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Oral health status of patients with multiple myeloma. Hematol Transfus Cell Ther 2019; 42:166-172. [PMID: 31582338 PMCID: PMC7248491 DOI: 10.1016/j.htct.2019.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/04/2019] [Accepted: 01/31/2019] [Indexed: 12/04/2022] Open
Abstract
Objective To describe the oral health status of patients with multiple myeloma and compare to a control group. Materials and methods The medical history of the studied subjects was obtained from the medical records and through interviews. Trained examiners evaluated the oral mucosa, teeth, periodontium and imaging aspects. The dental status was evaluated by the decayed, missing and filled teeth index. The presence of bone lesions was investigated with cone beam computer tomography images of the jaws. Results The most common oral mucosa features were paleness (31%) and coated tongue (14.3%) in the multiple myeloma group (N = 42); and coated (21.4%) and fissured tongue (10.7%) in the control group (N = 28). The mean DMFT index of patients with multiple myeloma was high, but not significantly different from controls (14.57 versus 19.69, p = 0.975). Hypodense lesions suggestive of multiple myeloma were observed in the jaws of 73.8% of the patients. Hypodense lesions related to teeth were detected in 33.3% of the patients and in 53.6% of the controls (p = 0.832). Conclusions The studied population of multiple myeloma patients presented many oral health issues that needed attention. Thus, oral care should be included in the routine treatment to improve the quality of the oral status in these patients.
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252
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Zahid MF, Ali N, Nasir M, Baig MH, Iftikhar M, Bin Mahmood SU, Malik A, Atif S, Beg MA. Infections in patients with multiple myeloma treated with conventional chemotherapy: a single-center, 10-year experience in Pakistan. Hematol Transfus Cell Ther 2019; 41:292-297. [PMID: 31412989 PMCID: PMC6978542 DOI: 10.1016/j.htct.2019.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/03/2019] [Accepted: 02/27/2019] [Indexed: 11/06/2022] Open
Abstract
Introduction Multiple myeloma (MM) is a common hematologic malignancy with variable degrees of immunodeficiency. Disease- and treatment-related compromise of the immune system predisposes patients to infections, which are a major cause of morbidity and mortality. Objective We aimed to establish the incidence and main characteristics of infections in MM patients treated at our center over a 10-year period. Method and results Of the 412 patients retrospectively analyzed, 154 (37.4%) were documented to have at least one episode of infection and were included in this study. A total of 244 infectious episodes were documented. The most common site of infection was the lung, followed by the genitourinary system. The most common infections were bacterial, followed by viral. Escherichia coli were the most common organism. In 160 (65.5%) episodes, the organism was not isolated. Thalidomide with dexamethasone was the most common treatment regimen, followed by melphalan with dexamethasone. Infection was the main cause of death in 26 (6.3%) out of all 412 patients. Conclusion Infections are a notable cause of morbidity and mortality in the clinical course of MM patients. By considering patient and disease characteristics, a risk-adapted selection of the MM treatment should be employed, with special attention toward patient age and disease-associated organ dysfunction. Patient education, access to healthcare and physician vigilance are also essential. Vaccination and antimicrobial prophylaxis may be considered prior to or during therapy.
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Affiliation(s)
| | - Natasha Ali
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan; Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Myra Nasir
- Medical Graduate, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Arhama Malik
- Medical Graduate, Aga Khan University, Karachi, Pakistan
| | - Sara Atif
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Mohammad Asim Beg
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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253
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Szabo AG, Iversen KF, Möller S, Plesner T. The Clinical Course of Multiple Myeloma in the Era of Novel Agents: A Retrospective, Single-Center, Real-World Study. Clin Hematol Int 2019; 1:220-228. [PMID: 34595433 PMCID: PMC8432372 DOI: 10.2991/chi.d.190805.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/21/2019] [Indexed: 11/14/2022] Open
Abstract
In this retrospective study we reviewed the clinical course of every patient with multiple myeloma treated from 2006 to 2016 at Vejle Hospital: 303 patients with a median age of 69 years at diagnosis received a median of four (range 1–18) lines of therapy; 149 in a 2006–2010 cohort and 154 in a 2011–2016 cohort. After initiation of treatment, the median decrease in the number of patients per each subsequent line of therapy was 22%. Lenalidomide-dexamethasone (n = 156), bortezomib-dexamethasone (n = 107), and bortezomib-lenalidomide-dexamethasone (n = 84) were the most commonly used regimens. The partial response or better rate was 78%, 58%, 55%, and 44% in lines of therapy one to four, respectively. The median (95% confidence interval [CI]) progression-free survival was 18 (15–22), 10 (8–13), 8 (7–10), and 6 (4–8) months in lines of therapy one to four, respectively. The median (95% CI) overall survival (OS) was 4.1 (3.7–4.8) years. Compared with the 2006–2010 cohort, patients in the 2011–2016 cohort had longer OS; 5.3 (4.7 to not reached) versus 3.4 (2.7–4.0) years, p < 0.0001. This was especially true in patients not treated with high-dose therapy and autologous stem cell transplantation; 4.7 (3.2–5.9) versus 2.6 (2.0–3.3) years, p = 0.0052. Patients in the 2011–2016 cohort were on treatment during a greater part of their life and had higher exposure to high-dose melphalan with autologous stem cell transplantation, lenalidomide, pomalidomide, daratumumab, and carfilzomib.
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Affiliation(s)
- Agoston Gyula Szabo
- Department of Hematology, Vejle Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | | | - Sören Möller
- OPEN - Open Patient Data Explorative Network, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 9 A, 5000, Odense C, Denmark
| | - Torben Plesner
- Department of Hematology, Vejle Hospital, Beriderbakken 4, 7100 Vejle, Denmark
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254
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Giri S, Zhu W, Wang R, Zeidan A, Podoltsev N, Gore SD, Neparidze N, Ma X, Gross CP, Davidoff AJ, Huntington SF. Underutilization of guideline-recommended supportive care among older adults with multiple myeloma in the United States. Cancer 2019; 125:4084-4095. [PMID: 31381151 DOI: 10.1002/cncr.32428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/20/2019] [Accepted: 06/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND With improving survival for patients with multiple myeloma (MM), supportive care that is focused on optimizing quality of life and minimizing treatment-related toxicities is increasingly important. The extent to which patients with MM are receiving recommended supportive care is unknown. METHODS This study used the Surveillance, Epidemiology, and End Results-Medicare database to identify older adults (age ≥66 years) diagnosed with MM in 2008-2013 who had received active treatment and survived 1 year or longer after their diagnosis. Outcomes of interest included guideline-recommended supportive care, which was defined as 1) bone-modifying drugs (BMDs) within the 12 months after the diagnosis, 2) influenza vaccination in the first season after the diagnosis, and 3) concomitant use of prophylactic antivirals with proteasome inhibitors. Multivariable logistic regression models were used to evaluate associations between patient/facility-level characteristics and supportive care use. RESULTS Among 1996 patients receiving MM-directed therapy, 64%, 52%, and 49% received BMDs, an influenza vaccination, and antiviral prophylaxis, respectively. Non-Hispanic black patients (odds ratio [OR] vs white patients, 0.63; 95% confidence interval [CI], 0.46-0.88) and patients with baseline renal impairment (OR, 0.43; 95% CI, 0.34-0.54) had lower odds of BMDs. Non-Hispanic blacks (OR, 0.52; 95% CI, 0.37-0.73) and those with dual Medicaid enrollment (OR, 0.76; 95% CI, 0.58-0.99) had lower odds of influenza vaccination. Treatment in a community-based setting was associated with reduced odds of antiviral prophylaxis (OR, 0.58; 95% CI, 0.46-0.72). CONCLUSIONS Substantial underutilization of guideline-recommended supportive care was observed among older adults with MM in the United States, and this was associated with both patient and facility characteristics. Targeted interventions are needed to improve supportive care for patients with MM.
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Affiliation(s)
- Smith Giri
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Weiwei Zhu
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Amer Zeidan
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Nikolai Podoltsev
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Steven D Gore
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Natalia Neparidze
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Cary P Gross
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Amy J Davidoff
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Scott F Huntington
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
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Riva E, Bove V, Villano F, Mori M, Córdoba C, Noria A, Petruskevicius P, Cardeza A, Díaz L. From guidelines to real world: results from the National Multiple Myeloma Registry in Uruguay on 222 newly diagnosed multiple myeloma patients from 2012 to 2015. Curr Med Res Opin 2019; 35:1197-1203. [PMID: 30621522 DOI: 10.1080/03007995.2019.1568091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: In the last decade, substantial improvements in the understanding of the biology of multiple myeloma and the development of novel therapeutic options have led to increased response rates, progression free survival and overall survival. In underdeveloped countries, it is a huge challenge to adapt for this evolution, both in diagnostic and therapeutic aspects. Methods: We conducted a retrospective, national analysis of all patients with newly diagnosed multiple myeloma in a recent period. Diagnostic and prognostic evaluation is carried out according to international recommendations in the majority of patients. Results: The clinical presentation at diagnosis is similar to those reported internationally, although with higher rates of anemia and severe renal failure. Most patients were diagnosed in advanced Durie-Salmon stage (80%), with high ISS score (48% ISS 3). Treatment, both in candidates and non-candidates for transplantation, is conditioned by a limited supply of possibilities, scarce availability of new drugs and absence of clinical trials. This determines lower results in response depth and survival. At 32 months, overall survival was 61.8%, with a statistical difference in favor of younger patients, standard-risk MM and those treated with novel drugs. No patient received antibacterial or antifungal prophylaxis while the majority received adequate antiviral prophylaxis. Infections were the main cause of death (29.7%), overcoming the disease itself. Conclusions: This analysis allows us to raise awareness about strengths and weaknesses in our management of MM patients. There is a need to promote earlier detection, improve supportive care and reduce infection mortality. Greater availability of evidence-based recommended treatment options is required. Access to clinical trials is warranted if care is to be improved.
