1
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Sauer S, Engelhardt M, Trautmann-Grill K, Kimmich C, Hänel M, Schmidt-Hieber M, Salwender H, Flossmann C, Heckmann H, Ertel F, Friederich A, Patel S, Thun B, Raab MS. Treatment pattern and outcomes of re-induction therapy prior to stem cell transplantation in patients with relapsed/refractory multiple myeloma in Germany. Bone Marrow Transplant 2024; 59:880-889. [PMID: 38480852 PMCID: PMC11161411 DOI: 10.1038/s41409-024-02208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 06/09/2024]
Abstract
There are limited data guiding choice of re-induction therapies for patients with relapsed/refractory multiple myeloma (RRMM) prior to stem cell transplantation (SCT). We performed a retrospective medical chart review of 171 patients with RRMM in Germany who received re-induction therapy in second line (78%; n = 134) or third line (22%; n = 37) prior to re-SCT. Index therapy was defined as first completed re-induction therapy for planned myeloablative conditioning and SCT in second/third line within the eligibility period (1/2016-12/2019). Most common pre-index first line and maintenance therapy used were bortezomib-based combinations (91%; n = 155/171) and lenalidomide (55%; n = 29/53), respectively. Median duration of index therapy line was 9 months; carfilzomib-based combinations were the most widely used in second/third line re-induction therapy (49%; n = 83/171), followed by daratumumab-based combinations (21%; n = 36/171). Overall response rates in second/third line were 87% after re-induction and 96% after SCT; median time to next treatment line after start of index therapy was 31 months; median progression-free survival (PFS) was 29 months; and median overall survival after index date was not reached. Based on these data, re-induction therapy with salvage SCT appears to be beneficial in selected patients with RRMM in clinical practice in Germany, translating into deep responses, long PFS and prolonged time to next treatment.
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Affiliation(s)
- Sandra Sauer
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Monika Engelhardt
- Medical Department, Hematology, Oncology & Stem Cell Transplantation, Faculty of Freiburg, Freiburg, Germany
| | | | - Christoph Kimmich
- Department of Oncology and Hematology, University Clinic Oldenburg, Oldenburg, Germany
| | - Mathias Hänel
- Department of Internal Medicine III, Chemnitz Hospital, Chemnitz, Germany
| | | | - Hans Salwender
- Asklepios Tumorzentrum Hamburg, AK Altona and AK St Georg, Hamburg, Germany
| | | | | | | | | | | | - Barbara Thun
- IQVIA Commercial GmbH & Co. OHG, Munich, Germany
| | - Marc S Raab
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
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2
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Nunnelee J, Cottini F, Zhao Q, Faisal MS, Elder P, Rosko A, Bumma N, Khan A, Umyarova E, Devarakonda S, Benson DM, Efebera YA, Sharma N. Early versus Late Discontinuation of Maintenance Therapy in Multiple Myeloma. J Clin Med 2022; 11:5794. [PMID: 36233663 PMCID: PMC9573258 DOI: 10.3390/jcm11195794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
Maintenance therapy after autologous stem cell transplant (ASCT) in multiple myeloma (MM) is the standard treatment and recommended to be continued until disease progression. However, in the real world, patients discontinue treatment due to various reasons. We sought to determine the effect of early versus late discontinuation on survival outcomes in MM patients who underwent ASCT at The Ohio State University. We retrospectively reviewed 340 patients who underwent ASCT from 2005 to 2016 and received maintenance therapy for at least six months without progression. We compared the outcomes of patients who received maintenance for three years or less (early group) to the patients who continued maintenance beyond three years (late group). Lenalidomide (89%) and bortezomib (10%) were the most common agents used for maintenance chemotherapy. In Kaplan−Meier analysis, patients in the late group had prolonged progression-free (PFS) (p < 0.001) and overall survival (OS) (p < 0.001). The 5-year estimated OS in late group was 96% vs. 79% in the early group and 5-year PFS was 80% in late group vs. 50% in the early group. The most common reasons for discontinuation of maintenance in early group were adverse events (55.9%) and patient preference (22.5%). For the late group, it was disease progression (23.9%) and adverse events (14.3%). Fifty-five percent of patients in the late group were still on maintenance treatment at the last follow-up. Continuation of maintenance therapy was thus associated with improved outcomes, while adverse events prevented most patients from continuing treatment.
