1
|
Grieve S, Puvvada N, Phinyomark A, Russell K, Murugesan A, Zed E, Hassan A, Legare JF, Kienesberger PC, Pulinilkunnil T, Reiman T, Scheme E, Brunt KR. Nanoparticle surface-enhanced Raman spectroscopy as a noninvasive, label-free tool to monitor hematological malignancy. Nanomedicine (Lond) 2021; 16:2175-2188. [PMID: 34547916 DOI: 10.2217/nnm-2021-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Aim: Monitoring minimal residual disease remains a challenge to the effective medical management of hematological malignancies; yet surface-enhanced Raman spectroscopy (SERS) has emerged as a potential clinical tool to do so. Materials & methods: We developed a cell-free, label-free SERS approach using gold nanoparticles (nanoSERS) to classify hematological malignancies referenced against two control cohorts: healthy and noncancer cardiovascular disease. A predictive model was built using machine-learning algorithms to incorporate disease burden scores for patients under standard treatment upon. Results: Linear- and quadratic-discriminant analysis distinguished three cohorts with 69.8 and 71.4% accuracies, respectively. A predictive nanoSERS model correlated (MSE = 1.6) with established clinical parameters. Conclusion: This study offers a proof-of-concept for the noninvasive monitoring of disease progression, highlighting the potential to incorporate nanoSERS into translational medicine.
Collapse
Affiliation(s)
- Stacy Grieve
- Department of Biology, University of New Brunswick, Saint John, New Brunswick, Canada.,IMPART investigator team, Canada
| | - Nagaprasad Puvvada
- Department of Pharmacology, Dalhousie University, Saint John, New Brunswick, Canada.,Department of Chemistry, Indrashil University, Gujarat, India
| | - Angkoon Phinyomark
- IMPART investigator team, Canada.,Institute of Biomedical Engineering, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Kevin Russell
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Alli Murugesan
- Department of Biology, University of New Brunswick, Saint John, New Brunswick, Canada.,Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Elizabeth Zed
- Department of Oncology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Ansar Hassan
- IMPART investigator team, Canada.,Department of Cardiac Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Jean-Francois Legare
- IMPART investigator team, Canada.,Department of Cardiac Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Petra C Kienesberger
- IMPART investigator team, Canada.,Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada.,Department of Biochemistry & Molecular Biology, Dalhousie University, Saint John, New Brunswick, Canada
| | - Thomas Pulinilkunnil
- IMPART investigator team, Canada.,Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada.,Department of Biochemistry & Molecular Biology, Dalhousie University, Saint John, New Brunswick, Canada
| | - Tony Reiman
- Department of Biology, University of New Brunswick, Saint John, New Brunswick, Canada.,IMPART investigator team, Canada.,Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada.,Department of Oncology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Erik Scheme
- IMPART investigator team, Canada.,Institute of Biomedical Engineering, University of New Brunswick, Fredericton, New Brunswick, Canada.,Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Keith R Brunt
- IMPART investigator team, Canada.,Department of Pharmacology, Dalhousie University, Saint John, New Brunswick, Canada.,Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| |
Collapse
|
2
|
Straka C, Salwender H, Knop S, Vogel M, Müller J, Metzner B, Langer C, Sayer H, Jung W, Dürk HA, Bassermann F, Gramatzki M, Rösler W, Wolf HH, Brugger W, Engelhardt M, Fischer T, Liebisch P, Einsele H. Full or intensity-reduced high-dose melphalan and single or double autologous stem cell transplant with or without bortezomib consolidation in patients with newly diagnosed multiple myeloma. Eur J Haematol 2021; 107:529-542. [PMID: 34270825 DOI: 10.1111/ejh.13690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE A post hoc subgroup analysis of two phase III trials (NCT00416273, NCT00416208) was carried out to investigate the influence of 100/140 and 200 mg/m² melphalan as well as single/double autologous stem cell transplantation (ASCT) on progression-free survival (PFS). Additionally, the effect of bortezomib consolidation on PFS was analyzed. METHODS Following induction therapy and high-dose melphalan with subsequent ASCT, patients with newly diagnosed multiple myeloma (NDMM) were randomized 1:1 to either four 35-day cycles of bortezomib consolidation (1.6 mg/m² IV on days 1, 8, 15, 22) or observation. RESULTS Of the 340 patients included in this analysis, 13.5% received 1 × MEL100/140, 22.9% 2 × MEL100/140, 31.2% 1 × MEL200, and 32.4% 2 × MEL200. With higher cumulative melphalan dose, PFS improved (P = .0085). PFS curves of patients treated with 2 × MEL100/140 and 1 × MEL200 were very similar. The superior dose effect of MEL200 over MEL100/140 was non-existent in the bortezomib consolidation arm but pronounced in the observation arm (P = .0015). Similarly, double ASCT was only beneficial in patients without bortezomib consolidation (P = .0569). CONCLUSIONS Full dose melphalan and double transplantation seem advantageous only as long as patients are not receiving bortezomib consolidation afterwards.
Collapse
Affiliation(s)
| | - Hans Salwender
- Asklepios Tumorzentrum, AK Altona und AK St. Georg, Hamburg, Germany
| | - Stefan Knop
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
| | | | | | - Bernd Metzner
- Universitätsklinik für Innere Medizin II, Oldenburg, Germany
| | - Christian Langer
- Universitätsklinikum Ulm, Klinik für Innere Medizin II, Ulm, Germany
| | - Herbert Sayer
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Jena, Germany
| | - Wolfram Jung
- Universitätsmedizin Göttingen, Göttingen, Germany
| | | | - Florian Bassermann
- Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | | | - Wolf Rösler
- Universitätsklinikum Erlangen, Erlangen, Germany
| | | | | | | | | | - Peter Liebisch
- Universitätsklinikum Ulm, Klinik für Innere Medizin II, Ulm, Germany
| | - Hermann Einsele
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
| |
Collapse
|
3
|
Mendonça de Pontes R, Flores-Montero J, Sanoja-Flores L, Puig N, Pessoa de Magalhães RJ, Corral-Mateos A, Salgado AB, García-Sánchez O, Pérez-Morán J, Mateos MV, Burgos L, Paiva B, te Marvelde J, van der Velden VHJ, Aguilar C, Bárez A, García-Mateo A, Labrador J, Leoz P, Aguilera-Sanz C, Durie B, van Dongen JJM, Maiolino A, Sobral da Costa E, Orfao A. B-Cell Regeneration Profile and Minimal Residual Disease Status in Bone Marrow of Treated Multiple Myeloma Patients. Cancers (Basel) 2021; 13:cancers13071704. [PMID: 33916787 PMCID: PMC8038337 DOI: 10.3390/cancers13071704] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
B-cell regeneration during therapy has been considered as a strong prognostic factor in multiple myeloma (MM). However, the effects of therapy and hemodilution in bone marrow (BM) B-cell recovery have not been systematically evaluated during follow-up. MM (n = 177) and adult (≥50y) healthy donor (HD; n = 14) BM samples were studied by next-generation flow (NGF) to simultaneously assess measurable residual disease (MRD) and residual normal B-cell populations. BM hemodilution was detected in 41 out of 177 (23%) patient samples, leading to lower total B-cell, B-cell precursor (BCP) and normal plasma cell (nPC) counts. Among MM BM, decreased percentages (vs. HD) of BCP, transitional/naïve B-cell (TBC/NBC) and nPC populations were observed at diagnosis. BM BCP increased after induction therapy, whereas TBC/NBC counts remained abnormally low. At day+100 postautologous stem cell transplantation, a greater increase in BCP with recovered TBC/NBC cell numbers but persistently low memory B-cell and nPC counts were found. At the end of therapy, complete response (CR) BM samples showed higher CD19- nPC counts vs. non-CR specimens. MRD positivity was associated with higher BCP and nPC percentages. Hemodilution showed a negative impact on BM B-cell distribution. Different BM B-cell regeneration profiles are present in MM at diagnosis and after therapy with no significant association with patient outcome.