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Affiliation(s)
- E Riva
- a Cátedra de Hematología , Hospital de Clínicas , Montevideo , Uruguay
- b Servicio de Hematología , Asociación Española Primera de Socorros Mutuos , Montevideo , Uruguay
- c Servicio de Hematología , Médica Uruguaya , Montevideo , Uruguay
- d Servicio de Hematología , Hospital Británico , Montevideo , Uruguay
| | - V Bove
- a Cátedra de Hematología , Hospital de Clínicas , Montevideo , Uruguay
- e Servicio de Hematología , Servicio Médico Integral , Montevideo , Uruguay
| | - F Villano
- a Cátedra de Hematología , Hospital de Clínicas , Montevideo , Uruguay
- f Servicio de Hematología , CASMU , Montevideo , Uruguay
| | - M Mori
- g Servicio de Hematología , Hospital Maciel , Montevideo , Uruguay
| | - C Córdoba
- h Servicio de Hematología , Asociación Médica de Salto , Salto , Uruguay
| | - A Noria
- i Departamento de Métodos Cuantitativos , Facultad de Medicina , Montevideo , Uruguay
| | - P Petruskevicius
- j Comisión Honoraria de Lucha Contra el Cáncer , Montevideo , Uruguay
| | - A Cardeza
- b Servicio de Hematología , Asociación Española Primera de Socorros Mutuos , Montevideo , Uruguay
| | - L Díaz
- a Cátedra de Hematología , Hospital de Clínicas , Montevideo , Uruguay
- e Servicio de Hematología , Servicio Médico Integral , Montevideo , Uruguay
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256
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Renaud L, Schraen S, Fouquet G, Guidez S, Demarquette H, Nudel M, Cayssials E, Bories C, Herbaux C, Systchenko T, Faucompré JL, Machet A, Sabirou F, Levy A, Bobin A, Richez V, Moya N, Gruchet C, Desmier D, van de Wyngaert Z, Carpentier B, Manier S, Facon T, Harding S, Leleu X. Response to pneumococcal vaccination in multiple myeloma. Cancer Med 2019; 8:3822-3830. [PMID: 31145552 PMCID: PMC6639194 DOI: 10.1002/cam4.2253] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/24/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022] Open
Abstract
Background Streptococcus pneumoniae infection causes morbidity and mortality in multiple myeloma patients. Pneumococcal vaccination is commonly given to immunocompromised myeloma patients; however response data are sparse. Here, we present longitudinal response data to pneumococcal vaccination in multiple myeloma patients. Method Twenty‐eight multiple myeloma patients were included, 25 of whom were newly diagnosed. All the patients received two vaccines Prevnar13® and Pneumo23®. Serotype‐specific IgG was measured by ELISA for all 23 vaccine serotypes at baseline, and then sequentially at different time points postvaccination until treatment ended. Response to vaccination is available for 20 patients. The primary endpoint was the incidence rate of patients who obtained an isotype response serum concentration after vaccination. Secondary endpoints included detailed isotype increase, time to first increase, further assessment of a decreased anti‐pneumococcal serum concentrations following treatment including autologous stem cell transplantation (ASCT), rate of infection with a special attention to pneumococcal infection. Results The median age was 66 years and the male to female ratio was 0.6. Anti‐pneumococcal capsular polysaccharide (anti‐PCP23) IgG, IgG2, IgA, and IgM responses were detected within 1 week postvaccination. Response to at least one subtype of antibody was obtained in 85% (n = 17) of patients, for at least two subtypes in 65% (n = 13), for at least three subtypes in 55% (n = 11), and 2 patients responded to all four subtypes. The median increase in the concentration of anti‐PCP23 isotypes was threefold following vaccination, with the highest increase observed when Pneumo23® was given more than 30 days after Prevnar13®. The anti‐pneumococcal geometric mean concentration decreased significantly for all subtypes over time independently of treatment approaches. Conclusion Myeloma has the ability to demonstrate a response to pneumococcal vaccine, independently of preexisting hypogammaglobulinemia and possibly of treatment‐induced immunodepression. We also observed a drop in the serum response overtime and following autologous transplantation. Further studies in larger sample are needed to understand the benefit of vaccination strategies in these patients.
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Affiliation(s)
- Loïc Renaud
- Department of Hematology, CHU Lille, Lille, France
| | | | | | - Stephanie Guidez
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | | | | | | | | | | | - Thomas Systchenko
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | | | - Antoine Machet
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Florence Sabirou
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Antony Levy
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Arthur Bobin
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | | | - Niels Moya
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Cécile Gruchet
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Deborah Desmier
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | | | | | | | | | | | - Xavier Leleu
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
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257
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Ludwig S, Theis C, Wolff C, Nicolle E, Witthohn A, Götte A. Complications and associated healthcare costs of transvenous cardiac pacemakers in Germany. J Comp Eff Res 2019; 8:589-597. [PMID: 31099255 DOI: 10.2217/cer-2018-0114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study evaluated the occurrence and associated costs of pacemaker complications in Germany from 2010 to 2013. Patients & methods: Patients with a de novo or replacement implantation of a single or dual chamber pacemaker between 2010 and 2013 were followed for 12 months post-implant using German health insurance claims data. A case-control analysis was performed using propensity score matching to estimate the costs of complications. Results: Out of 12,922 implanted patients, 12.0% had a complication in the year following the implant. Complications related to lead and pocket were found in 10.2% of all implanted patients; infections occurred in 1.7% patients. Healthcare costs up to 36 months post complication were on average €4627 higher than for pacemaker patients without a complication. Conclusion: Pacemaker complications are common and represent a burden for patients and healthcare systems generating substantial costs. Most of the pacemaker complications involved the pacing lead or pacemaker pocket.
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Affiliation(s)
- Saskia Ludwig
- HGC GesundheitsConsult GmbH, Mörsenbroicher Weg 200, 40470 Duesseldorf, Germany
| | - Cathrin Theis
- Robert-Bosch-Krankenhaus, Zentrum für Innere Medizin III Kardiologie, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Claudia Wolff
- Medtronic International Trading Sàrl, Route du Molliau 31, 1131 Tolochenaz, Switzerland
| | - Emmanuelle Nicolle
- Medtronic International Trading Sàrl, Route du Molliau 31, 1131 Tolochenaz, Switzerland
| | | | - Andreas Götte
- St. Vincenz Hospital Paderborn, Dept of Cardiology & Intensive Care Medicine, Am Busdorf 2, 33098 Paderborn, Germany
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258
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Atkins S, He F. Chemotherapy and Beyond: Infections in the Era of Old and New Treatments for Hematologic Malignancies. Infect Dis Clin North Am 2019; 33:289-309. [PMID: 30935703 DOI: 10.1016/j.idc.2019.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Treatment options for hematologic malignancies have been rapidly expanding in the past decade, resulting in better survival outcomes for many patients. Infection is an important cause of morbidity and mortality in this patient population. Cytotoxic chemotherapy has well-studied infectious risks related to the degree and duration of myelosuppression. Targeted therapies and immunotherapies have less clearly predictable infectious risk and diverse effects on immune function. This review discusses contemporary management of hematologic malignancies, followed by special discussion of novel agents, including signaling/small molecule inhibitors, monoclonal antibodies, immunomodulators, and immunotherapies, for treatment of hematologic malignancies with focus on infectious risk.
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Affiliation(s)
- Sarah Atkins
- Department of Internal Medicine, University of Minnesota, 420 Delaware Street Southeast, MMC 284, Minneapolis, MN 55455, USA
| | - Fiona He
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, 420 Delaware Street Southeast, MMC 480, Minneapolis, MN 55455, USA.
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259
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Na IK, Buckland M, Agostini C, Edgar JDM, Friman V, Michallet M, Sánchez-Ramón S, Scheibenbogen C, Quinti I. Current clinical practice and challenges in the management of secondary immunodeficiency in hematological malignancies. Eur J Haematol 2019; 102:447-456. [PMID: 30801785 PMCID: PMC6849602 DOI: 10.1111/ejh.13223] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 12/30/2022]
Abstract
Objective Despite long‐standing safe and effective use of immunoglobulin replacement therapy (IgRT) in primary immunodeficiency, clinical data on IgRT in patients with secondary immunodeficiency (SID) due to B‐cell lymphoproliferative diseases are limited. Here, we examine the correlation between approved IgRT indications, treatment recommendations, and clinical practice in SID. Methods An international online survey of 230 physicians responsible for the diagnosis of SID and the prescription of IgRT in patients with hematological malignancies was conducted. Results Serum immunoglobulin was measured in 83% of patients with multiple myeloma, 76% with chronic lymphocytic leukemia, and 69% with non‐Hodgkin lymphoma. Most physicians (85%) prescribed IgRT after ≥2 severe infections. In Italy, Germany, Spain, and the United States, immunoglobulin use was above average in patients with hypogammaglobulinemia, while in the UK considerably fewer patients received IgRT. The use of subcutaneous immunoglobulin was highest in France (34%) and lowest in Spain (19%). Immunologists measured specific antibody responses, performed test immunization, implemented IgRT, and used subcutaneous immunoglobulin more frequently than physicians overall. Conclusions The management of SID in hematological malignancies varied regionally. Clinical practice did not reflect treatment guidelines, highlighting the need for robust clinical studies on IgRT in this population and harmonization between countries and disciplines.
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Affiliation(s)
- Il-Kang Na
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Berlin, Germany
| | - Matthew Buckland
- UCL Centre for Immunodeficiency, Royal Free Hospital and Great Ormond Street Hospital NHS Foundation Trusts, London, UK
| | - Carlo Agostini
- Department of Internal Medicine, University Hospital, Padua University, Treviso, Italy
| | | | - Vanda Friman
- Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Mauricette Michallet
- Université Claude Bernard Lyon, Lyon, France.,Service d'Hématologie, Centre Léon Bérard, Lyon, France
| | - Silvia Sánchez-Ramón
- Departamento de Inmunología Clínica, Hospital Clínico San Carlos, Universidad Complutense of Madrid, Spain
| | - Carmen Scheibenbogen
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität (FU) Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
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260
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Barilà G, Compagno N, Liço A, Berno T, Bonaldi L, Teramo A, Manni S, Branca A, Frigo AC, Cinetto F, Piazza F, Semenzato G, Zambello R. Severe infections unrelated to neutropenia impact on overall survival in multiple myeloma patients: results of a single centre cohort study. Br J Haematol 2019; 186:e13-e17. [PMID: 30854624 DOI: 10.1111/bjh.15849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Gregorio Barilà
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Nicolò Compagno
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Albana Liço
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Tamara Berno
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Laura Bonaldi
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS-Padua, Padua, Italy
| | - Antonella Teramo
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Sabrina Manni
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Antonio Branca
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Anna C Frigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Biostatistics, Epidemiology and Public Health Unit, Padua University School of Medicine, Padua, Italy
| | - Francesco Cinetto
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Francesco Piazza
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Gianpietro Semenzato
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Renato Zambello
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
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261
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Infectious complications and NK cell depletion following daratumumab treatment of Multiple Myeloma. PLoS One 2019; 14:e0211927. [PMID: 30759167 PMCID: PMC6374018 DOI: 10.1371/journal.pone.0211927] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/17/2019] [Indexed: 12/16/2022] Open
Abstract
Treatment with Daratumumab (Dara), a monoclonal anti-CD38 antibody of IgG1 subtype, is effective in patients with multiple myeloma (MM). However, Dara also impairs the cellular immunity, which in turn may lead to higher susceptibility to infections. The exact link between immune impairment and infectious complications is unclear. In this study, we report that nine out of 23 patients (39%) with progressive MM had infectious complications after Dara treatment. Five of these patients had viral infections, two developed with bacterial infections and two with both bacterial and viral infections. Two of the viral infections were exogenous, i.e. acute respiratory syncytial virus (RSV) and human metapneumovirus (hMPV), while five consisted of reactivations, i.e. one herpes simplex (HSV), 1 varicella-zoster (VZV) and three cytomegalovirus (CMV). Infections were solely seen in patients with partial response or worse. Assessment of circulating lymphocytes indicated a selective depletion of NK cells and viral reactivation after Dara treatment, however this finding does not exclude the multiple components of viral immune-surveillance that may get disabled during this monoclonal treatment in this patient cohort. These results suggest that the use of antiviral and antibacterial prophylaxis and screening of the patients should be considered.
