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Wester R, Sonneveld P. Innovations in treatment and response evaluation in multiple myeloma. Haematologica 2016; 101:518-20. [PMID: 27132277 DOI: 10.3324/haematol.2016.142737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ruth Wester
- Erasmus MC Cancer Institute (EMC), Rotterdam, The Netherlands
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102
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Fajardo S, Zook F, Dotson E. Specialty pharmacy for hematologic malignancies. Am J Health Syst Pharm 2016; 73:797-809. [PMID: 27126835 DOI: 10.2146/ajhp150749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The oral oncology medications used in the treatment of chronic lymphocytic leukemia, chronic myeloid leukemia, multiple myeloma, and non-Hodgkin's lymphoma are reviewed, and the specialty pharmacy services at three large academic medical centers are described. SUMMARY More than one dozen oral oncology medications are being used for hematologic malignancies and afford patients increased convenience and the potential to improve their quality of life. These agents include ibrutinib, idelalisib, imatinib, dasatinib, nilotinib, bosutinib, ponatinib, thalidomide, lenalidomide, pomalidomide, panobinostat, ixazomib, and vorinostat. Despite the benefits of an autonomous-driven patient care plan, these high-risk, high-cost treatments are not without their challenges. Oral oncology medications are associated with significant barriers to adherence, including low health literacy, patient forgetfulness, complex administration instructions, troublesome adverse effects, and high copayments. Many outpatient cancer center pharmacies associated with large academic medical centers are now applying for specialty pharmacy designation. This affords the onsite dispensing pharmacy access to once-limited oral oncology medications that can be dispensed to clinic patients. In addition, the specialty pharmacy services offered within these cancer centers bridge an important gap in patient care and improve the care provided to oncology patients. CONCLUSION As oral oncology agents continue to be approved by FDA, oncology treatment teams must establish a comprehensive plan for their management. Because of their pharmacologic expertise, access to patients' medical records, and unique position within ambulatory care oncology teams, pharmacists can play an important role in patient education, laboratory monitoring, medication adherence, and cost saving.
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Affiliation(s)
- Susan Fajardo
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Felicia Zook
- Froedtert and the Medical College of Wisconsin, Milwaukee, WI
| | - Emily Dotson
- James Cancer Hospital, Ohio State Comprehensive Cancer Center, Columbus, OH
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Baertsch MA, Schlenzka J, Mai EK, Merz M, Hillengaß J, Raab MS, Hose D, Wuchter P, Ho AD, Jauch A, Hielscher T, Kunz C, Luntz S, Klein S, Schmidt-Wolf IGH, Goerner M, Schmidt-Hieber M, Reimer P, Graeven U, Fenk R, Salwender H, Scheid C, Nogai A, Haenel M, Lindemann HW, Martin H, Noppeney R, Weisel K, Goldschmidt H. Rationale and design of the German-Speaking Myeloma Multicenter Group (GMMG) trial ReLApsE: a randomized, open, multicenter phase III trial of lenalidomide/dexamethasone versus lenalidomide/dexamethasone plus subsequent autologous stem cell transplantation and lenalidomide maintenance in patients with relapsed multiple myeloma. BMC Cancer 2016; 16:290. [PMID: 27114074 PMCID: PMC4845347 DOI: 10.1186/s12885-016-2321-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 04/15/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite novel therapeutic agents, most multiple myeloma (MM) patients eventually relapse. Two large phase III trials have shown significantly improved response rates (RR) of lenalidomide/dexamethasone compared with placebo/dexamethasone in relapsed MM (RMM) patients. These results have led to the approval of lenalidomide for RMM patients and lenalidomide/dexamethasone has since become a widely accepted second-line treatment. Furthermore, in RMM patients consolidation with high-dose chemotherapy plus autologous stem cell transplantation has been shown to significantly increase progression free survival (PFS) as compared to cyclophosphamide in a phase III trial. The randomized prospective ReLApsE trial is designed to evaluate PFS after lenalidomide/dexamethasone induction, high-dose chemotherapy consolidation plus autologous stem cell transplantation and lenalidomide maintenance compared with the well-established lenalidomide/dexamethasone regimen in RMM patients. METHODS/DESIGN ReLApsE is a randomized, open, multicenter phase III trial in a planned study population of 282 RMM patients. All patients receive three lenalidomide/dexamethasone cycles and--in absence of available stem cells from earlier harvesting--undergo peripheral blood stem cell mobilization and harvesting. Subsequently, patients in arm A continue on consecutive lenalidomide/dexamethasone cycles, patients in arm B undergo high dose chemotherapy plus autologous stem cell transplantation followed by lenalidomide maintenance until discontinuation criteria are met. Therapeutic response is evaluated after the 3(rd) (arm A + B) and the 5(th) lenalidomide/dexamethasone cycle (arm A) or 2 months after autologous stem cell transplantation (arm B) and every 3 months thereafter (arm A + B). After finishing the study treatment, patients are followed up for survival and subsequent myeloma therapies. The expected trial duration is 6.25 years from first patient in to last patient out. The primary endpoint is PFS, secondary endpoints include overall survival (OS), RR, time to best response and the influence of early versus late salvage high dose chemotherapy plus autologous stem cell transplantation on OS. DISCUSSION This phase III trial is designed to evaluate whether high dose chemotherapy plus autologous stem cell transplantation and lenalidomide maintenance after lenalidomide/dexamethasone induction improves PFS compared with the well-established continued lenalidomide/dexamethasone regimen in RMM patients. TRIAL REGISTRATION ISRCTN16345835 (date of registration 2010-08-24).
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Affiliation(s)
- Marc-Andrea Baertsch
- />Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jana Schlenzka
- />Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Elias K. Mai
- />Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Merz
- />Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jens Hillengaß
- />Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marc S. Raab
- />Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Hose
- />Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Wuchter
- />Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anthony D. Ho
- />Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Jauch
- />Institute for Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - Thomas Hielscher
- />Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Christina Kunz
- />Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Steffen Luntz
- />Coordination Centre for Clinical Trials (KKS), University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Klein
- />Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Ingo G. H. Schmidt-Wolf
- />Center for Integrated Oncology, Med. Klinik und Poliklinik III, University Hospital Bonn, Bonn, Germany
| | - Martin Goerner
- />Hematology, Oncology and Palliative Care, Community Hospital Bielefeld, Bielefeld, Germany
| | | | - Peter Reimer
- />Hematology, Oncology and Stem Cell Transplantation, Evangelisches Krankenhaus Essen-Werden gGmbH, Essen, Germany
| | - Ullrich Graeven
- />Hematology, Oncology and Gastroenterology, Maria-Hilf-Krankenhaus, Mönchengladbach, Germany
| | - Roland Fenk
- />Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Duesseldorf, Germany
| | - Hans Salwender
- />Hematology, Oncology and Palliative Care, Asklepios Klinik Altona, Hamburg, Germany
| | - Christof Scheid
- />Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Axel Nogai
- />Internal Medicine III, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Mathias Haenel
- />Hematology, Oncology and Stem Cell Transplantation, Klinikum Chemnitz GmbH, Chemnitz, Germany
| | - Hans W. Lindemann
- />Hematology and Oncology, Kath. Krankenhaus Hagen gem. GmbH - St.-Marien-Hospital, Hagen, Germany
| | - Hans Martin
- />Hematology and Oncology, Goethe University, Frankfurt, Germany
| | | | - Katja Weisel
- />Hematology, Oncology and Immunology, University of Tuebingen, Tuebingen, Germany
| | - Hartmut Goldschmidt
- />Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- />National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
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Martino M, Tripepi G, Messina G, Vincelli ID, Console G, Recchia AG, Gentile M, Molica S, Morabito F. A phase II, single-arm, prospective study of bendamustine plus melphalan conditioning for second autologous stem cell transplantation in de novo multiple myeloma patients through a tandem transplant strategy. Bone Marrow Transplant 2016; 51:1197-203. [DOI: 10.1038/bmt.2016.94] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/27/2016] [Accepted: 02/26/2016] [Indexed: 11/09/2022]
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Italian consensus conference for the outpatient autologous stem cell transplantation management in multiple myeloma. Bone Marrow Transplant 2016; 51:1032-40. [PMID: 27042841 DOI: 10.1038/bmt.2016.79] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/07/2016] [Accepted: 02/19/2016] [Indexed: 01/28/2023]
Abstract
Multiple myeloma (MM) is the leading indication for autologous stem cell transplantation (ASCT) worldwide. The safety and efficacy of reducing hospital stay for MM patients undergoing ASCT have been widely explored, and different outpatient models have been proposed. However, there is no agreement on the criteria for selecting patients eligible for this strategy as well as the standards for their clinical management. On the basis of this rationale, the Italian Group for Stem Cell Transplantation (GITMO) endorsed a project to develop guidelines for the management of outpatient ASCT in MM, using evidence-based knowledge and consensus-formation techniques. An expert panel convened to discuss the currently available data on the practice of outpatient ASCT management and formulated recommendations according to the supporting evidence. Evidence gaps were filled with consensus-based statements. Three main topics were addressed: (1) the identification of criteria for selecting MM patients eligible for outpatient ASCT management; (2) the definition of standard procedures for performing outpatient ASCT (model, supportive care and monitoring during the aplastic phase); (3) the definition of the standard criteria and procedures for re-hospitalization during the aplastic phase at home. Herein, we report the summary and the results of the discussion and the consensus.
