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Canella A, Rajappa P. Therapeutic utility of engineered myeloid cells in the tumor microenvironment. Cancer Gene Ther 2023:10.1038/s41417-023-00600-7. [PMID: 36854896 DOI: 10.1038/s41417-023-00600-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/27/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
Despite promising results shown in hematologic tumors, immunotherapies for the treatment of solid tumors have mostly failed so far. The immunosuppressive tumor microenvironment and phenotype of tumor infiltrating macrophages are among the more prevalent reasons for this failure. Tumor associated macrophages (TAMs, M2-macrophages) are circulating myeloid cells recruited to the local tumor microenvironment, and together with regulatory T cells (T-regs), are reprogrammed to become immune suppressive. This results in the inactivation or hampered recruitment of cytotoxic CD8 + T and Natural Killer (NK) cells. Recently, attempts have been made to try to leverage specific myeloid functions and properties, including their ability to reach the TME and to mediate the phagocytosis of cancer cells. Additionally, myeloid cells have been used for drug delivery and reprogramming the tumor microenvironment in cancer patients. This approach, together with the advancements in genome editing, paved the way for the development of novel cell-mediated immunotherapies. This article focuses on the latest studies that detail the therapeutic properties of genetically engineered or pharmacologically modulated myeloid cells in cancer preclinical models, limitations, pitfalls, and evaluations of these approaches in patients with cancer.
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Affiliation(s)
- Alessandro Canella
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Prajwal Rajappa
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA. .,Department of Pediatrics and Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Limited benefits of thalidomide and dexamethasone maintenance after autologous stem cell transplantation in newly diagnosed multiple myeloma patients: a prospective phase II multi-center study in Korea. Curr Probl Cancer 2021; 46:100786. [PMID: 34481658 DOI: 10.1016/j.currproblcancer.2021.100786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/21/2021] [Accepted: 07/27/2021] [Indexed: 11/20/2022]
Abstract
Although the clinical outcome of newly diagnosed multiple myeloma has improved with maintenance therapy, maintenance with novel agents is not always available depending on medical expenses or drug accessibility. We intended to investigate the efficacy and toxicity of thalidomide/dexamethasone maintenance in Korean patients. In this multicenter phase 2 study, patients with newly diagnosed myeloma who underwent induction chemotherapy followed by autologous stem cell transplantation (ASCT) were enrolled to receive maintenance treatment of 100mg thalidomide daily for 28 days and 40mg dexamethasone daily for 4 days each cycle. Maintenance was given up to 12 cycles. The primary endpoint was a 1-year event free survival (EFS) rate. It was assumed that EFS at 1-year would be 91% with thalidomide and 1-year EFS below 82% would be of no effect. A total of 43 patients were consecutively enrolled (median age, 58 years [range, 34 - 65]; male, n = 31). With a median follow-up duration of 17.3 months (range, 1.1 - 32.2), EFS at 1 year was 65.1% (95% confidence interval [CI], 48.9 - 77.3). PFS and OS at 1 year was 85.6% (95% CI, 70.7 - 93.3) and 90.4 (95% CI, 76.3 - 96.3), respectively. In terms of side effects, 39 patients (90.7%) experienced adverse events (AEs) of any grade, and 14 patients (32.6%) experienced grade 3 or 4 adverse events. 15 patients (34.9%) failed to complete 12 cycles of maintenance, and the most common reason for premature termination was AEs (n = 6). In Korean patients the benefits of thalidomide maintenance does not seem to outweigh the toxicity of thalidomide, especially in high-risk MM. Considering the long clinical course of MM, preservation of quality of life and finances might be more beneficial for subsequent MM treatment.
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Abstract
INTRODUCTION The survival of multiple myeloma patients is increasing due to new medications, the widespread implementation of autologous stem cell transplantation and better supportive treatments. The controversy surrounding post-transplant treatment is debated due to a lack of large randomized trials comparing the different treatment modalities. The questions for each proposed treatment are whether it improves outcomes, has low cumulative toxicities and is easy to administer. Areas covered: In this review, we have summarized the current data on maintenance therapy in newly diagnosed MM patients undergoing ASCT, focusing on bortezomib, thalidomide and lenalidomide as well as newer agents Expert opinion: Maintenance treatment has been shown to deepen and prolong responses and increase PFS and OS. Lenalidomide is approved for maintenance and guidelines recommend its use post ASCT. Ixazomib has recently been reported to improve PFS.