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262
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Mikulska M, Cesaro S, de Lavallade H, Di Blasi R, Einarsdottir S, Gallo G, Rieger C, Engelhard D, Lehrnbecher T, Ljungman P, Cordonnier C. Vaccination of patients with haematological malignancies who did not have transplantations: guidelines from the 2017 European Conference on Infections in Leukaemia (ECIL 7). THE LANCET. INFECTIOUS DISEASES 2019; 19:e188-e199. [PMID: 30744964 DOI: 10.1016/s1473-3099(18)30601-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/21/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022]
Abstract
Patients with haematological malignancies are at high risk of infection because of various mechanisms of humoral and cell-mediated immune deficiencies, which mainly depend on underlying disease and specific therapies. Some of these infections are vaccine preventable. However, these malignancies are different from each other, and the treatment approaches are diverse and rapidly evolving, so it is difficult to have a common programme for vaccination in a haematology ward. Additionally, because of insufficient training about the topic, vaccination is an area often neglected by haematologists, and influenced by cultural differences, even among health-care workers, in compliance to vaccines. Several issues are encountered when addressing vaccination in haematology: the small size of the cohorts that makes it difficult to show the clinical benefits of vaccination, the subsequent need to rely on biological parameters, their clinical pertinence not being established in immunocompromised patients, scarcity of clarity on the optimal timing of vaccination in complex treatment schedules, and the scarcity of data on long-term protection in patients receiving treatments. Moreover, the risk of vaccine-induced disease with live-attenuated vaccines strongly limits their use. Here we summarise guidelines for patients without transplantations, and address the issue by the haematological group-myeloid and lymphoid-of diseases, with a special consideration for children with acute leukaemia.
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Affiliation(s)
- Malgorzata Mikulska
- University of Genoa (DISSAL) and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology Unit, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Hugues de Lavallade
- Deparment of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Roberta Di Blasi
- Haematology Department, Henri Mondor Hospital, Assistance Publique-Hopitaux de Paris, Créteil, France
| | - Sigrun Einarsdottir
- Section of Hematology, Department of Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, Göteborg, Sweden
| | - Giuseppe Gallo
- Pediatric Hematology Oncology Unit, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Christina Rieger
- Department of Hematology Oncology, University of Munich, Germering, Germany
| | - Dan Engelhard
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Ein-Kerem Jerusalem, Israel
| | - Thomas Lehrnbecher
- Paediatric Haematology and Oncology Department, Hospital for Children and Adolescents, University of Frankfurt, Frankfurt, Germany
| | - Per Ljungman
- Department of Cellular Therapy and Allogenenic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden
| | - Catherine Cordonnier
- Haematology Department, Henri Mondor Hospital, Assistance Publique-Hopitaux de Paris, Créteil, France; University Paris-Est Créteil, Créteil, France.
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263
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Patel SY, Carbone J, Jolles S. The Expanding Field of Secondary Antibody Deficiency: Causes, Diagnosis, and Management. Front Immunol 2019; 10:33. [PMID: 30800120 PMCID: PMC6376447 DOI: 10.3389/fimmu.2019.00033] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/08/2019] [Indexed: 12/11/2022] Open
Abstract
Antibody deficiency or hypogammaglobulinemia can have primary or secondary etiologies. Primary antibody deficiency (PAD) is the result of intrinsic genetic defects, whereas secondary antibody deficiency may arise as a consequence of underlying conditions or medication use. On a global level, malnutrition, HIV, and malaria are major causes of secondary immunodeficiency. In this review we consider secondary antibody deficiency, for which common causes include hematological malignancies, such as chronic lymphocytic leukemia or multiple myeloma, and their treatment, protein-losing states, and side effects of a number of immunosuppressive agents and procedures involved in solid organ transplantation. Secondary antibody deficiency is not only much more common than PAD, but is also being increasingly recognized with the wider and more prolonged use of a growing list of agents targeting B cells. SAD may thus present to a broad range of specialties and is associated with an increased risk of infection. Early diagnosis and intervention is key to avoiding morbidity and mortality. Optimizing treatment requires careful clinical and laboratory assessment and may involve close monitoring of risk parameters, vaccination, antibiotic strategies, and in some patients, immunoglobulin replacement therapy (IgRT). This review discusses the rapidly evolving list of underlying causes of secondary antibody deficiency, specifically focusing on therapies targeting B cells, alongside recent advances in screening, biomarkers of risk for the development of secondary antibody deficiency, diagnosis, monitoring, and management.
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Affiliation(s)
- Smita Y. Patel
- Clinical Immunology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Javier Carbone
- Clinical Immunology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
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264
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Régny C, Rodon P, Mariette C, El Zenni N, Pegourié-Bandelier B. Enquête sur l’évaluation des pratiques de prévention infectieuse dans le myélome. Med Mal Infect 2019; 49:76-78. [DOI: 10.1016/j.medmal.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 07/05/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
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265
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The risk of infections in multiple myeloma before and after the advent of novel agents: a 12-year survey. Ann Hematol 2019; 98:713-722. [DOI: 10.1007/s00277-019-03621-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/17/2019] [Indexed: 12/26/2022]
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266
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Girmenia C, Cavo M, Offidani M, Scaglione F, Corso A, Di Raimondo F, Musto P, Petrucci MT, Barosi G. Management of infectious complications in multiple myeloma patients: Expert panel consensus-based recommendations. Blood Rev 2019; 34:84-94. [PMID: 30683446 DOI: 10.1016/j.blre.2019.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/22/2018] [Accepted: 01/08/2019] [Indexed: 02/08/2023]
Abstract
The introduction of new therapeutic agents in multiple myeloma (MM), including proteasome inhibitors, immunoregulatory drugs and monoclonal antibodies, has improved the outcomes of patients, but in parallel has changed the frequency and epidemiology of infections. Hence, the great strides in the indications and use of new active treatments for MM need parallel progresses on the best approach to prophylaxis and supportive therapy for infections. Moving from the recognition that the above issue represents an unmet clinical need in MM, an expert panel assessed the scientific literature and composed a framework of recommendations for optimal infection control in patients candidate to active treatment for MM. The present publication represents a consensus document from questionnaires and consensus meetings held during 2017. The issues tackled in the project dealt with: infectious risk assessment, risk management and prophylaxis, intravenous immunoglobulin replacement therapy, antiviral and antibacterial vaccination. Considering the lack of conclusive and/or enough large studies for certain topics several recommendations derived from the personal experience of the experts.
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Affiliation(s)
- Corrado Girmenia
- Dipartimento di Ematologia, Oncologia, e Dermatologia, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
| | - Michele Cavo
- 'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Massimo Offidani
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesco Scaglione
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Corso
- Division of Hematology, Fondazione IRCCS - Policlinico San Matteo, Pavia, Italy
| | - Francesco Di Raimondo
- Division of Hematology, Azienda Policlinico-Vittorio Emanuele-Catania, and Department of Biomedicine and Molecular Medicine, University of Catania, Catania, Italy
| | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Pz, Italy
| | - Maria Teresa Petrucci
- Dipartimento di Ematologia, Oncologia, e Dermatologia, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
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267
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Vadamalai K, Sanche-Tejera D, Bress J, Mustafa SS. Screening for Humoral Immunodeficiency in Patients with Community-Acquired Pneumonia. J Hosp Med 2019; 14:33037. [PMID: 30534641 DOI: 10.12788/jhm.3106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Immunodeficiency is an underrecognized risk factor for infections, such as community-acquired pneumonia (CAP). OBJECTIVE We evaluated patients admitted with CAP for humoral immunodeficiency. DESIGN Prospective Cohort Study. SETTING Inpatients. PATIENTS, INTERVENTION, AND MEASUREMENTS We enrolled 100 consecutive patients admitted with a diagnosis of CAP from February 2017 to April 2017. Serum IgG, IgM, IgA, and IgE levels were obtained within the first 24 hours of admission. CURB-65 score and length of hospital stay were calculated. The Wilcoxon rank-sum test, Kruskal-Wallis test, and simple linear regression analysis were used in data analysis. RESULTS The prevalence of hypogammaglobinemia in patients with CAP was 38% (95% confidence interval: 28.47% to 48.25%). Twenty-seven of 100 patients had IgG hypogammaglobinemia (median: 598 mg/dL, IQ range: 459-654), 23 of 100 had IgM hypogammaglobinemia (median: 38 mg/dL, IQ range: 25-43), and 6 of 100 had IgA hypogammaglobinemia (median: 36 mg/dL, IQ range: 18-50). The median hospital length of stay for patients with IgG hypogammaglobinemia was significantly higher when compared to patients with normal IgG levels (five days, IQ range [3-10] vs three days, IQ range [2-5], P = .0085). Fourteen patients underwent further immune evaluation, resulting in one diagnosis of multiple myeloma, three patients diagnosed with specific antibody deficiency, and one patient diagnosed with selective IgA deficiency. CONCLUSION There is a high prevalence of hypogammaglobinemia in patients hospitalized with CAP, with IgG and IgM being the most commonly affected classes. IgG hypogammaglobinemia was associated with an increased length of hospitalization. Screening immunoglobulin levels in CAP patients may also uncover underlying humoral immunodeficiency or immunoproliferative disorders.
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Affiliation(s)
| | | | - Jonathan Bress
- Rochester Regional Health, Rochester, New York, USA
- Rochester Institute of Technology, Rochester, New York, USA
| | - S Shahzad Mustafa
- Rochester Regional Health, Rochester, New York, USA
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
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268
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A Phase I Study to Assess the Safety and Pharmacokinetics of Single-agent Lorvotuzumab Mertansine (IMGN901) in Patients with Relapsed and/or Refractory CD–56-positive Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:29-34. [DOI: 10.1016/j.clml.2018.08.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 08/31/2018] [Indexed: 11/20/2022]
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269
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Paner A, Okwuosa TM, Richardson KJ, Libby EN. Triplet therapies - the new standard of care for multiple myeloma: how to manage common toxicities. Expert Rev Hematol 2018; 11:957-973. [PMID: 30339769 DOI: 10.1080/17474086.2018.1538777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Multiple three drug combination regimens have been approved for the treatment of multiple myeloma in the last few years. Triplets have become the new standard of care for transplant eligible and ineligible patients with newly diagnosed as well as relapsed multiple myeloma. Novel agents have a unique profile of side effects. The management of toxicities is important to maintain quality of life and maximize treatment duration and benefit. Areas covered: This article reviews efficacy data, incidence of key adverse events and provide recommendations and expert opinion regarding how to manage common toxicities in triplet therapies. Relevant publications and abstracts were searched in PubMed, ASH, ASCO and EHA meetings. Guidelines from IMWG, NCCN, ESMO and ASCO, published trial protocols and prescribing information were used to formulate recommendations for the management of toxicities. Expert commentary: Side effects are a critical factor guiding the selection of optimal chemotherapy regimens for multiple myeloma. The majority of toxicities encountered with triplet therapies are reversible and can be readily managed with supportive care and dose modifications.
