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Petrakis I, Kontogiorgis C, Nena E, Delimpasi S, Loutsidi NE, Spanoudakis E, Intzes S, Misidou C, Symeonidou M, Giannakoulas N, Constantinidis TC, Terpos E. Does the Simultaneous Introduction of Several Pharmaceuticals in the Post-Lenalidomide Era Translate to Better Outcomes in Relapse Refractory Multiple Myeloma? Findings from the Real-World Innovation in Multiple Myeloma (REAL IMM) Study. Cancers (Basel) 2023; 15:5846. [PMID: 38136391 PMCID: PMC10741914 DOI: 10.3390/cancers15245846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Newer methodologies are needed to assess the real-world comparative effectiveness of a "generation" of pharmaceutical innovation versus the prior standard of care. This chart review study aimed to first evaluate the cumulative clinical benefits of pharmaceutical innovation in everyday relapse/refractory multiple myeloma before analyzing findings in the context of respective real-world outcomes from the bortezomib/lenalidomide era. Study endpoints included the 52-week PFS rate in second and third line of therapy (LOT), mPFS-2 across the first and second LOT, the ORR, reasons for discontinuation, and the treatment duration per therapeutic algorithm. Data from 107 patients were collected. The median follow-up was 2.0 years. Of the subjects who met the selection criteria for the second LOT, 72.2% maintained the PFS at 52 weeks. In the third-line setting, the PFS rate at 52 weeks was 63.5%. The mPFS across the first and second, the second, and the third LOTs were 26, 17, and 15 months, respectively. The ORR was 76.1% in the second and 69.7% in the third LOT. After non-response or progression, the main reason for drug discontinuation was treatment intolerability. The second-line ORR and the 52-week PFS rate were similar to previous real-world findings from the bortezomib/lenalidomide era. The cumulative mPFS across the second and third LOTs was higher than the respective mPFS across the first and second LOTs. Despite its limitations, the methodology and findings from this study may be used in future clinical and economic evaluations across all hematological malignancies.
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Affiliation(s)
- Ioannis Petrakis
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.K.); (T.C.C.)
| | - Christos Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.K.); (T.C.C.)
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.K.); (T.C.C.)
| | - Sosana Delimpasi
- Bone Marrow Transplantation Unit, Department of Hematology, Evangelismos Hospital, 10676 Athens, Greece; (S.D.); (N.E.L.)
| | - Natasa E. Loutsidi
- Bone Marrow Transplantation Unit, Department of Hematology, Evangelismos Hospital, 10676 Athens, Greece; (S.D.); (N.E.L.)
| | - Emmanouil Spanoudakis
- Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (S.I.); (C.M.); (M.S.)
| | - Stergios Intzes
- Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (S.I.); (C.M.); (M.S.)
| | - Christina Misidou
- Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (S.I.); (C.M.); (M.S.)
| | - Marianthi Symeonidou
- Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (S.I.); (C.M.); (M.S.)
| | - Nikolaos Giannakoulas
- Department of Hematology, School of Medicine, University of Thessaly, 41110 Larisa, Greece;
| | - Theodoros C. Constantinidis
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.K.); (T.C.C.)
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
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Ríos-Tamayo R, Soler JA, García-Sánchez R, Pérez Persona E, Arnao M, García-Guiñón A, Domingo A, González-Pardo M, de la Rubia J, Mateos MV. A glimpse into relapsed refractory multiple myeloma treatment in real-world practice in Spain: the GeminiS study. Hematology 2023; 28:2178997. [PMID: 36803194 DOI: 10.1080/16078454.2023.2178997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES To describe the incorporation of monoclonal antibodies (mAb) in real-world (RW) practice for the treatment of patients with relapsed refractory multiple myeloma (RRMM) in a setting with other treatment alternatives. METHODS This was an observational, multicenter, ambispective study of RRMM treated with or without a mAb. RESULTS A total of 171 patients were included. For the group treated without mAb, the median (95% CI) progression-free survival (PFS) to relapse was 22.4 (17.8-27.0) months; partial response or better (≥PR) and complete response or better (≥CR) was observed in 74.1% and 24.1% of patients, respectively; and median time to first response in first relapse was 2.0 months and in second relapse was 2.5 months. For the group of patients treated with mAb in first or second relapse, the median PFS was 20.9 (95% CI, could not be evaluated) months; the ≥ PR and ≥ CR rates were 76,2% and 28.6%, respectively; and the median time to first response in first relapse was 1.2 month and in second relapse was 1.0 months. The safety profiles for the combinations were consistent with those expected. CONCLUSIONS The incorporation of mAb in RW practice for the treatment of RRMM has shown good quality and speed of response with a similar safety profile shown in randomized clinical trials.
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Affiliation(s)
- Rafael Ríos-Tamayo
- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Juan Alfons Soler
- Department of Hematology, Hospital Universitari Parc Taulí de Sabadell, Catalonia, Spain
| | | | | | - Mario Arnao
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Antoni García-Guiñón
- Department of Hematology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Abel Domingo
- Department of Hematology, Hospital General de Granollers, Spain
| | | | - Javier de la Rubia
- Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Department, Universidad Católica "San Vicente Mártir", Valencia, Spain.,CIBERONC CB16/12/00284, Valencia, Spain
| | - María Victoria Mateos
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cancer (IBMCC-USAL, CSIC), Hospital Universitario de Salamanca, Salamanca, Spain
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- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Exosomal circ-CACNG2 promotes cardiomyocyte apoptosis in multiple myeloma via modulating miR-197-3p/caspase3 axis. Exp Cell Res 2022; 417:113229. [DOI: 10.1016/j.yexcr.2022.113229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022]
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Verbesselt M, Meekers E, Vandenberghe P, Delforge M, Vandenbriele C. Combined lenalidomide/bortezomib for multiple myeloma complicated by fulminant myocarditis: a rare case report of widely used chemotherapy. Eur Heart J Case Rep 2022; 6:ytac093. [PMID: 35274077 PMCID: PMC8904927 DOI: 10.1093/ehjcr/ytac093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/12/2021] [Accepted: 02/09/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Drug-induced myocarditis is a rare complication of certain cancer treatments, characterized by the development of myocardial inflammation shortly after initiation of treatment, potentially leading to heart failure and/or malignant arrhythmias. The development of eosinophilic myocarditis after administration of lenalidomide has been described and bortezomib has been associated with the development of cardiomyopathies and atherosclerosis. CASE SUMMARY A 69-year-old woman, recently diagnosed with multiple myeloma underwent local radiotherapy for a pathological fracture of the 4th lumbar vertebra and was treated with bortezomib-lenalidomide-dexamethasone. Within 19 days after therapy initiation, she presented with gastrointestinal symptoms, an erythematous pruritic rash, and general fatigue. Surprisingly, routine electrocardiogram (ECG) showed upwardly concave ST-elevation in I and aVL and ST-depressions in II, III, and aVF. Troponin levels were markedly elevated to 5470 ng/L. Complete blood count revealed eosinophilia. Based on further cardiac work-up, including echocardiography, coronary angiography, and cardiac magnetic resonance imaging (MRI) showing positive T2 imaging and patchy subepicardial late gadolinium enhancement, she was diagnosed with hypersensitivity myocarditis. Additional endomyocardial heart biopsy did not reveal any abnormalities, probably due to sampling error. After discontinuation of chemotherapy and prompt treatment with high doses of corticosteroids, the patient recovered. DISCUSSION Diagnosis of drug-induced myocarditis can be challenging and even long known widely used (chemo)therapy should be considered a potential trigger. Early diagnosis and treatment are crucial, warranting alertness for suggestive symptoms. Cardiac biomarkers, ECG monitoring, and cardiac MRI are key to confirm the diagnosis. In patients with preserved left ventricular systolic function, two-dimensional speckle tracking echocardiography can provide additional diagnostic information. Every patient presenting with eosinophilia and/or acute onset of auto-immune symptoms after initiation of therapy with lenalidomide/bortezomib deserves prompt cardiac screening. The gold standard remains an endomyocardial biopsy, although sampling error may occur.