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Affiliation(s)
- Iuliana Vaxman
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA.,b Institute of Hematology, Davidoff Cancer Center , Rabin Medical Center Petah , Tikva , Israel.,c Israel Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
| | - Morie Gertz
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
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Hu B, Thall P, Milton DR, Sasaki K, Bashir Q, Shah N, Patel K, Popat U, Hosing C, Nieto Y, Lin P, Delgado R, Jorgensen J, Manasanch E, Weber D, Thomas S, Orlowski RZ, Champlin R, Qazilbash MH. High-risk myeloma and minimal residual disease postautologous-HSCT predict worse outcomes. Leuk Lymphoma 2019; 60:442-452. [PMID: 30032678 DOI: 10.1080/10428194.2018.1485908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of our study was to determine the impact of high-risk disease (HRD) and MRD on outcomes in myeloma patients receiving bortezomib-based induction followed by autologous hematopoietic stem cell transplant (auto-HSCT). HRD included t(4:14), t(14;16), del 17p, del 1p and/or amplification 1q by cytogenetics/FISH; all others were standard-risk disease (SRD). A subset of 165 newly diagnosed myeloma patients in a 2:1 ratio of HRD:SRD was generated using propensity score based nearest neighbor matching. Multiparametric flow cytometry (MFC) was used to detect MRD after auto-HSCT in select patients. MRD+ status at 3 months post auto-HSCT (hazard ratio (HR = 4.23, p = .028) and HRD (HR = 1.72, p = .026) were associated with a shorter PFS. Similarly, MRD+ 3 months post auto-HSCT (HR = 6.93, p = .08) and HRD (HR = 3.54, p < .001) and were associated with a shorter OS. Despite bortezomib-based induction, upfront auto-HSCT, and use of maintenance therapy, PFS and OS remained worse in MRD+ and HRD patients.
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Affiliation(s)
- Bei Hu
- a Cancer Medicine , University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Peter Thall
- b Biostatistics , UT MD Anderson Cancer Center , Houston , TX, USA
| | - Denái R Milton
- b Biostatistics , UT MD Anderson Cancer Center , Houston , TX, USA
| | - Koji Sasaki
- c Department of Leukemia , The University of Texas, MD Anderson Cancer Center , 1515 Holcombe Blvd. Unit. 428 , Houston, TX, USA
| | - Qaiser Bashir
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Nina Shah
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Krina Patel
- f Lymphoma and Myeloma , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Uday Popat
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Chitra Hosing
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Yago Nieto
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Pei Lin
- e Hematopathology , University of Texas MD Anderson Cancer Center , Houston , TX, USA
| | - Ruby Delgado
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Jeffrey Jorgensen
- e Hematopathology , University of Texas MD Anderson Cancer Center , Houston , TX, USA
| | - Elisabet Manasanch
- f Lymphoma and Myeloma , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Donna Weber
- f Lymphoma and Myeloma , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Sheeba Thomas
- f Lymphoma and Myeloma , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Robert Z Orlowski
- f Lymphoma and Myeloma , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Richard Champlin
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Muzaffar H Qazilbash
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
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A Phase IIb, Multicenter, Open-Label, Safety, and Efficacy Study of High-Dose, Propylene Glycol-Free Melphalan Hydrochloride for Injection (EVOMELA) for Myeloablative Conditioning in Multiple Myeloma Patients Undergoing Autologous Transplantation. Biol Blood Marrow Transplant 2015; 21:2100-2105. [DOI: 10.1016/j.bbmt.2015.08.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/20/2015] [Indexed: 11/22/2022]
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Anderson KC, Alsina M, Atanackovic D, Biermann JS, Chandler JC, Costello C, Djulbegovic B, Fung HC, Gasparetto C, Godby K, Hofmeister C, Holmberg L, Holstein S, Huff CA, Kassim A, Krishnan AY, Kumar SK, Liedtke M, Lunning M, Raje N, Singhal S, Smith C, Somlo G, Stockerl-Goldstein K, Treon SP, Weber D, Yahalom J, Shead DA, Kumar R. Multiple Myeloma, Version 2.2016: Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2015; 13:1398-435. [PMID: 26553768 PMCID: PMC4891187 DOI: 10.6004/jnccn.2015.0167] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Multiple myeloma (MM) is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. Recent statistics from the American Cancer Society indicate that the incidence of MM is increasing. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) included in this issue address management of patients with solitary plasmacytoma and newly diagnosed MM.
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Harrison SJ, Cook G, Nibbs RJB, Prince HM. Immunotherapy of multiple myeloma: the start of a long and tortuous journey. Expert Rev Anticancer Ther 2014; 6:1769-85. [PMID: 17181491 DOI: 10.1586/14737140.6.12.1769] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The field of tumor immunotherapy is still in its infancy. It is becoming clear that the human immune response is the result of highly complex, continuously evolving interactions between cells of the adaptive and innate arms of the immune system, the internal and external environments, and normal and abnormal cells (e.g., myeloma plasma cells). Despite the considerable advances in our knowledge over the past 30 years, we have still only scratched the surface of the immune system's interaction with malignant diseases such as myeloma and to date, this has not translated into significantly better outcomes for patients with this disease. This review will summarize our current knowledge of the fundamental immunology of myeloma, review immunotherapy trials reported to date and discuss whether, in light of the current information, immunotherapy of multiple myeloma is an achievable goal.
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Affiliation(s)
- Simon J Harrison
- DHMO, Peter MacCallum Cancer Centre and Locked Bag 1, A'becket Street, Melbourne, Victoria 8006, Australia.