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VTD is superior to VCD prior to intensive therapy in multiple myeloma: results of the prospective IFM2013-04 trial. Blood 2016; 127:2569-74. [PMID: 27002117 DOI: 10.1182/blood-2016-01-693580] [Citation(s) in RCA: 197] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/07/2016] [Indexed: 12/21/2022] Open
Abstract
The Intergroupe Francophone du Myélome conducted a randomized trial to compare bortezomib-thalidomide-dexamethasone (VTD) with bortezomib-cyclophosphamide-dexamethasone (VCD) as induction before high-dose therapy and autologous stem cell transplantation (ASCT) in patients with newly diagnosed multiple myeloma. Overall, a total of 340 patients were centrally randomly assigned to receive VTD or VCD. After 4 cycles, on an intent-to-treat basis, 66.3% of the patients in the VTD arm achieved at least a very good partial response (primary end point) vs 56.2% in the VCD arm (P = .05). In addition, the overall response rate was significantly higher in the VTD arm (92.3% vs 83.4% in the VCD arm; P = .01). Hematologic toxicity was higher in the VCD arm, with significantly increased rates of grade 3 and 4 anemia, thrombocytopenia, and neutropenia. On the other hand, the rate of peripheral neuropathy (PN) was significantly higher in the VTD arm. With the exception of hematologic adverse events and PN, other grade 3 or 4 toxicities were rare, with no significant differences between the VTD and VCD arms. Our data support the preferential use of VTD rather than VCD in preparation for ASCT. This trial was registered at www.clinicaltrials.gov as #NCT01564537 and at EudraCT as #2013-003174-27.
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107
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Martino M, Recchia AG, Fedele R, Neri S, Vincelli ID, Moscato T, Gentile M, Morabito F. The role of tandem stem cell transplantation for multiple myeloma patients. Expert Opin Biol Ther 2016; 16:515-34. [PMID: 26698133 DOI: 10.1517/14712598.2016.1136285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Autologous Stem Cell Transplantation (ASCT) represents the standard treatment in eligible "de-novo" multiple myeloma (MM) patients. AREAS COVERED ASCT may be single or tandem, and a single ASCT can be followed by an allogeneic (Allo)-SCT. A systematic review has been conducted to examine the current evidence for the efficacy of using a tandem transplant strategy in MM. EXPERT OPINION A tandem ASCT approach should be considered for all patients, although the benefit from the second ASCT in patients who are in complete remission or experience a very good partial response should be answered in a clinical trial. Recent results with the new induction regimens indicate that there is a role for tandem ASCT in the presence of adverse cytogenetic abnormalities. Planned AlloSCT after ASCT has not been found to be superior in the majority of studies and is not recommended outside of a clinical trial. However, single or tandem ASCT are both appropriate options and participation in prospective clinical trials should be encouraged to resolve the debate in the era of novel agents for MM.
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Affiliation(s)
- Massimo Martino
- a Hematology, Stem Cell Collection and Transplant Unit, Oncology and Hematology Department , Azienda Ospedaliera BMM , Reggio Calabria , Italy
| | - Anna Grazia Recchia
- b Biotechnology Research Unit , Azienda Sanitaria Provinciale di Cosenza , Aprigliano (CS) , Italy
| | - Roberta Fedele
- a Hematology, Stem Cell Collection and Transplant Unit, Oncology and Hematology Department , Azienda Ospedaliera BMM , Reggio Calabria , Italy
| | - Santo Neri
- c Hematology Unit , Azienda Ospedaliera 'Papardo' , Messina , Italy
| | | | - Tiziana Moscato
- a Hematology, Stem Cell Collection and Transplant Unit, Oncology and Hematology Department , Azienda Ospedaliera BMM , Reggio Calabria , Italy
| | - Massimo Gentile
- e Hematology Unit , Azienda Ospedaliera Cosenza , Cosenza , Italy
| | - Fortunato Morabito
- b Biotechnology Research Unit , Azienda Sanitaria Provinciale di Cosenza , Aprigliano (CS) , Italy.,e Hematology Unit , Azienda Ospedaliera Cosenza , Cosenza , Italy
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Droz JP, Bianco L, Cenciu B, Forgues M, Santa F, Fayette J, Couppié P. Retrospective study of a cohort of adult patients with hematological malignancies in a tropical area. World J Hematol 2016; 5:37-50. [DOI: 10.5315/wjh.v5.i1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/13/2015] [Accepted: 01/07/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To review the characteristics of hematological malignancies in tropical areas, and to focus on the specific difficulties regarding their management.
METHODS: This is a retrospective narrative review of cases of patients with hematological malignancies. All medical files of patients with malignant disease whose treatment was coordinated by the Hemato-Oncology service of the Cayenne Hospital in French Guiana between the 1st of January 2010 and the 31st of December 2012 were reviewed. Clinical data were extracted from the medical files and included: Demographic data, comorbidities, serological status for human immunodeficiency virus, human T-lymphotropic virus 1 (HTLV1), hepatitis B virus and hepatitis C virus infections, cytology and pathology diagnoses, disease extension, treatment, organization of disease management, and follow-up. The subgroup of patients with hematological malignancies and virus-related malignancies were reviewed. Cases involving patients with Kaposi sarcoma, and information on solid tumor occurrence in virus-infected patients in the whole patient population were included. Since the data were rendered anonymous, no informed consent was obtained from the patients for this retrospective analysis. Data were compiled using EXCEL® software, and the data presentation is descriptive only. The references search was guided by the nature of the data and discussion.
RESULTS: In total, the clinical files of 594 patients (pts) were reviewed. Hematological malignancies were observed in 87 patients, and Kaposi sarcoma in 2 patients. In total, 70 patients had a viral infection, and 34 of these also had hematological malignancies. The hematological diagnoses were: Multiple myeloma in 27 pts, lymphoma (L) in 43 pts, myeloproliferative disorders in 17 pts and Kaposi sarcoma in two patients. The spectrum of non-Hodgkin lymphomas (NHL) was: Burkitt L (1 pt), follicular L (5 pts), chronic lymphocytic leukemia (5 pts), high-grade NHL (9 pts), mucosa-associated lymphoid tissue NHL (4 pts), T-cell lymphoma (4 pts), Adult T-cell lymphoma-leukemia (ATL)/lymphoma/leukemia (12 pts); three patients had Hodgkin disease. The spectrum of myeloproliferative diseases was: Chronic myelogenous leukemia (8 pts), thrombocytemia (5 pts) and acute leukemia (4 pts). There were no polycythemia vera, myelosclerosis, and myelodysplastic diseases. This appears to be due to bias in the recruitment process. The most important observations were: The specificity of HTLV1- related ATL malignancies, and the high incidence of virus infections in patients with hematological malignancies. Further, we noted several limitations regarding the treatment and organization of disease management. These were not related to the health care organization, but were due to a lack of board-certified hemato-oncology specialists, a lack of access to diagnostic tools (e.g., cytogenetic and molecular diagnosis, imaging techniques), the unavailability of radiotherapy, and the physical distance from mainland France. Yet the geography and cultures of the country also contributed to the encountered difficulties. These same limitations are seen in tropical countries with low and intermediate household incomes, but they are amplified by economic, social, and cultural issues. Thus, there is often little access to diagnostic procedures, adequate clinical management, and an unavailability of suitable medical treatments. Programs have been developed to establish centers of excellence, training in pathology diagnosis, and to provide free access to treatment.
CONCLUSION: Management of hematological malignancies in tropical areas requires particular skills regarding specific features of these diseases and in terms of the affected populations, as well as solid public health policies.
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Efficacy and Safety of Novel Agent-Based Therapies for Multiple Myeloma: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6848902. [PMID: 26949704 PMCID: PMC4753325 DOI: 10.1155/2016/6848902] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/15/2015] [Accepted: 12/22/2015] [Indexed: 12/26/2022]
Abstract
This study aimed at comparing bortezomib, thalidomide, and lenalidomide in patients with multiple myeloma (MM) for safety and efficacy using meta-analysis. This meta-analysis identified 17 randomized controlled trials (RCTs) including 6742 patients. These RCTs were separated according to the different agent-based regimens and to autologous stem-cell transplantation (ASCT). Complete response (CR), progression-free survival (PFS), overall survival (OS), and adverse events (AE) were combined. The total weighted risk ratio (RR) of CR was 3.29 [95% confidence interval (95% CI): 2.22–4.88] (P < 0.0001) for the novel agent-based regimens. These novel agent-based regimens showed greater benefit in terms of PFS of all subgroups irrespective of whether the patient received ASCT or not. The hazard ratio (HR) for PFS was 0.64 [95% CI: 0.60–0.69] (P < 0.00001). Improvements of OS could be found only in the bortezomib- and thalidomide-based regimens without ASCT. The pooled HRs were 0.74 [95% CI: 0.65–0.86] (P < 0.0001) and 0.80 [95% CI: 0.70–0.90] (P = 0.0004), respectively. Several AEs were shown more frequently in the novel agent-based regimens compared with controls such as hematologic events (neutropenia, anemia, and thrombocytopenia), gastrointestinal infection, peripheral neuropathy, thrombosis, and embolism events. In conclusion, in spite of the AEs, novel agent-based regimens are safe and effective for the treatment of MM.
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Katodritou E, Papadaki S, Konstantinidou P, Terpos E. Is it possible to cure myeloma without allogeneic transplantation? Transfus Apher Sci 2016; 54:63-70. [PMID: 26850930 DOI: 10.1016/j.transci.2016.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
During the last decades, a better understanding of the biology of multiple myeloma (MM) has led to the application of novel treatment strategies for MM patients. The new anti-myeloma regimens produce higher incidence of durable and of better quality responses and they improve overall survival, challenging the dogma of incurable disease, outside the context of allogeneic transplantation. This review presents all these strategies that aim to cure MM, including continuous treatment i.e. induction, consolidation and maintenance, treatment of asymptomatic MM and monitoring minimal residual disease using modern techniques, such as multi-parameter flow cytometry, molecular assays and advanced imaging.