Collapse
Affiliation(s)
- Robéria Mendonça de Pontes
- Internal Medicine Postgraduate Program, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil; (R.M.d.P.); (A.B.S.); (A.M.); (E.S.d.C.)
- Cytometry Service, Institute of Paediatrics and Puericultura Martagão Gesteira (IPPMG), Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-912, Brazil
| | - Juan Flores-Montero
- Translational and Clinical Research Program, Cancer Research Center (IBMCC, USAL-CSIC), Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (J.F.-M.); (A.C.-M.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) (CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480), Instituto Carlos III, 28029 Madrid, Spain; (L.S.-F.); (N.P.); (O.G.-S.); (J.P.-M.); (M.-V.M.); (L.B.); (B.P.); (P.L.)
| | - Luzalba Sanoja-Flores
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) (CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480), Instituto Carlos III, 28029 Madrid, Spain; (L.S.-F.); (N.P.); (O.G.-S.); (J.P.-M.); (M.-V.M.); (L.B.); (B.P.); (P.L.)
- Institute of Biomedicine of Seville, Department of Hematology, University Hospital Virgen del Rocío of the Consejo Superior de Investigaciones Científicas (CSIC), University of Seville, 41013 Seville, Spain
| | - Noemi Puig
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) (CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480), Instituto Carlos III, 28029 Madrid, Spain; (L.S.-F.); (N.P.); (O.G.-S.); (J.P.-M.); (M.-V.M.); (L.B.); (B.P.); (P.L.)
- Service of Hematology, University Hospital of Salamanca (USAL) and IBSAL, 37007 Salamanca, Spain
| | - Roberto J. Pessoa de Magalhães
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil;
| | - Alba Corral-Mateos
- Translational and Clinical Research Program, Cancer Research Center (IBMCC, USAL-CSIC), Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (J.F.-M.); (A.C.-M.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) (CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480), Instituto Carlos III, 28029 Madrid, Spain; (L.S.-F.); (N.P.); (O.G.-S.); (J.P.-M.); (M.-V.M.); (L.B.); (B.P.); (P.L.)
| | - Anna Beatriz Salgado
- Internal Medicine Postgraduate Program, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil; (R.M.d.P.); (A.B.S.); (A.M.); (E.S.d.C.)
| | - Omar García-Sánchez
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) (CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480), Instituto Carlos III, 28029 Madrid, Spain; (L.S.-F.); (N.P.); (O.G.-S.); (J.P.-M.); (M.-V.M.); (L.B.); (B.P.); (P.L.)
- Service of Hematology, University Hospital of Salamanca (USAL) and IBSAL, 37007 Salamanca, Spain
| | - José Pérez-Morán
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) (CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480), Instituto Carlos III, 28029 Madrid, Spain; (L.S.-F.); (N.P.); (O.G.-S.); (J.P.-M.); (M.-V.M.); (L.B.); (B.P.); (P.L.)
- Service of Hematology, University Hospital of Salamanca (USAL) and IBSAL, 37007 Salamanca, Spain
| | - Maria-Victoria Mateos
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) (CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480), Instituto Carlos III, 28029 Madrid, Spain; (L.S.-F.); (N.P.); (O.G.-S.); (J.P.-M.); (M.-V.M.); (L.B.); (B.P.); (P.L.)
- Service of Hematology, University Hospital of Salamanca (USAL) and IBSAL, 37007 Salamanca, Spain
| | - Leire Burgos
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) (CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480), Instituto Carlos III, 28029 Madrid, Spain; (L.S.-F.); (N.P.); (O.G.-S.); (J.P.-M.); (M.-V.M.); (L.B.); (B.P.); (P.L.)
- Centro de Investigación Médica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Bruno Paiva
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) (CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480), Instituto Carlos III, 28029 Madrid, Spain; (L.S.-F.); (N.P.); (O.G.-S.); (J.P.-M.); (M.-V.M.); (L.B.); (B.P.); (P.L.)
- Centro de Investigación Médica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Jeroen te Marvelde
- Department of Immunology, Erasmus MC, (EMC) University Medical Center Rotterdam, 3015 GA Rotterdam, The Netherlands; (J.t.M.); (V.H.J.v.d.V.)
| | - Vincent H. J. van der Velden
- Department of Immunology, Erasmus MC, (EMC) University Medical Center Rotterdam, 3015 GA Rotterdam, The Netherlands; (J.t.M.); (V.H.J.v.d.V.)
| | - Carlos Aguilar
- Department of Hematology, Hospital General de Santa Bárbara, 42005 Soria, Spain;
| | - Abelardo Bárez
- Department of Hematology, Complejo Asistencial de Ávila, 05071 Ávila, Spain;
| | | | - Jorge Labrador
- Department of Hematology and Research Unit, Hospital Universitario de Burgos, 09006 Burgos, Spain;
| | - Pilar Leoz
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) (CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480), Instituto Carlos III, 28029 Madrid, Spain; (L.S.-F.); (N.P.); (O.G.-S.); (J.P.-M.); (M.-V.M.); (L.B.); (B.P.); (P.L.)
- Service of Hematology, University Hospital of Salamanca (USAL) and IBSAL, 37007 Salamanca, Spain
| | | | - Brian Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, CA 90048, USA;
| | - Jacques J. M. van Dongen
- Department of Immunology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence: (J.J.M.v.D.); (A.O.); Tel.: +31-71-526-5128 (J.J.M.v.D.); +34-923-294811 (A.O.)
| | - Angelo Maiolino
- Internal Medicine Postgraduate Program, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil; (R.M.d.P.); (A.B.S.); (A.M.); (E.S.d.C.)
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil;
- Americas Centro de Oncologia Integrado, Rio de Janeiro 22290-030, Brazil
| | - Elaine Sobral da Costa
- Internal Medicine Postgraduate Program, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil; (R.M.d.P.); (A.B.S.); (A.M.); (E.S.d.C.)
- Cytometry Service, Institute of Paediatrics and Puericultura Martagão Gesteira (IPPMG), Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-912, Brazil
| | - Alberto Orfao
- Translational and Clinical Research Program, Cancer Research Center (IBMCC, USAL-CSIC), Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (J.F.-M.); (A.C.-M.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) (CB16/12/00400, CB16/12/00233, CB16/12/00369, CB16/12/00489 and CB16/12/00480), Instituto Carlos III, 28029 Madrid, Spain; (L.S.-F.); (N.P.); (O.G.-S.); (J.P.-M.); (M.-V.M.); (L.B.); (B.P.); (P.L.)