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8
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Shank BR, Brown VT, Schwartz RN. Multiple myeloma maintenance therapy: a review of the pharmacologic treatment. J Oncol Pharm Pract 2014; 21:36-51. [PMID: 24395544 DOI: 10.1177/1078155213514468] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over the last decade, numerous drug therapies have emerged for the treatment of multiple myeloma including immunomodulating agents namely thalidomide, lenalidomide, and pomalidomide and proteasome inhibitors namely bortezomib and carfilzomib. These agents have transformed the treatment of multiple myeloma and the role of high-dose chemotherapy followed by stem cell transplantation in the treatment of the disease. There are now studies that evaluate the use of drug therapy as maintenance following autologous stem cell transplantation; these studies have shown improvements in surrogate endpoints such as progression-free survival. Studies that have evaluated thalidomide or lenalidomide maintenance therapy have demonstrated an overall survival (OS) benefit in individuals with multiple myeloma who received high-dose chemotherapy followed by stem cell transplantation. A meta-analysis of thalidomide maintenance therapy did show a possible late survival benefit. The use of dexamethasone, thalidomide, lenalidomide, or combination bortezomib with thalidomide in patients who did not undergo transplantation demonstrated progression-free survival benefit; although there was no OS advantage for these agents in this population. There are a number of important considerations when selecting a drug therapy strategy for maintenance therapy which includes practical considerations such as route of administration and frequency of administration. Additionally, patient-specific elements such as potential toxicities, end-organ function, quality of life, cytogenetics, and previous treatment should be considered. Additional studies are needed to elicit the timing for initiation and duration of maintenance therapy, determine the role of cytogenetics, further characterize possible resistance patterns, and determine the combinations necessary to achieve an optimal increase in OS. Until more data are available, the risks and benefits should be evaluated on a patient-specific basis when deciding to initiate maintenance therapy or observation.
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Affiliation(s)
- Brandon R Shank
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Victoria T Brown
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA
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Schecter JM, Lentzsch S. Risk of secondary primary malignancies in maintenance therapy for multiple myeloma. Int J Hematol Oncol 2013. [DOI: 10.2217/ijh.13.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY There have been many advances in the treatment of patients with multiple myeloma over the past decade. As a result, the average life expectancy of patients with MM has improved. New medications, including immunomodulatory drugs (thalidomide, lenalidomide and pomalidomide) and proteasome inhibitors (bortezomib and carfilzomib) have entered clinical practice. On average, these medications are easier to tolerate than traditional chemotherapy allowing for long-term use of these drugs in a maintenance fashion. Clinical trials have appeared to establish the benefit of lower dose maintenance therapy for MM patients after induction chemotherapy and/or autologous stem cell transplant. These medications have been shown to improve not only the progression-free survival of patients, but also improve their overall survival compared with observation alone in some pivotal studies. With long-term maintenance therapy, a notable increase in secondary primary malignancies has been described. The exact mechanism behind this increase is uncertain, but may relate to the persistence of CD34+ cells in the setting of continued immunomodulatory exposure. Despite the concern of secondary primary malignancies, the risk:benefit ratio still favors maintenance therapy in many patients with multiple myeloma.
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Affiliation(s)
- Jordan M Schecter
- Division of Hematology/Oncology, New York Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, Herbert Irving Pavilion 9th Floor, New York, NY 10032–3702, USA
| | - Suzanne Lentzsch
- Division of Hematology/Oncology, New York Presbyterian Hospital, Columbia University Medical Center, 161 Fort Washington Avenue, Herbert Irving Pavilion 9th Floor, New York, NY 10032–3702, USA
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Morgan GJ, Davies FE. Role of thalidomide in the treatment of patients with multiple myeloma. Crit Rev Oncol Hematol 2013; 88 Suppl 1:S14-22. [PMID: 23827438 DOI: 10.1016/j.critrevonc.2013.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 05/23/2013] [Accepted: 05/30/2013] [Indexed: 01/06/2023] Open
Abstract
The first of the so-called "novel agents" (thalidomide, lenalidomide, and bortezomib), thalidomide has demonstrated activity as a single agent and in combination with other agents in patients with relapsed and/or refractory MM. The combination of melphalan, prednisone, and thalidomide (MPT) has become a standard treatment option for newly diagnosed patients who are ineligible for high-dose chemotherapy with autologous stem cell transplantation (ASCT). For patients intending to undergo ASCT, the combination of thalidomide, dexamethasone and cyclophosphamide can be used as a non-myelosuppressive induction regimen. Treatment with thalidomide is associated with an increased risk of developing peripheral neuropathy, which can be managed with dose reductions and discontinuation, and venous thromboembolism, which warrants thromboprophylaxis. While its adverse event profile may preclude prolonged use as maintenance therapy, thalidomide is an effective and well-tolerated salvage therapy option. Ongoing trials continue to evaluate novel thalidomide-based regimens to further optimize the use of thalidomide in the management of MM.
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Affiliation(s)
- Gareth J Morgan
- Institute of Cancer Research, Royal Marsden Hospital, London, UK.