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Affiliation(s)
- Eirini Katodritou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece; Greek Myeloma Study Group, Athens, Greece
| | - Sofia Papadaki
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | | | - Evangelos Terpos
- Greek Myeloma Study Group, Athens, Greece; Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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Tacchetti P, Cavo M, Rocchi S, Pezzi A, Pantani L, Brioli A, Testoni N, Terragna C, Zannetti BA, Mancuso K, Marzocchi G, Borsi E, Martello M, Rizzello I, Zamagni E. Prognostic impact of serial measurements of serum-free light chain assay throughout the course of newly diagnosed multiple myeloma treated with bortezomib-based regimens. Leuk Lymphoma 2016; 57:2058-64. [PMID: 26763357 DOI: 10.3109/10428194.2015.1124994] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We retrospectively investigated the role of serial serum-free light chain (sFLC) evaluations in 150 multiple myeloma (MM) patients treated with first-line bortezomib-based regimens. Baseline sFLC ratio (sFLCR) identified three groups of patients - normal, lightly abnormal (<100), and highly abnormal (≥100) - with different progression-free survival (PFS: 3-year estimate 72% versus 61% versus 44%, respectively, p = 0.03). Moreover, the achievement of a normal sFLCR correlated with extended PFS (49 versus 17 months, p < 0.0001) and overall survival (75 versus 43 months, p < 0.0001) as compared with abnormal sFLCR, a gain maintained in a multivariate analysis for PFS. At relapse, a high sFLCR was associated with earlier start of salvage therapy compared with sFLCR <100 (3-month probability: 89% versus 64%, p = 0.0426). In 20% of patients, sFLC escape preceded the conventional relapse by a median of 3.8 months. Our results highlight the role of sFLC assay in the prognosis and follow-up of MM.
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Affiliation(s)
- Paola Tacchetti
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Michele Cavo
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Serena Rocchi
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Annalisa Pezzi
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Lucia Pantani
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Annamaria Brioli
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Nicoletta Testoni
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Carolina Terragna
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Beatrice Anna Zannetti
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Katia Mancuso
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Giulia Marzocchi
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Enrica Borsi
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Marina Martello
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Ilaria Rizzello
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
| | - Elena Zamagni
- a Department of Experimental, Diagnostic and Specialty Medicine, "Seràgnoli" Institute of Hematology , Bologna University School of Medicine , Bologna , Italy
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[A retrospective analysis of autologous peripheral blood hematopoietic stem cell mobilizations and collections in 149 multiple myeloma patients]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 36:367-71. [PMID: 26031520 PMCID: PMC7342593 DOI: 10.3760/cma.j.issn.0253-2727.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To analyze the results and influential factors of mobilization and harvesting of autologous peripheral blood stem cell in patients with multiple myeloma (MM). METHODS Retrospective analysis of peripheral blood stem cell collection data [CD34⁺ cells collected, successful mobilization rate (CD34⁺ cells≥2×10⁶/kg body weight), good mobilization rate (CD34⁺ cells≥5×10⁶/kg body weight)] of 149 multiple myeloma patients who were treated with cyclophosphamide (CTX) or E-CHOP (etoposide+ CTX+epirubicin+vindesine+prednisone) chemotherapy combined with G-CSF mobilization from January 1998 to March 2014. The relevance between gender, age, subtype, DS staging, ISS staging, treatment before mobilization, disease status at mobilization, regiment of mobilizationand the collection results was analyzed. RESULTS A total of 177 stem cell mobilizations were performed in 149 MM patients, the median CD34⁺ cells harvested were 3.20 (0.13-22.34)×10⁶/kg body weight (BW), successful mobilization rate and good mobilization rate were 74.5% and 27.5%, respectively. The single logistic regression analysis showed that gender, age (>60 ys vs ≤60 ys), subtype, DS staging (III vs II+I), ISS staging (III vs II+I) and regiment of mobilization (E-CHOP+G-CSF vs ID-CTX+G-CSF) were not correlated with the cell collection or successful mobilization rate (P>0.05). However, successful collection rate of single harvest in old patients (age>60 ys) was lower (P<0.05), andthe good mobilization rate in patients at ISS stage III was lower (P<0.05). The collection results of patients with fewer cycles of treatment (treatment before mobilization ≤6 cycles) and optimal disease status (disease status at mobilization ≥partial remission) were much better. Analysis of logistic factors revealed that treatment efficacy before mobilization affected success rate of collection (P=0.006). Risk of collection failure in patients who received more than 6 cycles of treatment before mobilization was high (OR 3.57, 95% CI 1.45-8.78). CONCLUSION Gender, age, subtype, DS staging, ISS staging and mobilization regimen did not influence MM patients peripheral blood stem cell collection; but old patients may need twice mobilizations to collect sufficiently. Few cycles of treatment and stable disease status before mobilization is favorable to the mobilization and collection of peripheral blood stem cells.
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Cohen YC, Joffe E, Benyamini N, Dimopoulos MA, Terpos E, Trestman S, Held-Kuznetsov V, Avivi I, Kastritis E. Primary failure of bortezomib in newly diagnosed multiple myeloma – understanding the magnitude, predictors, and significance. Leuk Lymphoma 2016; 57:1382-8. [PMID: 26727104 DOI: 10.3109/10428194.2015.1121258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yael C Cohen
- a Department of Hematology , Sourasky Medical Center and Tel Aviv University , Tel Aviv , Israel
| | - Erel Joffe
- a Department of Hematology , Sourasky Medical Center and Tel Aviv University , Tel Aviv , Israel
| | - Noam Benyamini
- b Department of Hematology , Rambam Medical Center , Technion , Israel
| | - Meletios A Dimopoulos
- c Department of Clinical Therapeutics , National & Kapodistrian University of Athens School of Medicine , Athens , Greece
| | - Evangelos Terpos
- c Department of Clinical Therapeutics , National & Kapodistrian University of Athens School of Medicine , Athens , Greece
| | - Svetlana Trestman
- a Department of Hematology , Sourasky Medical Center and Tel Aviv University , Tel Aviv , Israel
| | | | - Irit Avivi
- a Department of Hematology , Sourasky Medical Center and Tel Aviv University , Tel Aviv , Israel
| | - Efstathios Kastritis
- c Department of Clinical Therapeutics , National & Kapodistrian University of Athens School of Medicine , Athens , Greece
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Song X, Cong Z, Wilson K. Real-world treatment patterns, comorbidities, and disease-related complications in patients with multiple myeloma in the United States. Curr Med Res Opin 2016; 32:95-103. [PMID: 26488820 DOI: 10.1185/03007995.2015.1105202] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe multiple myeloma (MM) treatment patterns and comorbidities over time in the US. RESEARCH DESIGN AND METHODS Study patients were newly diagnosed with MM (ICD-9-CM 203.0x) between 1 July 2006 and 31 March 2014 and had ≥6 months of data prior to the initial MM diagnosis in MarketScan Research Databases. Patients were followed until inpatient death or the end of data. First-line, second-line, and third-line treatment regimens were identified following diagnosis and were described over time based upon the start date of the first line of therapy (2006-2007, 2008-2014, 2013-2014). Comorbid conditions and disease-related complications were examined during the 6 months prior to the line of therapy start dates. RESULTS A total of 24,507 MM patients were examined (mean age: 65.2 years, 54.1% male, mean follow-up: 23 months, 16.2% transplant). Across all lines of therapy, the proportion of patients on thalidomide-based regimens decreased over time. In the first line, bortezomib-based regimens became more common from 2006-2007 to 2008-2014 (2006-2007: 17.0%, 2008-2014: 44.3%, 2013-2014: 49.4%). In the second line, lenalidomide- and bortezomib-based regimens were the most common (2013-2014: lenalidomide: 28.9%, bortezomib: 26.2%). The combination regimen of lenalidomide + bortezomib became more common in the first and second lines. In the third line, carfilzomib- and/or pomalidomide-based regimens were 37.0% in 2013-2014. Skeletal-related events, hypertension, anemia, and chronic kidney disease were the most prevalent comorbidities and disease-related complications. During the 6 months prior to each line of therapy, the prevalence of the majority of the comorbidities and complications increased as patients progressed to higher lines of therapy. CONCLUSIONS MM treatment patterns have been dynamic over time. Comorbid conditions and myeloma-related complications increase as patients progress and may worsen MM patients' prognoses over time. Combination regimens such as lenalidomide + bortezomib are more widely used as first- and second-line therapy. Newly approved agents (carfilzomib, pomalidomide) are the prevailing treatments in the third line and are under further investigation for earlier lines of therapy.
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Affiliation(s)
- Xue Song
- a a Truven Health Analytics , Ann Arbor , MI , USA
| | - Ze Cong
- b b Onyx Pharmaceuticals Inc. , South San Francisco , CA , USA
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Thomas AL, Coarfa C, Qian J, Wilkerson JJ, Rajapakshe K, Krett NL, Gunaratne PH, Rosen ST. Identification of potential glucocorticoid receptor therapeutic targets in multiple myeloma. NUCLEAR RECEPTOR SIGNALING 2015; 13:e006. [PMID: 26715915 PMCID: PMC4693629 DOI: 10.1621/nrs.13006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 10/27/2015] [Indexed: 12/29/2022]
Abstract
Glucocorticoids (GC) are a cornerstone of combination therapies for multiple myeloma. However, patients ultimately develop resistance to GCs frequently based on decreased glucocorticoid receptor (GR) expression. An understanding of the direct targets of GC actions, which induce cell death, is expected to culminate in potential therapeutic strategies for inducing cell death by regulating downstream targets in the absence of a functional GR. The specific goal of our research is to identify primary GR targets that contribute to GC-induced cell death, with the ultimate goal of developing novel therapeutics around these targets that can be used to overcome resistance to GCs in the absence of GR. Using the MM.1S glucocorticoid-sensitive human myeloma cell line, we began with the broad platform of gene expression profiling to identify glucocorticoid-regulated genes further refined by combination treatment with phosphatidylinositol-3’-kinase inhibition (PI3Ki). To further refine the search to distinguish direct and indirect targets of GR that respond to the combination GC and PI3Ki treatment of MM.1S cells, we integrated 1) gene expression profiles of combination GC treatment with PI3Ki, which induces synergistic cell death; 2) negative correlation between genes inhibited by combination treatment in MM.1S cells and genes over-expressed in myeloma patients to establish clinical relevance and 3) GR chromatin immunoprecipitation with massively parallel sequencing (ChIP-Seq) in myeloma cells to identify global chromatin binding for the glucocorticoid receptor (GR). Using established bioinformatics platforms, we have integrated these data sets to identify a subset of candidate genes that may form the basis for a comprehensive picture of glucocorticoid actions in multiple myeloma. As a proof of principle, we have verified two targets, namely RRM2 and BCL2L1, as primary functional targets of GR involved in GC-induced cell death.