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Affiliation(s)
- Agne Paner
- a Division of Hematology, Department of Internal Medicine , Rush University Medical Center , Chicago , IL , USA
| | - Tochukwu M Okwuosa
- b Division of Cardiology, Department of Internal Medicine , Rush University Medical Center , Chicago , IL , USA
| | - Kristin J Richardson
- a Division of Hematology, Department of Internal Medicine , Rush University Medical Center , Chicago , IL , USA
| | - Edward N Libby
- c Division of Medical Oncology, Department of Medicine , University of Washington , Seattle , WA , USA
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270
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Sørrig R, Klausen TW, Salomo M, Vangsted A, Gimsing P. Risk factors for infections in newly diagnosed Multiple Myeloma patients: A Danish retrospective nationwide cohort study. Eur J Haematol 2018; 102:182-190. [PMID: 30485563 DOI: 10.1111/ejh.13190] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Infections pose the greatest risk of early death in patients with Multiple Myeloma. However, few studies have analyzed the risk factors for infections in Multiple Myeloma patients. The aim of this study was to analyze the risk factors infections within a population-based MM cohort. METHODS Using Danish registries (from 2005 to 2013), we analyzed all ICD-10 codes for infections within the first 6 months of Multiple Myeloma diagnosis in 2557 patients. RESULTS Pneumonia and sepsis represented 46% of infections. Multivariable regression analysis showed that risk factors for pneumonia were male gender (HR 1.4; P = 0.001), ISS II (HR 1.6; P = 0.0004) and ISSIII (HR 1.8; P = 0.0004) and elevated LDH (HR 2.6; P = 0.0008). Risk factors for sepsis were high bone marrow plasma cell % (HR 1.1; P = 0.038), ISS II (HR 1.7; P = 0.007) ISS III (HR 2.0; P = 0.002) and creatinine (HR 2.1; P = 0.002). Neither immunoparesis (hypogammaglobulinemia) nor comorbidity was significant risk factors. CONCLUSIONS Our study suggests that tumor burden and renal impairment are risk factors for pneumonia and sepsis in the early phase of Multiple Myeloma.
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Affiliation(s)
- Rasmus Sørrig
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tobias W Klausen
- Hematological Research Laboratory, Herlev Hospital, Herlev, Denmark
| | - Morten Salomo
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Annette Vangsted
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Gimsing
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
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271
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Mustafa SS, Shah D, Bress J, Jamshed S. Response to PCV13 vaccination in patients with multiple myeloma versus healthy controls. Hum Vaccin Immunother 2018; 15:452-454. [PMID: 30303441 PMCID: PMC6422465 DOI: 10.1080/21645515.2018.1534516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Infections are a major cause of morbidity and mortality in individuals with multiple myeloma (MM). These individuals exhibit humoral dysfunction and show a suboptimal response to pneumococcal polysaccharide vaccine (PPV23). Since pneumococcal conjugate vaccine (PCV13) elicits a T cell dependent response, it is recommended in patients with multiple myeloma. This study compares the initial response to PCV13 and durability of the response at 6 months in patients with multiple myeloma versus normal controls. Seven patients with multiple myeloma and 18 control patients were enrolled in the study. Streptococcal pneumonia serotype IgG titers were drawn at baseline, day 30, and day 180 after MM patients and controls received PCV13. Although vaccination with PCV13 produced a similar initial response in patients with multiple myeloma compared to control subjects, the duration of response may have waned in patients with multiple myeloma as compared to control subjects.
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Affiliation(s)
- S Shahzad Mustafa
- a Department of Medicine , Rochester Regional Health , Rochester , NY , USA.,b Department of Medicine , University of Rochester School of Medicine and Dentistry , Rochester , NY , USA
| | - Deep Shah
- a Department of Medicine , Rochester Regional Health , Rochester , NY , USA
| | - Jonathan Bress
- a Department of Medicine , Rochester Regional Health , Rochester , NY , USA.,c Rochester Institute of Technology , Rochester , NY , USA
| | - Saad Jamshed
- a Department of Medicine , Rochester Regional Health , Rochester , NY , USA
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272
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Petersson C, Fust R, Hagstedt C, Wågström P, Nilsdotter-Augustinsson Å. "Experiences of the burden of treatment"-Patient reports of facilitated subcutaneous immunoglobulin treatment in adults with immunodeficiency. J Clin Nurs 2018; 27:4270-4278. [PMID: 29917296 DOI: 10.1111/jocn.14580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES To evaluate patient-reported experiences of facilitated subcutaneous immunoglobulin treatment in adults with primary or secondary immunodeficiency. BACKGROUND Decreased levels of circulating antibodies (humoral immunodeficiency) are often associated with higher infection rates which cause problems in daily living, for example, symptoms of severe and recurrent bacterial infections that may cause chronic lung diseases. For some diagnoses, treatment with immunoglobulin becomes critical and lifelong. The acceptability of administration forms is important to achieve adherence to treatment and to increase quality of life for these patients. DESIGN Convergent mixed-method approach. METHODS A structured telephone interview with nine questions evaluated on a score scale about treatment experience, satisfaction and ancillary supplies was used, followed by open-ended questions for each item. RESULTS Prohibiting factors were revealed, exemplified by problems due to technical issues and ancillary supply issues. Promoting factors were shown by high a satisfaction according to the score-scale when combining treatment with daily life as well as increased well-being. Facilitated subcutaneous immunoglobulin treatment led to fewer treatment sessions, with a time-saving aspect also described by high scores in the item concerning longer treatment interval. CONCLUSIONS The opportunity to be given the best possible treatment plan adjusted for each patient's situation is central. Healthcare professionals should discuss the different aspects that can promote and inhibit the outcomes of treatment. RELEVANCE TO CLINICAL PRACTICE The results can help professionals to understand different factors that may impinge on the patients' everyday life when they are forced into a lifelong treatment regimen. This knowledge is also important for nurses who have a responsibility to promote health concerning patients with long-term conditions in general.
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Affiliation(s)
- Christina Petersson
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Research Group at the Academy for Improvement of Health and Welfare, Futurum, Academy for Health and Care at Region Jönköping Council, Jönköping University, Jönköping, Sweden
| | - Ramona Fust
- Department of Infection Diseases, University Hospital of Linköping, Linköping, Sweden
| | - Carina Hagstedt
- Department of Infection Diseases, Region Hospital of Ryhov, Jönköping, Sweden
| | - Per Wågström
- Department of Infection Diseases, Region Hospital of Ryhov, Jönköping, Sweden.,Division of Microbiology and Molecular Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Åsa Nilsdotter-Augustinsson
- Department of Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden
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273
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King T, Jagger J, Wood J, Woodrow C, Snowden A, Haines S, Crosbie C, Houdyk K. Best Practice for the Administration of Daratumumab in Multiple Myeloma: Australian Myeloma Nurse Expert Opinion. Asia Pac J Oncol Nurs 2018; 5:270-284. [PMID: 29963589 PMCID: PMC5996585 DOI: 10.4103/apjon.apjon_9_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/07/2018] [Indexed: 01/23/2023] Open
Abstract
Patients with multiple myeloma (MM) are typically of an advanced age and may have significant co-existing medical conditions. They have often had multiple lines of therapy and as such experience disease-related effects alongside associated treatment toxicities. Daratumumab is a monoclonal antibody approved for the treatment of MM in the relapsed/refractory setting. Clinical studies found that daratumumab showed good tolerability as a monotherapy and in combination with current standard therapies. However, the administration of daratumumab does require specific management considerations. It is administered as an intravenous infusion and infusion-related reactions (IRRs) may occur. Daratumumab also interferes with routine blood transfusion tests, giving false positives for the indirect antiglobulin test. This article highlights key nursing care considerations and practical management aspects to improve the treatment experience of patients receiving daratumumab infusions. Pretreatment aspects, patient education, pre- and post-medication, daratumumab administration, and the management of IRRs are discussed. An IRR management sheet that could be used by nurses and a patient information sheet are located at the end of this article.
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Affiliation(s)
- Tracy King
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Jodie Wood
- Cancer Services, Flinders Medical Centre, Adelaide, SA, Australia
| | - Carmel Woodrow
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | - Sally Haines
- Haematology and Stem Cell Transplantation Service, The Alfred Hospital, Melbourne, Australia
| | | | - Kristen Houdyk
- Cancer Clinical Trials Centre, Austin Health, Melbourne, VIC, Australia
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274
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Ludwig H, Delforge M, Facon T, Einsele H, Gay F, Moreau P, Avet-Loiseau H, Boccadoro M, Hajek R, Mohty M, Cavo M, Dimopoulos MA, San-Miguel JF, Terpos E, Zweegman S, Garderet L, Mateos MV, Cook G, Leleu X, Goldschmidt H, Jackson G, Kaiser M, Weisel K, van de Donk NWCJ, Waage A, Beksac M, Mellqvist UH, Engelhardt M, Caers J, Driessen C, Bladé J, Sonneveld P. Prevention and management of adverse events of novel agents in multiple myeloma: a consensus of the European Myeloma Network. Leukemia 2018; 32:1542-1560. [PMID: 29720735 PMCID: PMC6035147 DOI: 10.1038/s41375-018-0040-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/23/2017] [Accepted: 11/30/2017] [Indexed: 01/03/2023]
Abstract
During the last few years, several new drugs have been introduced for treatment of patients with multiple myeloma, which have significantly improved the treatment outcome. All of these novel substances differ at least in part in their mode of action from similar drugs of the same drug class, or are representatives of new drug classes, and as such present with very specific side effect profiles. In this review, we summarize these adverse events, provide information on their prevention, and give practical guidance for monitoring of patients and for management of adverse events.