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Affiliation(s)
- Jordan Nunnelee
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Francesca Cottini
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Qiuhong Zhao
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Muhammad Salman Faisal
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Patrick Elder
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Ashley Rosko
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Naresh Bumma
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Abdullah Khan
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Elvira Umyarova
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Srinivas Devarakonda
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Don M. Benson
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
| | - Yvonne A. Efebera
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
- Bone Marrow Transplantation & Cellular Therapy, OhioHealth, Columbus, OH 43210, USA
| | - Nidhi Sharma
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH 43210, USA
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3
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Feasibility of Outpatient Stem Cell Transplantation in Multiple Myeloma and Risk Factors Predictive of Hospital Admission. J Clin Med 2022; 11:jcm11061640. [PMID: 35329966 PMCID: PMC8955129 DOI: 10.3390/jcm11061640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/26/2022] Open
Abstract
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) remains the standard of care for multiple myeloma (MM) patients. Although outpatient ASCT has been shown to be safe and feasible, the procedure is overall rare with most patients in the US undergoing inpatient ASCT. Furthermore, hospitalization rates for patients that undergo outpatient ASCT remain high. Adequate markers that predict hospitalization during outpatient ASCT are lacking, yet would be of great clinical value to select patients that are suited to outpatient ASCT. In this study we aimed to elucidate differences between planned outpatient and inpatient ASCT and further evaluated clinical characteristics that are significantly associated with hospitalization during planned outpatient hospitalization. Factors that were significantly associated with a planned inpatient ASCT included an advanced MM disease stage, worse performance status as well as non-Caucasian race, while low albumin levels and female gender were significantly associated with hospitalization during outpatient ASCT. The results of this analysis provide crucial knowledge of factors that are associated with planned inpatient ASCT and hospitalization during outpatient ASCT and could guide the treating physician in decision-making and further facilitate outpatient transplantation.
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4
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Devarakonda S, Efebera Y, Sharma N. Role of Stem Cell Transplantation in Multiple Myeloma. Cancers (Basel) 2021; 13:863. [PMID: 33670709 PMCID: PMC7922596 DOI: 10.3390/cancers13040863] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022] Open
Abstract
Autologous stem cell transplantation (auto-SCT) has been the standard of care in eligible newly diagnosed multiple myeloma (MM) patients. Outcomes of patients with MM have improved significantly due to the advent of several novel drugs. Upfront use of these drugs in induction therapy has significantly increased the rate and depth of responses that have translated into longer remission and survival. This has now raised a debate regarding the role and relevance of auto-SCT in the management of myeloma. However, clinical trials have confirmed the utility of auto-SCT even in the era of novel drugs. Tandem auto-SCT followed by maintenance has shown a progression-free survival (PFS) benefit in high-risk MM, and hence can be considered in young and fit patients with high-risk disease. Auto-SCT has the advantages of resetting the bone marrow microenvironment, short-lived toxicity compared to the long-term physical and financial toxicities of continued chemotherapy in the absence of SCT, very low transplant-related mortality (TRM) in high volume centers, and providing longer disease-free survival when followed by maintenance therapy. Allogeneic SCT is one potentially curative option for MM, albeit with an increased risk of death due to high TRM. Strategies to modulate the graft-versus-host disease (GVHD) while maintaining or improving the graft-versus-myeloma (GVM) effect could place allogeneic SCT back in the treatment armamentarium of MM.
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Affiliation(s)
| | - Yvonne Efebera
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, Columbus, OH 43210, USA; (S.D.); (N.S.)
