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Chari A, Florendo E, Mancia IS, Cho H, Madduri D, Parekh S, Richter J, Dhadwal A, Thomas J, Jiang G, Lagana A, Bhalla S, Jagannath S. Optimal Supportive Care With Selinexor Improves Outcomes in Patients With Relapsed/Refractory Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e975-e984. [PMID: 34404623 DOI: 10.1016/j.clml.2021.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Supportive care improves outcomes in many cancers. In the pivotal STORM study selinexor, a first-in-class, oral, selective exportin 1 inhibitor, and low-dose dexamethasone proved to be an effective treatment for patients with triple-class refractory myeloma. We conducted a post-hoc analysis to test the hypothesis that increased utilization of supportive care measures in a sub-cohort of the STORM study prolonged treatment duration with- and improved efficacy of- selinexor. MATERIALS AND METHODS The STORM protocol included specific recommendations for dose modifications and supportive care to mitigate selinexor most common adverse events (AEs) including nausea, fatigue, and thrombocytopenia. The Tisch Cancer Center at Mount Sinai School of Medicine (MSSM) incorporated additional supportive care strategies within the framework of the STORM protocol. RESULTS Of 123 patients enrolled in STORM, 28 were enrolled at MSSM. The overall response rate was 26.2% in the overall STORM population and 53.6% in the MSSM cohort. Moreover, duration of response, progression free survival, and overall survival were longer in the MSSM cohort. AEs and dose modification events were similar in the 2 groups. The MSSM cohort had more dose reductions (67.9% vs. 50.5%), and higher use of multiple antiemetic agents (71.4% vs. 50.1%) and romiplostim (32.1% vs. 6.3%), but less discontinuations due to treatment-related AEs (3.6% vs. 25.3%). CONCLUSION These results suggests that in addition to more frequent dose reductions, prompter and more aggressive supportive care may have contributed to the low discontinuation rate, longer duration therapy, and greater efficacy rates observed in the MSSM cohort. (ClinicalTrials.gov NCT02336815).
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Affiliation(s)
- Ajai Chari
- Icahn School of Medicine at Mount Sinai, New York, NY.
| | | | | | - Hearn Cho
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Deepu Madduri
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samir Parekh
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Josh Richter
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Joanne Thomas
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Grace Jiang
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Sherry Bhalla
- Icahn School of Medicine at Mount Sinai, New York, NY
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Nasr F, Ghoche AA, Diab S, Nasr L, Ammanouil E, Riachy C, Hallit S, Chahine G. Lebanese Real-World Experience in Treating Multiple Myeloma: A Multicenter Retrospective Study. Leuk Res Rep 2021; 15:100252. [PMID: 34141564 PMCID: PMC8188546 DOI: 10.1016/j.lrr.2021.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/29/2021] [Accepted: 05/23/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The present retrospective multicenter study aims at documenting characteristics of multiple myeloma (MM) patients and the effect of autologous stem cell transplant (ASCT) on survival. METHODS A total of 134 adult patients initiating any new MM therapy from January 2002 till December 2019 were included. Enrollment was stratified by disease subtype, induction protocol and transplant status. The characteristics and survival outcomes were recorded. RESULTS Mean age at diagnosis was 61.91 ± 10.83 years, with 62.7% male patients. Regarding the prognostic MM International Staging System (ISS), stage 3 was the most common at diagnosis with 50.8% of patients followed by stage 1 (25.4%) and stage 2 (23.8%). Maintenance treatment was given in 88.5% of the patients. 24.6% patients were transplanted, 41% were not and the remaining were unknown or still in induction. 86.1% of patients were alive at data cut off. A significantly higher mean progression free survival (PFS) was found in transplant patients (p=0.016). Using cox regression, creatinine >2 mg/dl (HR3.78) and hypercalcemia >11 mg/dl (HR=6.48) were significantly associated with a shorter PFS1. A significantly shorter overall survival (OS) was associated with hypercalcemia (HR=6.58), as well as male gender though not statistically significant in the latter. Difference in survival distributions by treatment was not statistically significant (bortezomib thalidomide dexamethasone (VTD) (p=0.211), bortezomib cyclophosphamide dexamethasone (VCD) (p=0.111) or bortezomib Revlimid dexamethasone (VRD) (p=0.312)). The interaction between ISS stage on diagnosis and transplant was not significantly associated with the overall survival. CONCLUSION The results of our retrospective study are in conformity with international data emphasizing the role of transplant in the treatment algorithm of newly diagnosed transplant-eligible multiple myeloma patients.