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, Vienna, Austria.
| | - Michel Delforge
- Department of Hematology, University Hospital Leuven, Catholic University Leuven, Leuven, Belgium
| | - Thierry Facon
- Department of Hematology, Lille University Hospital, Lille, France
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Philippe Moreau
- Department of Hematology, University Hospital, University of Nantes, Nantes, France
| | - Hervé Avet-Loiseau
- Centre de Recherches en Cancerologie de Toulouse CRCT, Institut National de la Sante et de la Recherche Medicale, Université Toulouse, Toulouse, France
| | - Mario Boccadoro
- Division of Hematology, Citta della Salute e della Scienza, University of Torino, Torino, Italy
| | - Roman Hajek
- Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Mohamad Mohty
- Department of Haematology, Saint Antoine Hospital, University Pierre and Marie Curie, and INSERM UMRs 938, Paris, France
| | - Michele Cavo
- A 'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jesús F San-Miguel
- Department of Hematology, Clinica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Laurent Garderet
- Department of Haematology, Saint Antoine Hospital, University Pierre and Marie Curie, and INSERM UMRs 938, Paris, France
| | - María-Victoria Mateos
- Hospital Universitario de Salamanca, Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
| | - Gordon Cook
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, PRC, and Inserm CIC1402, Hospital de la Miléterie, Poitiers, France
| | - Hartmut Goldschmidt
- National Center for Tumor Diseases, Heidelberg Medical University, Heidelberg, Germany
| | - Graham Jackson
- Department of Hematology, Newcastle University, Newcastle, UK
| | - Martin Kaiser
- Myeloma Group, The Institute of Cancer Research ICR, London, UK
| | - Katja Weisel
- Department of Hematology and Oncology, University of Tuebingen, Tuebingen, Germany
| | | | - Anders Waage
- Department of Hematology, St. Olavs Hospital, and IKOM, NTNU, Trondheim, Norway
| | - Meral Beksac
- Department of Medicine, Ankara University, Ankara, Turkey
| | - Ulf H Mellqvist
- Department of Hematology, Sahlgrenska Hospital, Gothenburg, Sweden
| | - Monika Engelhardt
- Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany
| | - Jo Caers
- Department of Hematology, University Hospital of Liège, Liège, Belgium
| | - Christoph Driessen
- Department of Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Joan Bladé
- Department of Hematology, Amyloidosis and Myeloma Unit, Hospital Clínic de Barcelona, Spain
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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275
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Low frequency of CD3 +CD4 +CD161 + T cells correlates with the occurrence of infections in refractory/relapsed multiple myeloma patients receiving lenalidomide plus low-dose dexamethasone treatment. Ann Hematol 2018; 97:2163-2171. [PMID: 29938309 PMCID: PMC7079859 DOI: 10.1007/s00277-018-3401-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 06/17/2018] [Indexed: 02/07/2023]
Abstract
The aim of this study was to explore the predictive implications of the composition of immune cell populations prior to lenalidomide plus high-dose dexamethasone (Len-Dex) initiation for the occurrence of infections. We prospectively examined immune cell populations in peripheral blood taken at baseline of lenalidomide plus low-dose dexamethasone (Len-dex) therapy and reviewed clinical and microbiology records in 90 patients with refractory/relapsed multiple myeloma (RRMM). Risk factors for infection were analyzed using logistic regression. During a median of 11 cycles of Len-dex treatment, 52 (57.8%) patients experienced at least 1 infection episode. Of a total of 92 episodes of infection, 58 (63%) episodes were clinically defined, 29 (31.5%) episodes were microbiologically defined, and 5 (5.4%) episodes were fever of unknown origin. Severe episodes were more frequently observed during the first 3 cycles. After adjusting for risk factors for infection based on univariate analyses, multivariate analyses showed that lower Hb (< 10 g/dL) was a clinically independent factor associated with occurrence of infections. Lower frequency (P = 0.044) and absolute count (P = 0.014) of circulating CD3+CD4+CD161+ cells prior to Len-dex treatment were also associated with the occurrence of infection, especially during the first 3 cycles of Len-dex therapy. In addition to several clinical predictive factors, we found that CD3+CD4+CD161+ cells may provide additional information for predicting the occurrence of infection in the early period of Len-dex therapy.
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276
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Heaney JLJ, Campbell JP, Iqbal G, Cairns D, Richter A, Child JA, Gregory W, Jackson G, Kaiser M, Owen R, Davies F, Morgan G, Dunn J, Drayson MT. Characterisation of immunoparesis in newly diagnosed myeloma and its impact on progression-free and overall survival in both old and recent myeloma trials. Leukemia 2018; 32:1727-1738. [PMID: 29925902 PMCID: PMC6087716 DOI: 10.1038/s41375-018-0163-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/27/2018] [Accepted: 04/27/2018] [Indexed: 12/13/2022]
Abstract
We measured immunosuppression at myeloma diagnosis and assessed the impact on survival in 5826 UK myeloma trial patients. Polyclonal immunoglobulin levels were below normal in 85% of patients and above normal in only 0.4% of cases for IgA, 0.2% for IgM and no cases for IgG. Immunoparesis had a greater impact in recent trials: median overall survival (OS) was up to 3 years longer for patients without immunoparesis compared to the old trials, less than 1 year longer. Median progression-free survival (PFS) was 39%, 36% and 57% longer for patients with normal IgG, IgA and IgM levels, respectively. The depth of IgM suppression, but not the depth of IgG or IgA suppression, was prognostic for survival: the most severely suppressed IgM tertile of patients OS was 0.9 years shorter than those in the top tertile, and 2.6 years shorter than OS of those with normal IgM levels (p = .007). The degree of suppression of polyclonal IgM levels below normal was associated with worse PFS (p = .0002). Infection does not appear to be the main mechanism through which immunoparesis affects survival. We hypothesise that IgM immunoparesis impacts through a combination of being associated with more aggressive disease and reduced immune surveillance against relapse.
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Affiliation(s)
- Jennifer L J Heaney
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - John P Campbell
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,University of Bath, Bath, UK
| | | | | | - Alex Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | | | | | | | - Roger Owen
- St James's University Hospital, Leeds, UK
| | - Faith Davies
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gareth Morgan
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
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277
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T V, V G, A ND. Multiple Myeloma Index for Risk of Infection. J Cancer 2018; 9:2211-2214. [PMID: 29937941 PMCID: PMC6010689 DOI: 10.7150/jca.24288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/10/2018] [Indexed: 12/11/2022] Open
Abstract
Based on our earlier research into the main characteristics and risk factors for infections in hospitalized patients with multiple myeloma, we created the numerical Multiple Myeloma Index for Risk of Infection (MMIRI) to predict infection in myeloma patients. The included factors that could influence the pathogenesis and incidence of infections were sex, performance status, Durie Salmon stage of disease, International Staging System, serum creatinine level, immune paresis, neutropenia, serum ferritin level, the presence of any catheters, disease duration, stable/progressive disease, and type of therapy. For each of these parameters, the strength of association with infection was statistically estimated and specific number of points was assigned to each of these parameters, proportional to the strength of the association. When designing the MMIRI, we included only those parameters that we determined were pathophysiologically associated with the infection. After further statistical analysis, we identified an optimal cutoff score of 6 or above as indicating a significant risk for infection, with a sensitivity of 93.2% and specificity of 80.2%. The scoring system in the retrospective receiver operating characteristic analysis showed an area under the curve of 0.918. The potential value of the MMIRI is the possibility of identifying those patients who would benefit from the prophylactic administration of antibiotics and other anti-infective measures while minimizing the contribution to antibiotic resistance related to the overuse of these drugs. As far as we know, this index represents the first attempt to create such an instrument for predicting the occurrence of infections in myeloma patients.
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Affiliation(s)
- Valkovic T
- Department of Hematology, Rheumatology and Clinical Immunology, University Hospital Center Rijeka and School of Medicine Rijeka, Croatia
| | - Gacic V
- Department of Hematology, University Hospital Center Mostar, Bosnia and Hercegovina
| | - Nacinovic-Duletic A
- Department of Hematology, Rheumatology and Clinical Immunology, University Hospital Center Rijeka and School of Medicine Rijeka, Croatia
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278
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Parker AR, Bradley C, Harding S, Sánchez-Ramón S, Jolles S, Kiani-Alikhan S. Measurement and interpretation of Salmonella typhi Vi IgG antibodies for the assessment of adaptive immunity. J Immunol Methods 2018; 459:1-10. [PMID: 29800575 DOI: 10.1016/j.jim.2018.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/26/2018] [Accepted: 05/21/2018] [Indexed: 01/15/2023]
Abstract
Response to polysaccharide vaccination can be an invaluable tool for assessing functionality of the adaptive immune system. Measurement of antibodies raised in response to Pneumovax®23 is the current gold standard test, but there are significant challenges and constraints in both the measurement and interpretation of the response. An alternative polysaccharide vaccine approach (Salmonella typhi Vi capsule (ViCPS)) has been suggested. In the present article, we review current evidence for the measurement of ViCPS antibodies in the diagnosis of primary and secondary antibody deficiencies. In particular, we review emerging data suggesting their interpretation in combination with the response to Pneumovax®23 and comment upon the utility of these vaccines to assess humoral immune responses while receiving immunoglobulin replacement therapy (IGRT).
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Affiliation(s)
| | | | | | - Silvia Sánchez-Ramón
- Department of Clinical Immunology Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Sorena Kiani-Alikhan
- Department of Immunology, Barts and The London National Health Service Trust, London, UK
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279
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von Lilienfeld-Toal M, Maschmeyer G. Challenges in Infectious Diseases for Haematologists. Oncol Res Treat 2018; 41:406-410. [PMID: 29734194 DOI: 10.1159/000487439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/06/2018] [Indexed: 01/11/2023]
Abstract
Infections remain a threat for patients with haematological malignancies. In accordance with the European Hematology Association roadmap we provide a concise overview regarding the most relevant current challenges in infectious diseases for haematologists. These include bacterial infections and the need for antibiotic stewardship as well as infections with community-acquired respiratory viruses, infections in patients receiving targeted therapies, re-activations of latent infections and vaccination strategies. The following review intends to summarise the most relevant information for clinicians currently caring for patients with haematological malignancies. Recommendations given are based on the guidelines published by the Infectious Diseases Working Party of the German Society of Haematology and Medical Oncology.