- Correspondence: (J.J.M.v.D.); (A.O.); Tel.: +31-71-526-5128 (J.J.M.v.D.); +34-923-294811 (A.O.)
| |
Collapse
|
4
|
Cransac A, Aho S, Cosme E, Chretien ML, Favennec C, Schreder L, Boutet M, Gueneau P, Giroud M, Caillot D, Boulin M. Self-management of immunomodulatory drug treatment in multiple myeloma patients. Eur J Cancer Care (Engl) 2020; 30:e13356. [PMID: 33159353 DOI: 10.1111/ecc.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 07/10/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Immunomodulatory drugs (IMIDs: thalidomide, lenalidomide and pomalidomide) are widely used in patients with multiple myeloma (MM). The aim of our study was to validate a questionnaire to evaluate the self-capacity of MM patients to manage IMID treatment including side effects. METHODS We used a method adapted from the recommendations of the European Organisation for Research and Treatment of Cancer (EORTC) to validate a French questionnaire for patients with MM treated with IMIDs. RESULTS The face validity was evaluated in 15 patients and the construct validity in 56 patients. For discriminant validity, two groups were constituted by gender and depending on whether they had a previous IMID treatment. The median questionnaire score was 11.33/16 (IQR 9.75-12.08) with a minimum of 5.2 and a maximum of 14.75. For discriminant validity, a statistically significant difference was observed for patient capacity to contact healthcare professionals in specific situations and drug intake in case of swallowing disorder. Convergent validity showed an acceptable reliability for the scores of the different questions. CONCLUSION The questionnaire has shown to be a valid tool for the assessment of the adherence and side-effect management skills for MM patients with IMID treatment.
Collapse
Affiliation(s)
- Amélie Cransac
- Department of Pharmacy, Dijon University Hospital, Dijon, France.,LNC-UMR1231, University of Burgundy and Franche Comté, Dijon, France
| | - Serge Aho
- Hospital Epidemiology and Infection Control Department, Dijon University Hospital, Dijon, France
| | - Edouard Cosme
- Department of Pharmacy, Dijon University Hospital, Dijon, France
| | - Marie-Lorraine Chretien
- Department of Clinical Hematology, Dijon University Hospital, Dijon, France.,SAPHIIR-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Camille Favennec
- Department of Clinical Hematology, Dijon University Hospital, Dijon, France
| | - Laure Schreder
- Oncology Coordination Center, Dijon University Hospital, Dijon, France
| | - Mérédith Boutet
- Department of Pharmacy, Dijon University Hospital, Dijon, France
| | - Pauline Gueneau
- Department of Pharmacy, Dijon University Hospital, Dijon, France
| | - Maurice Giroud
- LNC-UMR1231, University of Burgundy and Franche Comté, Dijon, France.,Department of Neurology, Dijon University Hospital, Dijon, France
| | - Denis Caillot
- Department of Clinical Hematology, Dijon University Hospital, Dijon, France
| | - Mathieu Boulin
- Department of Pharmacy, Dijon University Hospital, Dijon, France.,EPICAD LNC-UMR1231, University of Burgundy and Franche Comté, Dijon, France
| |
Collapse
|
5
|
Papadimitriou K, Kostopoulos IV, Tsopanidou A, Orologas-Stavrou N, Kastritis E, Tsitsilonis OE, Dimopoulos MA, Terpos E. Ex Vivo Models Simulating the Bone Marrow Environment and Predicting Response to Therapy in Multiple Myeloma. Cancers (Basel) 2020; 12:cancers12082006. [PMID: 32707884 PMCID: PMC7463609 DOI: 10.3390/cancers12082006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 01/10/2023] Open
Abstract
Multiple myeloma (MM) remains incurable despite the abundance of novel drugs. As it has been previously shown, preclinical 2D models fail to predict disease progression due to their inability to simulate the microenvironment of the bone marrow. In this review, we focus on 3D models and present all currently available ex vivo MM models that fulfil certain criteria, such as development of complex 3D environments using patients' cells and ability to test different drugs in order to assess personalized MM treatment efficacy of various regimens and combinations. We selected models representing the top-notch ex vivo platforms and evaluated them in terms of cost, time-span, and feasibility of the method. Finally, we propose where such a model can be more informative in a patient's treatment timeline. Overall, advanced 3D preclinical models are very promising as they may eventually offer the opportunity to precisely select the optimal personalized treatment for each MM patient.
Collapse
Affiliation(s)
- Konstantinos Papadimitriou
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece; (K.P.); (A.T.); (N.O.-S.); (O.E.T.)
| | - Ioannis V. Kostopoulos
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece; (K.P.); (A.T.); (N.O.-S.); (O.E.T.)
- Correspondence: (I.V.K.); (E.T.); Tel.: +30-210-7274929 (I.V.K.); +30-213-216-2846 (E.T.); Fax: +30-210-7274635 (I.V.K.); +30-213-216-2511 (E.T.)
| | - Anastasia Tsopanidou
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece; (K.P.); (A.T.); (N.O.-S.); (O.E.T.)
| | - Nikolaos Orologas-Stavrou
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece; (K.P.); (A.T.); (N.O.-S.); (O.E.T.)
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (M.A.D.)
| | - Ourania E. Tsitsilonis
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, 15784 Athens, Greece; (K.P.); (A.T.); (N.O.-S.); (O.E.T.)
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (M.A.D.)
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.K.); (M.A.D.)
- Correspondence: (I.V.K.); (E.T.); Tel.: +30-210-7274929 (I.V.K.); +30-213-216-2846 (E.T.); Fax: +30-210-7274635 (I.V.K.); +30-213-216-2511 (E.T.)
| |
Collapse
|
6
|
Zanwar S, Abeykoon JP, Kapoor P. Challenges and Strategies in the Management of Multiple Myeloma in the Elderly Population. Curr Hematol Malig Rep 2020; 14:70-82. [PMID: 30820879 DOI: 10.1007/s11899-019-00500-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Approximately one half of the patient-population in multiple myeloma (MM) is > 70 years at diagnosis. Despite notable strides in the management and improved survival, MM remains incurable, with an increasing proportion of elderly patients comprising the relapsed-refractory cohort. RECENT FINDINGS The arbitrary age cutoff at 65 years to define the elderly patient-population has evolved to a more nuanced categorization, incorporating a comprehensive assessment for determining frailty prior to commencing treatment. This step is critical in determining the therapy-intensity, including transplant-eligibility, to minimize toxicity. Dose-modifications are crucial, as the merits of continuous therapy are becoming evident in this patient-population. Bortezomib, lenalidomide, and dexamethasone (VRd) combination has emerged as standard of care for newly diagnosed MM. Fixed-duration Rd followed by reduced-dosed continuous R may be considered in select frail patients with standard-risk MM. Herein, we review the unique challenges encountered in elderly MM and discuss strategies for optimal management.
Collapse
Affiliation(s)
- Saurabh Zanwar
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Prashant Kapoor
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
7
|
Taha RY, Hasan S, Ibrahim F, Chantran Y, Sabah HE, Sivaraman S, Bozom IA, Sabbagh AA, Garderet L, Omri HE. Characterization of circulating myeloma tumor cells by next generation flowcytometry in scleromyxedema patient: a case report. Medicine (Baltimore) 2020; 99:e20726. [PMID: 32629647 PMCID: PMC7337479 DOI: 10.1097/md.0000000000020726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Scleromyxedema (rare cutaneous mucinosis), is characterized by the formation of lichenoid papules and presence of Serum monoclonal IgG in most cases, or all; after repeated testing. PATIENT CONCERNS The patient is a 51-year-old male presented with thick, disfiguring elephant-like erythematous skin folds over the forehead, papular shiny eruptions over ears and trunk and waxy erythematous papules over arms and hands without dysphagia or respiratory or neurologic symptoms DIAGNOSIS: : Skin biopsy from right arm was consistent with scleromyxedema. Serum cryoglobulin was reported negative. Complete blood count and routine blood biochemistry were normal. Thyroid function tests were normal. Serum protein electrophoresis and immunofixation showed monoclonal band of 14.5 g/L typed as IgG lambda. INTERVENTIONS Our patient was refractory to lenalidomide however improved clinically on immunoglobulins infusions on monthly basis without change in the MGUS level. OUTCOMES NGF analysis revealed approximately 0.25% Lambda monotypic plasma cells in the bone marrow expressing CD38, CD138, and CD27 with aberrant expression of CD56 and were negative for CD45, CD19, CD117, and CD81. We also detected 0.002% circulating plasma cells (PCs) in peripheral blood. CONCLUSION The immunophenotype of circulating tumor cells (CTCs) remain close to the malignant PCs phenotype in the BM. Hence, we report NGF approach as a novel diagnostic tool for highly sensitive MRD detection in plasma cell dyscrasias including scleromyxedema.