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Affiliation(s)
- Fadi Nasr
- Hotel Dieu de France University Hospital, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
- Mount Lebanon university Hospital, oncology and hematology department, Hazmieh, Lebanon
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Ahmad Al Ghoche
- Mount Lebanon university Hospital, oncology and hematology department, Hazmieh, Lebanon
| | - Saada Diab
- Mount Lebanon university Hospital, oncology and hematology department, Hazmieh, Lebanon
| | - Lewis Nasr
- Hotel Dieu de France University Hospital, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
| | - Emmanuel Ammanouil
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Christelle Riachy
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Georges Chahine
- Hotel Dieu de France University Hospital, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
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Chong LL, Soon YY, Soekojo CY, Ooi M, Chng WJ, de Mel S. Daratumumab-based induction therapy for multiple myeloma: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 159:103211. [PMID: 33387628 DOI: 10.1016/j.critrevonc.2020.103211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/13/2020] [Accepted: 12/20/2020] [Indexed: 11/17/2022] Open
Abstract
This study aims to evaluate the efficacy and safety of Daratumumab-based induction therapy (DBI) in newly diagnosed multiple myeloma (MM). We identified four eligible RCTs including 2735 patients. The primary outcomes of RCTs involving transplant eligible (TEMM) and non-transplant eligible MM (NTEMM) were stringent complete response (sCR) and progression-free survival (PFS) respectively. Meta-analysis was performed using random-effects models. DBI improved sCR rates for standard risk (SR) (OR 1.86, 95 % CI 1.41-2.46) but not HiR (high risk) (OR 0.78, 95 % CI 0.41-1.48) (interaction P = 0.01) TEMM. In NTEMM, DBI improved PFS in SR (HR 0.44, 95 % CI 0.35-0.55) but not HiR patients. (HR 0.81, 95 % CI 0.52-1.27) (interaction P = 0.02). In conclusion, while DBI is efficacious in SR patients, there is insufficient data to support a benefit in HiR-MM.
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Affiliation(s)
- Lip Leong Chong
- Department of Haematology Oncology, National University Cancer Institute Singapore, National University Health System Singapore, Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Health System Singapore, Singapore
| | - Cinnie Yentia Soekojo
- Department of Haematology Oncology, National University Cancer Institute Singapore, National University Health System Singapore, Singapore
| | - Melissa Ooi
- Department of Haematology Oncology, National University Cancer Institute Singapore, National University Health System Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wee Joo Chng
- Department of Haematology Oncology, National University Cancer Institute Singapore, National University Health System Singapore, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sanjay de Mel
- Department of Haematology Oncology, National University Cancer Institute Singapore, National University Health System Singapore, Singapore.
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Richardson PG, Zweegman S, O’Donnell EK, Laubach JP, Raje N, Voorhees P, Ferrari RH, Skacel T, Kumar SK, Lonial S. Ixazomib for the treatment of multiple myeloma. Expert Opin Pharmacother 2018; 19:1949-1968. [DOI: 10.1080/14656566.2018.1528229] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Paul G. Richardson
- Division of Hematologic Malignancy, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Jacob P. Laubach
- Division of Hematologic Malignancy, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Noopur Raje
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Peter Voorhees
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Renda H. Ferrari
- Global Medical Affairs, Millennium Pharmaceuticals, Inc, Cambridge, MA, USA
| | - Tomas Skacel
- Global Medical Affairs, Millennium Pharmaceuticals, Inc, Cambridge, MA, USA
| | | | - Sagar Lonial
- Hematology & Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Early relapse after autologous hematopoietic cell transplantation remains a poor prognostic factor in multiple myeloma but outcomes have improved over time. Leukemia 2017; 32:986-995. [PMID: 29263438 PMCID: PMC5871538 DOI: 10.1038/leu.2017.331] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 01/06/2023]
Abstract
Duration of initial disease response remains a strong prognostic factor in multiple myeloma (MM) particularly for upfront autologous hematopoietic cell transplant (AHCT) recipients. We hypothesized that new drug classes and combinations employed prior to AHCT as well as after post-AHCT relapse may have changed the natural history of MM in this population. We analyzed the Center for International Blood and Marrow Transplant Research database to track overall survival (OS) of MM patients receiving single AHCT within 12 months after diagnosis (N=3,256) and relapsing early post-AHCT (<24 months), and to identify factors predicting for early vs. late relapses (24–48 months post-AHCT). Over 3 periods (2001–2004, 2005–2008, 2009–2013), patient characteristics were balanced except for lower proportion of Stage III, higher likelihood of 1 induction therapy with novel triplets and higher rates of planned post-AHCT maintenance over time. The proportion of patients relapsing early was stable over time at 35–38%. Factors reducing risk of early relapse included lower stage, chemosensitivity, transplant after 2008 and post-AHCT maintenance. Shorter post-relapse OS was associated with early relapse, IgA MM, Karnofsky <90, stage III, >1 line of induction and lack of maintenance. Post-AHCT early relapse remains a poor prognostic factor, even though outcomes have improved over time.
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