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Affiliation(s)
- Matthias Verbesselt
- Department of Internal Medicine/Cardiology, Katholieke Universiteit Leuven (KUL), University Hospital Leuven (UZ Leuven), Herestraat 49, 3000 Leuven, Belgium
| | - Evelyne Meekers
- Department of Internal Medicine/Cardiology, Katholieke Universiteit Leuven (KUL), University Hospital Leuven (UZ Leuven), Herestraat 49, 3000 Leuven, Belgium
| | - Peter Vandenberghe
- Department of Hematology, Katholieke Universiteit Leuven (KUL), University Hospital Leuven (UZ Leuven), Herestraat 49, 3000 Leuven, Belgium
| | - Michel Delforge
- Department of Hematology, Katholieke Universiteit Leuven (KUL), University Hospital Leuven (UZ Leuven), Herestraat 49, 3000 Leuven, Belgium
| | - Christophe Vandenbriele
- Department of Cardiology, Katholieke Universiteit Leuven (KUL), University Hospital Leuven (UZ Leuven), Herestraat 49, 3000 Leuven, Belgium
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Burgess J, Ferdousi M, Gosal D, Boon C, Matsumoto K, Marshall A, Mak T, Marshall A, Frank B, Malik RA, Alam U. Chemotherapy-Induced Peripheral Neuropathy: Epidemiology, Pathomechanisms and Treatment. Oncol Ther 2021; 9:385-450. [PMID: 34655433 PMCID: PMC8593126 DOI: 10.1007/s40487-021-00168-y] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This review provides an update on the current clinical, epidemiological and pathophysiological evidence alongside the diagnostic, prevention and treatment approach to chemotherapy-induced peripheral neuropathy (CIPN). FINDINGS The incidence of cancer and long-term survival after treatment is increasing. CIPN affects sensory, motor and autonomic nerves and is one of the most common adverse events caused by chemotherapeutic agents, which in severe cases leads to dose reduction or treatment cessation, with increased mortality. The primary classes of chemotherapeutic agents associated with CIPN are platinum-based drugs, taxanes, vinca alkaloids, bortezomib and thalidomide. Platinum agents are the most neurotoxic, with oxaliplatin causing the highest prevalence of CIPN. CIPN can progress from acute to chronic, may deteriorate even after treatment cessation (a phenomenon known as coasting) or only partially attenuate. Different chemotherapeutic agents share both similarities and key differences in pathophysiology and clinical presentation. The diagnosis of CIPN relies heavily on identifying symptoms, with limited objective diagnostic approaches targeting the class of affected nerve fibres. Studies have consistently failed to identify at-risk cohorts, and there are no proven strategies or interventions to prevent or limit the development of CIPN. Furthermore, multiple treatments developed to relieve symptoms and to modify the underlying disease in CIPN have failed. IMPLICATIONS The increasing prevalence of CIPN demands an objective approach to identify at-risk patients in order to prevent or limit progression and effectively alleviate the symptoms associated with CIPN. An evidence base for novel targets and both pharmacological and non-pharmacological treatments is beginning to emerge and has been recognised recently in publications by the American Society of Clinical Oncology and analgesic trial design expert groups such as ACTTION.
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Affiliation(s)
- Jamie Burgess
- Department of Cardiovascular and Metabolic Medicine, The Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Trust, Liverpool, UK.
- Clinical Sciences Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK.
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - David Gosal
- Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Cheng Boon
- Department of Clinical Oncology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Kohei Matsumoto
- Department of Cardiovascular and Metabolic Medicine, The Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Trust, Liverpool, UK
| | - Anne Marshall
- Department of Cardiovascular and Metabolic Medicine, The Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Trust, Liverpool, UK
| | - Tony Mak
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Andrew Marshall
- Faculty of Health and Life Sciences, Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L7 8TX, UK
- Faculty of Health and Life Sciences, The Pain Research Institute, University of Liverpool, Liverpool, L9 7AL, UK
- Department of Pain Medicine, The Walton Centre, Liverpool, L9 7LJ, UK
| | - Bernhard Frank
- Department of Pain Medicine, The Walton Centre, Liverpool, L9 7LJ, UK
| | - Rayaz A Malik
- Research Division, Qatar Foundation, Weill Cornell Medicine-Qatar, Education City, Doha, Qatar
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, The Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Trust, Liverpool, UK.
- Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, M13 9PT, UK.
- Clinical Sciences Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK.
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6
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Ocio EM, Montes-Gaisán C, Bustamante G, Garzón S, González E, Pérez E, Sirvent M, Arguiñano JM, González Y, Ríos R, de Miguel D, Grande M, Fernández A, Naves A, Rosiñol L. Clinical and Sociodemographic Characteristics of Patients With Relapsed and/or Refractory Multiple Myeloma and Their influence on Treatment in the Real-World Setting in Spain: The CharisMMa Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:e241-e249. [PMID: 34774462 DOI: 10.1016/j.clml.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Treatment of relapsed and/or refractory multiple myeloma (RRMM) should be established based on multiple factors, including previous treatment and the sociodemographic/clinical characteristics of the patients. However, patients enrolled in randomized-controlled trials often do not mirror the scenario encountered in real-world practice, thus challenging therapeutic decisions in day-to-day practice. PATIENTS AND METHODS This observational, cross-sectional, multicenter study aimed to investigate the sociodemographic and clinical characteristics of patients with RRMM treated in routine practice in Spain and their influence on treatment regimens. RESULTS The study included 276 RRMM patients (median age 69 years; no gender predominance). Seventy-four percent of patients had CRAB features at the time of study inclusion, 65.9% bone lesions, 28.7% high-risk cytogenetics, and 27.0% were at ISS stage III; 65.1% were retired and lived in urban areas (75.7%) with their relatives (85.8%); 28.7% had some dependence degree. Patients had experienced their last relapse in a median of 1.61 months before enrollment and had received a median of 2 treatment lines (range 1-10). Second-and third-line therapies were mostly based on immunomodulatory drugs, followed by proteasome inhibitors (PIs), whereas monoclonal antibodies prevailed in later treatment lines. The presence of extramedullary plasmacytomas, the absence of osteopenia, and being in the second or third treatment line (vs. later lines) significantly increased the odds of receiving PIs. CONCLUSIONS RRMM treatment in the real-world setting is highly heterogeneous and is primarily influenced by the number of previous lines. The consideration of patients' clinical and sociodemographic characteristics may support clinicians in making therapeutic decisions.
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Affiliation(s)
- Enrique M Ocio
- Complejo Hospitalario de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain; Hospital Universitario Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| | - Carmen Montes-Gaisán
- Hospital Universitario Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| | | | | | | | - Ernesto Pérez
- Bioaraba, [Grupo diagnóstico y terapéutica oncológica], Vitoria-Gasteiz, Spain; Osakidetza, [OSI Araba], Hospital Universitario Araba, [Servicio de hematología], Vitoria-Gasteiz, Spain
| | | | | | | | - Rafael Ríos
- Hospital Virgen de las Nieves, Granada, Spain
| | | | - Marta Grande
- Takeda Farmacéutica España, Madrid, Spain; Universidad de Alcalá, Madrid, Spain
| | | | | | - Laura Rosiñol
- Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
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Bila J, Katodritou E, Guenova M, Basic-Kinda S, Coriu D, Dapcevic M, Ibricevic-Balic L, Ivanaj A, Karanfilski O, Zver S, Beksac M, Terpos E, Dimopoulos MA. Bone Marrow Microenvironment Interplay and Current Clinical Practice in Multiple Myeloma: A Review of the Balkan Myeloma Study Group. J Clin Med 2021; 10:jcm10173940. [PMID: 34501388 PMCID: PMC8432054 DOI: 10.3390/jcm10173940] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
The course of multiple myeloma (MM) is influenced by a variety of factors, including the specificity of the tumour microenvironment (TME). The aim of this review is to provide insight into the interplay of treatment modalities used in the current clinical practice and TME. Bortezomib-based triplets are the standard for MM first-line treatment. Bortezomib is a proteasome inhibitor (PI) which inhibits the nuclear factor kappa B (NF-κB) pathway. However, bortezomib is decreasing the expression of chemokine receptor CXCR4 as well, possibly leading to the escape of extramedullary disease. Immunomodulatory drugs (IMiDs), lenalidomide, and pomalidomide downregulate regulatory T cells (Tregs). Daratumumab, anti-cluster of differentiation 38 (anti-CD38) monoclonal antibody (MoAb), downregulates Tregs CD38+. Bisphosphonates inhibit osteoclasts and angiogenesis. Sustained suppression of bone resorption characterises the activity of MoAb denosumab. The plerixafor, used in the process of stem cell mobilisation and harvesting, block the interaction of chemokine receptors CXCR4-CXCL12, leading to disruption of MM cells’ interaction with the TME, and mobilisation into the circulation. The introduction of several T-cell-based immunotherapeutic modalities, such as chimeric-antigen-receptor-transduced T cells (CAR T cells) and bispecific antibodies, represents a new perspective in MM treatment affecting TME immune evasion. The optimal treatment approach to MM patients should be adjusted to all aspects of the individual profile including the TME niche.