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Reece D, Song K, LeBlanc R, Mezzi K, Olujohungbe A, White D, Zaman F, Belch A. Efficacy and safety of busulfan-based conditioning regimens for multiple myeloma. Oncologist 2013; 18:611-8. [PMID: 23628980 PMCID: PMC3662853 DOI: 10.1634/theoncologist.2012-0384] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 11/14/2012] [Indexed: 11/17/2022] Open
Abstract
Multiple myeloma is a malignancy of B cells characterized by accumulation of abnormal plasma cells in the bone marrow. In the past 20 years, the use of high-dose therapies and novel agents has resulted in significant and meaningful improvements in survival. Autologous stem cell transplantation (auto-SCT) following a high-dose melphalan-conditioning regimen represents the standard of care for younger patients as well as older patients with a good performance status. A number of strategies have been proposed to improve the outcome of auto-SCTs, including the incorporation of new agents such as thalidomide, lenalidomide, and bortezomib into the induction regimen administered before auto-SCT; the administration of maintenance therapy after auto-SCT; the incorporation of novel agents into chemotherapeutic regimens after transplantation as consolidation therapy; and the use of reduced-intensity allogeneic transplantation after an initial autograft. Although these approaches have demonstrated some success in improving responses after auto-SCT, none of these strategies are curative. An additional strategy to improve outcomes after auto-SCT is to enhance the immediate pretransplant conditioning regimens by either increasing the dose of melphalan or by incorporating novel agents, such as busulfan. This literature review focuses on the efficacy and safety of busulfan-based conditioning regimens for auto-SCT in patients with multiple myeloma.
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Affiliation(s)
- Donna Reece
- Princess Margaret Hospital, Division of Medical Oncology and Hematology, Toronto, Ontario, Canada.
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Berenson JR, Yellin O, Bessudo A, Boccia RV, Noga SJ, Gravenor DS, Patel-Donnelly D, Siegel RS, Kewalramani T, Gorak EJ, Nassir Y, Swift RA, Mayo D. Phase I/II trial assessing bendamustine plus bortezomib combination therapy for the treatment of patients with relapsed or refractory multiple myeloma. Br J Haematol 2012; 160:321-30. [DOI: 10.1111/bjh.12129] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/05/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ori Yellin
- Oncotherapeutics; West Hollywood; CA; USA
| | - Alberto Bessudo
- San Diego Pacific Oncology Hematology Associates, Inc.; Encinitas; CA; USA
| | | | - Stephen J. Noga
- Weinberg Cancer Institute at Franklin Square Hospital; Baltimore; MD; USA
| | | | | | - Robert S. Siegel
- George Washington University - Medical Faculty Associates; Washington; DC; USA
| | | | | | | | | | - Debra Mayo
- Teva Pharmaceutical Industries Ltd.; Frazer; PA; USA
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Moreau P, Avet-Loiseau H, Harousseau JL, Attal M. Current trends in autologous stem-cell transplantation for myeloma in the era of novel therapies. J Clin Oncol 2011; 29:1898-906. [PMID: 21482979 DOI: 10.1200/jco.2010.32.5878] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Since the mid 1990s, high-dose therapy followed by autologous stem-cell transplantation (ASCT) has been considered the standard of care for frontline therapy in younger patients with multiple myeloma (MM). During the past 10 years, thalidomide, bortezomib, and lenalidomide have been widely incorporated to the therapeutic armamentarium for the treatment of this disease. These agents show promise for improving the rate of complete remission both before and after ASCT without increasing toxicity. However, it is not clear whether such therapies are superior if they are used as an alternative to transplantation or whether they may reduce the need for and use of transplantation in patients in whom treatment is indicated. Therefore, the role of ASCT itself is a matter of debate: Should it be used upfront or as salvage treatment at the time of progression in patients initially treated with novel agents? This review presents current trends in ASCT for MM in the era of novel therapies.
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Lonial S, Kaufman J, Tighiouart M, Nooka A, Langston AA, Heffner LT, Torre C, McMillan S, Renfroe H, Harvey RD, Lechowicz MJ, Khoury HJ, Flowers CR, Waller EK. A Phase I/II Trial Combining High-Dose Melphalan and Autologous Transplant with Bortezomib for Multiple Myeloma: A Dose- and Schedule-Finding Study. Clin Cancer Res 2010; 16:5079-86. [DOI: 10.1158/1078-0432.ccr-10-1662] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Engelhardt M, Kleber M, Udi J, Wäsch R, Spencer A, Patriarca F, Knop S, Bruno B, Gramatzki M, Morabito F, Kropff M, Neri A, Sezer O, Hajek R, Bunjes D, Boccadoro M, Straka C, Cavo M, Polliack A, Einsele H, Palumbo A. Consensus statement from European experts on the diagnosis, management, and treatment of multiple myeloma: from standard therapy to novel approaches. Leuk Lymphoma 2010; 51:1424-43. [DOI: 10.3109/10428194.2010.487959] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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16
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Li Y, Hou J, Wang D, Fu W, Yuan Z, Chen Y, Tao Z. Prognostic factors for the efficacy of thalidomide in the treatment of multiple myeloma: A clinical study of 110 patients in China. Leuk Lymphoma 2009; 47:2593-600. [PMID: 17169804 DOI: 10.1080/10428190600955753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Thalidomide (Thal) has been used for a few years as salvage treatment for patients with multiple myeloma (MM). However, the response rate in Chinese patients treated with Thal has not been determined and the prognostic factors for response rate (RR), progression-free survival (PFS) and overall survival (OS) not yet well identified. This study enrolled 110 Chinese patients with MM who received either Thal alone, Thal plus dexamethasone (Thal + Dex) or Thal plus conventional chemotherapy (Thal + CC). Their laboratory and clinical parameters were retrospectively analysed. The overall RR was 63.6% (complete response rate 6.4%, partial response rate 57.3%). Patients aged < 65 years, time from diagnosis to the start of Thal treatment < 6 months or combined therapy had a significantly higher RR (p < 0.05). In univariate analysis, age < 65years predicted a longer PFS (p = 0.008). Age < 65 years, serum creatinine < 176.8 micromol L-1 and serum beta 2 microglobulin (beta2M) < 3.5 mg L-1 were associated with longer OS (p = 0.028, 0.045 and 0.019, respectively). Multi-factor analysis suggested that serum beta2M was the only independent prognostic factor for OS (p = 0.025).