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Affiliation(s)
- Alexandra L Thomas
- Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (ALT, JQ, NLK, STR); Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, Texas (CC, JJW, KR); University of Houston, Department of Biology and Biochemistry, Houston, Texas (JJW, PHG) and Feinberg School of Medicine, Northwestern University, Department of Medicine, Chicago, Illinois (STR)
| | - Cristian Coarfa
- Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (ALT, JQ, NLK, STR); Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, Texas (CC, JJW, KR); University of Houston, Department of Biology and Biochemistry, Houston, Texas (JJW, PHG) and Feinberg School of Medicine, Northwestern University, Department of Medicine, Chicago, Illinois (STR)
| | - Jun Qian
- Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (ALT, JQ, NLK, STR); Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, Texas (CC, JJW, KR); University of Houston, Department of Biology and Biochemistry, Houston, Texas (JJW, PHG) and Feinberg School of Medicine, Northwestern University, Department of Medicine, Chicago, Illinois (STR)
| | - Joseph J Wilkerson
- Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (ALT, JQ, NLK, STR); Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, Texas (CC, JJW, KR); University of Houston, Department of Biology and Biochemistry, Houston, Texas (JJW, PHG) and Feinberg School of Medicine, Northwestern University, Department of Medicine, Chicago, Illinois (STR)
| | - Kimal Rajapakshe
- Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (ALT, JQ, NLK, STR); Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, Texas (CC, JJW, KR); University of Houston, Department of Biology and Biochemistry, Houston, Texas (JJW, PHG) and Feinberg School of Medicine, Northwestern University, Department of Medicine, Chicago, Illinois (STR)
| | - Nancy L Krett
- Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (ALT, JQ, NLK, STR); Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, Texas (CC, JJW, KR); University of Houston, Department of Biology and Biochemistry, Houston, Texas (JJW, PHG) and Feinberg School of Medicine, Northwestern University, Department of Medicine, Chicago, Illinois (STR)
| | - Preethi H Gunaratne
- Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (ALT, JQ, NLK, STR); Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, Texas (CC, JJW, KR); University of Houston, Department of Biology and Biochemistry, Houston, Texas (JJW, PHG) and Feinberg School of Medicine, Northwestern University, Department of Medicine, Chicago, Illinois (STR)
| | - Steven T Rosen
- Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois (ALT, JQ, NLK, STR); Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, Texas (CC, JJW, KR); University of Houston, Department of Biology and Biochemistry, Houston, Texas (JJW, PHG) and Feinberg School of Medicine, Northwestern University, Department of Medicine, Chicago, Illinois (STR)
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Deep Response in Multiple Myeloma: A Critical Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:832049. [PMID: 26783530 PMCID: PMC4689894 DOI: 10.1155/2015/832049] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/23/2015] [Indexed: 11/17/2022]
Abstract
Novel and more effective treatment strategies against multiple myeloma (MM) have significantly prolonged patients' survival and raised interest in the depth of response and its association with clinical outcome. Minimal residual disease (MRD) has emerged as one of the most relevant prognostic factors in MM and should be included in a new definition of complete response (CR). Although further standardization is still required, MRD monitoring should be applied in prospective clinical trials as a sensitive tool to compare and evaluate the efficacy of different treatment strategies, particularly in the consolidation and maintenance settings, and implement individualized therapy-monitoring approaches. Here, we review current definition of deep response in MM, advantages and limitations of current MRD assessment assays, clinical evidences for MRD monitoring as a prognostic tool for therapeutic decisions in MM, and challenges to develop uniform criteria for MRD monitoring.
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Shah N, Biran N, Vesole DH. Ixazomib: an oral proteasome inhibitor for the treatment of multiple myeloma. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2016.1122516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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118
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A Phase IIb, Multicenter, Open-Label, Safety, and Efficacy Study of High-Dose, Propylene Glycol-Free Melphalan Hydrochloride for Injection (EVOMELA) for Myeloablative Conditioning in Multiple Myeloma Patients Undergoing Autologous Transplantation. Biol Blood Marrow Transplant 2015; 21:2100-2105. [DOI: 10.1016/j.bbmt.2015.08.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/20/2015] [Indexed: 11/22/2022]
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Giralt S, Garderet L, Durie B, Cook G, Gahrton G, Bruno B, Hari P, Lokhorst H, McCarthy P, Krishnan A, Sonneveld P, Goldschmidt H, Jagannath S, Barlogie B, Mateos M, Gimsing P, Sezer O, Mikhael J, Lu J, Dimopoulos M, Mazumder A, Palumbo A, Abonour R, Anderson K, Attal M, Blade J, Bird J, Cavo M, Comenzo R, de la Rubia J, Einsele H, Garcia-Sanz R, Hillengass J, Holstein S, Johnsen HE, Joshua D, Koehne G, Kumar S, Kyle R, Leleu X, Lonial S, Ludwig H, Nahi H, Nooka A, Orlowski R, Rajkumar V, Reiman A, Richardson P, Riva E, San Miguel J, Turreson I, Usmani S, Vesole D, Bensinger W, Qazilbash M, Efebera Y, Mohty M, Gasparreto C, Gajewski J, LeMaistre CF, Bredeson C, Moreau P, Pasquini M, Kroeger N, Stadtmauer E. American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed Multiple Myeloma. Biol Blood Marrow Transplant 2015; 21:2039-2051. [PMID: 26428082 PMCID: PMC4757494 DOI: 10.1016/j.bbmt.2015.09.016] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 12/14/2022]
Abstract
In contrast to the upfront setting in which the role of high-dose therapy with autologous hematopoietic cell transplantation (HCT) as consolidation of a first remission in patients with multiple myeloma (MM) is well established, the role of high-dose therapy with autologous or allogeneic HCT has not been extensively studied in MM patients relapsing after primary therapy. The International Myeloma Working Group together with the Blood and Marrow Transplant Clinical Trials Network, the American Society of Blood and Marrow Transplantation, and the European Society of Blood and Marrow Transplantation convened a meeting of MM experts to: (1) summarize current knowledge regarding the role of autologous or allogeneic HCT in MM patients progressing after primary therapy, (2) propose guidelines for the use of salvage HCT in MM, (3) identify knowledge gaps, (4) propose a research agenda, and (5) develop a collaborative initiative to move the research agenda forward. After reviewing the available data, the expert committee came to the following consensus statement for salvage autologous HCT: (1) In transplantation-eligible patients relapsing after primary therapy that did NOT include an autologous HCT, high-dose therapy with HCT as part of salvage therapy should be considered standard; (2) High-dose therapy and autologous HCT should be considered appropriate therapy for any patients relapsing after primary therapy that includes an autologous HCT with initial remission duration of more than 18 months; (3) High-dose therapy and autologous HCT can be used as a bridging strategy to allogeneic HCT; (4) The role of postsalvage HCT maintenance needs to be explored in the context of well-designed prospective trials that should include new agents, such as monoclonal antibodies, immune-modulating agents, and oral proteasome inhibitors; (5) Autologous HCT consolidation should be explored as a strategy to develop novel conditioning regimens or post-HCT strategies in patients with short (less than 18 months remissions) after primary therapy; and (6) Prospective randomized trials need to be performed to define the role of salvage autologous HCT in patients with MM relapsing after primary therapy comparing it to "best non-HCT" therapy. The expert committee also underscored the importance of collecting enough hematopoietic stem cells to perform 2 transplantations early in the course of the disease. Regarding allogeneic HCT, the expert committee agreed on the following consensus statements: (1) Allogeneic HCT should be considered appropriate therapy for any eligible patient with early relapse (less than 24 months) after primary therapy that included an autologous HCT and/or high-risk features (ie, cytogenetics, extramedullary disease, plasma cell leukemia, or high lactate dehydrogenase); (2) Allogeneic HCT should be performed in the context of a clinical trial if possible; (3) The role of postallogeneic HCT maintenance therapy needs to be explored in the context of well-designed prospective trials; and (4) Prospective randomized trials need to be performed to define the role salvage allogeneic HCT in patients with MM relapsing after primary therapy.
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Affiliation(s)
- Sergio Giralt
- Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York.