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Affiliation(s)
- Jelena Bila
- Clinic of Hematology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-638-292-992
| | - Eirini Katodritou
- Department of Hematology, Theagenio Cancer Hospital, 54639 Thessaloniki, Greece;
| | - Margarita Guenova
- Laboratory of Haematopathology and Immunology, National Specialised Hospital for Active Treatment of Haematological Diseases, 1756 Sofia, Bulgaria;
| | - Sandra Basic-Kinda
- Divison of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Daniel Coriu
- Centre of Hematology and Bone Marrow Transplant, “Fundeni” Clinical Institute, “Carol Davila” University of Medicine and Pharmacy, 022328 Bucharest, Romania;
| | - Milena Dapcevic
- Division of Hematology, Clinical Center of Montenegro, Podgorica 81000, Montenegro;
| | - Lejla Ibricevic-Balic
- Clinic of Hematology, University Clinical Center of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Arben Ivanaj
- Department of Hematology, University Medical Center “Mother Teresa”, 1001 Tirana, Albania;
| | - Oliver Karanfilski
- University Clinic of Hematology, Faculty of Medicine, University of Skopje, 1000 Skopje, North Macedonia;
| | - Samo Zver
- Department of Hematology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Meral Beksac
- Department of Hematology, Tissue Typing Laboratory and Donor Registry, Faculty of Medicine, University of Ankara, Ankara 06590, Turkey;
| | - Evangelos Terpos
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (M.A.D.)
| | - Meletios Athanassios Dimopoulos
- Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (M.A.D.)
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Richardson PG, Kumar SK, Masszi T, Grzasko N, Bahlis NJ, Hansson M, Pour L, Sandhu I, Ganly P, Baker BW, Jackson SR, Stoppa AM, Gimsing P, Garderet L, Touzeau C, Buadi FK, Laubach JP, Cavo M, Darif M, Labotka R, Berg D, Moreau P. Final Overall Survival Analysis of the TOURMALINE-MM1 Phase III Trial of Ixazomib, Lenalidomide, and Dexamethasone in Patients With Relapsed or Refractory Multiple Myeloma. J Clin Oncol 2021; 39:2430-2442. [PMID: 34111952 DOI: 10.1200/jco.21.00972] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The double-blind, placebo-controlled, phase III TOURMALINE-MM1 study demonstrated a statistically significant improvement in progression-free survival with ixazomib-lenalidomide-dexamethasone (ixazomib-Rd) versus placebo-Rd in patients with relapsed or refractory multiple myeloma. We report the final analyses for overall survival (OS). PATIENTS AND METHODS Patients were randomly assigned to ixazomib-Rd (n = 360) or placebo-Rd (n = 362), stratified by number of prior therapies (1 v 2 or 3), previous proteasome inhibitor (PI) exposure (yes v no), and International Staging System disease stage (I or II v III). OS (intent-to-treat population) was a key secondary end point. RESULTS With a median follow-up of 85 months, median OS with ixazomib-Rd versus placebo-Rd was 53.6 versus 51.6 months (hazard ratio, 0.939; P = .495). Lower hazard ratios, indicating larger magnitude of OS benefit with ixazomib-Rd versus placebo-Rd, were seen in predefined subgroups: refractory to any (0.794) or last (0.742) treatment line; age > 65-75 years (0.757); International Staging System stage III (0.779); 2/3 prior therapies (0.845); high-risk cytogenetics (0.870); and high-risk cytogenetics and/or 1q21 amplification (0.862). Following ixazomib-Rd versus placebo-Rd, 71.7% versus 69.9% of patients received ≥ 1 anticancer therapy, of whom 24.7% versus 33.9% received daratumumab and 71.8% versus 76.9% received PIs (next-line therapy: 47.5% v 55.8%). Rates of new primary malignancies were similar with ixazomib-Rd (10.3%) and placebo-Rd (11.9%). There were no new or additional safety concerns. CONCLUSION Median OS values in both arms were the longest reported in phase III studies of Rd-based triplets in relapsed or refractory multiple myeloma at the time of this analysis; progression-free survival benefit with ixazomib-Rd versus placebo-Rd did not translate into a statistically significant OS benefit on intent-to-treat analysis. OS benefit was greater in subgroups with adverse prognostic factors. OS interpretation was confounded by imbalances in subsequent therapies received, especially PIs and daratumumab.
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Affiliation(s)
| | | | - Tamás Masszi
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Norbert Grzasko
- Department of Experimental Haematooncology, Medical University of Lublin, Lublin, Poland.,Center of Oncology of the Lublin Region St Jana z Dukli, Lublin, Poland
| | - Nizar J Bahlis
- Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, Canada
| | - Markus Hansson
- Department of Hematology, Skåne University Hospital, Lund, Sweden.,Sahlgrenska Academy, Göteborg, Sweden
| | - Luděk Pour
- Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Peter Ganly
- Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
| | - Bartrum W Baker
- Department of Haematology, Palmerston North Hospital, Palmerston North, New Zealand
| | - Sharon R Jackson
- Department of Haematology, Middlemore Hospital, Auckland, New Zealand
| | - Anne-Marie Stoppa
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Peter Gimsing
- Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
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9
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Ntanasis-Stathopoulos I, Gavriatopoulou M, Terpos E, Dimopoulos MA. Real-World Treatment of Patients With Relapsed/Refractory Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:379-385. [PMID: 33714682 DOI: 10.1016/j.clml.2021.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 01/18/2023]
Abstract
The continuous advances in the treatment landscape of multiple myeloma has led to the approval of several novel agents and their combinations that significantly improved patient outcomes. Despite their undoubtful effectiveness in the context of clinical trials, their impact on real-world (RW) clinical practice remains debatable. RW data on the role of novel agents and their combinations among patients with relapsed/refractory multiple myeloma have confirmed the efficacy of proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies. However, the magnitude of the benefit and the safety profile may differ among RW studies and between RW and pivotal clinical trials. Several variables may pertain to these observations and include patient selection, ethnicity, age, comorbidities, disease stage at diagnosis and at relapse, number of prior lines of therapy, disease subtype, presence of renal impairment, extramedullary disease, and cytogenetic abnormalities. All these contribute to a varying degree of disease and patient heterogeneity among the studies that may result in a differential treatment effect. The expertise of each medical center and the treatment setting in terms of availability and drug access are particularly important as well. Interestingly, RW observations may serve as proof of concept for designing novel clinical trials, as is the case with retreatment studies. In conclusion, clinical trial and RW data are complementary, and they should be considered to improve both clinical trial design and clinical practice.
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Affiliation(s)
- Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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10
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Santoleri F, Lasala R, Ranucci E, Rocchi M, Pulini S, Morelli AM, Spadano A, Costantini A. Adherence to and effectiveness of lenalidomide after 1 year of treatment in a real world setting. J Oncol Pharm Pract 2020; 28:24-30. [PMID: 33349148 DOI: 10.1177/1078155220980807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In combination with dexamethasone, lenalidomide is prescribed in the oral treatment of Multiple Myeloma for patients who have received at least one previous therapy. OBJECTIVE The objective of this study is to evaluate medication adherence to lenalidomide of Multiple Myeloma patients, as well as Progression Free Survival and Overall Survival one year from the beginning of the treatment. SETTING The study was carried out in Pescara Hospital, in Italy. All Multiple Myeloma patients who began lenalidomide therapy between January 1, 2012 and June 30, 2016 were included in our study. METHODS Adherence to treatment was calculated by using the ratio between the Received Daily Dose and the Prescribed Daily Dose. Effectiveness in real world has been evaluated as Progression Free Survival and Overall Survival one year from the beginning of the treatment.Main outcomes measure: We assessed medication adherence and effectiveness of lenalidomide in the treatment of Multiple Myeloma. RESULTS Adherence to the overall mean treatment was 0.73 ± 0.15, relative to 81 patients evaluated in our study. 32% of patients achieved an adherence equal to or greater than 80%. Real-life effectiveness in terms of Progression Free Survival and Overall Survival showed values of 53.75% and 88%, respectively, one year from the beginning of treatment. CONCLUSION The analysis of adherence in Multiple Myeloma patients treated with lenalidomide one year from the beginning of therapy reveal a concerning lack of adherence. Moreover, the lack of correlation of the levels of adherence with patient-related variables shows that, in the case of Multiple Myeloma, adherence is not related to personal, social and environmental characteristics that may determine each patient's correct treatment implementation, but is directly influenced by disease evolution.