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Affiliation(s)
- Yonghua Li
- Department of Hematology, Changzheng Hospital, The Second Military Medical University, Shanghai, PR, China
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Offidani M, Corvatta L, Polloni C, Piersantelli MN, Gentili S, Galieni P, Visani G, Alesiani F, Catarini M, Brunori M, Samori A, Burattini M, Centurioni R, Ferranti M, Giuliodori L, Candela M, Mele A, Marconi M, Leoni P. Thalidomide-dexamethasoneversusInterferon-alpha-dexamethasone as maintenance treatment after ThaDD induction for multiple myeloma: a prospective, multicentre, randomised study. Br J Haematol 2009; 144:653-9. [DOI: 10.1111/j.1365-2141.2008.07495.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Musto P, D'Auria F, Pietrantuono G, Bringhen S, Morabito F, Di Raimondo F, Pozzi S, Sacchi S, Boccadoro M, Palumbo A. Role of thalidomide in previously untreated patients with multiple myeloma. Expert Rev Anticancer Ther 2009; 8:1569-80. [PMID: 18925849 DOI: 10.1586/14737140.8.10.1569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Thalidomide represents one of the most relevant therapeutic advances for patients with multiple myeloma over the last 10 years. Despite some toxicities, it has demonstrated significant efficacy in elderly patients, as well as in the setting of younger subjects receiving autologous stem cell transplantation. Here, we report and discuss the clinical results achieved with thalidomide alone or in combination with dexamethasone or other drugs, such as melphalan, cyclophosphamide, doxorubicin and bortezomib, in previously untreated myeloma patients.
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Affiliation(s)
- Pellegrino Musto
- Unit of Hematology and Stem Cell Transplantation, IRCCS-CROB, Oncology Referral Center of Basilicata, Rionero in Vulture, Pz, Italy.
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20
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In pursuit of the allo-immune response in multiple myeloma: where do we go from here? Bone Marrow Transplant 2008; 43:91-9. [DOI: 10.1038/bmt.2008.397] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sze DMY, Hou J, Zhou L. Newly developed effective anti-cancer drugs targeting multiple myeloma. Drug Dev Res 2008. [DOI: 10.1002/ddr.20275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chong YP, Kim S, Ko OB, Koo JE, Lee D, Park SH, Park SJ, Lee D, Kim SW, Suh C. Poor outcomes for IgD multiple myeloma patients following high-dose melphalan and autologous stem cell transplantation: a single center experience. J Korean Med Sci 2008; 23:819-24. [PMID: 18955788 PMCID: PMC2580008 DOI: 10.3346/jkms.2008.23.5.819] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Immunoglobulin (Ig) D multiple myeloma (MM) accounts for 2% of all MM cases and has been reported to be associated with poor prognosis compared with other MM subtypes. The aim of the present study was to compare the effects of high-dose melphalan treatment and autologous stem cell transplantation (ASCT) on the survival of patients with IgD MM and patients with other MM subtypes. Between November 1998 and January 2005, a total of 77 patients with MM who underwent ASCT at the Asan Medical Center were enrolled in this study. High-dose melphalan (total 200 mg/m2) was used as high-dose chemotherapy. The study population was divided into two groups based on MM subtype: those with IgD MM; and those with other MM subtypes. A total of 8 patients with IgD MM were identified, accounting for about 10% of the study population. Thirty-six patients (47%) had IgG MM, 17 patients (22%) had IgA MM, and 16 patients (20%) had free light-chain MM. The two groups were similar in baseline characteristics. The median follow-up was 17 months and the median overall survival (OS) was 39 months. In the IgD MM group, median eventfree survival (EFS) and OS were 6.9 and 12 months, respectively. In the patients with other MM subtypes, median EFS and OS were 11.5 and 55.5 months (p=0.01, p<0.01), respectively. Multivariate analysis of all patients identified IgD subtype (p=0.002) and Southwest Oncology Group (SWOG) stage 2 or greater at the time of ASCT (p=0.01) as adverse prognostic factors for survival. In this small study at a single center in Korea, patients with IgD MM had poorer outcomes after ASCT than did patients with other MM subtypes.