Collapse
Affiliation(s)
- Ruba Y. Taha
- Hamad Medical Corporation, Hematology and Medical Oncology Department
| | - Saba Hasan
- Hamad Medical Corporation, Hematology and Medical Oncology Department
| | - Firyal Ibrahim
- Hamad Medical Corporations, department and Laboratory Medicine and Pathology, Doha, Qatar
| | | | - Hesham El Sabah
- Hamad Medical Corporation, Hematology and Medical Oncology Department
| | - Siveen Sivaraman
- Hamad Medical Corporations, Interim Translational research Institute iTRI, Doha, Qatar
| | - Issam Al Bozom
- Hamad Medical Corporations, department and Laboratory Medicine and Pathology, Doha, Qatar
| | - Ahmad Al Sabbagh
- Hamad Medical Corporations, department and Laboratory Medicine and Pathology, Doha, Qatar
| | - Laurent Garderet
- Maladies du sang CHU de l’AP-HP Hôpital St-Antoine 184 rue du fg St-Antoine 75571 Paris, France
| | - Halima El Omri
- Hamad Medical Corporation, Hematology and Medical Oncology Department
| |
Collapse
|
8
|
Dennis M, Maoz A, Cirstea D, Patel A, Lerner A, Sarosiek S. Treatment disparities in minority groups with multiple myeloma at a safety-net hospital. Leuk Lymphoma 2020; 61:2507-2510. [PMID: 32460648 DOI: 10.1080/10428194.2020.1767290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Michael Dennis
- Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Asaf Maoz
- Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Diana Cirstea
- Section of Hematology & Medical Oncology, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Ami Patel
- Section of Hematology & Medical Oncology, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Adam Lerner
- Section of Hematology & Medical Oncology, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Shayna Sarosiek
- Section of Hematology & Medical Oncology, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| |
Collapse
|
9
|
Cransac A, Aho S, Boulin M. Comments on: High adherence of patients with multiple myeloma who receive treatment with immunomodulatory drugs (IMIDS) in hematology/oncology group practices in Germany. Support Care Cancer 2020; 28:1-2. [DOI: 10.1007/s00520-019-04886-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 05/21/2019] [Indexed: 11/25/2022]
|
10
|
Hus I, Mańko J, Jawniak D, Jurczyszyn A, Charliński G, Poniewierska-Jasak K, Usnarska-Zubkiewicz L, Sawicki M, Druzd-Sitek A, Świderska A, Kopińska A, Grząśko N, Raźny M, Wędłowska A, Perzyński A, Gałązka A, Dytfeld D, Kubicki T, Rodzaj M, Waszczuk-Gajda A, Drozd-Sokołowska J, Pogłódek B, Pasternak A, Długosz-Danecka M, Szymczyk A, Dmoszyńska A. High efficacy and safety of VTD as an induction protocol in patients with newly diagnosed multiple myeloma eligible for high dose therapy and autologous stem cell transplantation: A report of the Polish Myeloma Study Group. Oncol Lett 2019; 18:5811-5820. [PMID: 31788054 PMCID: PMC6865789 DOI: 10.3892/ol.2019.10929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 08/07/2019] [Indexed: 11/28/2022] Open
Abstract
The present retrospective analysis evaluated the efficacy and safety of the VTD (bortezomib, thalidomide, dexamethasone) regimen in 205 newly-diagnosed patients with multiple myeloma (MM) eligible for high dose therapy and autologous stem cell transplantation (HDT/ASCT) in routine clinical practice. With a median of 6 cycles (range, 1–8), at least partial response was achieved in 94.6% and at least very good partial response (VGPR) was achieved in 67.8% of patients. Peripheral neuropathy (PN) grade 2–4 was observed in 28.7% of patients. In 72% of patients undergoing stem cell mobilization one apheresis allowed the number of stem cells sufficient for transplantation to be obtained. Following HDT/ASCT the sCR rate increased from 4.9 to 14.4% and CR from 27.8 to 35.6%. The results demonstrated that VTD as an induction regimen was highly efficient in transplant eligible patients with MM with increased at least VGPR rate following prolonged treatment (≥6 cycles). Therapy exhibited no negative impact on stem cell collection, neutrophils and platelets engraftment following ASCT. Therapy was generally well tolerated and PN was the most common reason of dose reduction or treatment discontinuation.
Collapse
Affiliation(s)
- Iwona Hus
- Department of Clinical Transplantology, Medical University of Lublin, 20-081 Lublin, Poland
| | - Joanna Mańko
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
| | - Dariusz Jawniak
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
| | - Artur Jurczyszyn
- Department of Hematology, Collegium Medicum, Jagiellonian University, 30-051 Cracow, Poland
| | - Grzegorz Charliński
- Department of Hematology, Specialist Muncipial Hospital, 87-100 Torun, Poland
| | | | - Lidia Usnarska-Zubkiewicz
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Mateusz Sawicki
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | | | - Alina Świderska
- Department of Hematology, University Hospital in Zielona Góra, 65-046 Zielona Góra, Poland
| | - Anna Kopińska
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, 40-032 Katowice, Poland
| | - Norbert Grząśko
- Department of Hematology, St. John of Dukla Lublin Region Cancer Center, 20-090 Lublin, Poland
| | - Małgorzata Raźny
- Department of Hematology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Cracow, Poland
| | - Aleksandra Wędłowska
- Department of Hematology and Transplantology, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Aleksander Perzyński
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 00-791 Warsaw, Poland
| | - Aleksandra Gałązka
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 00-791 Warsaw, Poland
| | - Dominik Dytfeld
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Tadeusz Kubicki
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Marek Rodzaj
- Department of Hematology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Cracow, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Bartłomiej Pogłódek
- Department of Oncologic Hematology, Specialist Hospital, 36-200 Brzozów, Poland
| | - Anna Pasternak
- Department of Hematology, Independent Public Health Care of Ministry of The Interior and Administration, 10-228 Olsztyn, Poland
| | - Monika Długosz-Danecka
- Department of Hematology, Collegium Medicum, Jagiellonian University, 30-051 Cracow, Poland
| | - Agnieszka Szymczyk
- Department of Clinical Transplantology, Medical University of Lublin, 20-081 Lublin, Poland
| | - Anna Dmoszyńska
- Department of Clinical Transplantology, Medical University of Lublin, 20-081 Lublin, Poland
| |
Collapse
|
11
|
Impact of Minimal Residual Disease Detection by Next-Generation Flow Cytometry in Multiple Myeloma Patients with Sustained Complete Remission after Frontline Therapy. Hemasphere 2019; 3:e300. [PMID: 31976475 PMCID: PMC6924563 DOI: 10.1097/hs9.0000000000000300] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/27/2019] [Accepted: 09/15/2019] [Indexed: 02/05/2023] Open
Abstract
Minimal residual disease (MRD) was monitored in 52 patients with sustained CR (≥2 years) after frontline therapy using next-generation flow (NGF) cytometry. 25% of patients initially MRD- reversed to MRD+. 56% of patients in sustained CR were MRD+; 45% at the level of 10−5; 17% at 10−6. All patients who relapsed during follow-up were MRD+ at the latest MRD assessment, including those with ultra-low tumor burden. MRD persistence was associated with specific phenotypic profiles: higher erythroblasts’ and tumor-associated monocytes/macrophages’ predominance in the bone marrow niche. NGF emerges as a suitable method for periodic, reproducible, highly-sensitive MRD-detection at the level of 10−6.
