rochester, Minnesota
| | | | - Omar Nadeem
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Rachid Baz
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Melissa Alsina
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Craig Sauter
- Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Krina Patel
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gurbakhash Kaur
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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Wagner CB, Julian K, Bryan B, Steinbach MN, Shewan S, Maxwell L, Vigil M, Mohyuddin GR, Godara A, McClune B, Galarza Fortuna G, Sborov D. Novel chemotherapy combination of carfilzomib with dexamethasone, cyclophosphamide, etoposide and cisplatin (K-DCEP) for the treatment of relapsed/refractory aggressive plasma cell dyscrasias. Leuk Lymphoma 2024:1-4. [PMID: 38824620 DOI: 10.1080/10428194.2024.2350670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/27/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Charlotte B Wagner
- Department of Pharmacy, University of Utah Hospitals and Clinics, Huntsman Cancer Institute, UT, USA
| | - Kelley Julian
- Department of Pharmacy, University of Utah Hospitals and Clinics, Huntsman Cancer Institute, UT, USA
| | - Baylee Bryan
- Department of Pharmacy, University of Utah Hospitals and Clinics, Huntsman Cancer Institute, UT, USA
| | - Mary N Steinbach
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
| | - Samuel Shewan
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
| | - Lindsay Maxwell
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
| | - Meghan Vigil
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
| | | | - Amandeep Godara
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
| | - Brian McClune
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
| | | | - Douglas Sborov
- Internal Medicine, University of Utah Health Huntsman Cancer Institute, UT, USA
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Meseha M, Hoffman J, Kazandjian D, Landgren O, Diamond B. Minimal Residual Disease-Adapted Therapy in Multiple Myeloma: Current Evidence and Opinions. Curr Oncol Rep 2024; 26:679-690. [PMID: 38676789 PMCID: PMC11169024 DOI: 10.1007/s11912-024-01537-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE OF REVIEW Multiple myeloma (MM) is a biologically heterogeneous malignancy with relatively uniform treatment paradigms. This review aims to assess the growing role of Minimal Residual Disease (MRD) assessment in facilitating response-adapted therapeutic decision making to individualize therapy in MM. RECENT FINDINGS MRD has been repeatedly demonstrated to provide strong prognostic information, superseding traditional IMWG response criteria. The use of MRD to modulate therapy remains controversial. Here, we review the existing landscape of MRD-adapted trial designs in both induction/consolidation and maintenance settings, including recent data from influential studies and retrospective analyses. We navigate existing data, leverage the increased resolution of longitudinal MRD assessments, and comment on trials in progress to explain our current utilization of MRD in the clinic. MRD transcends traditional response assessments by providing a window into disease-treatment interaction over time. As a strong patient-level surrogate, MRD has limited current use in individualizing treatment, but is poised to comprehensively shape treatment strategies at many key points in a patient's MM course.
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Affiliation(s)
- Mina Meseha
- Myeloma Institute, Sylvester Comprehensive Cancer Center, University of Miami, 1120 NW 14th Street, Clinical Research Building, Miami, FL, 33136, USA
| | - James Hoffman
- Myeloma Institute, Sylvester Comprehensive Cancer Center, University of Miami, 1120 NW 14th Street, Clinical Research Building, Miami, FL, 33136, USA
| | - Dickran Kazandjian
- Myeloma Institute, Sylvester Comprehensive Cancer Center, University of Miami, 1120 NW 14th Street, Clinical Research Building, Miami, FL, 33136, USA
| | - Ola Landgren
- Myeloma Institute, Sylvester Comprehensive Cancer Center, University of Miami, 1120 NW 14th Street, Clinical Research Building, Miami, FL, 33136, USA
| | - Benjamin Diamond
- Myeloma Institute, Sylvester Comprehensive Cancer Center, University of Miami, 1120 NW 14th Street, Clinical Research Building, Miami, FL, 33136, USA.