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Affiliation(s)
- Yong Pil Chong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ok Bae Ko
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ja Eun Koo
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Danbi Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Jung Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Daeho Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang We Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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23
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Chang JE, Juckett MB, Callander NS, Kahl BS, Gangnon RE, Mitchell TL, Longo WL. Thalidomide maintenance following high-dose melphalan with autologous stem cell support in myeloma. ACTA ACUST UNITED AC 2008; 8:153-8. [PMID: 18650178 DOI: 10.3816/clm.2008.n.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recent experience with thalidomide maintenance after high-dose chemotherapy with autologous stem cell support has demonstrated improvement in progression-free survival (PFS) and overall survival (OS). We further explored the tolerability and efficacy of lower doses of maintenance thalidomide in this single-institution study. PATIENTS AND METHODS Thirty-eight patients with myeloma were enrolled and treated with melphalan 200 mg/m(2) followed by autologous stem cell transplantation. Thalidomide 50 mg per day was started on day > or = 60 after recovery of blood counts and was escalated to a maximum dose of 200 mg per day. Responses were assessed at 2 months, 1 year, and 2 years after transplantation. RESULTS Of the 38 enrolled patients, 7 patients never received thalidomide. Among 31 patients receiving thalidomide, complete or very good partial responses were observed in 65% and 42% of patients at 1 and 2 years, respectively. Tolerability was a major issue, with only 17 patients completing 1 year of thalidomide. The goal of dosing 200 mg per day was achieved in just 17 of 31 patients, and the median tolerated thalidomide dose was 100 mg per day. Sensory neuropathy was the primary reason for dose modification and discontinuation. No thromboembolic events were observed. The median PFS was 20.8 months, and the median OS was > 60 months. CONCLUSION Thalidomide maintenance at a goal dose of 200 mg per day was not feasible in this population, with our data suggesting that 100 mg per day is a more reasonable maintenance dose.
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Affiliation(s)
- Julie E Chang
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA.
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24
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Hassoun H, Flombaum C, D'Agati VD, Rafferty BT, Cohen A, Klimek VM, Boruchov A, Kewalramani T, Reich L, Nimer SD, Comenzo RL. High-dose melphalan and auto-SCT in patients with monoclonal Ig deposition disease. Bone Marrow Transplant 2008; 42:405-12. [DOI: 10.1038/bmt.2008.179] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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25
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García Quetglas E, Azanza Perea JR, Lecumberri Villamediana R. [New therapeutic strategies for multiple myeloma. Efficacy and cost-effectiveness analyses]. Med Clin (Barc) 2008; 130:626-35. [PMID: 18482531 DOI: 10.1157/13120342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The objective of the present article is the review of the most important therapeutic innovations in the treatment of multiple myeloma in terms of efficacy and cost-effectiveness. Besides autologous transplant with peripheral-blood stem-cell, thalidomide establishes as one of the most powerful therapeutic tools in induction and maintenance treatment and together with lenalidomide and bortezomib as therapy for relapsing/refractory multiple myeloma. Considering, the last named situation thalidomide can be an adequate therapeutical option in combination with dexamethasone. Under a strictly pharmacoeconomic point of view, lenalidomide and bortezomib seem to be additional alternatives in patients previously treated with thalidomide.
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Affiliation(s)
- Emilio García Quetglas
- Servicio de Farmacología Clínica, Clínica Universitaria de Navarra, Pamplona, Navarra. España.
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26
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Bensinger W. Stem-Cell Transplantation for Multiple Myeloma in the Era of Novel Drugs. J Clin Oncol 2008; 26:480-92. [DOI: 10.1200/jco.2007.11.6863] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The treatment of multiple myeloma (MM) is changing rapidly. During the last 10 years, higher rates of complete response (CR) and prolonged progression-free and overall survival have been seen with high-dose chemotherapy plus autologous stem-cell transplantation (HDT-ASCT). Achievement of CR and good partial response have been shown to be key prognostic factors for prolonged survival, with eradication of minimal residual disease seeming crucial to long-term disease-free survival. Until recently, high rates of CR and other major responses were primarily seen with HDT-ASCT, but insights into the biology of MM have led to the development and approval of new drugs with significant activity, and new induction regimens based on these novel agents are offering improved responses. Thalidomide, bortezomib, and lenalidomide have been combined with corticosteroids, alkylators, and anthracyclines in front-line MM treatment. Phase II studies have indicated that high rates of response and CR may be achieved. The substantial activity seen with these new drug combinations has prompted a re-examination of the role of SCT in MM treatment. Will achievement of major responses with these new regimens translate into improved survival after consolidation with transplantation? Will these improved induction regimens reduce the need for tandem transplantation, or does achievement of CR obviate the need for front-line transplantation altogether? To help address these questions, randomized trials are needed, as well as tests with improved sensitivity to better define depth of remission.
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Raab MS, Breitkreutz I, Anderson KC. Targeted treatments to improve stem cell outcome: old and new drugs. Bone Marrow Transplant 2007; 40:1129-37. [PMID: 17768392 DOI: 10.1038/sj.bmt.1705829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Thalidomide, lenalidomide and bortezomib have been approved for the treatment of relapsed or refractory multiple myeloma in the recent years. These agents are now being increasingly integrated into therapeutic regimens for newly diagnosed patients. First data are available on the promising activity of these novel agents in induction therapy, as well as maintenance treatment to improve outcome after stem cell transplantation. Whether these early results will lead to prolonged overall survival and thereby ultimately redefine the role of stem cell transplantation in first-line treatment of multiple myeloma will be one of the most important questions to be answered in the coming years. Bone Marrow Transplantation (2007) 40, 1129-1137; doi:10.1038/sj.bmt.1705829; published online 3 September 2007.