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280
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Sørrig R, Klausen TW, Salomo M, Vangsted A, Gimsing P. Risk factors for blood stream infections in multiple myeloma: A population-based study of 1154 patients in Denmark. Eur J Haematol 2018; 101:21-27. [DOI: 10.1111/ejh.13066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Rasmus Sørrig
- Department of Hematology; Rigshospitalet; Copenhagen Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | | | - Morten Salomo
- Department of Hematology; Rigshospitalet; Copenhagen Denmark
| | - Annette Vangsted
- Department of Hematology; Rigshospitalet; Copenhagen Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Peter Gimsing
- Department of Hematology; Rigshospitalet; Copenhagen Denmark
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281
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Dumontet C, Hulin C, Dimopoulos MA, Belch A, Dispenzieri A, Ludwig H, Rodon P, Van Droogenbroeck J, Qiu L, Cavo M, Van de Velde A, Lahuerta JJ, Allangba O, Lee JH, Boyle E, Perrot A, Moreau P, Manier S, Attal M, Roussel M, Mohty M, Mary JY, Civet A, Costa B, Tinel A, Gaston-Mathé Y, Facon T. A predictive model for risk of early grade ≥ 3 infection in patients with multiple myeloma not eligible for transplant: analysis of the FIRST trial. Leukemia 2018; 32:1404-1413. [PMID: 29784907 PMCID: PMC5990520 DOI: 10.1038/s41375-018-0133-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 11/25/2022]
Abstract
Infections are a major cause of death in patients with multiple myeloma. A post hoc analysis of the phase 3 FIRST trial was conducted to characterize treatment-emergent (TE) infections and study risk factors for TE grade ≥ 3 infection. The number of TE infections/month was highest during the first 4 months of treatment (defined as early infection). Of 1613 treated patients, 340 (21.1%) experienced TE grade ≥ 3 infections in the first 18 months and 56.2% of these patients experienced their first grade ≥ 3 infection in the first 4 months. Risk of early infection was similar regardless of treatment. Based on the analyses of data in 1378 patients through multivariate logistic regression, a predictive model of first TE grade ≥ 3 infection in the first 4 months retained Eastern Cooperative Oncology Group performance status and serum β2-microglobulin, lactate dehydrogenase, and hemoglobin levels to define high- and low-risk groups showing significantly different rates of infection (24.0% vs. 7.0%, respectively; P < 0.0001). The predictive model was validated with data from three clinical trials. This predictive model of early TE grade ≥ 3 infection may be applied in the clinical setting to guide infection monitoring and strategies for infection prevention.
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Affiliation(s)
| | | | | | | | | | - Heinz Ludwig
- Wilhelminen Hospital, Wilhelminen Cancer Research Institute, Vienna, Austria
| | | | | | - Lugui Qiu
- Blood Disease Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | | | | | | | - Eileen Boyle
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | | | - Salomon Manier
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | | | | | - Jean Yves Mary
- INSERM U1153, University Hospital Saint-Louis, Paris, France
| | | | - Bruno Costa
- Celgene International Sàrl, Boudry, Switzerland
| | | | | | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France.
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282
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Gherardin NA, Loh L, Admojo L, Davenport AJ, Richardson K, Rogers A, Darcy PK, Jenkins MR, Prince HM, Harrison SJ, Quach H, Fairlie DP, Kedzierska K, McCluskey J, Uldrich AP, Neeson PJ, Ritchie DS, Godfrey DI. Enumeration, functional responses and cytotoxic capacity of MAIT cells in newly diagnosed and relapsed multiple myeloma. Sci Rep 2018. [PMID: 29515123 PMCID: PMC5841305 DOI: 10.1038/s41598-018-22130-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mucosal-associated invariant T (MAIT) cells are T cells that recognise vitamin-B derivative Ag presented by the MHC-related-protein 1 (MR1) antigen-presenting molecule. While MAIT cells are highly abundant in humans, their role in tumour immunity remains unknown. Here we have analysed the frequency and function of MAIT cells in multiple myeloma (MM) patients. We show that MAIT cell frequency in blood is reduced compared to healthy adult donors, but comparable to elderly healthy control donors. Furthermore, there was no evidence that MAIT cells accumulated at the disease site (bone marrow) of these patients. Newly diagnosed MM patient MAIT cells had reduced IFNγ production and CD27 expression, suggesting an exhausted phenotype, although IFNγ-producing capacity is restored in relapsed/refractory patient samples. Moreover, immunomodulatory drugs Lenalidomide and Pomalidomide, indirectly inhibited MAIT cell activation. We further show that cell lines can be pulsed with vitamin-B derivative Ags and that these can be presented via MR1 to MAIT cells in vitro, to induce cytotoxic activity comparable to that of natural killer (NK) cells. Thus, MAIT cells are reduced in MM patients, which may contribute to disease in these individuals, and moreover, MAIT cells may represent new immunotherapeutic targets for treatment of MM and other malignancies.
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Affiliation(s)
- Nicholas A Gherardin
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria, 3010, Australia.,Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.,ARC Centre of Excellence in Advanced Molecular Imaging, University of Melbourne, Parkville, Victoria, 3010, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - Liyen Loh
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Lorenztino Admojo
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - Alexander J Davenport
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - Kelden Richardson
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - Amy Rogers
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - Phillip K Darcy
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - Misty R Jenkins
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.,The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, 3050, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - H Miles Prince
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.,Clinical Haematology and Bone Marrow Transplant Service, Royal Melbourne Hospital, Parkville, Victoria, 3002, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, 3010, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - Simon J Harrison
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.,Clinical Haematology and Bone Marrow Transplant Service, Royal Melbourne Hospital, Parkville, Victoria, 3002, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, 3010, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - Hang Quach
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, 3010, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - David P Fairlie
- Division of Chemistry & Structural Biology, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, 4072, Australia.,ARC Centre of Excellence in Advanced Molecular Imaging, University of Queensland, Queensland, 4072, Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - James McCluskey
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Adam P Uldrich
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria, 3010, Australia.,ARC Centre of Excellence in Advanced Molecular Imaging, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Paul J Neeson
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - David S Ritchie
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia.,Clinical Haematology and Bone Marrow Transplant Service, Royal Melbourne Hospital, Parkville, Victoria, 3002, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, 3010, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - Dale I Godfrey
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria, 3010, Australia. .,ARC Centre of Excellence in Advanced Molecular Imaging, University of Melbourne, Parkville, Victoria, 3010, Australia.
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283
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Singh G, Arora A, Singh A, Kalra P, Rani S, Singh K, Maurya IK, Mandal RS. Molecular Design, Synthesis, Computational Screening, Antimicrobial Evaluation and Molecular Docking Study of Acetylinic Isatin Hybrids. ChemistrySelect 2018. [DOI: 10.1002/slct.201703051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Gurjaspreet Singh
- Department of Chemistry and Centre of Advanced Studies; Panjab University; Chandigarh 160014 India
| | - Aanchal Arora
- Khalsa College for Women; Civil Lines, Ludhiana; Punjab 141001 India
| | - Akshpreet Singh
- Department of Chemistry and Centre of Advanced Studies; Panjab University; Chandigarh 160014 India
| | - Pooja Kalra
- Department of Chemistry and Centre of Advanced Studies; Panjab University; Chandigarh 160014 India
| | - Sunita Rani
- Department of Chemistry and Centre of Advanced Studies; Panjab University; Chandigarh 160014 India
| | - Kashmir Singh
- Department of Biotechnology; Panjab University; Chandigarh 160014 India
| | - Indresh K. Maurya
- Department of Microbial Biotechnology; Panjab University; Chandigarh 160014 India
| | - Rahul S. Mandal
- Biomedical Informatics Center; National Institute of Cholera and Enteric Diseases; Kolkata, WB India
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284
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Redelman-Sidi G, Michielin O, Cervera C, Ribi C, Aguado JM, Fernández-Ruiz M, Manuel O. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Immune checkpoint inhibitors, cell adhesion inhibitors, sphingosine-1-phosphate receptor modulators and proteasome inhibitors). Clin Microbiol Infect 2018; 24 Suppl 2:S95-S107. [PMID: 29427804 DOI: 10.1016/j.cmi.2018.01.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/18/2018] [Accepted: 01/27/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The present review is part of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in Compromised Hosts (ESGICH) consensus document on the safety of targeted and biological therapies. AIMS To review, from an infectious diseases perspective, the safety profile of immune checkpoint inhibitors, LFA-3-targeted agents, cell adhesion inhibitors, sphingosine-1-phosphate receptor modulators and proteasome inhibitors, and to suggest preventive recommendations. SOURCES Computer-based Medline searches with MeSH terms pertaining to each agent or therapeutic family. CONTENT T-lymphocyte-associated antigen 4 (CTLA-4) and programmed death (PD)-1/PD-1 ligand 1 (PD-L1)-targeted agents do not appear to intrinsically increase the risk of infection but can induce immune-related adverse effects requiring additional immunosuppression. Although CD4+ T-cell lymphopenia is associated with alefacept, no opportunistic infections have been observed. Progressive multifocal leukoencephalopathy (PML) may occur during therapy with natalizumab (anti-α4-integrin monoclonal antibody (mAb)) and efalizumab (anti-CD11a mAb), but no cases have been reported to date with vedolizumab (anti-α4β7 mAb). In patients at high risk for PML (positive anti-JC polyomavirus serology with serum antibody index >1.5 and duration of therapy ≥48 months), the benefit-risk ratio of continuing natalizumab should be carefully considered. Fingolimod induces profound peripheral blood lymphopenia and increases the risk of varicella zoster virus (VZV) infection. Prophylaxis with (val)acyclovir and VZV vaccination should be considered. Proteasome inhibitors also increase the risk of VZV infection, and antiviral prophylaxis with (val)acyclovir is recommended. Anti-Pneumocystis prophylaxis may be considered in myeloma multiple patients with additional risk factors (i.e. high-dose corticosteroids). IMPLICATIONS Clinicians should be aware of the risk of immune-related adverse effects and PML in patients receiving immune checkpoint and cell adhesion inhibitors respectively.
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Affiliation(s)
- G Redelman-Sidi
- Service of Infectious Disease, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.
| | - O Michielin
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - C Cervera
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - C Ribi
- Department of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (i+12), Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (i+12), Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - O Manuel
- Department of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
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285
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Leng S, Lentzsch S, Shen Y, Tsai WY, Wright JD, Hershman DL, Neugut AI. Use and impact of herpes zoster prophylaxis in myeloma patients treated with proteasome inhibitors. Leuk Lymphoma 2018; 59:2465-2469. [PMID: 29390929 DOI: 10.1080/10428194.2018.1429605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Siyang Leng
- a Department of Medicine, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Suzanne Lentzsch
- a Department of Medicine, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Yanhan Shen
- c Department of Biostatistics, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Wei-Yann Tsai
- c Department of Biostatistics, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Jason Dennis Wright
- b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA.,e Department of Obstetrics and Gynecology, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Dawn Lauryn Hershman
- a Department of Medicine, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Alfred I Neugut
- a Department of Medicine, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , NY , USA
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286
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Sørrig R, Klausen TW, Salomo M, Vangsted AJ, Frølund UC, Andersen KT, Klostergaard A, Helleberg C, Pedersen RS, Pedersen PT, Helm-Petersen S, Teodorescu EM, Preiss B, Abildgaard N, Gimsing P. Immunoparesis in newly diagnosed Multiple Myeloma patients: Effects on overall survival and progression free survival in the Danish population. PLoS One 2017; 12:e0188988. [PMID: 29216227 PMCID: PMC5720701 DOI: 10.1371/journal.pone.0188988] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/16/2017] [Indexed: 11/23/2022] Open
Abstract
Immunoparesis (hypogammaglobulinemia) is associated to an unfavorable prognosis in newly diagnosed Multiple myeloma (MM) patients. However, this finding has not been validated in an unselected population-based cohort. We analyzed 2558 newly diagnosed MM patients in the Danish Multiple Myeloma Registry representing the entire MM population in Denmark from 2005–2013. Two-thousand two hundred and fifty three patients (90%) presented with reduction below lower normal levels of at least one uninvolved immunoglobulin. Using multivariable Cox regression we found that high age, high ISS score, high LDH and IgA MM were associated to both shorter overall survival and progression free survival. Furthermore, bone marrow plasma cell % was associated to short progression free survival. Immunoparesis had no independent significant effect on OS (HR 0.9 (95%CI: 0.7;1.0; p = 0.12)). Likewise, the number of suppressed immunoglobulins or the relative degree of suppressed uninvolved immunoglobulins from lower normal level (quantitative immunoparesis) was not associated to OS in the multivariable analysis. However, quantitative immunoparesis with at least 25% reduction (from lower normal level) of uninvolved immunoglobulins was associated to shorter PFS for the entire population. The impact of quantitative immunoparesis on PFS was present irrespective of calendar periods 2005–2008 and 2009–2013. Our population-based study does not confirm that immunoparesis at diagnosis is an independent prognostic factor regarding OS. However, quantitative immunoparesis is associated to a shorter PFS.