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Chen Z, Yang A, Chen A, Dong J, Lin J, Huang C, Zhang J, Liu H, Zeng Z, Miao W. [ 68Ga]Pentixafor PET/CT for staging and prognostic assessment of newly diagnosed multiple myeloma: comparison to [ 18F]FDG PET/CT. Eur J Nucl Med Mol Imaging 2024; 51:1926-1936. [PMID: 38286937 DOI: 10.1007/s00259-024-06621-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 01/31/2024]
Abstract
PURPOSE To evaluate the prognostic performance of [68Ga]Pentixafor PET/CT at baseline for staging of patients with newly diagnosed multiple myeloma (MM) and to compare it with [18F]FDG PET/CT and the Revised-International Staging System (R-ISS). METHODS Patients who underwent [68Ga]Pentixafor and [18F]FDG PET/CT imaging were retrospectively included. Patient staging was performed according to the Durie-Salmon PLUS staging system based on [68Ga]Pentixafor PET/CT and [18F]FDG PET/CT images, and the R-ISS. Progression-free survival (PFS) at patient follow-up was estimated using the Kaplan-Meier estimator and compared using the log-rank test. Area under the receiver operating characteristic curve (AUC) was calculated to assess predictive performance. RESULTS Fifty-five MM patients were evaluated. Compared with [18F]FDG PET, [68Ga]Pentixafor PET detected 25 patients as the same stage, while 26 patients were upstaged and 4 patients were downstaged (P = 0.001). After considering the low-dose CT data, there was no statistically significant difference in the number of patients classified in each stage using [68Ga]Pentixafor PET/CT and [18F]FDG PET/CT (P = 0.091). [68Ga]Pentixafor PET/CT-based staging discriminated PFS outcomes in patients with different disease stages (stage I vs. stage II, stage I vs. stage III, and stage II vs. stage III; all P < 0.05), whereas for [18F]FDG PET/CT, there was only a difference in median PFS between stage I and III (P = 0.021). When staged by R-ISS, the median PFS for stage III was significantly lower than that for stage I and II (P = 0.008 and 0.035, respectively). When predicting 2-year PFS based on staging, the AUC of [68Ga]Pentixafor PET/CT was significantly higher than that of [68Ga]Pentixafor PET (0.923 vs. 0.821, P = 0.002), [18F]FDG PET (0.923 vs. 0.752 P = 0.002), and R-ISS (0.923 vs. 0.776, P = 0.005). CONCLUSIONS [68Ga]Pentixafor PET/CT-based staging possesses substantial potential to predict disease progression in newly diagnosed MM patients.
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Affiliation(s)
- Zhenying Chen
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Apeng Yang
- Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Aihong Chen
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Jinfeng Dong
- Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Junfang Lin
- Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Chao Huang
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Jiaying Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Huimin Liu
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Zhiyong Zeng
- Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
| | - Weibing Miao
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
- Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
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Hungria V, Robak P, Hus M, Zherebtsova V, Ward C, Ho PJ, Ribas de Almeida AC, Hajek R, Kim K, Grosicki S, Sia H, Bryant A, Pitombeira de Lacerda M, Aparecida Martinez G, Sureda Balarí AM, Sandhu I, Cerchione C, Ganly P, Dimopoulos M, Fu C, Garg M, Abdallah AO, Oriol A, Gatt ME, Cavo M, Rifkin R, Fujisaki T, Mielnik M, Pirooz N, McKeown A, McNamara S, Zhou X, Nichols M, Lewis E, Rogers R, Baig H, Eccersley L, Roy-Ghanta S, Opalinska J, Mateos MV. Belantamab Mafodotin, Bortezomib, and Dexamethasone for Multiple Myeloma. N Engl J Med 2024. [PMID: 38828933 DOI: 10.1056/nejmoa2405090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Belantamab mafodotin had single-agent activity in patients with relapsed or refractory multiple myeloma, a finding that supports further evaluation of the agent in combination with standard-care therapies. METHODS In this phase 3, open-label, randomized trial, we evaluated belantamab mafodotin, bortezomib, and dexamethasone (BVd), as compared with daratumumab, bortezomib, and dexamethasone (DVd), in patients who had progression of multiple myeloma after at least one line of therapy. The primary end point was progression-free survival. Key secondary end points were overall survival, response duration, and minimal residual disease (MRD)-negative status. RESULTS In total, 494 patients were randomly assigned to receive BVd (243 patients) or DVd (251 patients). At a median follow-up of 28.2 months (range, 0.1 to 40.0), median progression-free survival was 36.6 months (95% confidence interval [CI], 28.4 to not reached) in the BVd group and 13.4 months (95% CI, 11.1 to 17.5) in the DVd group (hazard ratio for disease progression or death, 0.41; 95% CI, 0.31 to 0.53; P<0.001). Overall survival at 18 months was 84% in the BVd group and 73% in the DVd group. An analysis of the restricted mean response duration favored BVd over DVd (P<0.001). A complete response or better plus MRD-negative status occurred in 25% of the patients in the BVd group and 10% of those in the DVd group. Grade 3 or higher adverse events occurred in 95% of the patients in the BVd group and 78% of those in the DVd group. Ocular events were more common in the BVd group than in the DVd group (79% vs. 29%); such events were managed with dose modifications, and events of worsening visual acuity mostly resolved. CONCLUSIONS As compared with DVd therapy, BVd therapy conferred a significant benefit with respect to progression-free survival among patients who had relapsed or refractory multiple myeloma after at least one line of therapy. Most patients had grade 3 or higher adverse events. (Funded by GSK; DREAMM-7 ClinicalTrials.gov number, NCT04246047; EudraCT number, 2018-003993-29.).