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Affiliation(s)
- M S Raab
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
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Abstract
The melphalan-prednisone regimen has been considered as standard therapy for patients with multiple myeloma (MM) for many years. Recently, high-dose chemotherapy with stem-cell support has extended progression-free survival and increased overall survival, and it is now considered conventional therapy in younger patients. However, most patients relapse and the salvage treatment is not very effective. New active drugs, including immunomodulatory agents, thalidomide (Thal) and lenalidomide, and the proteasome inhibitor bortezomib, have shown promising anti-myeloma activity. These novel treatments are aimed at overcoming resistance of tumour cells to conventional chemotherapy, acting both directly on myeloma cells and indirectly by blocking the interactions of myeloma cells with their local microenvironment and suppressing growth and survival signals induced by autocrine and paracrine loops in the bone marrow. Thal has been widely studied, mostly in combination regimens in patients with relapsed MM and, more recently, in front-line therapy, showing efficacy in terms of response rate and event-free survival. Bortezomib has been found to possess remarkable activity, especially in combination with other chemotherapeutic agents, in relapsed/refractory and newly diagnosed MM, as well as in patients presenting adverse prognostic factors. Lenalidomide, in combination with dexamethasone, is showing high overall response rates in relapsed and refractory MM and promising results also in first-line therapy. In this paper, the results of the most significant trials with Thal, bortezomib and lenalidomide are reported. Several ongoing clinical studies will hopefully allow the identification of the most active combinations capable of improving survival in patients with MM.
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Affiliation(s)
- F Merchionne
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Policlinico, Piazza Giulio Cesare 11, I-70124 Bari, Italy.
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29
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Mehta J, Singhal S. High-dose chemotherapy and autologous hematopoietic stem cell transplantation in myeloma patients under the age of 65 years. Bone Marrow Transplant 2007; 40:1101-14. [PMID: 17680020 DOI: 10.1038/sj.bmt.1705799] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
One or two cycles of high-dose chemotherapy with autologous hematopoietic stem cell transplantation have been shown to improve response rates and survival in myeloma. While this observation has largely been made in patients under the age of 65 years, there is evidence to suggest that the conclusions can be extrapolated to older individuals as well. In contrast to other hematologic malignancies treated with high-dose therapy, autografted myeloma patients continue to relapse several years after transplantation, and few patients are cured with this modality. However, up to a third of patients may be alive beyond a decade; some with excellent quality of life giving rise to the concept of 'operational cure'. Relapsing disease can be treated with novel agents or repeat high-dose chemotherapy and transplantation. The pressing questions to which answers are not obvious at the moment are whether tandem transplantation should be offered to all patients, and whether novel agents should be used before transplantation or reserved for relapse. Despite their excellent activity, there is no evidence so far that novel agents such as thalidomide, bortezomib and lenalidomide can replace high-dose chemotherapy and stem cell transplantation.
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Affiliation(s)
- J Mehta
- Division of Hematology/Oncology, Feinberg School of Medicine, Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA.
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30
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Abstract
Therapeutic advances in the treatment of multiple myeloma have significantly improved remission duration and overall survival (OS). These strategies have included the use of immunotherapy (interferon), novel agents (bortezomib, thalidomide, and lenalidomide), corticosteroids, and chemotherapy. While novel agents have had a major impact on response rates with initial therapy, most patients with multiple myeloma will eventually relapse. In the setting of minimal residual disease following standard dose or high-dose therapy, a number of different 'maintenance' strategies have emerged to prolong the duration of initial or subsequent remissions. The impact of these strategies on OS and event-free survival (EFS) is critically important, as the use of ineffective maintenance therapy adds the burden of additional cost, morbidity, and may reduce quality of life. Truly successful maintenance therapy will be effective in the setting of minimal residual disease, and will improve not only EFS, but also OS. This review summarizes the currently available data in the maintenance setting for multiple myeloma, and will discuss potential future trials to further address this important issue.