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Affiliation(s)
- Rasmus Sørrig
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | | | - Morten Salomo
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Kristian T. Andersen
- Department of Internal Medicine, Hematological section, Vejle Hospital, Vejle, Denmark
| | - Anja Klostergaard
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Robert S. Pedersen
- Department of Internal Medicine, Hematological section, Holstebro Hospital, Holsterbro, Denmark
| | - Per T. Pedersen
- Department of Hematology, Esbjerg Hospital, Esbjerg, Denmark
| | | | | | - Birgitte Preiss
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Peter Gimsing
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
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287
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Oncolytic virotherapy as an immunotherapeutic strategy for multiple myeloma. Blood Cancer J 2017; 7:640. [PMID: 29208938 PMCID: PMC5802552 DOI: 10.1038/s41408-017-0020-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/03/2017] [Accepted: 10/12/2017] [Indexed: 12/22/2022] Open
Abstract
Multiple Myeloma (MM), a clonal malignancy of antibody-producing plasma cells, is the second most common hematologic malignancy and results in significant patient morbidity and mortality. The high degree of immune dysregulation in MM, including T cell imbalances and up-regulation of immunosuppressive checkpoint proteins and myeloid derived suppressor cells, allows this malignancy to escape from host immune control. Despite advances in the therapeutic landscape of MM over the last decade, including the introduction of immunomodulatory drugs, the prognosis for this disease is poor, with less than 50% of patients surviving 5 years. Thus, novel treatment strategies are required. Oncolytic viruses (OV) are a promising new class of therapeutics that rely on tumour specific oncolysis and the generation of a potent adaptive anti-tumour immune response for efficacy. To date, a number of OV have shown efficacy in pre-clinical studies of MM with three reaching early phase clinical trials. OVs represent a rational therapeutic strategy for MM based on (1) their tumour tropism, (2) their ability to potentiate anti-tumour immunity and (3) their ability to be rationally combined with other immunotherapeutic agents to achieve a more robust clinical response.
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288
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Vacca A, Melaccio A, Sportelli A, Solimando AG, Dammacco F, Ria R. Subcutaneous immunoglobulins in patients with multiple myeloma and secondary hypogammaglobulinemia: a randomized trial. Clin Immunol 2017; 191:110-115. [PMID: 29191714 DOI: 10.1016/j.clim.2017.11.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/13/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022]
Abstract
Multiple myeloma is commonly associated with a reduction of non-paraprotein immunoglobulins, resulting in a higher risk of infections that represent the leading cause of the patients' death. Therefore, immunoglobulin replacement therapy appears a logical approach. A total number of 46 myeloma patients were randomly enrolled: 24 of them were assigned to receive subcutaneous immunoglobulins, and 22 were controls. The primary endpoint was the evaluation of the annual rate of severe infections in immunoglobulins-receiving patients as compared with those untreated. Subcutaneous immunoglobulins-treated patients showed a significantly lower number of severe infections per year. Adverse events were limited to the site of infusion and were easily manageable. Health-related quality of life was significantly better in subcutaneous immunoglobulins-receiving patients. By decreasing the rate of infections, the prophylactic administration of SCIg improves both adherence to chemotherapy and health-related quality of life, and is cost-effective by reducing the need of hospitalization and the use of antibiotics.
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Affiliation(s)
- Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Assunta Melaccio
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Azzurra Sportelli
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Antonio G Solimando
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Roberto Ria
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy.
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289
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King T, Faiman B. Steroid-Associated Side Effects: A Symptom Management Update on Multiple Myeloma Treatment
. Clin J Oncol Nurs 2017; 21:240-249. [PMID: 28315528 DOI: 10.1188/17.cjon.240-249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND One constant and relatively unchanged aspect of treatment of multiple myeloma (MM) is the use of glucocorticosteroids, or steroids, which can cause a wide range of adverse side effects and harm patients' quality of life.
. OBJECTIVES The objective of this study was to provide updated recommendations on the management of steroid-associated side effects in patients with MM.
. METHODS A study of steroid-associated side effects in MM treatment regimens was reviewed to provide updated recommendations to healthcare professionals. FINDINGS Identifying the side effects of steroids and managing them promptly contribute to the success of steroid-containing regimens for patients with MM.
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290
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Bridging the gap between the randomised clinical trial world and the real world by combination of population-based registry and electronic health record data: A case study in haemato-oncology. Eur J Cancer 2017; 86:178-185. [PMID: 28992561 DOI: 10.1016/j.ejca.2017.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/01/2017] [Accepted: 09/04/2017] [Indexed: 11/21/2022]
Abstract
Randomised clinical trials (RCTs) are considered the basis of evidence-based medicine. It is recognised more and more that application of RCT results in daily practice of clinical decision-making is limited because the RCT world does not correspond with the clinical real world. Recent strategies aiming at substitution of RCT databases by improved population-based registries (PBRs) or by improved electronic health record (EHR) systems to provide significant data for clinical science are discussed. A novel approach exemplified by the HemoBase haemato-oncology project is presented. In this approach, a PBR is combined with an advanced EHR, providing high-quality data for observational studies and support of best practice development. This PBR + EHR approach opens a perspective on randomised registry trials.
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291
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Brigle K, Pierre A, Finley-Oliver E, Faiman B, Tariman J, Miceli T, Board A. Myelosuppression, Bone Disease, and Acute Renal Failure: Evidence-Based Recommendations for Oncologic Emergencies. Clin J Oncol Nurs 2017; 21:60-76. [DOI: 10.1188/17.cjon.s5.60-76] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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292
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Lv H, Wu X, Ma G, Sun L, Meng J, Song X, Zhang J. An integrated bioinformatical analysis of miR-19a target genes in multiple myeloma. Exp Ther Med 2017; 14:4711-4720. [PMID: 29201171 PMCID: PMC5704339 DOI: 10.3892/etm.2017.5173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 05/19/2017] [Indexed: 12/20/2022] Open
Abstract
MicroRNA (miR)-19a, as an oncomiR, has been studied in several types of cancer; however, its role in the development and progression of multiple myeloma (MM) remains unclear. The present study used a bioinformatics approach to investigate the involvement of miR-19a in MM. miR-19a targets were predicted using target prediction programs, followed by screening for differentially expressed genes in MM. The function of these genes was then annotated using gene ontology term enrichment, signaling pathway enrichment and protein-protein interaction (PPI) analysis. In addition, natural language processing (NLP) was performed to identify genes associated with MM. A total of 715 putative targets of miR-19a were identified in the present study, of which 40 were experimentally validated. A total of 121 genes were identified to be differentially expressed in MM, including 80 upregulated genes and 41 downregulated genes. Among the differentially expressed genes, ras homolog family member B, clathrin heavy chain, prosaposin and protein phosphatase 6 regulatory subunit 2 were predicted target genes of miR-19a. The results of NLP revealed that 2 of the differentially expressed genes, Y-box binding protein 1 and TP53 regulated inhibitor of apoptosis 1, were reported to be associated with MM. In addition, 41 target genes of miR-19a were identified to be associated with the development and progression of MM. These results may aid in understanding the molecular mechanisms of miR-19a in the development and progression of MM. In addition, the results of the present study indicate that targets genes of miR-19a are potential candidate biomarkers for MM.
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Affiliation(s)
- Hongyan Lv
- Department of Hematology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Xianda Wu
- Department of Hematology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Guiru Ma
- Department of Hematology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Lixia Sun
- Department of Hematology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Jianbo Meng
- Department of Hematology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Xiaoning Song
- Department of Hematology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Jinqiao Zhang
- Department of Hematology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
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293
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Infectious complications in multiple myeloma receiving autologous stem cell transplantation in the past 10 years. Int J Hematol 2017; 106:801-810. [PMID: 28825207 DOI: 10.1007/s12185-017-2313-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/05/2017] [Accepted: 08/07/2017] [Indexed: 12/23/2022]
Abstract
Infection is one of the main causes of early-treatment mortality in multiple myeloma (MM) patients during autologous stem cell transplantation (autoSCT). In the present study, we sought to determine the incidence of, and risk factors for, infection during hospital stays after autoSCT. We retrospectively evaluated 324 autoSCT events that occurred in 285 MM patients between 2006 and 2015, and reviewed the clinical characteristics of patients and history of infections. Sixty-eight infection events occurred, including bacteremia (24), other bacterial infections (7), as well as infections caused by Cytomegalovirus (17), Herpes simplex virus (12), Varicella zoster virus (3), Aspergillus (3) and Pneumocystis jiroveci (2). There was no significant difference in number of infections in the 2006-2010 and 2011-2015 periods (P = 0.194). Risk factors for bacteremia included higher beta-2 microglobulin levels at diagnosis [≥3.5 mg/L; adjusted odds ratio (aOR) 3.544 (95% CI 1.070-11.736), P = 0.038] and previous bortezomib treatment [aOR 4.270 (95% CI 1.389-13.125), P = 0.011]. In-hospital mortality occurred in 1.2% of all cases and all were infection-related. In conclusion, infection was the main cause of in-hospital mortality in patients who underwent autoSCT. Bacteremia was the most common type of microbiologically confirmed infection, and was associated with higher beta-2 microglobulin levels and previous bortezomib treatment.