Collapse
|
12
|
Yao R, Hu X, Zhou S, Zhang Q, Huang H, Sun N, Guo W, Yu K, Lin Y. Once-weekly bortezomib had similar effectiveness and lower thrombocytopenia occurrence compared with twice-weekly bortezomib regimen in treating patients with newly diagnosed multiple myeloma in China. Medicine (Baltimore) 2019; 98:e17147. [PMID: 31574817 PMCID: PMC6775427 DOI: 10.1097/md.0000000000017147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The study aims to examine the treatment effect and adverse reactions of patients with newly diagnosed MM receiving different bortezomib-based regimens.This was a retrospective study of patients with newly diagnosed MM and who were treated with bortezomib-based combined chemotherapy at the Department of Hematology of the 2 affiliated hospitals of Wenzhou Medical University between July 2009 and May 2016. Cox proportion hazard multivariate analyses were carried out to assess the differences in treatment effect and adverse events between standard (1.3 mg/m on days 1, 4, 8, 11) and weekly (1.6 mg/m on days 1, 8, 15) cohorts, as well as the differences between intravenous injection and subcutaneous injection therapy. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier method and the log-rank test.Among the 117 patients, 78 patients were treated with bortezomib standard therapy and 39 patients were treated with bortezomib weekly therapy (all with intravenous injection). In all patients, the treatment strategy was not independently associated with PFS or OS. The patients in the weekly therapy group had less thrombocytopenia events than those in the standard therapy group. The subcutaneous route had similar treatment effect as the intravenous route, but the incidence of peripheral neuropathy was lower.The once-weekly bortezomib regimen was similar in effectiveness to standard therapy in treating patients with newly diagnosed MM, but the incidence of thrombocytopenia was lower with the weekly regimen compared with the standard regimen.
Collapse
Affiliation(s)
- Rongxin Yao
- Department of Hematology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Xudong Hu
- Department of Hematology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Shuping Zhou
- Department of Hematology, Ningbo Yinzhou Second Hospital, Ningbo, Zhejiang, China
| | - Qianying Zhang
- Department of Hematology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - He Huang
- Department of Hematology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Ni Sun
- Department of Hematology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Wenjian Guo
- Department of Hematology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Kang Yu
- Department of Hematology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Ying Lin
- Department of Hematology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| |
Collapse
|
13
|
Martino M, Rossi M, Ferreri A, Loteta B, Morabito A, Moscato T, Console G, Innao V, Naso V, Provenzano PF, Recchia AG, Gentile M. Quality of life outcomes in multiple myeloma patients: a summary of recent clinical trials. Expert Rev Hematol 2019; 12:665-684. [PMID: 31251688 DOI: 10.1080/17474086.2019.1634541] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Management of multiple myeloma (MM) has improved over recent years. Health-related quality of life (HRQoL) data is becoming increasingly important, owing to improved survival outcomes. Areas covered: The authors performed an expert review of the literature to identify evidence-based data available on HRQoL in frontline and relapsed/refractory MM (RRMM) patients. Expert opinion: De-novo patients should be informed that the HRQoL is expected to improve during first-line treatment with different degrees of possible deterioration during the first cycles. Achievement of a maximal response should be strongly considered, particularly in the frontline setting, but must also be balanced with tolerability, HRQoL, and patient preferences. The same degree of improvement in HRQoL cannot be expected during conventional relapse treatments, where patients should be prepared only for stabilization of HRQoL. However, focusing attention only on measures such as toxicity may provide just a partial view of overall treatment effectiveness. Nonetheless, the authors believe the added value of taking into consideration the patient's perspectives and the importance of patient-reported outcomes in the evaluation of treatment effects should be considered mandatory. The incorporation of quality of life assessment into clinical and research practice has the potential of improving treatment outcomes.
Collapse
Affiliation(s)
- Massimo Martino
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Marco Rossi
- b Department of Experimental and Clinical Medicine, Magna Græcia University , Catanzaro , Italy
| | - Anna Ferreri
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Barbara Loteta
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Antonella Morabito
- c Pharmacy Unit, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Tiziana Moscato
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Giuseppe Console
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Vanessa Innao
- d Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina , Messina , Italy
| | - Virginia Naso
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Pasquale Fabio Provenzano
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Anna Grazia Recchia
- e Department of Hematology, Unità di Ricerca Biotecnologica (URB) , Cosenza , Italy
| | - Massimo Gentile
- f Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata , Cosenza , Italy
| |
Collapse
|
14
|
Cavo M, Tacchetti P, Zamagni E. Front-line treatment of multiple myeloma. Hemasphere 2019; 3:127-130. [PMID: 35309768 PMCID: PMC8925677 DOI: 10.1097/hs9.0000000000000242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/01/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Michele Cavo
- Seràgnoli Institute of Hematology, Alma Mater Studiorum-Bologna University School of Medicine, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Paola Tacchetti
- Seràgnoli Institute of Hematology, Alma Mater Studiorum-Bologna University School of Medicine, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Zamagni
- Seràgnoli Institute of Hematology, Alma Mater Studiorum-Bologna University School of Medicine, S.Orsola-Malpighi Hospital, Bologna, Italy
| |
Collapse
|
15
|
Mateos MV, González-Calle V. Improving the conditioning regimen in multiple myeloma. LANCET HAEMATOLOGY 2019; 6:e234-e235. [PMID: 30910540 DOI: 10.1016/s2352-3026(19)30028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 11/16/2022]
|
16
|
Cransac A, Aho S, Chretien ML, Giroud M, Caillot D, Boulin M. Adherence to immunomodulatory drugs in patients with multiple myeloma. PLoS One 2019; 14:e0214446. [PMID: 30917164 PMCID: PMC6436707 DOI: 10.1371/journal.pone.0214446] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 03/13/2019] [Indexed: 01/08/2023] Open
Abstract
Background Immunomodulatory drugs (thalidomide, lenalidomide and pomalidomide; IMID) are widely used in the treatment of multiple myeloma patients. To date, few data are available on IMID adherence in multiple myeloma patients. The aim of our study was to evaluate IMID adherence and to compare two indirect methods to measure IMID adherence in multiple myeloma patients: a specific questionnaire and the medication possession ratio (MPR). Another aim was to explore this specific questionnaire for the assessment of IMID adherence in multiple myeloma patients. Methods All consecutive multiple myeloma patients, with at least two consecutive dispensations of thalidomide, lenalidomide or pomalidomide in our hospital were included in this prospective study. IMID adherence was measured using a specific questionnaire and the medication possession ratio. Relationship between the questionnaire scores and variables of interest was evaluated by multiple linear regression with a robust variance estimator. Findings Sixty-three patients were included in our study. The mean questionnaire score was 8.2±1.2 and the mean medication possession ratio value was 0.97±0.06. A total of 76% of patients were considered adherent according to the questionnaire (i.e. score ≥ 8), 94% according to the medication possession ratio (i.e. MPR ≥ 0.90), and 70% according to the questionnaire and the medication possession ratio. No statistically significant linear association was observed between the questionnaire score and any variables of interest including medication possession ratio. All Cronbach’s alpha were relatively low (range 0.0342–0.2443), showing a low correlation of the different questions with the questionnaire score. Conclusions Our study is the first prospective study evaluating IMID adherence in multiple myeloma patients in real life. The high adherence to IMIDs reported here, regardless of the drug, is encouraging considering the efficacy, toxicity and elevated cost of IMIDs. The specific questionnaire should be used with caution to evaluate IMID adherence.