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5
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Kortüm KM, Einsele H. [Diagnostic and therapeutic considerations on recurrence of multiple myeloma : A current overview]. Internist (Berl) 2019; 60:34-41. [PMID: 30536028 DOI: 10.1007/s00108-018-0528-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The treatment of multiple myeloma remains in a state of profound change. Over the past decades both disease-free survival and overall survival have been significantly prolonged by the approval of new drugs; however, despite high response rates and achievement of deep responses to primary treatment, recurrence of the disease is still expected in nearly all patients treated. Fortunately, good treatment options for myeloma patients in relapse are also currently available and the possible combinations of approved substances are numerous. Patient-specific criteria, such as primary response, comorbidities and treatment-associated toxicity can thus be taken into account more frequently in the selection of a suitable treatment of recurrences; however, the lack of comparative studies of new substances and extensive interindividual disease heterogeneity continue to make it difficult to select the best treatment of recurrence in a specific case. Therefore, the treatment of recurrence of multiple myeloma, especially for patients with high-risk features, remains a clinical challenge. This review article deliberately dispenses with the commonly used combination of mere study results and a more practical approach should be taught for the rational planning of treatment for recurrent multiple myeloma. This includes new insights into tumor evolution and taking current developments in the drug treatment of multiple myeloma into account.
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Affiliation(s)
- K M Kortüm
- Medizinische Klinik 2, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97074, Würzburg, Deutschland.
| | - H Einsele
- Medizinische Klinik 2, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97074, Würzburg, Deutschland
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6
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The first-in-human study of the pan-PIM kinase inhibitor PIM447 in patients with relapsed and/or refractory multiple myeloma. Leukemia 2019; 33:2924-2933. [PMID: 31092894 DOI: 10.1038/s41375-019-0482-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 12/27/2022]
Abstract
PIM447, a novel pan-PIM inhibitor, has shown preclinical activity in multiple myeloma (MM). In the multicenter, open-label, first-in-human study, patients with relapsed and/or refractory MM were enrolled to determine the maximum-tolerated dose (MTD) or recommended dose (RD), safety, pharmacokinetics, and preliminary anti-myeloma activity of PIM447. PIM447 was administered in escalating oral doses of 70-700 mg once daily (q.d.) for 28-day continuous cycles. Seventy-nine patients with a median of four prior therapies were enrolled. Seventy-seven patients (97.5%) had an adverse event (AE) suspected as treatment related, with treatment-related grade 3/4 AEs being mostly hematologic. Eleven dose-limiting toxicities occurred, and an MTD of 500 mg q.d. and an RD of 300 mg q.d. were established. The main reason for discontinuation was disease progression in 54 patients (68.4%). In the entire study population, a disease control rate of 72.2%, a clinical benefit rate of 25.3%, and an overall response rate of 8.9% were observed per modified International Myeloma Working Group criteria. Median progression-free survival at the RD was 10.9 months. PIM447 was well tolerated and demonstrated single-agent antitumor activity in relapsed/refractory MM patients, providing proof of principle for Pim (Proviral Insertions of Moloney Murine leukemia virus) kinase inhibition as a novel therapeutic approach in MM.
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7
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Vulpis E, Stabile H, Soriani A, Fionda C, Petrucci MT, Mariggio' E, Ricciardi MR, Cippitelli M, Gismondi A, Santoni A, Zingoni A. Key Role of the CD56 lowCD16 low Natural Killer Cell Subset in the Recognition and Killing of Multiple Myeloma Cells. Cancers (Basel) 2018; 10:cancers10120473. [PMID: 30501078 PMCID: PMC6317053 DOI: 10.3390/cancers10120473] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 11/27/2018] [Indexed: 01/08/2023] Open
Abstract
Natural Killer (NK) cells play a pivotal role in the immunosurveillance of Multiple Myeloma (MM), but it is still undefined whether the NK cell functional properties underlying their protective activity against MM are confined to distinct NK cell populations. Interestingly, herein we report that the CD56lowCD16low NK cell subset displayed higher cytolytic activity compared to the other NK cell subsets (i.e., CD56highCD16+/−, CD56lowCD16high) against MM cells and its activity was impaired in MM patients. Decreased DNAM-1 expression levels were observed on the CD56lowCD16low NK cells during MM progression. Evaluating NK cell subset frequency after autologous hematopoietic stem cell transplantation, we found that CD56lowCD16low NK cells recovered earlier after transplantation. Overall, our data denote a key role of CD56lowCD16low subpopulation in the killing of MM cells and suggest that the reconstitution of CD56lowCD16low subpopulation after HSCT could be a useful approach of adoptive immunotherapy in the treatment of relapsed/refractory MM patients.