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Affiliation(s)
- Vania Hungria
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Pawel Robak
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Marek Hus
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Vera Zherebtsova
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Christopher Ward
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - P Joy Ho
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Ana Carolina Ribas de Almeida
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Roman Hajek
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Kihyun Kim
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Sebastian Grosicki
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Hanlon Sia
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Adam Bryant
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Marcelo Pitombeira de Lacerda
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Gracia Aparecida Martinez
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Anna Maria Sureda Balarí
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Irwindeep Sandhu
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Claudio Cerchione
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Peter Ganly
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Meletios Dimopoulos
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Chengcheng Fu
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Mamta Garg
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Al-Ola Abdallah
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Albert Oriol
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Moshe E Gatt
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Michele Cavo
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Robert Rifkin
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Tomoaki Fujisaki
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Michał Mielnik
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Nick Pirooz
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Astrid McKeown
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Simon McNamara
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Xiangdong Zhou
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Maureen Nichols
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Eric Lewis
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Rachel Rogers
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Hena Baig
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Lydia Eccersley
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Sumita Roy-Ghanta
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - Joanna Opalinska
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
| | - María-Victoria Mateos
- From Clinica São Germano (V.H.) and Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo (G.A.M.), São Paulo, Centro de Pesquisa e Ensino em Saúde de Santa Catarin, Florianópolis (A.C.R.A.), and Universidade da Região de Joinville and Centro de Hematologia e Oncologia, Joinville (M.P.L.) - all in Brazil; Medical University of Lodz, Lodz (P.R.), Medical University of Lublin, Lublin (M.H., M.M.), and the Medical University of Silesia, Katowice (S.G.) - all in Poland; Gorodskaya Klinicheskaya Bol'nitsa Imeni Saint Petersburg Botkina, Moscow (V.Z.); the Royal North Shore Hospital (C.W.) and Liverpool Hospital (A.B.), Sydney, Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW (P.J.H.), and Pindara Private Hospital, Gold Coast, QLD (H.S.) - all in Australia; the Department of Hematooncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic (R.H.); Sungkyunkwan University and Samsung Medical Center, Seoul, South Korea (K.K.); Institut Català d'Oncologia-L'Hospitalet de Llobregat-Barcelona, Barcelona (A.M.S.B.), Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona (A.O.), and Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Ciberonc, Salamanca (M.-V.M.) - all in Spain; Cross Cancer Institute, Edmonton (I.S.), and GSK, Mississauga (H.B.) - both in Canada; the Hematology Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori," IRST IRCCS, Meldola (C.C.), and IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna (M.C.) - both in Italy; Christchurch Hospital, Christchurch, New Zealand (P.G.); National and Kapodistrian University of Athens, Athens (M.D.); the First Affiliated Hospital of Soochow University, Suzhou, China (C.F.); University Hospitals of Leicester NHS Trust, Leicester (M.G.), GSK, Stevenage (A.M., S.M.), and GSK, London (L.E.) - all in the United Kingdom; University of Kansas Cancer Center, Fairway (A.-O.A.); the Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (M.E.G.); Rocky Mountain Cancer Centers-Denver-Midtown, Denver (R. Rifkin); Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); GSK, Upper Providence, PA (N.P., X.Z., R. Rogers, S.R.-G., J.O.); and GSK, Durham (M.N.), and GSK, Research Triangle Park (E.L.) - both in North Carolina
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Charalampous C, Goel U, Kapoor P, Binder M, Buadi F, Dingli D, Dispenzieri A, Fonder A, Gertz M, Gonsalves W, Hayman S, Hobbs M, Hwa YL, Kourelis T, Lacy M, Leung N, Lin Y, Warsame R, Kyle RA, Rajkumar V, Kumar SK. Association of Thrombocytopenia With Disease Burden, High-Risk Cytogenetics, and Survival in Newly Diagnosed Multiple Myeloma Patients Treated With Novel Therapies. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00224-6. [PMID: 38955580 DOI: 10.1016/j.clml.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The effect of thrombocytopenia has not been studied in the era of novel treatments in multiple myeloma (MM). OBJECTIVE To evaluate the clinical characteristics and outcomes in MM patients presenting with thrombocytopenia. MATERIALS Newly diagnosed MM patients between 2008 and 2018 who received at least 2 novel agents at induction. Thrombocytopenia was defined as a platelet count of less than < 150,000/mm3. RESULTS A total of 648 patients were identified. Thrombocytopenia was found in 120 patients (18.5%). Baseline disease characteristics associated with higher rates of thrombocytopenia at baseline included IgA myeloma, P < .01, ISS 3 versus 1 or 2, P < .01, R-ISS 3 versus 1 or 2, P < .01, renal failure (CrCl < 30 mL/min), P < .01, hypercalcemia (Ca > 11.5 mg/dL), P < .01, elevated LDH, P < .03, anemia (Hb < 10 g/dL), P < .01, higher serum monoclonal protein, P < .02, and > 60% plasma cells in the bone marrow, P < .01. Thrombocytopenia was more prevalent across patients with t(4;14) and t(14;16), but was not associated with an overall high-risk fluorescence in situ hybridization (FISH) classification. Median OS was significantly lower among patients with thrombocytopenia (64.4 vs. 145.0 months, P < .01). In multivariable Cox regression, thrombocytopenia was associated with mortality (HR = 2.45, 95% CI, 1.7-3.6) independently of age, sex, high-risk FISH, ISS stage, response at induction, percentage of plasma cells in the BM, and anemia. CONCLUSION We found that thrombocytopenia was seen among one-fifth of MM patients and was more common in patients with (t[4; 14] and t[14; 16]). Thrombocytopenia had an independent association with worse survival.