| | | | - Brian Durie
- International Myeloma Foundation, Los Angeles, California
| | - Gordon Cook
- St. James University Hospital, Leed, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Maria Mateos
- Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | | | - Jin Lu
- Peking University Institute of Hematology, People's Hospital, Beijing, Peoples Republic of China
| | - Meletios Dimopoulos
- National and Kapodistrian University of Athens Alexandra Hospital, Athens, Greece
| | | | | | - Rafat Abonour
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Kenneth Anderson
- Dana Farber Cancer Institute, Harvard University, Boston, Massachusetts
| | | | - Joan Blade
- Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Jenny Bird
- University Hospital Bristol, Bristol, United Kingdom
| | - Michele Cavo
- Seragnoli Institut of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | | | | | | | | | | | | | - Douglas Joshua
- Royal Prince Alfred Hospital, Sydney University Medical School, Sydney, Australia
| | - Guenther Koehne
- Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Sagar Lonial
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia
| | - Heinz Ludwig
- Wilhelminenkrebsforschungsinstituts, Vienna, Austria
| | | | - Anil Nooka
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia
| | - Robert Orlowski
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Anthony Reiman
- Dalhousie University Medical School, Dalhousie, Nova Scotia, Canada
| | - Paul Richardson
- Dana Farber Cancer Institute, Harvard University, Boston, Massachusetts
| | | | | | | | - Saad Usmani
- Levine Cancer Institute, Charlotte, North Carolina
| | - David Vesole
- John Theurer Cancer Center, Hackensack, New Jersey
| | | | | | | | - Mohamed Mohty
- University Marie and Pierre Curie, Hospital St Antoine, Paris, France
| | | | | | | | - Chris Bredeson
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | | | - Edward Stadtmauer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania
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Cavo M, Pantani L, Pezzi A, Petrucci MT, Patriarca F, Di Raimondo F, Marzocchi G, Galli M, Montefusco V, Zamagni E, Gamberi B, Tacchetti P, Brioli A, Palumbo A, Sonneveld P. Bortezomib-thalidomide-dexamethasone (VTD) is superior to bortezomib-cyclophosphamide-dexamethasone (VCD) as induction therapy prior to autologous stem cell transplantation in multiple myeloma. Leukemia 2015; 29:2429-31. [PMID: 26442610 DOI: 10.1038/leu.2015.274] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- M Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - L Pantani
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - A Pezzi
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - M T Petrucci
- Azienda Policlinico Umberto I, University La Sapienza, Roma, Italy
| | - F Patriarca
- Hematology and Bone Marrow Transplant Unit, Udine, Italy
| | - F Di Raimondo
- Department of Clinical and Molecular Bio-Medicine, University of Catania, Catania, Italy
| | - G Marzocchi
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - M Galli
- Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - V Montefusco
- Hematology-Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - E Zamagni
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - B Gamberi
- Arcispedale S. Maria Nuova, Hematology, Reggio Emilia, Italy
| | - P Tacchetti
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - A Brioli
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - A Palumbo
- University of Torino, Azienda Ospedaliero-Universitaria (AOU) S. Giovanni Battista Torino, Torino, Italy
| | - P Sonneveld
- Department of Hematology, Erasmus MC, Rotterdam, The Netherlands
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Colombo M, Galletti S, Garavelli S, Platonova N, Paoli A, Basile A, Taiana E, Neri A, Chiaramonte R. Notch signaling deregulation in multiple myeloma: A rational molecular target. Oncotarget 2015; 6:26826-40. [PMID: 26308486 PMCID: PMC4694956 DOI: 10.18632/oncotarget.5025] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/03/2015] [Indexed: 12/16/2022] Open
Abstract
Despite recent therapeutic advances, multiple myeloma (MM) is still an incurable neoplasia due to intrinsic or acquired resistance to therapy. Myeloma cell localization in the bone marrow milieu allows direct interactions between tumor cells and non-tumor bone marrow cells which promote neoplastic cell growth, survival, bone disease, acquisition of drug resistance and consequent relapse. Twenty percent of MM patients are at high-risk of treatment failure as defined by tumor markers or presentation as plasma cell leukemia. Cumulative evidences indicate a key role of Notch signaling in multiple myeloma onset and progression. Unlike other Notch-related malignancies, where the majority of patients carry gain-of-function mutations in Notch pathway members, in MM cell Notch signaling is aberrantly activated due to an increased expression of Notch receptors and ligands; notably, this also results in the activation of Notch signaling in surrounding stromal cells which contributes to myeloma cell proliferation, survival and migration, as well as to bone disease and intrinsic and acquired pharmacological resistance. Here we review the last findings on the mechanisms and the effects of Notch signaling dysregulation in MM and provide a rationale for a therapeutic strategy aiming at inhibiting Notch signaling, along with a complete overview on the currently available Notch-directed approaches.
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Affiliation(s)
- Michela Colombo
- Department of Health Sciences, Università degli Studi di Milano, 20142 Milano, Italy
| | - Serena Galletti
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano; Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milano, Italy
| | - Silvia Garavelli
- Department of Health Sciences, Università degli Studi di Milano, 20142 Milano, Italy
| | - Natalia Platonova
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano; Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milano, Italy
| | - Alessandro Paoli
- Department of Health Sciences, Università degli Studi di Milano, 20142 Milano, Italy
| | - Andrea Basile
- Department of Health Sciences, Università degli Studi di Milano, 20142 Milano, Italy
| | - Elisa Taiana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano; Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milano, Italy
| | - Antonino Neri
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano; Hematology, Fondazione Cà Granda IRCCS Policlinico, 20122 Milano, Italy
| | - Raffaella Chiaramonte
- Department of Health Sciences, Università degli Studi di Milano, 20142 Milano, Italy
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Kim C, Lee HS, Min CK, Lee JJ, Kim K, Yoon DH, Eom HS, Lee H, Lee WS, Shin HJ, Lee JH, Park Y, Jo JC, Do YR, Mun YC. The prognostic impact of inflammatory factors in patients with multiple myeloma treated with thalidomide in Korea. Korean J Intern Med 2015; 30:675-83. [PMID: 26354062 PMCID: PMC4578032 DOI: 10.3904/kjim.2015.30.5.675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The purpose of this study was to determine the correlations between inflammatory factors-including absolute lymphocyte count, lactate dehydrogenase, β2-microglobulin, albumin, C-reactive protein, and ferritin-and the prognosis for survival in patients with multiple myeloma (MM) treated with induction chemotherapy containing thalidomide and who underwent autologous stem cell transplantation (ASCT). METHODS Data from patients at 13 university hospitals in South Korea were collected retrospectively between December 2005 and May 2013. RESULTS The median age of the 232 patients was 57 years (range, 33 to 77) and the male to female ratio was 1.09:1. In the multivariate analysis, fewer than two combined abnormal inflammatory factors was the only independent prognostic factor for superior progression-free survival (relative risk [RR], 0.618; 95% confidence interval [CI], 0.409 to 0.933; p = 0.022), and platelet count > 100 × 10(9)/L and fewer than two combined abnormal inflammatory factors were independent prognostic factors for superior overall survival (RR, 4.739; 95% CI, 1.897 to 11.839; p = 0.001 and RR, 0.263; 95% CI, 0.113 to 0.612; p = 0.002, respectively). CONCLUSIONS Patients with two or more than two combined inflammatory factors who were treated with thalidomide induction chemotherapy and who underwent ASCT showed significantly shorter survival compared to those with fewer than two combined inflammatory factors. These results could be helpful for predicting prognosis in patients with MM.
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Affiliation(s)
- Cheolsu Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
- Correspondence to Ho Sup Lee, M.D. Division of Hematology and Oncology, Department of Internal Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-6363 Fax: +82-51-990-5820 E-mail:
| | - Chang-Ki Min
- Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Je Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Kihyun Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeon Seok Eom
- Department of Internal Medicine, National Cancer Center, Goyang, Korea
| | - Hyewon Lee
- Department of Internal Medicine, National Cancer Center, Goyang, Korea
| | - Won Sik Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Ho-Jin Shin
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Yong Park
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan, Korea
| | - Young Rok Do
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Gao M, Yang G, Han Y, Kong Y, Wu H, Tao Y, Zhan F, Shi J, Wu X. Single-agent bortezomib or bortezomib-based regimens as consolidation therapy after autologous hematopoietic stem cell transplantation in multiple myeloma: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 2015; 8:12202-12210. [PMID: 26550130 PMCID: PMC4612815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/28/2015] [Indexed: 06/05/2023]
Abstract
The efficacy and safety of single-agent bortezomib or bortezomib-based regimens as consolidation therapy after autologous hematopoietic stem cell transplantation (ASCT) in patients with multiple myeloma (MM) has been in question. To address the issue, we conducted a meta-analysis of two randomized double-blind placebo-controlled studies involving a total of 691 patients. The primary outcomes of interest were progression-free survival (PFS) and response rate. Secondary outcomes included overall survival (OS) and adverse events. There was a marked benefit in 3-year PFS with bortezomib (Odds Ratio [OR] = 1.52, 95% confidence interval [CI] = 1.11 to 2.08), whereas there was no difference in 3-year overall survival (OS; OR = 0.91, 95% CI = 0.60 to 1.37). More bortezomib-treated paitents achieved at least a very good partial response (≥ VGPR) (OR = 1.73, 95% CI = 1.19 to 2.51). The rate of complete response or near-complete response (CR/nCR) was significantly higher with bortezomib consolidation therapy (OR = 1.62, 95% CI = 1.18 to 2.22). For adverse events, more patients in the bortezomib consolidation therapy arm experienced peripheral neuropathy (OR = 4.03, 95% CI = 2.72 to 5.96). Significant differences were also seen with those experiencing peripheral neuropathy greater than grade 2 (OR = 4.26, 95% CI = 1.06 to 17.11). Based on these results, we conclude that single-agent bortezomib or bortezomib-based regimens as consolidation therapy after ASCT in patients with MM was effective in the improvement of PFS and response rate. However, peripheral neuropathy must be closely monitored.
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Affiliation(s)
- Minjie Gao
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai, China
| | - Guang Yang
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai, China
| | - Ying Han
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai, China
| | - Yuanyuan Kong
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai, China
| | - Huiqun Wu
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai, China
| | - Yi Tao
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai, China
| | - Fenghuang Zhan
- Department of Internal Medicine, University of Iowa, Carver College of MedicineIowa, USA
| | - Jumei Shi
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai, China
| | - Xiaosong Wu
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai, China
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124
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Prognostic Effect of Comorbidity Indices in Elderly Patients With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:416-9. [DOI: 10.1016/j.clml.2015.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 03/18/2015] [Indexed: 11/15/2022]
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125
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Zamagni E, Nanni C, Mancuso K, Tacchetti P, Pezzi A, Pantani L, Zannetti B, Rambaldi I, Brioli A, Rocchi S, Terragna C, Martello M, Marzocchi G, Borsi E, Rizzello I, Fanti S, Cavo M. PET/CT Improves the Definition of Complete Response and Allows to Detect Otherwise Unidentifiable Skeletal Progression in Multiple Myeloma. Clin Cancer Res 2015; 21:4384-90. [DOI: 10.1158/1078-0432.ccr-15-0396] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/27/2015] [Indexed: 11/16/2022]
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Borsi E, Terragna C, Brioli A, Tacchetti P, Martello M, Cavo M. Therapeutic targeting of hypoxia and hypoxia-inducible factor 1 alpha in multiple myeloma. Transl Res 2015; 165:641-50. [PMID: 25553605 DOI: 10.1016/j.trsl.2014.12.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
Abstract
Multiple myeloma (MM) is a clonal B-cell malignancy characterized by accumulation of malignant plasma cells (PCs) within the bone marrow (BM). The PCs are in close contact with stromal cells, which secrete growth factors and cytokines, promoting tumor cell growth and survival. Despite the availability of new drugs with immunomodulatory properties targeting the neoplastic clone and its microenvironment, MM is still an incurable disease, with patients experiencing subsequent phases of remission and relapse, eventually leading to disease resistance and patient death. It is now well established that the MM BM microenvironment is hypoxic, a condition required for the activation of the hypoxia-inducible factor 1 alpha (HIF-1α). It has been shown that HIF-1α is constitutively expressed in MM even in normoxic conditions, suggesting that HIF-1α suppression might be part of a therapeutic strategy. Constitutively activated HIF-1α enhances neovascularization, increases glucose metabolism, and induces the expression of antiapoptotic proteins. HIF-1α is thought to be one of the most important molecular targets in the treatment of cancer, and a variety of chemical inhibitors for HIF-1α have been developed to date. This review examines the role of HIF-1α in MM and recent developments in harnessing the therapeutic potential of HIF-1α inhibition in MM.