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Affiliation(s)
- Elisabetta Vulpis
- Department of Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, 00161 Rome, Italy.
| | - Helena Stabile
- Department of Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, 00161 Rome, Italy.
| | - Alessandra Soriani
- Department of Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, 00161 Rome, Italy.
| | - Cinzia Fionda
- Department of Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, 00161 Rome, Italy.
| | - Maria Teresa Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, 00161 Rome, Italy.
| | - Elena Mariggio'
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, 00161 Rome, Italy.
| | - Maria Rosaria Ricciardi
- Division of Hematology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy.
| | - Marco Cippitelli
- Department of Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, 00161 Rome, Italy.
| | - Angela Gismondi
- Department of Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, 00161 Rome, Italy.
| | - Angela Santoni
- Department of Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, 00161 Rome, Italy.
- IRCCS, Neuromed, 86077 Pozzilli, Italy.
| | - Alessandra Zingoni
- Department of Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, 00161 Rome, Italy.
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8
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Richardson PG, Laubach J, Gandolfi S, Facon T, Weisel K, O’Gorman P. Maintenance and continuous therapy for multiple myeloma. Expert Rev Anticancer Ther 2018; 18:751-764. [DOI: 10.1080/14737140.2018.1490181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Paul G. Richardson
- Department of Hematology and Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jacob Laubach
- Department of Hematology and Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Sara Gandolfi
- Department of Hematology and Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Thierry Facon
- Department of Haematology, Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | - Katja Weisel
- Department of Hematology and Oncology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Peter O’Gorman
- Department of Haematology, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
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9
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Nijhof IS, van de Donk NWCJ, Zweegman S, Lokhorst HM. Current and New Therapeutic Strategies for Relapsed and Refractory Multiple Myeloma: An Update. Drugs 2018; 78:19-37. [PMID: 29188449 PMCID: PMC5756574 DOI: 10.1007/s40265-017-0841-y] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although survival of multiple myeloma patients has at least doubled during recent years, most patients eventually relapse, and treatment at this stage may be particularly complex. At the time of relapse, the use of alternative drugs to those given upfront is current practice. However, many new options are currently available for the treatment of relapsed multiple myeloma, including recently approved drugs, such as the second- and third-generation proteasome inhibitors carfilzomib and ixazomib, the immunomodulatory agent pomalidomide, the monoclonal antibodies daratumumab and elotuzumab and the histone deacetylase inhibitor panobinostat, but also new targeted agents are under active investigation (e.g. signal transduction modulators, kinesin spindle protein inhibitors, and inhibitors of NF-kB, MAPK, AKT). We here describe a new paradigm for the treatment of relapsed multiple myeloma. The final goal should be finding a balance among efficacy, toxicity, and cost and, at the end of the road, achieving long-lasting control of the disease and eventually even cure in a subset of patients.