Collapse
Affiliation(s)
- Amélie Cransac
- Department of Pharmacy, Dijon University Hospital and LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
| | - Serge Aho
- Hospital Epidemiology and Infection Control Department, University Hospital, Dijon, France
| | - Marie-Lorraine Chretien
- Department of Clinical Hematology, University Hospital and SAPHIIR-UMR 1231, University of Burgundy & Franche Comté, Dijon, France
| | - Maurice Giroud
- Department of Neurology, Dijon University Hospital and LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
| | - Denis Caillot
- Department of Clinical Hematology, University Hospital, Dijon, France
| | - Mathieu Boulin
- Department of Pharmacy, Dijon University Hospital and EPICAD LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
| |
Collapse
|
17
|
Blum A, Haussmann K, Streitz M, Schlickeiser S, Tietze-Buerger C, Blau IW, Uharek L. Standardized assay for assessment of minimal residual disease in blood, bone marrow and apheresis from patients with plasma cell myeloma. Sci Rep 2019; 9:2922. [PMID: 30814612 PMCID: PMC6393516 DOI: 10.1038/s41598-019-39631-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 01/24/2019] [Indexed: 12/21/2022] Open
Abstract
The recent advances in myeloma treatment result in significantly better outcomes, defined as increased progression free survival (PFS) and overall survival (OS). Since there is a proven correlation between the extend of response and prolonged survival, there is an urgent need for highly sensitive assays for the detection of minimal residual disease (MRD). Next generation flow cytometry has become a valuable approach for sensitive evaluation of the depth of complete response (CR). Here, we report the diagnostic performance and validation results of a single-tube 9-color panel assay. The validation design included intra-assay analysis measuring accuracy, inter-assay analysis estimating method’s linearity and precision and inter-assay analysis evaluating repeatability. Furthermore, in inter-operator analysis assessed the comparability of the result analysis of different operators. Staining stability was evaluated in age-of-stain experiments. Our validation results show that a reliable detection of residual myeloma cells is feasible to a detection level of 10−5 with a single-tube assay for a variety of materials (peripheral blood, bone marrow and stem cell apheresis). This study establishes highly sensitive, fully standardized approach for MRD detection in myeloma that is ready for implementation in routine diagnostic laboratories.
Collapse
Affiliation(s)
- Agnieszka Blum
- Charité Stem Cell Facility, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany.
| | - Katy Haussmann
- Charité Stem Cell Facility, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Mathias Streitz
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Stephan Schlickeiser
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Carola Tietze-Buerger
- Charité Stem Cell Facility, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Igor Wolfgang Blau
- Department of Haematology, Oncology, Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Lutz Uharek
- Charité Stem Cell Facility, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany
| |
Collapse
|
18
|
Mateos MV, de la Calle VG. Lenalidomide as maintenance for every newly diagnosed patient with multiple myeloma. Lancet Oncol 2018; 20:5-6. [PMID: 30559052 DOI: 10.1016/s1470-2045(18)30764-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 11/17/2022]
|
19
|
Remes K, Anttila P, Silvennoinen R, Putkonen M, Ollikainen H, Terävä V, Sinisalo M, Kananen K, Schain F, Castren-Kortegangas P, Järvinen TM, Pisini M, Wahl F, Dixon T, Leval A. Real-world treatment outcomes in multiple myeloma: Multicenter registry results from Finland 2009-2013. PLoS One 2018; 13:e0208507. [PMID: 30517181 PMCID: PMC6281251 DOI: 10.1371/journal.pone.0208507] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022] Open
Abstract
Outcomes for patients with multiple myeloma (MM) have improved with the advent of novel therapies, however, real-world evidence of outcomes in clinical practice is scarce. We conducted a multi-center registry study to build a reliable picture of treatment and patient outcomes in Finland. The aim of this study was also to understand any methodological challenges in assessing treatment outcomes using disease registry data. Methods: We carried out a retrospective, observational study using data from the national Finnish Hematology Registry (FHR) to provide real-world evidence of outcomes for all adult patients diagnosed with and treated for MM between 2009–2013 at one of the six regional hospitals, with at least six months of recorded follow-up. Patients were identified within the FHR by applying eligibility criteria of a diagnosis of MM and verifiable records of medical treatment and lines of treatment during the study period. Patients receiving allogenic stem cell transplantation were excluded from the cohort, as were individuals who only had monoclonal gammopathy of undetermined significance diagnosis and patients who had not initiated treatment during this period. Kaplan Meier curves were used to calculate overall survival and time to next treatment. Stratification was carried out by drug status (conventional/novel) and by autologous stem cell transplant (ASCT) status. Results: A total of 321 patients met the inclusion criteria and were included in this study. Overall survival (OS) was longest in patients who received first-line novel therapy and ASCT (median not reached during 60-month follow-up) versus 46.2 months for novel first-line therapy without ASCT and 25.6 months for first-line conventional therapy without ASCT. Similarly, median time to next treatment were 33.9 months, 12.6 months and 7.8 months, respectively. Conclusions: The adoption of novel treatments in MM in Finland has had substantial impact on patient outcomes. Given the reality of complex treatment combinations for MM and relatively low patient numbers, assessing individual treatment effectiveness will require substantial cohort sizes and advanced, collaborative analytics on an international scale.
Collapse
Affiliation(s)
- Kari Remes
- Turku University Hospital and University of Turku, Dept of Clinical Hematology, Turku, Finland
| | - Pekka Anttila
- University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland
| | | | - Mervi Putkonen
- Turku University Hospital and University of Turku, Dept of Clinical Hematology, Turku, Finland
| | | | | | - Marjatta Sinisalo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Kristiina Kananen
- Kainuu Joint Authority for Social and Health Care, Clinic of Internal Medicine, Kajaani, Finland
| | | | | | | | | | - Felix Wahl
- Department of Mathematics, Stockholm University, SE, Stockholm, Sweden
| | - Tricia Dixon
- JB Medical Ltd, The Old Brickworks, Sudbury, Suffolk, United Kingdom
| | - Amy Leval
- Janssen Cilag AB, Solna, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Instutitet, Stockholm, Sweden
- * E-mail:
| |
Collapse
|
20
|
Sanoja-Flores L, Flores-Montero J, Garcés JJ, Paiva B, Puig N, García-Mateo A, García-Sánchez O, Corral-Mateos A, Burgos L, Blanco E, Hernández-Martín J, Pontes R, Díez-Campelo M, Millacoy P, Rodríguez-Otero P, Prosper F, Merino J, Vidriales MB, García-Sanz R, Romero A, Palomera L, Ríos-Tamayo R, Pérez-Andrés M, Blanco JF, González M, van Dongen JJM, Durie B, Mateos MV, San-Miguel J, Orfao A. Next generation flow for minimally-invasive blood characterization of MGUS and multiple myeloma at diagnosis based on circulating tumor plasma cells (CTPC). Blood Cancer J 2018; 8:117. [PMID: 30455467 PMCID: PMC6242818 DOI: 10.1038/s41408-018-0153-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 12/26/2022] Open
Abstract
Here, we investigated for the first time the frequency and number of circulating tumor plasma cells (CTPC) in peripheral blood (PB) of newly diagnosed patients with localized and systemic plasma cell neoplasms (PCN) using next-generation flow cytometry (NGF) and correlated our findings with the distinct diagnostic and prognostic categories of the disease. Overall, 508 samples from 264 newly diagnosed PCN patients, were studied. CTPC were detected in PB of all active multiple myeloma (MM; 100%), and smoldering MM (SMM) patients (100%), and in more than half (59%) monoclonal gammopathy of undetermined significance (MGUS) cases (p <0.0001); in contrast, CTPC were present in a small fraction of solitary plasmacytoma patients (18%). Higher numbers of CTPC in PB were associated with higher levels of BM infiltration and more adverse prognostic features, together with shorter time to progression from MGUS to MM (p <0.0001) and a shorter survival in MM patients with active disease requiring treatment (p ≤ 0.03). In summary, the presence of CTPC in PB as assessed by NGF at diagnosis, emerges as a hallmark of disseminated PCN, higher numbers of PB CTPC being strongly associated with a malignant disease behavior and a poorer outcome of both MGUS and MM.