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Affiliation(s)
- Enrica Borsi
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Institute of Hematology, "L. & A. Seràgnoli," Bologna University, S. Orsola's University Hospital, Bologna, Italy
| | - Carolina Terragna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Institute of Hematology, "L. & A. Seràgnoli," Bologna University, S. Orsola's University Hospital, Bologna, Italy
| | - Annamaria Brioli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Institute of Hematology, "L. & A. Seràgnoli," Bologna University, S. Orsola's University Hospital, Bologna, Italy
| | - Paola Tacchetti
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Institute of Hematology, "L. & A. Seràgnoli," Bologna University, S. Orsola's University Hospital, Bologna, Italy
| | - Marina Martello
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Institute of Hematology, "L. & A. Seràgnoli," Bologna University, S. Orsola's University Hospital, Bologna, Italy
| | - Michele Cavo
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Institute of Hematology, "L. & A. Seràgnoli," Bologna University, S. Orsola's University Hospital, Bologna, Italy.
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Arikian SR, Milentijevic D, Binder G, Gibson CJ, Hu XH, Nagarwala Y, Hussein M, Corvino FA, Surinach A, Usmani SZ. Patterns of total cost and economic consequences of progression for patients with newly diagnosed multiple myeloma. Curr Med Res Opin 2015; 31:1105-15. [PMID: 25785551 DOI: 10.1185/03007995.2015.1031732] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have addressed the cost patterns of patients with multiple myeloma (MM) before and after first relapse. This US claims analysis evaluated, from a US health plan perspective, patterns of total direct costs of care from treatment initiation to progression for patients with MM treated with novel agents, using time to next therapy (TTNT) as a proxy measure for progression. METHODS A retrospective study was conducted using a large US claims database, evaluating patients with claims for MM between 2006 and 2013. Patients with claims for stem cell transplant (SCT) were excluded. The analysis focused on patients receiving lenalidomide (LEN) or bortezomib (BORT) based treatment, for whom complete claim history was available through initiation of subsequent treatment. Average patient monthly direct costs were determined, including medical and pharmacy costs, and total cost patterns over quarterly time periods were calculated. RESULTS The study population comprised 2843 patients with newly diagnosed MM (NDMM) and 1361 with relapsed MM. Total monthly cost for patients with NDMM declined steadily, from $15,734 initially to $5082 at 18+ months after therapy. Upon initiation of second-line therapy, total monthly costs rose to $13,876 and declined to $6446 18 months later. Although NDMM cost levels for individual ordinal months were similar between the LEN and BORT groups, TTNT was longer for LEN-based treatments (37 months). The BORT-treated cohort had higher average monthly total costs for NDMM and for the common time period through 37 months after initiation of therapy ($7534 vs $10,763 for LEN and BORT, respectively). Key limitations of this study, in addition to the lack of mortality and staging information available from claims data, include the definition of TTNT based on change in treatment or a defined gap in therapy prior to retreatment, which may differ from actual time of progression in some patients. CONCLUSIONS For patients with NDMM receiving either LEN- or BORT-based treatment without SCT, followed until TTNT, total direct monthly costs (drug + medical) declined steadily over time. Monthly costs returned to near initial levels when patients began second-line therapy and then followed a similar pattern of decline. Due to the longer TTNT for patients initiated on LEN and the associated longer period of below-average costs, patients initiated with LEN-based treatments had mean monthly total costs >$3200 lower than total costs for patients initiated on BORT during the first 3 years after starting treatment, cumulating to nearly $120,000 in lower costs for patients initiated on LEN.
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128
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Stem cell mobilization and autologous stem cell transplantation after pretreatment with bendamustine, prednisone and bortezomib (BPV) in newly diagnosed multiple myeloma. J Cancer Res Clin Oncol 2015; 141:2013-22. [DOI: 10.1007/s00432-015-1984-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
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Abstract
Abstract
In the past decade, one of the major advances in the management of patients with symptomatic newly diagnosed multiple myeloma has been the introduction of novel agents, thalidomide, bortezomib, and lenalidomide, as part of frontline treatment in both transplant and nontransplant candidates. These drugs have markedly improved the rate of complete remission, and time to progression, progression-free survival, and overall survival have significantly increased. This article focuses on more recent frontline therapeutic approaches both in older patients, not eligible for high-dose therapy and autologous stem cell transplantation (ASCT), and in younger patients eligible for early ASCT.
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130
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Mohty M, Harousseau JL. Treatment of autologous stem cell transplant-eligible multiple myeloma patients: ten questions and answers. Haematologica 2015; 99:408-16. [PMID: 24598852 DOI: 10.3324/haematol.2013.096149] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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131
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New criteria for response assessment: role of minimal residual disease in multiple myeloma. Blood 2015; 125:3059-68. [PMID: 25838346 DOI: 10.1182/blood-2014-11-568907] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/17/2015] [Indexed: 12/26/2022] Open
Abstract
Assessment of minimal residual disease (MRD) is becoming standard diagnostic care for potentially curable neoplasms such as acute lymphoblastic leukemia. In multiple myeloma (MM), the majority of patients will inevitably relapse despite achievement of progressively higher complete remission (CR) rates. Novel treatment protocols with inclusion of antibodies and small molecules might well be able to further increase remission rates and potentially also cure rates. Therefore, MRD diagnostics becomes essential to assess treatment effectiveness. This review summarizes reports from the past 2 decades, which demonstrate that persistent MRD by multiparameter flow cytometry, polymerase chain reaction, next-generation sequencing, and positron emission tomography/computed tomography, predicts significantly inferior survival among CR patients. We describe the specific features of currently available techniques for MRD monitoring and outline the arguments favoring new criteria for response assessment that incorporate MRD levels. Extensive data indicate that MRD information can potentially be used as biomarker to evaluate the efficacy of different treatment strategies, help on treatment decisions, and act as surrogate for overall survival. The time has come to address within clinical trials the exact role of baseline risk factors and MRD monitoring for tailored therapy in MM, which implies systematic usage of highly sensitive, cost-effective, readily available, and standardized MRD techniques.
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132
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Richardson PG, Moreau P, Laubach JP, Gupta N, Hui AM, Anderson KC, San Miguel JF, Kumar S. The investigational proteasome inhibitor ixazomib for the treatment of multiple myeloma. Future Oncol 2015; 11:1153-68. [DOI: 10.2217/fon.15.9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
ABSTRACT Ixazomib is an investigational, reversible 20S proteasome inhibitor. It is the first oral proteasome inhibitor under clinical investigation in multiple myeloma (MM). Under physiological conditions, the stable citrate ester drug substance, ixazomib citrate (MLN9708), rapidly hydrolyzes to the biologically active boronic acid, ixazomib (MLN2238). Preclinical studies have demonstrated antitumor activity in MM cell lines and xenograft models. In Phase I/II clinical studies ixazomib has had generally manageable toxicities, with limited peripheral neuropathy observed to date. Preliminary data from these studies indicate ixazomib is active as a single agent in relapsed/refractory MM and as part of combination regimens in newly diagnosed patients. Phase III studies in combination with lenalidomide–dexamethasone are ongoing.