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Affiliation(s)
- Inger S Nijhof
- Department of Hematology, VU University Medical Center, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
| | - Niels W C J van de Donk
- Department of Hematology, VU University Medical Center, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - Henk M Lokhorst
- Department of Hematology, VU University Medical Center, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
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10
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Hari P, Mateos MV, Abonour R, Knop S, Bensinger W, Ludwig H, Song K, Hajek R, Moreau P, Siegel DS, Feng S, Obreja M, Aggarwal SK, Iskander K, Goldschmidt H. Efficacy and safety of carfilzomib regimens in multiple myeloma patients relapsing after autologous stem cell transplant: ASPIRE and ENDEAVOR outcomes. Leukemia 2017; 31:2630-2641. [PMID: 28439109 PMCID: PMC5729352 DOI: 10.1038/leu.2017.122] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/09/2017] [Accepted: 04/03/2017] [Indexed: 01/12/2023]
Abstract
Autologous stem cell transplantation (ASCT) is a standard treatment for eligible multiple myeloma (MM) patients, but many patients will relapse after ASCT and require subsequent therapy. The proteasome inhibitor carfilzomib is approved for relapsed or refractory MM (RRMM). In phase 3 trials, carfilzomib-based regimens (ASPIRE, carfilzomib-lenalidomide-dexamethasone; ENDEAVOR, carfilzomib-dexamethasone) demonstrated superior progression-free survival (PFS) compared with standard therapies for RRMM (ASPIRE: lenalidomide-dexamethasone; ENDEAVOR, bortezomib-dexamethasone). This subgroup analysis of ASPIRE and ENDEAVOR evaluated outcomes according to prior ASCT status. In total, 446 patients in ASPIRE and 538 in ENDEAVOR had prior ASCT. Median PFS was longer for carfilzomib-based regimens vs non-carfilzomib-based regimens for patients with prior ASCT (ASPIRE: 26.3 vs 17.8 months (hazard ratio (HR)=0.68); ENDEAVOR: not estimable vs 10.2 months (HR=0.61)), those with one prior line of therapy that included ASCT (ASPIRE: 29.7 vs 17.8 months (HR=0.70); ENDEAVOR: not estimable vs 11.2 months (HR=0.46)), and those without prior ASCT (ASPIRE: 26.4 vs 16.6 months (HR=0.76); ENDEAVOR: 17.7 vs 8.5 months (HR=0.43)). Overall response rates also favored the carfilzomib-based regimens. No new safety signals were detected. This analysis suggests that carfilzomib-based treatment may lead to improvement in PFS and response rates regardless of prior transplant status. Further evaluation is warranted.
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Affiliation(s)
- P Hari
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - M-V Mateos
- Hematology, Hospital Clinico Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - R Abonour
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - S Knop
- Medizinische Klinik der Universitat Wurzburg, Wurzburg, Germany
| | - W Bensinger
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - H Ludwig
- Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver, British Columbia, Canada
| | - K Song
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - R Hajek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - P Moreau
- Department of Hematology, University of Nantes, Nantes, France
| | - D S Siegel
- John Theurer Cancer Center at Hackensack University, Hackensack, NJ, USA
| | - S Feng
- Amgen Inc., Thousand Oaks, CA, USA
| | - M Obreja
- Amgen Inc., Thousand Oaks, CA, USA
| | | | | | - H Goldschmidt
- Universitatsklinikum Heidelberg, Heidelberg, Germany
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11
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Patel P, Oh AL, Koshy M, Sweiss K, Saraf SL, Quigley JG, Khan I, Mahmud N, Hacker E, Ozer H, Peace DJ, Weichselbaum RR, Aydogan B, Rondelli D. A phase 1 trial of autologous stem cell transplantation conditioned with melphalan 200 mg/m2and total marrow irradiation (TMI) in patients with relapsed/refractory multiple myeloma. Leuk Lymphoma 2017; 59:1666-1671. [DOI: 10.1080/10428194.2017.1390231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pritesh Patel
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Annie L. Oh
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Matthew Koshy
- University of Illinois Cancer Center, Chicago, IL, USA
- Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
- Department of Cellular and Radiation Oncology, University of Chicago, Chicago, IL, USA
| | - Karen Sweiss
- University of Illinois Cancer Center, Chicago, IL, USA
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA
| | - Santosh L. Saraf
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - John G. Quigley
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Irum Khan
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Nadim Mahmud
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Eileen Hacker
- University of Illinois Cancer Center, Chicago, IL, USA
- Department of Biobehavioural Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Howard Ozer
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - David J. Peace