Collapse
Affiliation(s)
- L Sanoja-Flores
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J Flores-Montero
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J J Garcés
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - B Paiva
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - N Puig
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - A García-Mateo
- Department of Hematology, Health Care Center of Segovia (CAS), Segovia, Spain
| | - O García-Sánchez
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - A Corral-Mateos
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - L Burgos
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - E Blanco
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J Hernández-Martín
- Department of Hematology, Health Care Center of Segovia (CAS), Segovia, Spain
| | - R Pontes
- Faculty of Medicine, Federal University of Rio de Janeiro and Institute of Pediatrics and Childhood Care, Rio de Janeiro, Brazil
| | - M Díez-Campelo
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - P Millacoy
- Department of Hematology, Hospital Center of Navarra (CHN), Pamplona, Spain
| | - P Rodríguez-Otero
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - F Prosper
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - J Merino
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - M B Vidriales
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - R García-Sanz
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - A Romero
- Primary Care Center Miguel Armijo, Sanidad de Castilla y León (SACYL), Salamanca, Spain
| | - L Palomera
- Department of Hematology, University Hospital Lozano Blesa (HULB), Zaragoza, Spain
| | - R Ríos-Tamayo
- Department of Hematology, Virgen de las Nieves Hospital (HVN), Granada, Spain
| | - M Pérez-Andrés
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J F Blanco
- Department of Orthopedics, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain
| | - M González
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - J J M van Dongen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - B Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, CA, USA
| | - M V Mateos
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - J San-Miguel
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - A Orfao
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain.
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain.
| |
Collapse
|
21
|
Zheleznyak A, Shokeen M, Achilefu S. Nanotherapeutics for multiple myeloma. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2018; 10:e1526. [PMID: 29701006 PMCID: PMC6185771 DOI: 10.1002/wnan.1526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/19/2018] [Accepted: 03/23/2018] [Indexed: 01/11/2023]
Abstract
Multiple myeloma (MM) is an age-related hematological malignancy with an estimated 30,000 new cases and 13,000 deaths per year. A disease of antibody-secreting malignant plasma B-cells that grow primarily in the bone marrow (BM), MM causes debilitating fractures, anemia, renal failure, and hypercalcemia. In addition to the abnormal genetic profile of MM cells, the permissive BM microenvironment (BMM) supports MM pathogenesis. Although advances in treatment options have significantly enhanced survival in MM patients, transient perfusion of small-molecule drugs in the BM does not provide sufficient residence to enhance MM cell-drug interaction, thus allowing some myeloma cells to escape the first line of treatment. As such, there remains a crucial need to develop advanced drug delivery systems that can navigate the complex BMM and effectively reach the myeloma cells. The high vascular density and spongy nature of bone structure suggest that nanoparticles (NPs) can serve as smart drug-delivery systems capable of extravasation and retention in various BM compartments to exert a durable therapeutic effect. In this focus article, we first summarize the pathophysiology of MM, emphasizing how the BM niche presents serious challenges for effective treatment of MM with small-molecule drugs. We then pivot to current efforts to develop NP-based drug carriers and intrinsically therapeutic nanotherapeutics. The article concludes with a brief perspective on the opportunities and challenges in developing and translating nanotherapeutics to improve the treatment outcomes of MM patients. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease.
Collapse
Affiliation(s)
| | - Monica Shokeen
- Departments of Radiology, and Biomedical Engineering, Washington University, St. Louis, MO, USA
| | - Samuel Achilefu
- Departments of Radiology, Biomedical Engineering, and Biochemistry & Molecular Biophysics, Washington University, St. Louis, MO, USA
| |
Collapse
|
22
|
Knauf W, Aldaoud A, Hutzschenreuter U, Klausmann M, Dille S, Wetzel N, Jänicke M, Marschner N. Survival of non-transplant patients with multiple myeloma in routine care differs from that in clinical trials-data from the prospective German Tumour Registry Lymphatic Neoplasms. Ann Hematol 2018; 97:2437-2445. [PMID: 30069704 PMCID: PMC6208687 DOI: 10.1007/s00277-018-3449-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/17/2018] [Indexed: 11/29/2022]
Abstract
Despite increasing treatment options, multiple myeloma (MM) remains incurable for most patients. Data on improvement of outcomes are derived from selected patient populations enrolled in clinical trials and might not be conferrable to all patients. Therefore, we assessed the trial eligibility, sequential treatment, and survival of non-transplant patients with MM treated in German routine care. The prospective clinical cohort study TLN (Tumour Registry Lymphatic Neoplasms) recruited 285 non-transplant patients with symptomatic MM at start of first-line treatment in 84 centres from 2009 to 2011. Demographic and clinical data were collected until August 2016. Trial-ineligibility was determined by presence of at least one of the common exclusion criteria: heart/renal failure, liver/renal diseases, polyneuropathy, HIV positivity. All other patients were considered potentially trial-eligible. Thirty percent of the patients in our study were classified as trial-ineligible. Median first-line progression-free survival (PFS) and overall survival (OS) of trial-ineligible patients were inferior to that of potentially trial-eligible patients: PFS 16.2 months (95% CI (confidence interval) 11.1–20.4) vs. 27.3 months (95% CI 23.3–33.0); OS 34.2 months (95% CI 21.6–48.1) vs. 58.6 months (95% CI 48.6–64.4). A high percentage of non-transplant patients with MM in German routine care would be ineligible for participation in clinical trials. Despite similar treatment algorithms, their first-line PFS and OS were shorter than those of potentially trial-eligible patients; the survival data of the latter were similar to results from clinical trials. Physicians should be aware of the fact that results from clinical trials may not mirror “real world” patient outcomes when discussing outcome expectations with patients. Trial registration: Clinicaltrials.gov identifier: NCT00889798.