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Affiliation(s)
| | - Utkarsh Goel
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Prashant Kapoor
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Moritz Binder
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Francis Buadi
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - David Dingli
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Angela Dispenzieri
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Amie Fonder
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Morie Gertz
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Wilson Gonsalves
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Suzanne Hayman
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Miriam Hobbs
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lisa Hwa
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Taxiarchis Kourelis
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Martha Lacy
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Nelson Leung
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Rahma Warsame
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Robert A Kyle
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Vincent Rajkumar
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN
| | - Shaji K Kumar
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN.
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50
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Pour L, Micheva I, Usenko G, Mikala G, Masszi T, Simeonova K, Thuresson M, Huledal G, Norin S, Bakker NA, Minarik J. PORT: A Randomized, Cross-Over, Phase 2 Study of Melflufen Peripheral Versus Central Intravenous Administration in Patients With Relapsed/Refractory Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e267-e275.e2. [PMID: 38490927 DOI: 10.1016/j.clml.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Melflufen, a first-in-class alkylating peptide-drug conjugate, rapidly enters tumor cells and metabolizes to melphalan. In previous studies, melflufen was administered via central venous catheter (CVC). However, administration by peripheral venous catheter (PVC) may be preferable. PATIENTS AND METHODS PORT was a two-period, phase 2 crossover study of CVC versus PVC melflufen administration in patients with relapsed/refractory multiple myeloma. Adults with ≥ 2 prior therapies refractory to/intolerant of an immunomodulatory drug and a proteasome inhibitor were randomized 1:1 to weekly oral dexamethasone plus melflufen (40 mg) via CVC or PVC infusion on day 1 of 28-day cycle 1. In cycle 2, patients continued dexamethasone and crossed over to the other melflufen administration route. In cycle 3, all patients received melflufen until progression; PVC or CVC routes were allowed based upon investigator decision. Pharmacokinetic sampling was performed during and after melflufen infusion. Primary endpoints were melphalan pharmacokinetic parameters (Cmax, AUC(0-t), and AUC(0-∞)) and frequency and severity of PVC-related local reactions. RESULTS The 90% CIs for adjusted geometric mean ratios for pharmacokinetic parameters following CVC versus PVC administration were within the 0.8-1.25 bioequivalence range (Cmax 0.946 [90% CI: 0.849, 1.053]; AUC(0-t) 0.952 [90% CI: 0.861, 1.053]; AUC(0-∞) 0.955 [90% CI: 0.863, 1.058]). In both arms, adverse events were primarily hematological and similar; no phlebitis or local infusion-related reactions occurred. CONCLUSION Melflufen PVC and CVC administrations are bioequivalent based on melphalan pharmacokinetic parameters. Melflufen via PVC was well tolerated, with no infusion-related reactions or new safety signals and may represent an alternative route of administration.
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Affiliation(s)
- Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Ilina Micheva
- Hematology Clinic, University Hospital "St. Marina," Medical University, Varna, Bulgaria
| | - Ganna Usenko
- City Clinical Hospital #4 of Dnipro, Dnipro, Ukraine
| | - Gabor Mikala
- Department of Hematology and Stem Cell Transplantation, National Institute for Hematology and Infectious Diseases, South Pest Central Hospital, Budapest, Hungary
| | - Tamas Masszi
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
| | - Kameliya Simeonova
- Specialized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria
| | | | | | | | | | - Jiri Minarik
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic.
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