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Affiliation(s)
| | - Ruggero Lasala
- Hospital pharmacy, Pescara General Hospital, Pescara, Italy
| | - Elena Ranucci
- Hospital pharmacy, Pescara General Hospital, Pescara, Italy
| | - Marco Rocchi
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Stefano Pulini
- Department of Haematology, Pescara General Hospital, Pescara, Italy
| | | | - Antonio Spadano
- Department of Haematology, Pescara General Hospital, Pescara, Italy
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11
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Sanchez-Petitto G, Hardy N, Burke A, McCusker MG, Li A, Badros AZ. Eosinophilic Myocarditis in a Patient With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e392-e394. [PMID: 32349910 DOI: 10.1016/j.clml.2020.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Gabriela Sanchez-Petitto
- Division of Hematology/Oncology, Department of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD; Division of General Internal Medicine, Department of Medicine, University of Maryland Medical Center, Baltimore, MD
| | - Naomi Hardy
- Department of Pathology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Allen Burke
- Department of Pathology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Michael G McCusker
- Division of Hematology/Oncology, Department of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD; Division of General Internal Medicine, Department of Medicine, University of Maryland Medical Center, Baltimore, MD
| | - Andrew Li
- Division of General Internal Medicine, Department of Medicine, University of Maryland Medical Center, Baltimore, MD
| | - Ashraf Z Badros
- Division of Hematology/Oncology, Department of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD; Division of General Internal Medicine, Department of Medicine, University of Maryland Medical Center, Baltimore, MD.
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12
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Jo JC, Lee HS, Kim K, Lee JJ, Yoon SS, Bang SM, Kim JS, Eom HS, Yoon DH, Lee Y, Shin HJ, Park Y, Lee WS, Do YR, Mun YC, Lee MH, Kim HJ, Kim SH, Kim MK, Lim SN, Cho SH, Park SK, Yi JH, Lee JH, Kim J, Min CK. The effectiveness and safety of lenalidomide and dexamethasone in patients with relapsed/refractory multiple myeloma in real-world clinical practice: a study of the Korean Multiple Myeloma Working Party (KMMWP-151 study). Ann Hematol 2019; 99:309-319. [DOI: 10.1007/s00277-019-03904-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/13/2019] [Indexed: 11/29/2022]
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13
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Islam B, Lustberg M, Staff NP, Kolb N, Alberti P, Argyriou AA. Vinca alkaloids, thalidomide and eribulin-induced peripheral neurotoxicity: From pathogenesis to treatment. J Peripher Nerv Syst 2019; 24 Suppl 2:S63-S73. [PMID: 31647152 DOI: 10.1111/jns.12334] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023]
Abstract
Vinca alkaloids, thalidomide, and eribulin are widely used to treat patients with childhood acute lymphoblastic leukemia (ALL), adults affected by multiple myeloma and locally invasive or metastatic breast cancer, respectively. However, soon after their introduction into clinical practice, chemotherapy-induced peripheral neurotoxicity (CIPN) emerged as their main non-hematological and among dose-limiting adverse events. It is generally perceived that vinca alkaloids and the antiangiogenic agent thalidomide are more neurotoxic, compared to eribulin. The exposure to these chemotherapeutic agents is associated with an axonal, length-dependent, sensory polyneuropathy of mild to moderate severity, whereas it is considered that the peripheral nerve damage, unless severe, usually resolves soon after treatment discontinuation. Advanced age, high initial and prolonged dosing, coadministration of other neurotoxic chemotherapeutic agents and pre-existing neuropathy are the common risk factors. Pharmacogenetic biomarkers might be used to define patients at increased susceptibility of CIPN. Currently, there is no established therapy for CIPN prevention or treatment; symptomatic treatment for neuropathic pain and dose reduction or withdrawal in severe cases is considered, at the cost of reduced cancer therapeutic efficacy. This review critically examines the pathogenesis, epidemiology, risk factors (both clinical and pharmacogenetic), clinical phenotype and management of CIPN as a result of exposure to vinca alkaloids, thalidomide and its analogue lenalidomide as also eribulin.
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Affiliation(s)
- Badrul Islam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Maryam Lustberg
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Comprehensive Cancer, Columbus, Ohio
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Noah Kolb
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
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14
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Varga G, Nagy Z, Demeter J, Kosztolányi S, Szomor Á, Alizadeh H, Deák B, Schneider T, Plander M, Szendrei T, Váróczy L, Illés Á, Bátai Á, Pető M, Mikala G. Real World Efficacy and Safety Results of Ixazomib Lenalidomide and Dexamethasone Combination in Relapsed/Refractory Multiple Myeloma: Data Collected from the Hungarian Ixazomib Named Patient Program. Pathol Oncol Res 2019; 25:1615-1620. [PMID: 30712192 PMCID: PMC6815275 DOI: 10.1007/s12253-019-00607-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 01/17/2019] [Indexed: 12/25/2022]
Abstract
Ixazomib-Revlimid-Dexamethasone is an all-oral treatment protocol for multiple myeloma with a manageable tolerability profile which was available through a named patient program for Hungarian patients from December 2015 to April 2017. We analyzed the clinical characteristics and survival of 77 patients treated at 7 centers within this program. The majority of patients responded, we found complete response in 9, very good partial response in 8, partial response in 32, minor response or stable disease in 13 and progressive disease in 11 patients. Progression free survival was 11.4 months. There was a trend of longer progression free survival in those with 1 vs. >1 prior treatment, with equally good effectivity in standard risk and high risk cytogenetic groups. The adverse events were usually mild, none leading to permanent drug interruptions. There were 5 fatalities: 3 infections and 2 pulmonary embolisms. Our real word data support the use of Ixazomib-Revlimid-Dexamethasone as a highly effective and well tolerated oral treatment protocol for relapsed myeloma.
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Affiliation(s)
- Gergely Varga
- 3rd Department of Internal Medicine, Semmelweis University, H-1125, Kútvölgyi út 4, Budapest, Hungary.
| | - Zsolt Nagy
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Judit Demeter
- 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | | | - Árpád Szomor
- 1st Department of Internal Medicine, University of Pécs, Pécs, Hungary
| | - Hussain Alizadeh
- 1st Department of Internal Medicine, University of Pécs, Pécs, Hungary
| | - Beáta Deák
- National Institute of Oncology, Budapest, Hungary
| | | | - Márk Plander
- Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Tamás Szendrei
- Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - László Váróczy
- Department of Hematology, Institute for Medicine, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Árpád Illés
- Department of Hematology, Institute for Medicine, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Árpád Bátai
- Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute for Hematology and Infectious Diseases, Budapest, Hungary
| | - Mónika Pető
- Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute for Hematology and Infectious Diseases, Budapest, Hungary
| | - Gábor Mikala
- Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute for Hematology and Infectious Diseases, Budapest, Hungary
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15
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Swan D, Rocci A, Bradbury C, Thachil J. Venous thromboembolism in multiple myeloma - choice of prophylaxis, role of direct oral anticoagulants and special considerations. Br J Haematol 2018; 183:538-556. [DOI: 10.1111/bjh.15684] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/18/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Dawn Swan
- Department of Haematology; University Hospital Galway; Galway Republic of Ireland
| | - Alberto Rocci
- Department of Haematology; Manchester University Hospitals NHS Foundation Trust; Manchester United Kingdom
- Faculty of Biology, Medicine and Health; School of Medical Science; Division of Cancer Science; University of Manchester; Manchester United Kingdom
| | - Charlotte Bradbury
- Cellular and Molecular Medicine; University of Bristol; Bristol United Kingdom
- Bristol Haematology and Oncology Centre; University Hospitals Bristol NHS Foundation Trust; Bristol United Kingdom
| | - Jecko Thachil
- Department of Haematology; Manchester University Hospitals NHS Foundation Trust; Manchester United Kingdom
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16
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Richardson PG, San Miguel JF, Moreau P, Hajek R, Dimopoulos MA, Laubach JP, Palumbo A, Luptakova K, Romanus D, Skacel T, Kumar SK, Anderson KC. Interpreting clinical trial data in multiple myeloma: translating findings to the real-world setting. Blood Cancer J 2018; 8:109. [PMID: 30413684 PMCID: PMC6226527 DOI: 10.1038/s41408-018-0141-0] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/26/2018] [Accepted: 10/09/2018] [Indexed: 01/04/2023] Open
Abstract
Substantial improvements in survival have been seen in multiple myeloma (MM) over recent years, associated with the introduction and widespread use of multiple novel agents and regimens, as well as the emerging treatment paradigm of continuous or long-term therapy. However, these therapies and approaches may have limitations in the community setting, associated with toxicity burden, patient burden, and other factors including cost. Consequently, despite improvements in efficacy in the rigorously controlled clinical trials setting, the same results are not always achieved in real-world practice. Furthermore, the large number of different treatment options and regimens under investigation in various MM settings precludes the feasibility of obtaining head-to-head clinical trial data, and there is a temptation to use cross-trial comparisons to evaluate data across regimens. However, multiple aspects, including patient-related, disease-related, and treatment-related factors, can influence clinical trial outcomes and lead to differences between studies that may confound direct comparisons between data. In this review, we explore the various factors requiring attention when evaluating clinical trial data across available agents/regimens, as well as other considerations that may impact the translation of these findings into everyday MM management. We also investigate discrepancies between clinical trial efficacy and real-world effectiveness through a literature review of non-clinical trial data in relapsed/refractory MM on novel agent-based regimens and evaluate these data in the context of phase 3 trial results for recently approved and commonly used regimens. We thereby demonstrate the complexity of interpreting data across clinical studies in MM, as well as between clinical studies and routine-care analyses, with the aim to help clinicians consider all the necessary issues when tailoring individual patients' treatment approaches.