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
| | - Ralph R. Weichselbaum
- Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
- Department of Cellular and Radiation Oncology, University of Chicago, Chicago, IL, USA
| | - Bulent Aydogan
- Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
- Department of Cellular and Radiation Oncology, University of Chicago, Chicago, IL, USA
| | - Damiano Rondelli
- Division of Hematology/Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
- University of Illinois Cancer Center, Chicago, IL, USA
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12
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Zannetti BA, Tacchetti P, Pantani L, Gamberi B, Tosi P, Rocchi S, Cellini C, Ronconi S, Pezzi A, Mancuso K, Rizzello I, Caratozzolo I, Martello M, Dozza L, Cavo M, Zamagni E. Novel agent-based salvage autologous stem cell transplantation for relapsed multiple myeloma. Ann Hematol 2017; 96:2071-2078. [PMID: 29063955 DOI: 10.1007/s00277-017-3140-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a standard frontline therapy for multiple myeloma (MM). Therapeutic options for patients with relapsed MM after ASCT include novel agents in different combos, salvage ASCT (sASCT), and allogeneic transplant, with no unique standard of care. We retrospectively analyzed 66 MM patients who relapsed after up-front single or double ASCT(s) and received novel agent-based sASCT at five Italian centers. Median event-free survival from up-front ASCT(s) to first relapse (EFS1) was 44 months. Seventy-three percent of patients received sASCT at first disease progression. Re-induction regimens were bortezomib based in 87% of patients. Response to re-induction therapy included complete response (CR) 18%, ≥ very good partial response (VGPR) 48%, and overall response rate (ORR) 83%. Response to sASCT included CR 44%, ≥ VGPR 77%, and ORR 94%. With a median follow-up of 24 months after sASCT, 39 patients experienced disease progression. Median EFS from sASCT (EFS2) was 17 months. Median overall survival from ASCT (OS1) and sASCT (OS2) was 166 and 43 months, respectively. EFS2 and OS2 were significantly shorter in patients with EFS1 ≤ 24 months, in patients who did not receive sASCT at first disease progression and in patients with extramedullary disease (EMD). In multivariate analysis, EFS1 ≤ 24 months was associated with shorter EFS2 and OS2, EMD was associated with shorter EFS2, and < CR after sASCT was associated with shorter OS2. Novel agent-based sASCT is a safe and effective procedure for relapsed MM.
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Affiliation(s)
- Beatrice Anna Zannetti
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Paola Tacchetti
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lucia Pantani
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Barbara Gamberi
- Hematology Unit, "Arcispedale Santa Maria Nuova - IRCCS" Hospital, Reggio Emilia, Italy
| | | | - Serena Rocchi
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Claudia Cellini
- Hematology Unit, "S. Maria delle Croci" Hospital, Ravenna, Italy
| | - Sonia Ronconi
- Oncology and Hematology Unit, "Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori" Hospital, Meldola, Italy
| | - Annalisa Pezzi
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Katia Mancuso
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Ilaria Rizzello
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Isola Caratozzolo
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Marina Martello
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Luca Dozza
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Michele Cavo
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Elena Zamagni
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
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McCarthy PL, Holstein SA. Role of stem cell transplant and maintenance therapy in plasma cell disorders. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:504-511. [PMID: 27913522 PMCID: PMC6142442 DOI: 10.1182/asheducation-2016.1.504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Autologous stem cell transplant (ASCT) has been an important component of therapy for myeloma patients eligible for high-dose chemotherapy. Recent studies comparing early transplant to low-dose chemotherapy support the continued use of ASCT as consolidation following induction therapy, even in the era of immunomodulatory drugs, proteasome inhibitors, and other novel agents. Despite the marked improvements in outcomes with this approach, most patients will eventually experience disease progression. Thus, inclusion of post-ASCT consolidation/maintenance strategies is used to improve long-term disease control. Multiple randomized studies support the use of lenalidomide maintenance therapy following ASCT. The next generation of clinical trials will incorporate novel agents such as monoclonal antibodies, proteasome inhibitors, and other novel pathway modulatory agents into post-ASCT treatment strategies with the goal of achieving even deeper responses and longer durations of disease control.