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Affiliation(s)
- Paul G Richardson
- Division of Hematologic Malignancy, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Philippe Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | - Jacob P Laubach
- Division of Hematologic Malignancy, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Neeraj Gupta
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Ai-Min Hui
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Kenneth C Anderson
- Division of Hematologic Malignancy, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Jesús F San Miguel
- Clinica Universidad de Navarra, Centro Investigación Medica Aplicada (CIMA), Pamplona, Spain
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Mancio Silva J, Fontes-Carvalho R, Valente D, Almeida C, Cruz AJ, Tente D, Coelho H, Oliveira M, Albuquerque A, Ribeiro VG. Extracorporeal membrane oxygenation as bridge-to-decision in acute heart failure due to systemic light-chain amyloidosis. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:174-81. [PMID: 25803181 PMCID: PMC4373156 DOI: 10.12659/ajcr.892772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 58 Final Diagnosis: Acute hear failure Symptoms: Dispnoea • edema • fatigue Medication: — Clinical Procedure: Bone marrow biopsy • endomyocardial biopsy • abdominal subcutaneous fat biopsy under ECMO support Specialty: Cardiology
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Affiliation(s)
- Jennifer Mancio Silva
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Dília Valente
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Cristiana Almeida
- Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Antonio José Cruz
- Department of Internal Medicine, Centro Hospitalar Entre-Douro e Vouga, Santa Maria da Feira, Portugal
| | - David Tente
- Department of Pathology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Henrique Coelho
- Department of Haematology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Marco Oliveira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Aníbal Albuquerque
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Vasco Gama Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
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Mai EK, Bertsch U, Dürig J, Kunz C, Haenel M, Blau IW, Munder M, Jauch A, Schurich B, Hielscher T, Merz M, Huegle-Doerr B, Seckinger A, Hose D, Hillengass J, Raab MS, Neben K, Lindemann HW, Zeis M, Gerecke C, Schmidt-Wolf IGH, Weisel K, Scheid C, Salwender H, Goldschmidt H. Phase III trial of bortezomib, cyclophosphamide and dexamethasone (VCD) versus bortezomib, doxorubicin and dexamethasone (PAd) in newly diagnosed myeloma. Leukemia 2015; 29:1721-9. [DOI: 10.1038/leu.2015.80] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 12/18/2022]
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135
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Utilization of stored autologous PBSCs to support second autologous transplantation in multiple myeloma patients in the era of novel agent therapy. Bone Marrow Transplant 2015; 50:663-7. [DOI: 10.1038/bmt.2015.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/29/2014] [Accepted: 01/14/2015] [Indexed: 11/08/2022]
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136
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Treatment-related symptom management in patients with multiple myeloma: a review. Support Care Cancer 2015; 23:1431-45. [DOI: 10.1007/s00520-014-2552-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 11/30/2014] [Indexed: 11/26/2022]
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137
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Brioli A, Perrone G, Patriarca F, Pezzi A, Nobile F, Ballerini F, Motta MR, Ronconi S, Tacchetti P, Catalano L, Zannetti BA, Rizzi S, Volpe S, Zamagni E, Liberati AM, Mancuso K, Boccadoro M, Davies FE, Morgan GJ, Palumbo A, Cavo M. Successful mobilization of PBSCs predicts favorable outcomes in multiple myeloma patients treated with novel agents and autologous transplantation. Bone Marrow Transplant 2015; 50:673-8. [DOI: 10.1038/bmt.2014.322] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/29/2014] [Accepted: 12/02/2014] [Indexed: 01/08/2023]
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138
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Garcia IN. Role of Hematopoietic Stem Cell Transplantation in Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:86-91. [DOI: 10.1016/j.clml.2014.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
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139
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Wang JH, Zheng WW, Cheng ST, Liu BX, Liu FR, Song JQ. Correlation between microRNA‑21 and sprouty homolog 2 gene expression in multiple myeloma. Mol Med Rep 2015; 11:4220-4. [PMID: 25633921 PMCID: PMC4394969 DOI: 10.3892/mmr.2015.3280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 01/09/2015] [Indexed: 11/21/2022] Open
Abstract
The aim of the present study was to investigate the expression level of microRNA 21 (miR-21) in the peripheral blood of patients with multiple myeloma (MM) and to investigate the correlation between miR-21 and sprouty homolog 2 (SPRY2) gene expression levels in MM. A total of 30 patients with MM, 15 with monoclonal gammopathy of undetermined significance (MGUS) and 20 normal control (NC) outpatients were selected for the detection of miR-21 and SPRY2 expression using reverse transcription-quantitative polymerase chain reaction. In addition, western blot analysis was performed to detect the expression of miR-21 and SPRY2 in MM cell lines. The expression of miR-21 in U-266 cells following lipofectamine transfection of fluorescence-labeled miR-21 mimic/inhibitor was observed using a fluorescence microscope and the expression level of SPRY2 in the miR-21 mimic/inhibitor-transfected U-266 cells was detected using western blot analysis. The miR-21 expression level in the circulating serum of the MM patient group was significantly higher (P<0.01) than that of the MGUS and NC groups. The MM cell lines with high endogenous miR-21 expression exhibited an expression level of SPRY2 that was significantly lower than that in the MM cells with low endogenous miR-21 expression. The transfection efficiency of fluorescence-labeled miR-21 mimic/inhibitor was >90%. Compared with the miR-21 expression level in untreated U-266 cells (0.82±0.13), the expression level of miR-21 was increased by 120.2-fold in miR-21 mimic-transfected cells (98.6±14.2; P<0.001) and was decreased by 61.9% in the miR-21 inhibitor-transfected cells (0.37±0.06; P<0.05). The grayscale value of protein bands demonstrated that SPRY2 protein expression significantly decreased in miR-21 mimic-transfected U-266 cells compared with that in the inhibitor-transfected, siRNA-transfected and untreated cells (P<0.01). miR-21 may represent a negative regulator involved in the downregulation of SPRY2 in MM. miR-21 is closely associated with the pathogenesis, progression and prognosis of MM and may thus be used as an indicator of poor MM prognosis.
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Affiliation(s)
- Jin-Hang Wang
- Laboratory Department of the First Affiliated Hospital of China Medical University, China Medical University School of Medicine Based in Shenyang, Teaching and Research Section of Cell Biology, Shenyang, Liaoning 110001, P.R. China
| | - Wen-Wen Zheng
- Laboratory Department of the First Affiliated Hospital of China Medical University, China Medical University School of Medicine Based in Shenyang, Teaching and Research Section of Cell Biology, Shenyang, Liaoning 110001, P.R. China
| | - Shi-Tong Cheng
- Laboratory Department of the First Affiliated Hospital of China Medical University, China Medical University School of Medicine Based in Shenyang, Teaching and Research Section of Cell Biology, Shenyang, Liaoning 110001, P.R. China
| | - Bo-Xin Liu
- Laboratory Department of the First Affiliated Hospital of China Medical University, China Medical University School of Medicine Based in Shenyang, Teaching and Research Section of Cell Biology, Shenyang, Liaoning 110001, P.R. China
| | - Fu-Rong Liu
- Laboratory Department of the First Affiliated Hospital of China Medical University, China Medical University School of Medicine Based in Shenyang, Teaching and Research Section of Cell Biology, Shenyang, Liaoning 110001, P.R. China
| | - Jian-Qing Song
- Laboratory Department of the First Affiliated Hospital of China Medical University, China Medical University School of Medicine Based in Shenyang, Teaching and Research Section of Cell Biology, Shenyang, Liaoning 110001, P.R. China
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Kamber C, Zimmerli S, Suter-Riniker F, Mueller BU, Taleghani BM, Betticher D, Zander T, Pabst T. Varicella zoster virus reactivation after autologous SCT is a frequent event and associated with favorable outcome in myeloma patients. Bone Marrow Transplant 2015; 50:573-8. [PMID: 25599166 DOI: 10.1038/bmt.2014.290] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 11/09/2022]
Abstract
The occurrence of varicella zoster virus (VZV) reactivation is increased after allogeneic transplantation, whereas limited data are available for herpes zoster (HZ) after autologous SCT (ASCT). We determined the incidence and the prognostic significance of HZ and its correlation with VZV serology in 191 consecutive myeloma patients undergoing high-dose melphalan chemotherapy with ASCT. We found that VZV reactivation occurred in 57 (30%) patients, in 8.5% during induction and in 21.5% after ASCT peaking at 8 months after ASCT. Disease burden due to HZ was assessed as high or rather high in 70% of the patients. By immune fluorescence and Serion Elisa VZV IgG assessment, 90.8% of all patients had specific anti-VZV antibodies at ASCT. Lower specific antibody titers at transplantation were observed in patients with HZ after ASCT than in those without reactivation (P=0.009). Finally, OS was better in myeloma patients with HZ after ASCT compared with patients without HZ (P=0.007). Our data indicate that VZV reactivation after ASCT is a frequent event carrying a significant disease burden and it is associated with improved survival. Low levels of specific VZV antibodies at ASCT suggest increased vulnerability for VZV reactivation.
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Affiliation(s)
- C Kamber
- Department of Medical Oncology, University Hospital and University of Bern, Bern, Switzerland
| | - S Zimmerli
- Department of Infectious Diseases, University Hospital and University of Bern, Bern, Switzerland
| | - F Suter-Riniker
- Department of Infectious Diseases, University Hospital and University of Bern, Bern, Switzerland
| | - B U Mueller
- Department of Clinical Research, University Hospital and University of Bern, Bern, Switzerland
| | - B M Taleghani
- Department of Hematology, University Hospital and University of Bern, Bern, Switzerland
| | - D Betticher
- Department of Oncology, Cantonal Hospital, Fribourg, Switzerland
| | - T Zander
- Department of Medical Oncology, Cantonal Hospital, Lucerne, Switzerland
| | - T Pabst
- Department of Medical Oncology, University Hospital and University of Bern, Bern, Switzerland
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141
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Abstract
Recent developments in the treatment of multiple myeloma (MM) have led to improvements in response rates and to increased survival. A major advance in the last decade has been the introduction of the novel agents thalidomide, bortezomib, and lenalidomide as part of front-line treatment in both the transplant and nontransplant settings. However, disease relapse is inevitable for the majority of patients and myeloma typically recurs more aggressively with each relapse, eventually leading to the development of treatment-refractory disease. Several phase II and III trials have demonstrated the efficacy of recently approved agents in the setting of relapsed and relapsed and refractory MM, including pomalidomide and carfilzomib. Ixazomib, an oral proteasome inhibitor, and multiple other novel classes of agents are being investigated. These include monoclonal antibodies and histone deacetylase inhibitors, which may further add to the therapeutic armamentarium for this malignancy. Therefore, in a disease characterized by multiple relapses, the optimal sequencing of the different effective options is an important consideration in attempting to prolong survival.
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Affiliation(s)
- Philippe Moreau
- From the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| | - Cyrille Touzeau
- From the Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
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142
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Abstract
For the last 20 years, high-dose therapy with autologous stem cell transplantation (ASCT) for multiple myeloma has been considered a standard frontline treatment for younger patients with adequate organ function. With the introduction of novel agents, specifically thalidomide, bortezomib, and lenalidomide, the role of ASCT has changed in several ways. First, novel agents have been incorporated successfully as induction regimens, increasing the response rate before ASCT, and are now being used as part of both consolidation and maintenance with the goal of extending progression-free and overall survival. These approaches have shown considerable promise with significant improvements in outcome. Furthermore, the efficacy of novel therapeutics has also led to the investigation of these agents upfront without the immediate application of ASCT, and compelling preliminary results have been reported. Next-generation novel agents and the use of monoclonal antibodies have raised the possibility of not only successful salvage strategies to facilitate delayed transplantation for younger patients, but also the prospect of an nontransplantation approach achieving the same outcome. Moreover, this could be achieved without incurring acute toxicity or long-term complications that are inherent to high-dose alkylation, and melphalan exposure in particular. At present, the role of ASCT has therefore become an area of debate: should it be used upfront in all eligible patients, or should it be used as a salvage treatment at the time of progression for patients achieving a high quality of response with initial therapy? There is a clear need to derive a consensus that is useful for clinicians considering both protocol-directed and non-protocol-directed options for their patients. Participation in ongoing prospective randomized trials is considered vital. While preliminary randomized data from studies in Europe favor early ASCT with novel agents, differences in both agents and the combinations used, as well as limited information on overall survival and benefit for specific patient subsets, suggest that one size does not fit all. Specifically, the optimal approach to treatment of younger patients eligible for ASCT remains a key area for further research. A rigid approach to its use outside of a clinical study is difficult to justify and participation in prospective studies should be a priority.