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Affiliation(s)
| | - Jesus F San Miguel
- Centro Investigación Medica Aplicada (CIMA), IDISNA; CIBERONC, Clinica Universidad de Navarra, Pamplona, Spain
| | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel Dieu, Nantes, France
| | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jacob P Laubach
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Antonio Palumbo
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Katarina Luptakova
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Dorothy Romanus
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Tomas Skacel
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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17
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Katodritou E, Kyrtsonis MC, Delimpasi S, Kyriakou D, Symeonidis A, Spanoudakis E, Vasilopoulos G, Anagnostopoulos A, Kioumi A, Zikos P, Aktypi A, Briasoulis E, Megalakaki A, Repousis P, Adamopoulos I, Gogos D, Kotsopoulou M, Pappa V, Papadaki E, Fotiou D, Nikolaou E, Giannopoulou E, Hatzimichael E, Giannakoulas N, Douka V, Kokoviadou K, Timotheatou D, Terpos E. Real-world data on Len/Dex combination at second-line therapy of multiple myeloma: treatment at biochemical relapse is a significant prognostic factor for progression-free survival. Ann Hematol 2018; 97:1671-1682. [PMID: 29756171 PMCID: PMC6097756 DOI: 10.1007/s00277-018-3361-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/02/2018] [Indexed: 11/26/2022]
Abstract
We evaluated progression-free survival (PFS) rate of patients treated with lenalidomide/dexamethasone (Len/Dex), the efficacy of the combination, and the prognostic significance of treatment at biochemical vs. clinical relapse on PFS in 207 consecutive myeloma patients treated with Len/Dex in second line, according to routine clinical practice in Greece. First-line treatment included bortezomib-based (63.3%) or immunomodulatory drug-based (34.8%) therapies; 25% of patients underwent autologous stem cell transplantation. Overall response rate was 73.4% (17.8% complete response and 23.7% very good partial response); median time to best response was 6.7 months. Overall, median PFS and 12-month PFS rate was 19.2 months and 67.6%, respectively. 67.5% of patients had biochemical relapse and 32.5% had clinical relapse prior to initiation of Len/Dex. Median PFS was 24 months for patients treated at biochemical relapse vs. 13.2 months for those treated at clinical relapse (HR:0.63, p = 0.006) and the difference remained significant after adjustment for other prognostic factors. Type of relapse was the strongest prognostic factor for PFS in multivariate analysis. These real-world data confirm the efficacy of Len/Dex combination at first relapse; more importantly, it is demonstrated for the first time outside a clinical trial setting that starting therapy with Len/Dex at biochemical, rather than at clinical relapse, is a significant prognostic factor for PFS, inducing a 37% reduction of the probability of disease progression or death.
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Affiliation(s)
- Eirini Katodritou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece.
| | - Marie-Christine Kyrtsonis
- First Department of Propaedeutic Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sosana Delimpasi
- Department of Hematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - Despoina Kyriakou
- Department of Transfusion Medicine, School of Medicine, University of Thessaly, Larissa, Greece
| | - Argiris Symeonidis
- Department of Internal Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
| | - Emmanouil Spanoudakis
- Department of Hematology, Dimokrition University of Alexandroupolis, Alexandroupolis, Greece
| | - Georgios Vasilopoulos
- Department of Hematology, School of Medicine, University of Thessaly, Larissa, Greece
| | - Achilles Anagnostopoulos
- Department of Hematology and Bone Marrow Transplantation Unit, George Papanicolaou Hospital, Thessaloniki, Greece
| | - Anna Kioumi
- Department of Hematology, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | | | - Evangelos Briasoulis
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | | | | | | | | | | | | | | | - Eftychia Nikolaou
- First Department of Propaedeutic Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleftheria Hatzimichael
- Department of Hematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Nikolaos Giannakoulas
- Department of Hematology, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vassiliki Douka
- Department of Hematology and Bone Marrow Transplantation Unit, George Papanicolaou Hospital, Thessaloniki, Greece
| | - Kyriaki Kokoviadou
- Department of Hematology, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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18
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Leleu X, Masszi T, Bahlis NJ, Viterbo L, Baker B, Gimsing P, Maisnar V, Samoilova O, Rosiñol L, Langer C, Song K, Izumi T, Cleeland C, Berg D, Lin HM, Zhu Y, Skacel T, Moreau P, Richardson PG. Patient-reported health-related quality of life from the phase III TOURMALINE-MM1 study of ixazomib-lenalidomide-dexamethasone versus placebo-lenalidomide-dexamethasone in relapsed/refractory multiple myeloma. Am J Hematol 2018; 93:985-993. [PMID: 29726031 DOI: 10.1002/ajh.25134] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/29/2018] [Accepted: 04/30/2018] [Indexed: 11/12/2022]
Abstract
TOURMALINE-MM1 is a phase III, randomized, double-blind, placebo-controlled study of ixazomib plus lenalidomide and dexamethasone (IRd) versus placebo-Rd in patients with relapsed/refractory multiple myeloma following 1-3 prior lines of therapy. The study met its primary endpoint, demonstrating significantly longer progression-free survival (PFS) in the IRd arm versus placebo-Rd arm (median 20.6 vs 14.7 months, hazard ratio 0.74, P = .01), with limited additional toxicity. Patient-reported health-related quality of life (HRQoL) was a secondary endpoint of TOURMALINE-MM1. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core-30 (QLQ-C30) and Multiple Myeloma Module 20 (QLQ-MY20) were completed at screening, the start of cycles 1 and 2, every other cycle, the end of treatment, and every 4 weeks until progression. Over median follow-up of 23.3 and 22.9 months in the IRd and placebo-Rd arms, mean QLQ-C30 global health status (GHS)/QoL scores were maintained from baseline over the course of treatment in both groups, with no statistically significant differences between groups. EORTC QLQ-C30 function domain scores were also generally maintained from baseline; similarly, physical, emotional, and social function domains were maintained with IRd versus placebo-Rd, with slightly higher mean change from baseline scores at earlier time points with IRd. Findings from this double-blind study demonstrate that addition of ixazomib to Rd significantly improved efficacy while HRQoL was maintained, reflecting the limited additional toxicity seen with IRd versus placebo-Rd, and support the feasibility of long-term IRd administration.
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Affiliation(s)
- Xavier Leleu
- Department of Haematology, Hospital La Milétrie, and INSERM CIC 1402, Poitiers, France
| | - Tamas Masszi
- Department of Hematology and Stem Cell Transplantation, St. István and St. László Hospital, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Nizar J Bahlis
- Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Luisa Viterbo
- Serviço de Onco-Hematologia, Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial (IPOPFG, EPE), Porto, Portugal
| | - Bartrum Baker
- Department of Haematology, Palmerston North Hospital, Palmerston North, Manawatu, New Zealand
| | - Peter Gimsing
- Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Vladimir Maisnar
- 4th Department of Medicine - Hematology, University Hospital, Hradec Kralove, Czech Republic
| | - Olga Samoilova
- Nizhnii Novgorod Region Clinical Hospital, Nizhnii Novgorod, Russia
| | - Laura Rosiñol
- Department of Hematology, University of Barcelona, Barcelona, Spain
| | - Christian Langer
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Kevin Song
- Division of Hematology, University of British Columbia, Vancouver, Canada
| | - Tohru Izumi
- Department of Hematology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Charles Cleeland
- Department of Symptom Research, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Deborah Berg
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Huamao Mark Lin
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Yanyan Zhu
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Tomas Skacel
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
- Department of Hematology, Charles University General Hospital, Prague, Czech Republic
| | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel Dieu, Nantes, France
| | - Paul G Richardson
- Department of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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19
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Leleu X, Gay F, Flament A, Allcott K, Delforge M. Incidence of neutropenia and use of granulocyte colony-stimulating factors in multiple myeloma: is current clinical practice adequate? Ann Hematol 2018; 97:387-400. [PMID: 29282494 PMCID: PMC5797221 DOI: 10.1007/s00277-017-3191-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/20/2017] [Indexed: 12/21/2022]
Abstract
Although immunomodulatory drugs, alkylating agents, corticosteroids, protease inhibitors, and therapeutic monoclonal antibodies improve multiple myeloma outcomes, treatment burden is still an issue. Neutropenia is a known complication of cytotoxic cancer therapy and is often associated with infections; it is an important consideration in myeloma given the fact that patients often have a weakened immune system. The risk of febrile neutropenia increases with severe and persisting neutropenia. Recombinant granulocyte colony-stimulating factors (G-CSFs) are commonly used to reduce the incidence, duration, and severity of febrile neutropenia. Here, we review the risk and management of neutropenia associated with new and commonly used anti-myeloma agents. Few papers report the use of G-CSF in patients with multiple myeloma receiving anti-cancer treatments, and fewer describe whether G-CSF was beneficial. None of the identified studies reported G-CSF primary prophylaxis. Further studies are warranted to evaluate the need for G-CSF prophylaxis in multiple myeloma. Prophylaxis may be particularly useful in patients at high risk of prolonged severe neutropenia.