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Affiliation(s)
- R Mihelic
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
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31
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Treatment of Newly Diagnosed Multiple Myeloma Based on Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART): Consensus Statement. Mayo Clin Proc 2007. [DOI: 10.1016/s0025-6196(11)61029-x] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Modified conditioning regimen \busulfan-cyclophosphamide followed by allogeneic stem cell transplantation in patients with multiple myeloma. Chin Med J (Engl) 2007. [DOI: 10.1097/00029330-200703020-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Dispenzieri A, Rajkumar SV, Gertz MA, Fonseca R, Lacy MQ, Bergsagel PL, Kyle RA, Greipp PR, Witzig TE, Reeder CB, Lust JA, Russell SJ, Hayman SR, Roy V, Kumar S, Zeldenrust SR, Dalton RJ, Stewart AK. Treatment of newly diagnosed multiple myeloma based on Mayo Stratification of Myeloma and Risk-adapted Therapy (mSMART): consensus statement. Mayo Clin Proc 2007; 82:323-41. [PMID: 17352369 DOI: 10.4065/82.3.323] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Multiple myeloma is a neoplastic plasma cell dyscrasia that on a yearly basis affects nearly 17,000 individuals and kills more than 11,000. Although no cure exists, many effective treatments are available that prolong survival and improve the quality of life of patients with this disease. The purpose of this consensus is to offer a simplified, evidence-based algorithm of decision making for patients with newly diagnosed myeloma. In cases in which evidence is lacking, our team of 18 Mayo Clinic myeloma experts reached a consensus on what therapy could generally be recommended. The focal point of our strategy revolves around risk stratification. Although a multitude of risk factors have been identified throughout the years, including age, tumor burden, renal function, lactate dehydrogenase, beta2-microglobulin, and serum albumin, our group has now recognized and endorsed a genetic stratification and patient functional status for treatment.
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Affiliation(s)
- Angela Dispenzieri
- Division of Hematology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
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Suvannasankha A, Fausel C, Juliar BE, Yiannoutsos CT, Fisher WB, Ansari RH, Wood LL, Smith GG, Cripe LD, Abonour R. Final Report of Toxicity and Efficacy of a Phase II Study of Oral Cyclophosphamide, Thalidomide, and Prednisone for Patients with Relapsed or Refractory Multiple Myeloma: A Hoosier Oncology Group Trial, HEM01‐21. Oncologist 2007; 12:99-106. [PMID: 17227904 DOI: 10.1634/theoncologist.12-1-99] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thalidomide has direct antimyeloma and immunomodulatory effects. In addition, both thalidomide and metronomic chemotherapy inhibit angiogenesis. The synergy of such a combination may decrease toxicity while maintaining efficacy. The Hoosier Oncology Group conducted a phase II trial of oral cyclophosphamide (50 mg b.i.d. for 21 days), thalidomide (200 mg/day), and prednisone (50 mg q.o.d.) (CTP) per 28-day course in patients with relapsed multiple myeloma (MM). Of the 37 patients enrolled, 16 had prior stem cell transplantation. The median follow-up time was 25.3 months (95% confidence interval [CI] 23.2-27.7). Of 35 patients treated, 22 patients (62.9%) responded: 7 (20.0%) complete responses, 2 (5.7%) near-complete responses, and 13 (37.1%) partial responses. Eight patients (22.9%) had stable disease, and three (8.6%) had disease progression. Two patients withdrew from the study early due to reasons unrelated to progression or toxicity and were treated as nonresponders. The median time to best response and time to progression were 3.6 months (95% CI 2.8-10.9) and 13.2 months (95% CI 9.4-21.0), respectively. The median number of treatment cycles was seven (range 1-12 cycles). Grade III to IV toxicities included leukopenia (42.9%; febrile neutropenia, 11.4%), hyperglycemia (20%), sensory neuropathy (11.4%), thromboses (8%), and motor neuropathy (5.7%). No patient withdrew from the study due to toxicity. The efficacy and low toxicity of the CTP regimen support the future development of such an approach in MM.
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Affiliation(s)
- Attaya Suvannasankha
- Division of Hematology and Oncology, Department of Medicine, Indiana University School of Medicine, 1044 West Walnut Street, Indianapolis, Indiana 46202, USA
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Martino M, Console G, Callea V, Stelitano C, Massara E, Irrera G, Messina G, Morabito F, Iacopino P. Low tolerance and high toxicity of thalidomide as maintenance therapy after double autologous stem cell transplant in multiple myeloma patients. Eur J Haematol 2007; 78:35-40. [PMID: 17042773 DOI: 10.1111/j.1600-0609.2006.00774.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although a double autologous peripheral blood stem cell transplant (APBSCT) is an effective therapy for patients (pts) with multiple myeloma and extends progression-free survival and overall survival, pts show a continued pattern of recurrent disease. The feasibility and tolerability of thalidomide (Thal) administered in the post-transplantation period as maintenance therapy was tested in 17 pts at a dose of 100 mg/d starting between 3 and 5 months after the second transplantation and continuing either until toxicity precluded further therapy or until pts had disease progression. After a median administration of 13 months (range: 3-26), 76.5% (13 pts) failed to tolerate Thal because of: transiet ischemic attack (three pts), severe fatigue (two), neutropenia (one), piastrinopenia (one), severe opportunistic infectious (two), erectile impotence (one), gastrointestinal toxicity (anorexia with weight loss one), peripheral neuropathy (two). After a median follow-up of 36 months (range: 10-59) from the second transplant, 13 patients attained a CR + near CR (with a conversion rate from 47.1% to 76.5%). In conclusion, Thal as maintenance therapy after double ASCT is associated with low feasibility and high toxicity and could prevent a lengthy use of this antineoplastic agent.
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Affiliation(s)
- Massimo Martino
- Department of Bone Marrow Transplant, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
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36
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Current Awareness in Hematological Oncology. Hematol Oncol 2006. [DOI: 10.1002/hon.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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