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143
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All transplantation-eligible patients with myeloma should receive ASCT in first response. Hematology 2014; 2014:250-4. [DOI: 10.1182/asheducation-2014.1.250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AbstractIn this last decade, one of the major advances in the management of multiple myeloma has been the introduction of the novel agents thalidomide, bortezomib, and lenalidomide as part of frontline treatment in young patients eligible for high-dose therapy (HDT) and autologous stem cell transplantation (ASCT). These drugs have markedly improved the rate of complete remission both before and after ASCT without substantially increasing toxicity. The implementation of an “optimal strategy” consisting of novel-agent-based induction, HDT, and the use of novel agents in consolidation and maintenance may result in a 5-year survival rate of 80% and cure might be considered in a subset of patients who present with good prognostic features at the time of diagnosis. Nevertheless, the high efficacy of the novel agents has led some groups to test these agents upfront without ASCT. At the end of 2014, preliminary randomized data favor early ASCT plus novel agents over novel agents alone. Therefore, the optimal approach to the treatment of multiple myeloma is still to propose the most effective treatment that should involve the use of frontline ASCT in young patients eligible for HDT.
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144
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Early or delayed transplantation for multiple myeloma in the era of novel therapy: does one size fit all? Hematology 2014; 2014:255-61. [DOI: 10.1182/asheducation-2014.1.255] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
For the last 20 years, high-dose therapy with autologous stem cell transplantation (ASCT) for multiple myeloma has been considered a standard frontline treatment for younger patients with adequate organ function. With the introduction of novel agents, specifically thalidomide, bortezomib, and lenalidomide, the role of ASCT has changed in several ways. First, novel agents have been incorporated successfully as induction regimens, increasing the response rate before ASCT, and are now being used as part of both consolidation and maintenance with the goal of extending progression-free and overall survival. These approaches have shown considerable promise with significant improvements in outcome. Furthermore, the efficacy of novel therapeutics has also led to the investigation of these agents upfront without the immediate application of ASCT, and compelling preliminary results have been reported. Next-generation novel agents and the use of monoclonal antibodies have raised the possibility of not only successful salvage strategies to facilitate delayed transplantation for younger patients, but also the prospect of an nontransplantation approach achieving the same outcome. Moreover, this could be achieved without incurring acute toxicity or long-term complications that are inherent to high-dose alkylation, and melphalan exposure in particular. At present, the role of ASCT has therefore become an area of debate: should it be used upfront in all eligible patients, or should it be used as a salvage treatment at the time of progression for patients achieving a high quality of response with initial therapy? There is a clear need to derive a consensus that is useful for clinicians considering both protocol-directed and non-protocol-directed options for their patients. Participation in ongoing prospective randomized trials is considered vital. While preliminary randomized data from studies in Europe favor early ASCT with novel agents, differences in both agents and the combinations used, as well as limited information on overall survival and benefit for specific patient subsets, suggest that one size does not fit all. Specifically, the optimal approach to treatment of younger patients eligible for ASCT remains a key area for further research. A rigid approach to its use outside of a clinical study is difficult to justify and participation in prospective studies should be a priority.
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145
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Post-Autologous (ASCT) Stem Cell Transplant Therapy in Multiple Myeloma. Adv Hematol 2014; 2014:652395. [PMID: 25525435 PMCID: PMC4265378 DOI: 10.1155/2014/652395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/13/2014] [Accepted: 10/14/2014] [Indexed: 12/22/2022] Open
Abstract
Autologous stem cell transplant (ASCT) is the standard of care in transplant-eligible multiple myeloma patients and is associated with significant improvement in progression-free survival (PFS), complete remission rates (CR), and overall survival (OS). However, majority of patients eventually relapse, with a median PFS of around 36 months. Relapses are harder to treat and prognosis declines with each relapse. Achieving and maintaining "best response" to initial therapy is the ultimate goal of first-line treatment and sustained CR is a powerful surrogate for extended survival especially in high-risk multiple myeloma. ASCT is often followed by consolidation/maintenance phase to deepen and/or maintain the response achieved by induction and ASCT. Novel agents like thalidomide, lenalidomide, and bortezomib have been used as single agents or in combination. Thalidomide use has been associated with a meaningful improvement in PFS and EFS, however, with substantial side effects. Data with lenalidomide maintenance after-ASCT is favorable, but the optimal duration of lenalidomide maintenance is still unclear. Bortezomib use has been associated with superior outcomes, predominantly in high-risk myeloma patients. Combination regimens utilizing a proteasome inhibitor (i.e., bortezomib) with an immunomodulatory drug (thalidomide or lenalidomide) have provided the best outcomes. This review article serves as a review of the best available evidence in post-ASCT approaches in multiple myeloma.
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146
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Bianchi G, Anderson KC. Understanding biology to tackle the disease: Multiple myeloma from bench to bedside, and back. CA Cancer J Clin 2014; 64:422-44. [PMID: 25266555 DOI: 10.3322/caac.21252] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/21/2014] [Accepted: 08/21/2014] [Indexed: 02/01/2023] Open
Abstract
Multiple myeloma (MM) is a cancer of antibody-producing plasma cells. The pathognomonic laboratory finding is a monoclonal immunoglobulin or free light chain in the serum and/or urine in association with bone marrow infiltration by malignant plasma cells. MM develops from a premalignant condition, monoclonal gammopathy of undetermined significance (MGUS), often via an intermediate stage termed smoldering multiple myeloma (SMM), which differs from active myeloma by the absence of disease-related end-organ damage. Unlike MGUS and SMM, active MM requires therapy. Over the past 6 decades, major advancements in the care of MM patients have occurred, in particular, the introduction of novel agents (ie, proteasome inhibitors, immunomodulatory agents) and the implementation of hematopoietic stem cell transplantation in suitable candidates. The effectiveness and good tolerability of novel agents allowed for their combined use in induction, consolidation, and maintenance therapy, resulting in deeper and more sustained clinical response and extended progression-free and overall survival. Previously a rapidly lethal cancer with few therapeutic options, MM is the hematologic cancer with the most novel US Food and Drug Administration-approved drugs in the past 15 years. These advances have resulted in more frequent long-term remissions, transforming MM into a chronic illness for many patients.
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Affiliation(s)
- Giada Bianchi
- Hematology Oncology Fellow, Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics, Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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147
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Reconstruction of multiple myeloma lesions around the pelvis and acetabulum. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:643-53. [PMID: 25326868 DOI: 10.1007/s00590-014-1555-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/12/2014] [Indexed: 10/24/2022]
Abstract
Multiple myeloma is a malignancy of monoclonal plasma cells (plasma cells are of B-lymphocyte lineage of the hematopoietic system). It is the second most prevalent blood malignancy after non-Hodgkin's lymphoma. It accounts for approximately 1 % of all malignancies and 2 % of all cancer deaths. Bony involvement is very common; the incidence of pelvic and periacetabular involvement in MM is reported to be around 6 %. Lytic lesions comprise a hallmark of multiple myeloma, which may be complicated with pathologic fractures in a substantial percentage of patients. Pelvic and periacetabular bony involvement of multiple myeloma is associated with some unique characteristics regarding the biomechanics of this specific anatomical region, the morbidity, the overall survival, and prognosis, which all reflect to impairment of quality of life. In this paper, we review the special features of multiple myeloma lesions around the pelvis and acetabulum and present an algorithm of management with the use of current surgical techniques.
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148
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Multiple Myeloma in Older Adults. CURRENT GERIATRICS REPORTS 2014. [DOI: 10.1007/s13670-014-0096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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149
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Preeshagul IR, Van Besien K, Mark TM. Controversies in multiple myeloma: to transplant or not? Curr Hematol Malig Rep 2014; 9:360-7. [PMID: 25145553 DOI: 10.1007/s11899-014-0230-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The treatment of multiple myeloma (MM) has dramatically changed in the last decade due to the introduction of the immunomodulatory drugs (IMIDs) and proteasome inhibitors, otherwise known as the novel agents. Prior to the advent of the novel agents, the gold standard of treatment had been high-dose chemotherapy with autologous stem cell transplantation (HDT/ASCT) for eligible candidates. Given the remarkable activity of the novel agents, and the significant morbidity of HDT/ASCT, the role of stem cell transplantation has now come into question. In this review, we explore the benefits and drawbacks to HDT/ASCT in the era of the novel therapies.
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Affiliation(s)
- Isabel Ruth Preeshagul
- Department of Medicine, Division of Hematology and Oncology, Mount Sinai Beth Israel, 16th street and 1st avenue, New York, NY, 10003, USA,
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150
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Pandya C, Hashmi S, Khera N, Gertz MA, Dispenzieri A, Hogan W, Siddiqui M, Noyes K, Kumar SK. Cost-effectiveness analysis of early vs. late autologous stem cell transplantation in multiple myeloma. Clin Transplant 2014; 28:1084-91. [PMID: 25040732 DOI: 10.1111/ctr.12421] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Autologous stem cell transplant (ASCT) is the current standard of care for most patients with multiple myeloma (MM) who are transplant eligible, yet the timing of ASCT is disputed due to a similar overall (OS) and progression-free survival with an early ASCT (eASCT) or a delayed ASCT (dASCT) approach. OBJECTIVE We developed a decision analytic model to perform cost-effectiveness analysis of the two commonly used treatment strategies for MM. METHODS Data on disease progression and treatment effectiveness came from 2001 to 2008 cohort treated at the Mayo Clinic and from published studies. Cost analysis was performed from a third-party payer perspective. RESULTS The Consumer Price Index adjusted 2012 costs of eASCT and dASCT were $249 236 and $262 610, respectively. eASCT cohort had a benefit of 1.96 quality-adjusted life years (QALYs), 0.23 QALYs more than dASCT, implying that eASCT is preferred (dominant) over dASCT. The most critical variables in one-way sensitivity analysis were treatment-related mortality and OS associated with eASCT strategy. CONCLUSIONS We conclude that eASCT could potentially be a relatively cost-effective treatment option for appropriate patients with MM, and these results would help patients, providers, and payers in decision making for timing of ASCT.
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Affiliation(s)
- Chintan Pandya
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
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