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Affiliation(s)
- Xavier Leleu
- Department of Haematology and CIC Inserm U1082, Hôpital La Milétrie, Poitiers, France.
| | - Francesca Gay
- Myeloma Unit, Division of Haematology, Azienda Ospedaliero-Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Kim Allcott
- Oxford PharmaGenesis, Tubney, Oxfordshire, OX13 5QJ, UK
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Cavo M, Terpos E, Bargay J, Einsele H, Cavet J, Greil R, de Wit E. The multiple myeloma treatment landscape: international guideline recommendations and clinical practice in Europe. Expert Rev Hematol 2018; 11:219-237. [PMID: 29415570 DOI: 10.1080/17474086.2018.1437345] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Guidelines provide recommendations on the management of multiple myeloma (MM), but there are no standard algorithms for the choice and sequencing of treatments. As a result, there is widespread variation in the interpretation and implementation of these guidelines. Areas covered: This review will cover: the real-world data on MM treatment patterns; the approved agents available for the treatment of MM; a comparative summary of the national and international clinical guidelines; a discussion on the impact reimbursement decisions have on treatment availability. Expert commentary: In the future, treatment choices may become even more complex as clonal heterogeneity is better understood in the context of response to treatment, and next-generation agents become available. Although information on real-world practice patterns can provide further guidance, to date, few studies have generated data on patients treated with the newer agents in real-world settings. Furthermore, the translation of guideline recommendations into clinical practice across Europe is inconsistent. Additional real-world data are therefore vital to understanding current clinical practice patterns, so that new agents can be effectively incorporated into existing treatment strategies. Such information may aid the development of better guidance, which will ultimately help to ensure that patients receive the best possible care.
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Affiliation(s)
- Michele Cavo
- a "Seràgnoli" Institute of Hematology and Medical Oncology , Bologna University School of Medicine , Bologna , Italy
| | - Evangelos Terpos
- b Department of Clinical Therapeutics , National and Kapodistrian University of Athens School of Medicine , Athens , Greece
| | - Joan Bargay
- c Department of Hematology and Hemotherapy , Hospital Son Llàtzer , Mallorca , Spain
| | - Hermann Einsele
- d Julius-Maximilians-University of Würzburg, and Department of Internal Medicine II , University Hospital Würzburg , Würzburg , Germany
| | - Jim Cavet
- e Consultant Hematologist , Christie National Health Service Foundation Trust , Manchester , UK.,f University of Manchester , Manchester , UK
| | - Richard Greil
- g University Clinic for Internal Medicine III, and Laboratory of Immunological and Molecular Cancer Research (LIMCR), Third Medical Department , Paracelsus Medical University, and Salzburg Cancer Research Institute , Salzburg , Austria
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Martino M, Recchia AG, Console G, Gentile M, Cimminiello M, Gallo GA, Ferreri A, Naso V, Irrera G, Messina G, Moscato T, Vigna E, Vincelli ID, Morabito F. Can we improve the conditioning regimen before autologous stem cell transplantation in multiple myeloma? Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1387050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Massimo Martino
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | | | - Giuseppe Console
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Massimo Gentile
- Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata, Cosenza, Italy
| | - Michele Cimminiello
- Hematology and Stem Cell Transplantation Unit, “S. Carlo” Hospital, Potenza, Italy
| | - Giuseppe Alberto Gallo
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Anna Ferreri
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Virginia Naso
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Giuseppe Irrera
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Giuseppe Messina
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Tiziana Moscato
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Ernesto Vigna
- Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata, Cosenza, Italy
| | - Iolanda Donatella Vincelli
- Hematology, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio, Italy
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Analysis of Common Eligibility Criteria of Randomized Controlled Trials in Newly Diagnosed Multiple Myeloma Patients and Extrapolating Outcomes. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:575-583.e2. [PMID: 28886839 DOI: 10.1016/j.clml.2017.06.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/08/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The performance of multiple myeloma (MM) therapies in a general patient population and specific eligibility criteria that might limit enrollment into randomized controlled trials (RCTs) have not been evaluated in depth. This study aimed to determine if improvements seen with MM therapies in RCTs are reflected in the general patient population and to identify eligibility criteria that can be modified to increase enrollment. PATIENTS AND METHODS The Connect MM Registry is a prospective observational cohort study of patients with newly diagnosed MM (NDMM) in the United States. Using common RCT exclusion criteria collected from 16 published studies, patients in the registry were categorized according to their eligibility for inclusion in RCTs. RESULTS On the basis of common criteria, 563 of 1406 of registry patients (40.0%) are ineligible for RCTs. Criteria leading to exclusion included M-protein ≤ 1.0 g/dL (25.2%), creatinine > 2.5 mg/dL (13.9%), low absolute neutrophil count (10.0%), and low hemoglobin (9.6%). Significantly more RCT-ineligible versus RCT-eligible patients had hypercalcemia (11.0% vs. 5.5%), elevated creatinine levels (38.9% vs. 6.2%), low hemoglobin levels (59.5% vs. 39.5%), or International Staging System stage III disease (40.1% vs. 22.1%; P < .001 for all comparisons). RCT-ineligible patients had a lower 3-year survival rate than RCT-eligible patients (63% vs. 70%). The incidence of serious adverse events was similar between groups. CONCLUSION Of patients with NDMM enrolled in the Connect MM Registry, 40% are ineligible for RCTs. This study provides insight into potential modifications of standard eligibility criteria that can lead to improved RCT design and accelerated enrollment.
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Mark TM, Guarneri D, Forsberg P, Rossi A, Pearse R, Perry A, Pekle K, Tegnestam L, Greenberg J, Shore T, Gergis U, Mayer S, Van Besien K, Ely S, Jayabalan D, Sherbenou D, Coleman M, Niesvizky R. A Phase I Trial of High-Dose Lenalidomide and Melphalan as Conditioning for Autologous Stem Cell Transplantation in Relapsed or Refractory Multiple Myeloma. Biol Blood Marrow Transplant 2017; 23:930-937. [PMID: 28285081 DOI: 10.1016/j.bbmt.2017.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/06/2017] [Indexed: 12/13/2022]
Abstract
Autologous stem cell transplantation (ASCT) conditioned with high-dose chemotherapy has long been established as the standard of care for eligible patients with newly diagnosed multiple myeloma. Despite recent therapeutic advances, high-dose melphalan (HDM) remains the chemotherapy regimen of choice in this setting. Lenalidomide (LEN) in combination with low-dose dexamethasone is recognized as a standard of care for patients with relapsed or refractory multiple myeloma (RRMM), and there is growing support for the administration of LEN as maintenance therapy post-ASCT. In view of the above, the present phase I clinical trial was designed to evaluate the safety and tolerability of high-dose LEN (HDLEN) in patients with RRMM, and to determine the maximum tolerated dose of HDLEN when added to HDM before ASCT. Despite administering HDLEN at doses of up to 350 mg/day, the maximum tolerated dose could not be determined, owing to an insufficient number of dose-limiting toxicities in the 21 patients enrolled in the trial. Conditioning with HDLEN plus HDM was associated with a favorable tolerability profile. Adverse events following ASCT were as expected with HDM. Median progression-free and overall survival were 10 months and 22 months, respectively, in this population of heavily pretreated patients. Our findings suggest that HDLEN in combination with HDM may offer significant potential as a conditioning regimen before ASCT in patients with RRMM. These preliminary findings are now being evaluated further in an ongoing phase II clinical trial.