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294
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Thompson MA, Oaks MK, Singh M, Michel KM, Mullane MP, Tarawneh HS, Kraut A, Hamm KJ. Multiple Myeloma Baseline Immunoglobulin G Level and Pneumococcal Vaccination Antibody Response. J Patient Cent Res Rev 2017; 4:131-135. [PMID: 31413979 DOI: 10.17294/2330-0698.1453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Infections are a major cause of morbidity and mortality in multiple myeloma (MM), a cancer of the immune system. Vaccination clinical efficacy endpoints have not been demonstrated, and there are limited data on surrogate markers of efficacy. This pilot study evaluated sequential immunologic markers after standard pneumococcal vaccination (PV) in patients with MM and non-MM controls. Vaccination was standard for PV (PCV13 or PPV23), with laboratory testing at baseline and at 2, 4, 12 and 24 weeks after vaccination. Immunoglobulin G (IgG) antibodies to pneumococcal antigens were detected by ELISA. Prevaccination total IgG levels and IgG subclass levels were also measured by ELISA. Four of 6 controls responded with at least a 2-fold increase in antibody concentration; only 2 controls had a sustained increase in concentration. Six of 8 patients with MM had at least a 2-fold antibody increase; however, only 2 of these patients showed a sustained increase of antipneumococcal antibody. Response rate differences were not statistically significant in this small pilot, and there was no relationship between responsiveness to PV and initial serum total IgG levels or IgG subclasses at study entry. Future prospective studies are needed to ascertain the immunological and clinical efficacy and effectiveness of various vaccines and vaccination strategies in MM.
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Affiliation(s)
- Michael A Thompson
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI.,Aurora Cancer Care, Aurora Health Care, Milwaukee, WI
| | - Martin K Oaks
- Transplant Research Laboratory, Aurora St. Luke's Medical Center, Aurora Health Care, Milwaukee, WI
| | - Maharaj Singh
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI
| | - Karen M Michel
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI
| | | | | | - Angi Kraut
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI
| | - Kayla J Hamm
- Aurora Cancer Care, Aurora Health Care, Milwaukee, WI
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295
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Ziogas DC, Terpos E, Gavriatopoulou M, Migkou M, Fotiou D, Roussou M, Kanellias N, Tatouli I, Eleutherakis-Papaiakovou E, Panagiotidis I, Ntanasis-Stathopoulos I, Kastritis E, Dimopoulos MA. Coexistence of leishmaniasis and multiple myeloma in the era of monoclonal antibody (anti-CD38 or anti-SLAMF7) containing triplets: one shared story of two exceptional cases. Leuk Lymphoma 2017; 59:983-987. [PMID: 28782413 DOI: 10.1080/10428194.2017.1361031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Dimitrios C Ziogas
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Evangelos Terpos
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Maria Gavriatopoulou
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Magdalini Migkou
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Despoina Fotiou
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Maria Roussou
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Nikolaos Kanellias
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Ioanna Tatouli
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Evangelos Eleutherakis-Papaiakovou
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Ioannis Panagiotidis
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Ioannis Ntanasis-Stathopoulos
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Efstathios Kastritis
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
| | - Meletios A Dimopoulos
- a Department of Clinical Therapeutics , Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine , Athens , Greece
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296
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Reiser M, Borte M, Huscher D, Baumann U, Pittrow D, Sommer C, Stangel M, Fasshauer M, Gold R, Hensel M. Management of patients with malignancies and secondary immunodeficiencies treated with immunoglobulins in clinical practice: Long-term data of the SIGNS study. Eur J Haematol 2017; 99:169-177. [PMID: 28467615 DOI: 10.1111/ejh.12900] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We aimed to describe the current management and outcomes of patients with secondary immunodeficiencies (SID) on intravenous (IV) or subcutaneous (SC) immunoglobulins (IG) as maintenance therapy to prevent infections. METHODS Non-interventional, prospective study (average follow-up 20.5 months). RESULTS Of the 307 SID patients (mean age 63.7±14.4 years, 52% males, in 31% IG newly initiated), 95.4% received IV IG (mean dosing interval 4.6 weeks, average dose 199 mg/kg per 4 weeks) and 4.6% were treated with SC IG (2.6 weeks, 343 mg/kg per 4 weeks). Median IG through level at first documentation was 5.8 g/L and did not differ between IV and SC treatment or between underlying malignancies. In 24.1% of patients, treatment was interrupted temporarily, over a mean of 11.6±6.3 months. In patients with newly initiated IG treatment the 82% overall infection rate prior to treatment dropped to 21% at 1 year. CONCLUSIONS Under clinical practice conditions, IG replacement therapy in SID patients was feasible, diminished infection rates and improved quality of life. Average IG doses were relatively low. Tolerability of IV IG treatment was excellent.
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Affiliation(s)
- Marcel Reiser
- PIOH - Praxis internistischer Onkologie und Hämatologie, Köln, Germany
| | - Michael Borte
- Paediatric Rheumatology, Immunology and Infectiology, Hospital St. Georg, Leipzig, Germany
| | - Dörte Huscher
- Epidemiology unit, German Rheumatism Research Centre, A Leibniz institute, Berlin, Germany
| | - Ulrich Baumann
- Paediatric Pulmonology, Allergy and Neonatology, Hanover Medical School, Hanover, Germany
| | - David Pittrow
- Medical Faculty, Institute for Clinical Pharmacology, Technical University Dresden, Dresden, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Martin Stangel
- Department of Neurology, Hanover Medical School, Hanover, Germany
| | - Maria Fasshauer
- Paediatric Rheumatology, Immunology and Infectiology, Hospital St. Georg, Leipzig, Germany
| | - Ralf Gold
- Department for Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
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297
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Moreau P, Dimopoulos MA, Richardson PG, Siegel DS, Cavo M, Corradini P, Weisel K, Delforge M, O'Gorman P, Song K, Chen C, Bahlis N, Oriol A, Hansson M, Kaiser M, Anttila P, Raymakers R, Joao C, Cook G, Sternas L, Biyukov T, Slaughter A, Hong K, Herring J, Yu X, Zaki M, San-Miguel J. Adverse event management in patients with relapsed and refractory multiple myeloma taking pomalidomide plus low-dose dexamethasone: A pooled analysis. Eur J Haematol 2017; 99:199-206. [DOI: 10.1111/ejh.12903] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2015] [Indexed: 12/22/2022]
Affiliation(s)
| | | | | | - David S. Siegel
- John Theurer Cancer Center; Hackensack University Medical Center; Hackensack NJ USA
| | - Michele Cavo
- Bologna University School of Medicine; Bologna Italy
| | - Paolo Corradini
- University of Milano, Fondazione IRCCS Istituto Nazionale de Tumori; Milano Italy
| | - Katja Weisel
- University Hospital of Tuebingen; Tuebingen Germany
| | | | - Peter O'Gorman
- Mater Misericordiae University Hospital; University College Dublin; Dublin Ireland
| | - Kevin Song
- Vancouver General Hospital; Vancouver British Columbia Canada
| | | | - Nizar Bahlis
- Tom Baker Cancer Center; University of Calgary; Calgary Canada
| | - Albert Oriol
- Institut Català d'Oncologia, Institut Josep Carreras; Hospital Germans Trias i Pujol; Barcelona Spain
| | | | | | - Pekka Anttila
- Helsinki University and Helsinki University Hospital Comprehensive Cancer; Helsinki Finland
| | | | - Cristina Joao
- Hemato-Oncology Department; Champalimaud Foundation for the Unknown and Faculdade de Ciências Médicas-NOVA University; Lisbon Portugal
| | - Gordon Cook
- St James's Institute of Oncology; St James's University Hospital; Leeds UK
| | | | | | | | | | | | - Xin Yu
- Celgene Corporation; Summit NJ USA
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298
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Yang Y, Lin J, Ma Z, Li J, Li D, Wang B, Fei Q. Potential roles of microRNAs and their target genes in human multiple myeloma. Eur J Haematol 2017; 99:178-185. [PMID: 28467652 DOI: 10.1111/ejh.12901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Yong Yang
- Department of Orthopedics; Beijing Friendship Hospital; Capital Medical University; Beijing China
| | - Jisheng Lin
- Department of Orthopedics; Beijing Friendship Hospital; Capital Medical University; Beijing China
| | - Zhao Ma
- Department of Orthopedics; Beijing Friendship Hospital; Capital Medical University; Beijing China
| | - Jinjun Li
- Department of Orthopedics; Beijing Friendship Hospital; Capital Medical University; Beijing China
| | - Dong Li
- Department of Orthopedics; Beijing Friendship Hospital; Capital Medical University; Beijing China
| | - Bingqiang Wang
- Department of Orthopedics; Beijing Friendship Hospital; Capital Medical University; Beijing China
| | - Qi Fei
- Department of Orthopedics; Beijing Friendship Hospital; Capital Medical University; Beijing China
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299
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300
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Alemu A, Singh M, Blumberg C, Richards JO, Oaks MK, Thompson MA. Multiple Myeloma Vaccination Patterns in a Large Health System: A Pilot Study. J Patient Cent Res Rev 2017; 4:53-59. [PMID: 31413971 DOI: 10.17294/2330-0698.1415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Common reasons for hospitalization and death in patients with multiple myeloma (MM) are infections. As patients with MM are living longer and are treated with immunomodulatory drugs, there is a need to immunize against vaccine-preventable diseases and ultimately determine the efficacy of these vaccines. We evaluated vaccination practice patterns in MM patients at our health system using electronic medical records and data analytics. Methods This institutional review board-approved study retrospectively reviewed patients with MM who visited the health system from May 2012 to May 2014. Data collected included demographics, influenza vaccination (FV) and pneumonia vaccination (PV) history, hospitalization episodes and associated costs, and duration of survival. Patients were considered PV-positive if vaccinated within 5 years prior to study. FV was defined as optimal (two FV in 2012-2014), suboptimal (one FV in 2012-2014) or none (in 2012-2014). Results Of 411 MM patients, 55% were male and 85% Caucasian. Nearly 58% received PV in the past 5 years. FV was 15% optimal, 52% suboptimal and 33% none. A total of 444 hospitalizations involving 204 patients were observed over 2-year follow-up. More than $23 million was incurred from hospitalizations in the 2-year study period. There was no statistically significant difference in all-cause hospitalization and overall survival by FV and PV status. Conclusions Despite recommendations of vaccination in multiple myeloma, our cohort had low rates of influenza and pneumonia vaccination. FV and PV status did not show any significant association with additional hospitalization or overall survival in this pilot study. Future prospective studies are needed to ascertain the immunological and clinical efficacy and effectiveness of these vaccines in immunosuppressed patients.
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Affiliation(s)
| | - Maharaj Singh
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI
| | - Chris Blumberg
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI
| | - John O Richards
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI
| | - Martin K Oaks
- Transplant Research Laboratory, Aurora St. Luke's Medical Center, Aurora Health Care, Milwaukee, WI
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