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Affiliation(s)
- Philip L. McCarthy
- Department of Medicine, Blood and Marrow Transplant Program, Roswell Park Cancer Institute, Buffalo, NY; and
| | - Sarah A. Holstein
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE
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14
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Abstract
AbstractAutologous stem cell transplant (ASCT) has been an important component of therapy for myeloma patients eligible for high-dose chemotherapy. Recent studies comparing early transplant to low-dose chemotherapy support the continued use of ASCT as consolidation following induction therapy, even in the era of immunomodulatory drugs, proteasome inhibitors, and other novel agents. Despite the marked improvements in outcomes with this approach, most patients will eventually experience disease progression. Thus, inclusion of post-ASCT consolidation/maintenance strategies is used to improve long-term disease control. Multiple randomized studies support the use of lenalidomide maintenance therapy following ASCT. The next generation of clinical trials will incorporate novel agents such as monoclonal antibodies, proteasome inhibitors, and other novel pathway modulatory agents into post-ASCT treatment strategies with the goal of achieving even deeper responses and longer durations of disease control.
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Garderet L, Cook G, Auner HW, Bruno B, Lokhorst H, Perez-Simon JA, Sahebi F, Scheid C, Morris C, van Biezen A, Sobh M, Michallet M, Gahrton G, Schönland S, Kröger N. Treatment options for relapse after autograft in multiple myeloma – report from an EBMT educational meeting. Leuk Lymphoma 2016; 58:797-808. [DOI: 10.1080/10428194.2016.1228926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Lonial S, Kaufman J, Reece D, Mateos MV, Laubach J, Richardson P. Update on elotuzumab, a novel anti-SLAMF7 monoclonal antibody for the treatment of multiple myeloma. Expert Opin Biol Ther 2016; 16:1291-301. [DOI: 10.1080/14712598.2016.1221920] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jonathan Kaufman
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Donna Reece
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Canada
| | - Maria-Victoria Mateos
- Haematology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Jacob Laubach
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paul Richardson
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
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Naymagon L, Abdul-Hay M. Novel agents in the treatment of multiple myeloma: a review about the future. J Hematol Oncol 2016; 9:52. [PMID: 27363832 PMCID: PMC4929712 DOI: 10.1186/s13045-016-0282-1] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/21/2016] [Indexed: 02/07/2023] Open
Abstract
Multiple myeloma (MM) is a disease that affects plasma cells and can lead to devastating clinical features such as anemia, lytic bone lesions, hypercalcemia, and renal disease. An enhanced understanding of MM disease mechanisms has led to new more targeted treatments. There is now a plethora of treatments available for MM. In this review article, our aim is to discuss many of the novel agents that are being studied or have recently been approved for the treatment of MM. These agents include the following: immunomodulators (pomalidomide), proteasome inhibitors (carfilzomib, marizomib, ixazomib, oprozomib), alkylating agents (bendamustine), AKT inhibitors (afuresertib), BTK inhibitors (ibrutinib), CDK inhibitors (dinaciclib), histone deacetylase inhibitors (panobinostat, rocilinostat, vorinostat), IL-6 inhibitors (siltuximab), kinesin spindle protein inhibitors (filanesib), monoclonal antibodies (daratumumab, elotuzumab, indatuximab, SAR650984), and phosphoinositide 3-kinase (PI3K) inhibitors.
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Affiliation(s)
| | - Maher Abdul-Hay
- Department of Medicine, New York University, New York, USA. .,Perlmutter Cancer Center, New York University, New York, USA. .,NYU School of Medicine, 240 East 38th Street, 19 Floor, New York, NY, 10016, USA.