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Affiliation(s)
- Tomer M Mark
- Department of Medicine, Division of Hematology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Danielle Guarneri
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Peter Forsberg
- Department of Medicine, Division of Hematology, University of Colorado School of Medicine, Aurora, Colorado
| | - Adriana Rossi
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Roger Pearse
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Arthur Perry
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Karen Pekle
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Linda Tegnestam
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - June Greenberg
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Tsiporah Shore
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Usama Gergis
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Sebastian Mayer
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Koen Van Besien
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Scott Ely
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - David Jayabalan
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Daniel Sherbenou
- Department of Medicine, Division of Hematology, University of Colorado School of Medicine, Aurora, Colorado
| | - Morton Coleman
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Ruben Niesvizky
- Department of Medicine, Division of Hematology/Oncology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
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Reneau JC, Asante D, van Houten H, Sangaralingham LR, Buadi FK, Lerman A, Herrmann J. Cardiotoxicity risk with bortezomib versus lenalidomide for treatment of multiple myeloma: A propensity matched study of 1,790 patients. Am J Hematol 2017; 92:E15-E17. [PMID: 27813147 DOI: 10.1002/ajh.24599] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 11/06/2022]
Affiliation(s)
- John C. Reneau
- Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Dennis Asante
- Department of Health Sciences Research, Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | - Holly van Houten
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic; Rochester Minnesota
- OptumLabs; Cambridge Massachusetts
| | - Lindsey R. Sangaralingham
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic; Rochester Minnesota
| | | | - Amir Lerman
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Joerg Herrmann
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
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Myeloma in the Real World: What Is Really Happening? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 17:133-144.e1. [PMID: 28153487 DOI: 10.1016/j.clml.2016.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/16/2016] [Accepted: 12/14/2016] [Indexed: 12/25/2022]
Abstract
Multiple myeloma (MM) is the second most common hematologic malignancy and is predominantly a disease of the elderly. In the past 2 decades, a range of new therapeutic options have become available, leading to improvements in patient outcomes, including both attainment of remission and overall survival. These improved outcomes have heralded a paradigm shift from a palliative approach toward more active management, including the use of sequential therapies, with the goal of prolonging progression-free and overall survival and preserving organ function to enable delivery of further therapy at relapse. Until now, most outcome data for MM have come from clinical trials, with few reports available on patients treated outside the clinical trial setting-in the "real world." Clinical trials are routinely undertaken in specialist centers, and extrapolation of these trial data to broader clinical practice might not accurately reflect "real-world" patient outcomes. Optimal management of MM is of key importance for positive patient outcomes, and further scrutiny of the efficacy and safety of the various reported therapies and how clinical trial findings are being translated or applied in the real-world management of MM is required. In the present review, we have described the minimal published evidence available through a comprehensive published data search of MEDLINE using the OvidSP interface on the management and outcomes of MM outside the setting of clinical trials, including evidence on the uptake of new therapies and their efficacy and tolerability in standard practice. Clinical registries might be able to help provide these data in the future.
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Usnarska-Zubkiewicz L, Dębski J, Butrym A, Legieć W, Hus M, Dmoszyńska A, Stella-Hołowiecka B, Zaucha JM, Januszczyk J, Rymko M, Torosian T, Charliński G, Lech-Marańda E, Malenda A, Jurczyszyn A, Urbańska-Ryś H, Druzd-Sitek A, Błońska D, Urbanowicz A, Hołojda J, Pogrzeba J, Rzepecki P, Hałka J, Subocz E, Becht R, Zdziarska B, Dytfeld D, Nowicki A, Bołkun Ł, Kłoczko J, Knopińska-Posłuszny W, Zubkiewicz-Kucharska A, Kuliczkowski K. Efficacy and safety of lenalidomide treatment in multiple myeloma (MM) patients--Report of the Polish Myeloma Group. Leuk Res 2015; 40:90-9. [PMID: 26626207 DOI: 10.1016/j.leukres.2015.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/06/2015] [Accepted: 11/03/2015] [Indexed: 11/19/2022]
Abstract
UNLABELLED The aim of the multi-centre retrospective study was to evaluate the efficacy and safety of lenalidomide (LEN) therapy in patients with resistant or relapsed multiple myeloma (MM) as well as in patients with stable disease (LEN used due to neurological complications). The primary endpoint of this study was an overall response rate (ORR). The secondary endpoints were as follows: time to progression (TTP), overall survival (OS) and the safety of drug use. Data were collected in 19 centres of the Polish Multiple Myeloma Study Group. The study group consisted of 306 subjects: 153 females and 153 males. In 115 patients (38.8%, group A), a resistant myeloma was diagnosed; in 135 (44.1%, group B) a relapse, and in 56 (18.3%, group C) a stable disease were stated. In 92.8% of patients, LEN+DEX combination was used; in remaining group, LEN monotherapy or a combination therapy LEN+bortezomib or LEN+bendamustine and other were used. In the entire study group, ORR was 75.5% (including 12.4% patients achieving complete remission [CR] or stringent CR [sCR]). Median time to progression (TTP) was 20 months. Median overall survival (OS) was 33.3 months. The regression model for "treatment response" was on the borderline of statistical significance (p=0.07), however the number of LEN treatment cycles ≥ 6 (R(2)=17.2%), baseline LDH level (R(2)=1.1%) and no ASCT use (R(2)=1.7%) where the factors most affecting treatment response achievement. The regression model for dependant variable--"overall survival"--was statistically significant (p=0.0000004). Factors with the most impact on OS were as follows: number of LEN cycles treatment ≥ 6 (R(2)=16.7%), treatment response achievement (R(2)=6.9%), β-2-microglobulin (β-2-M) level (R(2)=4.8%), renal function (R(2)=3.0%) and lack of 3/4 grade adverse events (R(2)=1.4%). SUMMARY LEN is an effective and safe therapeutic option, even in intensively treated resistant and relapsed MM patients, as well as in patients with stable disease and previous treatment-induced neurological complications. In particular, the number of LEN treatment cycles ≥ 6 was the factor which affected treatment response achievement the most, together with an important impact on OS.
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Affiliation(s)
- L Usnarska-Zubkiewicz
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland.
| | - J Dębski
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland
| | - A Butrym
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland; Department of Physiology, Wroclaw Medical University, Poland
| | - W Legieć
- Department of Haematology and Bone Marrow Transplantation, Medical University of Lublin, Poland
| | - M Hus
- Department of Haematology and Bone Marrow Transplantation, Medical University of Lublin, Poland
| | - A Dmoszyńska
- Department of Haematology and Bone Marrow Transplantation, Medical University of Lublin, Poland
| | - B Stella-Hołowiecka
- Department of Haematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | | | | | - M Rymko
- Department of Haematology, District Hospital in Torun, Poland
| | - T Torosian
- Department of Haematology, Oncology and Internal Medicine, Warsaw Medical University, Poland
| | - G Charliński
- Department of Haematology, Oncology and Internal Medicine, Warsaw Medical University, Poland
| | - E Lech-Marańda
- Department of Haematology, Institute of Haematology and Blood Transfusion, Warsaw, Poland; Centre of Postgraduate Medical Education, Warsaw, Poland
| | - A Malenda
- Department of Haematology, Institute of Haematology and Blood Transfusion, Warsaw, Poland
| | - A Jurczyszyn
- Department of Haematology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | - H Urbańska-Ryś
- Department of Haematology, Medical University of Lodz, Poland
| | - A Druzd-Sitek
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | - D Błońska
- Department of Haematology and Neoplasmatic Diseases of Haematopoiesis, Bydgoszcz, Poland
| | - A Urbanowicz
- Department of Clinical Oncology and Haematology, District Hospital in Suwalki, Poland
| | - J Hołojda
- Department of Haematology, District Specialist Hospital in Legnica, Poland
| | - J Pogrzeba
- Department of Haematology and Haematooncology, District Hospital in Opole, Poland
| | - P Rzepecki
- Department of Internal Diseases and Haematology, Military Institute of Medicine, Central Clinical Hospital of the Ministry of National Defence, Warsaw, Poland
| | - J Hałka
- Department of Internal Diseases and Haematology, Military Institute of Medicine, Central Clinical Hospital of the Ministry of National Defence, Warsaw, Poland
| | - E Subocz
- Department of Internal Diseases and Haematology, Military Institute of Medicine, Central Clinical Hospital of the Ministry of National Defence, Warsaw, Poland
| | - R Becht
- Department of Haematology, Pomeranian Medical University, Szczecin, Poland
| | - B Zdziarska
- Department of Haematology, Pomeranian Medical University, Szczecin, Poland
| | - D Dytfeld
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poland
| | - A Nowicki
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poland
| | - Ł Bołkun
- Department of Haematology, University Clinical Hospital of Białystok, Poland
| | - J Kłoczko
- Department of Haematology, University Clinical Hospital of Białystok, Poland
| | - W Knopińska-Posłuszny
- Ministry of the Interior Hospital in Olsztyn with Warmia and Masuria Oncology Center, Poland
| | - A Zubkiewicz-Kucharska
- Department of Endocrinology and Diabetology for Children and Adolescents, Wroclaw Medical University, Poland
| | - K Kuliczkowski
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland
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Nguyen KL, Alrezk R, Mansourian PG, Naeim A, Rettig MB, Lee CC. The Crossroads of Geriatric Cardiology and Cardio-Oncology. CURRENT GERIATRICS REPORTS 2015; 4:327-337. [PMID: 26543801 PMCID: PMC4624825 DOI: 10.1007/s13670-015-0147-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cancer and cardiovascular disease (CVD) are two major causes of mortality in older adults. With improved survival and outcomes from cancer and CVD, the role of the geriatrician is evolving. Geriatricians provide key skills to facilitate patient-centered and value-based care in the growing older population of cancer patients (and survivors). Cancer treatment in older adults is particularly injurious with respect to complications stemming from cancer therapy and as well as to CVD related to cancer therapy in the context of physiologic aging. To best meet their natural potential as caregiving leaders, geriatricians must hone skills and insights pertaining to oncologic and cardiovascular care, insights that can inform and enhance key management expertise. In this paper, we will review common chemotherapy and radiation-induced cardiovascular complications, screening recommendations, and advance the concept of a geriatric, cardiology, and oncology collaboration. We assert that geriatricians are well suited to a leadership role in the care of older cardio-oncology patients and in the education of primary care physicians and subspecialists on geriatric principles.
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Affiliation(s)
- Kim-Lien Nguyen
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA 90073 USA ; Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073 USA
| | - Rami Alrezk
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA 90073 USA ; Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA USA ; GRECC, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - Pejman G Mansourian
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073 USA
| | - Arash Naeim
- Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA USA ; Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Matthew B Rettig
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA 90073 USA ; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA USA ; Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Cathy C Lee
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA 90073 USA ; Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA USA ; GRECC, VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
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Pulte D, Jansen L, Castro FA, Emrich K, Katalinic A, Holleczek B, Brenner H. Trends in survival of multiple myeloma patients in Germany and the United States in the first decade of the 21st century. Br J Haematol 2015; 171:189-196. [PMID: 26123295 DOI: 10.1111/bjh.13537] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
Multiple myeloma is a chronic, incurable but highly treatable neoplasm. Recent population-based studies have shown improvements in survival for patients diagnosed in the early 21st century. Here, we examine trends in survival for patients diagnosed with multiple myeloma in Germany and the United States (US) between 2002 and 2010. Data were extracted from 11 population-based cancer registries in Germany and from the Surveillance, Epidemiology and End Results database in the US. Myeloma patients aged 15-74 years with diagnosis and follow-up between 1997 and 2010 from Germany and the US were included. Period analysis was employed to assess trends in 5-year relative survival in Germany and the US between 2002-04 and 2008-10. Age-adjusted 5-year relative survival increased from 47·3% to 53·8% in Germany and from 39·8% to 53·2% in the US between 2002-04 and 2008-10. There was a strong age gradient with lower survival among older patients, which persisted over time and was more pronounced in Germany than the US. Five-year relative survival estimates for patients diagnosed with multiple myeloma below 75 years of age steadily increased throughout the first decade of the 21st century and reached levels above 50% in both Germany and the US, probably reflecting the increased use of newer agents in myeloma treatment.
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Affiliation(s)
- Dianne Pulte
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Cardeza Foundation and Division of Hematology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Felipe A Castro
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Katharina Emrich
- Cancer Registry of Rhineland-Palatinate, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Centre, Heidelberg, Germany
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Wang J, Guo H, Zhou X. Clinical utility and patient consideration in the use of lenalidomide for multiple myeloma in Chinese patients. Onco Targets Ther 2015; 8:1277-84. [PMID: 26082645 PMCID: PMC4459627 DOI: 10.2147/ott.s65762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multiple myeloma (MM) is an incurable hematologic malignancy caused by the autonomous growth of malignant plasma cells. In the last decade, the introduction of novel targeted agents such as thalidomide, bortezomib, and lenalidomide has dramatically improved the clinical outcome of MM patients in both the frontline and recurrent settings. Lenalidomide is a synthetic derivative of thalidomide, which has been shown to significantly improve overall survival, time to progression, and overall response rates in patients with MM. The China Food and Drug Administration approved the use of lenalidomide in patients with MM in 2013. In a Phase II trial, lenalidomide plus low-dose dexamethasone was associated with a high response rate and acceptable safety profile in heavily pretreated Chinese patients with relapsed/refractory MM, including those with renal impairment and IgD subtype. However, lenalidomide will remain as a second-line antimyeloma drug in the near future because of its high price and the policy of health insurance reimbursement in People’s Republic of China. In this review, we summarize the clinical utility and patient considerations in the use of lenalidomide for MM in Chinese patients. Further studies with larger sample sizes are required to investigate the better quality, longer duration, and more clinically meaningful outcomes of lenalidomide in the treatment of MM in Chinese patients.
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Affiliation(s)
- Jing Wang
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, People's Republic of China
| | - Hongfeng Guo
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, People's Republic of China
| | - Xin Zhou
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, People's Republic of China
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Kuroda J, Kobayashi T, Taniwaki M. Prognostic indicators of lenalidomide for multiple myeloma: consensus and controversy. Expert Rev Anticancer Ther 2015; 15:787-804. [PMID: 25947283 DOI: 10.1586/14737140.2015.1044249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The long-term outcome of multiple myeloma (MM) has been greatly improved through new agents, one being lenalidomide (LEN). Based upon the findings of in vitro experiments, its mode of action against MM occurs through a combination of direct tumoricidal effects on myeloma cells, modulatory effects on tumor immunity and tumor microenvironment-regulatory effects. However, it has not been clearly defined whether the clinical response and long-term outcome of MM with LEN treatment truly reflect the mechanisms of action of LEN proposed by in vitro studies. To ascertain what is known and what remains to be elucidated with LEN, we review the current literature on the mode of action of LEN in association with myeloma pathophysiology, and discuss the prognostic indicators in the treatment of MM with LEN.
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Affiliation(s)
- Junya Kuroda
- Department of Medicine, Division of Hematology and Oncology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
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Kim HJ, Yoon SS, Eom HS, Kim K, Kim JS, Lee JJ, Bang SM, Min CK, Park JS, Lee JH. Use of lenalidomide in the management of relapsed or refractory multiple myeloma: expert recommendations in Korea. Blood Res 2015; 50:7-18. [PMID: 25830125 PMCID: PMC4377347 DOI: 10.5045/br.2015.50.1.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/10/2015] [Accepted: 02/10/2015] [Indexed: 01/06/2023] Open
Abstract
Multiple myeloma (MM) is the third most common hematologic malignancy in Korea. Historically, the incidence of MM in Korea has been lower than that in Western populations, although there is growing evidence that the incidence of MM in Asian populations, including Korea, is increasing rapidly. Despite advances in the management of MM, patients will ultimately relapse or become refractory to their current treatment, and alternative therapeutic options are required in the relapsed/refractory setting. In Korea, although lenalidomide/dexamethasone is indicated for the treatment of relapsed or refractory MM (RRMM) in patients who have received at least one prior therapy, lenalidomide is reimbursable specifically only in patients with RRMM who have failed bortezomib-based treatment. Based on evidence from pivotal multinational clinical trials as well as recent studies in Asia, including Korea, lenalidomide/dexamethasone is an effective treatment option for patients with RRMM, regardless of age or disease status. Adverse events associated with lenalidomide/dexamethasone, including hematologic toxicity, venous thromboembolism, fatigue, rash, infection, and muscle cramps, are largely predictable and preventable/manageable with appropriate patient monitoring and/or the use of standard supportive medication and dose adjustment/interruption. Lenalidomide/dexamethasone provides an optimal response when used at first relapse, and treatment should be continued long term until disease progression. With appropriate modification of the lenalidomide starting dose, lenalidomide/dexamethasone is effective in patients with renal impairment and/or cytopenia. This review presents updated evidence from the published clinical literature and provides recommendations from an expert panel of Korean physicians regarding the use of lenalidomide/dexamethasone in patients with RRMM.
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Affiliation(s)
- Hyo Jung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Seok Eom
- Hematology-Oncology Clinic, National Cancer Center, Ilsan, Korea
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Bundang, Korea
| | - Chang-Ki Min
- Division of Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Joon Seong Park
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hoon Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Raheja D, Specht C, Simmons Z. Paraproteinemic neuropathies. Muscle Nerve 2014; 51:1-13. [DOI: 10.1002/mus.24471] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Divisha Raheja
- Department of Neurology; Penn State Hershey Medical Center; EC 037, 30 Hope Drive Hershey Pennsylvania 17033 USA
| | - Charles Specht
- Department of Neurology; Penn State Hershey Medical Center; EC 037, 30 Hope Drive Hershey Pennsylvania 17033 USA
- Department of Pathology; Penn State Hershey Medical Center; Hershey Pennsylvania USA
- Department of Ophthalmology; Penn State Hershey Medical Center; Hershey Pennsylvania USA
- Department of Neurosurgery; Penn State Hershey Medical Center; Hershey Pennsylvania USA
| | - Zachary Simmons
- Department of Neurology; Penn State Hershey Medical Center; EC 037, 30 Hope Drive Hershey Pennsylvania 17033 USA
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