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18
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Pawarode A, Mineishi S, Reddy P, Braun TM, Khaled YA, Choi SW, Magenau JM, Harris AC, Connelly JA, Kitko CL, Parkin BL, Goldstein SC, Yanik GA, Levine JE, Ferrara JL, Couriel DR. Reducing Treatment-Related Mortality Did Not Improve Outcomes of Allogeneic Myeloablative Hematopoietic Cell Transplantation for High-Risk Multiple Myeloma: A University of Michigan Prospective Series. Biol Blood Marrow Transplant 2015. [PMID: 26211984 DOI: 10.1016/j.bbmt.2015.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Despite the ongoing advent of more effective immunomodulators and proteasome inhibitors, multiple myeloma (MM) remains incurable and no effective therapy is available for advanced aggressive disease. Although allogeneic (Allo) hematopoietic cell transplantation (HCT) has a curative potential, the outcomes remain poor because of high treatment-related mortality (TRM), mostly due to regimen-related toxicities and graft-versus-host disease (GVHD) in case of myeloablative conditionings, high relapse rate in case of reduced-intensity or nonmyeloablative regimens, and possibly other unknown MM-specific issues. In an attempt to improve TRM, without compromising conditioning intensity, we prospectively explored the feasibility and efficacy of a myeloablative but reduced-toxicity conditioning regimen, consisting of fludarabine and busulfan (FluBu4; fludarabine 40 mg/m(2)/day and busulfan 3.2 mg/kg/day i.v. × 4 days) in 22 patients with high-risk or advanced refractory MM. The majority (14 of 22, 64%) had prior autologous HCT. The median HCT-specific comorbidity index score was 3 (range, 0 to 6), with 46% having a Karnofsky performance score < 80%. Ten patients had unrelated donors, 3 of whom were 7/8 HLA-loci matched. GVHD prophylaxis was tacrolimus and methotrexate in 20 (91%). Most patients had active MM at transplantation, with a partial response in 12 of 22 (46%) and stable disease in 1 of 22 (4.5%). All 22 patients tolerated the FluBu4 conditioning well, without early toxic deaths or graft failure. Common regimen-related toxicities included mild to moderate mucositis (18 of 22, 82%) and mild transient liver function abnormality (9 of 22, 41%). There were no grade 4 toxicities but grade 3 mucositis occurred in 7 of 22 patients (32%). The cumulative incidence of severe, grades III and IV acute GVHD at day 180 was 23% (95% confidence interval [CI], 10% to 47%) and that of chronic GVHD was 68% (95% CI, 46% to 88%). The cumulative incidences of TRM at 100 days, 1 year, and 3 years were 9% (95% CI, 2% to 33%), 19% (95% CI, 7% to 44%), and 29% (95% CI, 13% to 55%), respectively. Two TRMs were due to idiopathic pneumonia syndrome and 1 was due to cirrhosis. They all had decreased pre-HCT corresponding organ function, with HCT-specific comorbidity index scores of > 3. With a median follow-up of 58.7 (range, 39 to 82) months, the cumulative incidences of relapse at 1 and 3 years were 37% (95% CI, 20% to 61%) and 50% (95% CI, 29% to 75%); those for 1-year and 3-year overall survival (OS) were 58% (95% CI, 40% to 83%) and 29% (95% CI, 15% to 57%), respectively, and those for the 1-year and 3-year progression-free survivals (PFS) were 40% (95% CI, 23% to 67%) and 15% (95% CI, 5% to 42%), respectively. In summary, the use of the myeloablative FluBu4 conditioning Allo-HCT for high-risk MM resulted in decreased TRM, compared with that of Allo-HCT using conventional myeloablative regimens; however, the relapse rate was high, including in those developing moderate-to-severe chronic GVHD. This suggested a less robust graft-versus-myeloma effect against high-risk MM, thus resulting in poor PFS and OS. Nonetheless, the FluBu4 regimen may be used as a lower-TRM platform to combine with other strategies, eg, addition of an MM-targeted agent and/or maintenance therapy with these agents, to decrease relapse or progression in patients with high-risk MM.
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Affiliation(s)
- Attaphol Pawarode
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan.
| | - Shin Mineishi
- Blood and Marrow Transplantation and Cell Therapy Program, University of Alabama at Birmingham, Alabama
| | - Pavan Reddy
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Thomas M Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Yasser A Khaled
- Blood and Marrow Transplantation Program, The University of Tennessee, Memphis, Tennessee
| | - Sung W Choi
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - John M Magenau
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Andrew C Harris
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - James A Connelly
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Carrie L Kitko
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Brian L Parkin
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Steven C Goldstein
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Gregory A Yanik
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - John E Levine
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - James L Ferrara
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel R Couriel
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
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