Collapse
Affiliation(s)
- Wolfgang Knauf
- Joint Outpatient-Centre for Oncology, Frankfurt a. M., Germany
| | - Ali Aldaoud
- Joint Outpatient-Centre for Haematology and Oncology, Leipzig, Germany
| | | | - Martine Klausmann
- Joint Outpatient-Centre for Haematology and Oncology, Aschaffenburg, Germany
| | | | - Natalie Wetzel
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Norbert Marschner
- Outpatient-Centre for Interdisciplinary Oncology and Haematology, Wirthstrasse 11c, 79110, Freiburg, Germany.
| | | |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Pereira MG, Silva I, Pereira M, Faria S, Silva B, Monteiro S, Ferreira G. Unmet needs and quality of life in multiple myeloma patients. J Health Psychol 2018; 25:1717-1731. [DOI: 10.1177/1359105318772073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This cross-sectional study analysed the contributors and moderators of quality of life. The sample comprised 124 Portuguese multiple myeloma patients assessed on social support, spirituality, unmet needs, psychological morbidity and quality-of-life measures. Results showed that being older and a woman, as well as psychological morbidity and unmet emotional needs were significant predictors of worse quality of life as measured by the QLQ-C30. Unmet financial needs moderated the relationship between psychological morbidity and quality of life. Results emphasize the importance of intervening in patients’ unmet emotional needs and psychological morbidity in order to promote quality of life, in this population.
Collapse
|
25
|
Dumontet C, Couray-Targe S, Teisseire M, Karlin L, Maucort-Boulch D. Real life management of patients hospitalized with multiple myeloma in France. PLoS One 2018; 13:e0196596. [PMID: 29715281 PMCID: PMC5929551 DOI: 10.1371/journal.pone.0196596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 04/16/2018] [Indexed: 12/15/2022] Open
Abstract
Background Patients with multiple myeloma included in prospective clinical trials are highly selected and therefore are expected not to be representative of the entire patient population. Additionally recommendations based on literature data and randomized trials are not systematically implemented in all patients. We sought to determine how patients hospitalized with a diagnosis of multiple myeloma are currently treated in France. Methods and findings We performed a nation-wide search using the Programme de Médicalisation des Systèmes d’Information (PMSI) database which includes anonymous data for all patients hospitalized in France. We identified newly diagnosed cases in 2012 and analyzed the number and duration of hospital stays, coexisting conditions and treatment modalities with data available until the end of 2015. A diagnosis of multiple myeloma was determined for the first time during a hospitalization in France in 2012 in 6,282 patients (3,234 males and 3,048 females). The median age at diagnosis was 74 years (72 in males and 76 in females). A majority (55.3%) of patients were diagnosed and treated in a single heath center, including 37% in a university hospital and 52% in a non-university public hospital. Comorbidities potentially impacting on myeloma treatment were present in 57.5% of patients at diagnosis, and 15% had an associated diagnosis of another neoplasia. Intensive therapies with stem cell transplants were performed in 1033 patients (16% of total), the majority of which were aged less than 65 (881 patients, 85.3%). Stem cell transplants were performed more frequently in males while the distance between the site of residence and the transplant center had no impact on likelihood of receiving a transplant. Only 60% of patients less than 65 years old who were treated for their disease underwent intensification with stem cell transplant within the 4-year follow-up period. Conclusions A large majority of patients hospitalized with a diagnosis of multiple myeloma are elderly, in particular females, and not eligible for transplants. Among the patients aged less than 65 and receiving therapy for their disease, 40% do not undergo transplants. These data emphasize the need for alternative therapies.
Collapse
Affiliation(s)
- Charles Dumontet
- Hematology Department, Hospices Civils de Lyon, Pierre-Bénite, France.,Université Lyon I, Villeurbanne, France
| | | | | | - Lionel Karlin
- Hematology Department, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Delphine Maucort-Boulch
- Université Lyon I, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistiques, Lyon, France.,CNRS UMR 5558, Equipe Biostatistique Santé, Pierre-Bénite, France
| |
Collapse
|
26
|
Xia J, Wang L, Zhou X, Wang J, Wang H, Guo H. Early mortality in elderly patients undergoing treatment for multiple myeloma in real-world practice. J Int Med Res 2018; 46:2230-2237. [PMID: 29584537 PMCID: PMC6023076 DOI: 10.1177/0300060518757640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives This study was performed to analyze the risk factors for early mortality (EM) in elderly patients undergoing treatment for multiple myeloma (MM) in real-world clinical practice. Methods Retrospective data from 108 elderly patients who were newly diagnosed with MM from January 2007 to July 2015 were analyzed in a single hematology center. EM was defined as death of any cause within 12 months after diagnosis. A multivariate regression model was used to evaluate EM. Results EM occurred in 16 (14.8%) elderly patients with newly diagnosed MM. The most common cause of death was infection (10/16, 62.5%). In the multivariate analysis, only an age of ≥75 years, International Staging System (ISS) stage III disease, and high lactate dehydrogenase concentration were significantly and independently associated with EM. Conclusion Our results suggest that infection is the leading cause of EM in elderly patients with MM. An age of ≥75 years, ISS stage III disease, and a high lactate dehydrogenase concentration are significant predictors of EM. We should further target this higher-risk patient population to define personalized therapy with which to improve outcomes.
Collapse
Affiliation(s)
- Jun Xia
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Lingling Wang
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Xin Zhou
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Jing Wang
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Huan Wang
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Hongfeng Guo
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| |
Collapse
|
27
|
Genomic discovery and clonal tracking in multiple myeloma by cell-free DNA sequencing. Leukemia 2018; 32:1838-1841. [PMID: 29749395 DOI: 10.1038/s41375-018-0115-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/05/2018] [Accepted: 03/12/2018] [Indexed: 02/07/2023]
|
28
|
Mateos MV, San Miguel JF. Management of multiple myeloma in the newly diagnosed patient. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:498-507. [PMID: 29222298 PMCID: PMC6142596 DOI: 10.1182/asheducation-2017.1.498] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Multiple myeloma is the second most frequent hematological disease. The introduction of melphalan as high-dose therapy followed by autologous hematopoietic cell transplantation (HDT/ASCT) for young patients and the availability of novel agents for young and elderly patients with multiple myeloma have dramatically changed the perspective of treatment. However, further research is necessary if we want definitively to cure the disease. Treatment goals for transplant-eligible and non-transplant-eligible patients should be to prolong survival by achieving the best possible response while ensuring quality of life. For young patients, HDT-ASCT is a standard of care for treatment, and its efficacy has been enhanced and challenged by the new drugs. For elderly patients, treatment options were once limited to alkylators, but new upfront treatment combinations based on novel agents (proteasome inhibitors and immunomodulatory drugs) combined or not with alkylators have significantly improved outcomes. Extended treatment of young and elderly patients improves the quality and duration of clinical responses; however, the optimal scheme, appropriate doses, and duration of long-term therapy have not yet been fully determined. This review summarizes progress in the treatment of patients with newly diagnosed multiple myeloma, addressing critical questions such as the optimal induction, early vs late ASCT, consolidation and/or maintenance for young patients, and how we can choose the best treatment option for non-transplant-eligible patients.
Collapse
Affiliation(s)
- María-Victoria Mateos
- Hospital Universitario de Salamanca-Instituto Biosanitario de Salamanca, Salamanca, Spain; and
| | - Jesús F. San Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Navarra, Spain
| |
Collapse
|
29
|
Ixazomib significantly prolongs progression-free survival in high-risk relapsed/refractory myeloma patients. Blood 2017; 130:2610-2618. [PMID: 29054911 DOI: 10.1182/blood-2017-06-791228] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/09/2017] [Indexed: 12/12/2022] Open
Abstract
Certain cytogenetic abnormalities are known to adversely impact outcomes in patients with multiple myeloma (MM). The phase 3 TOURMALINE-MM1 study demonstrated a significant improvement in progression-free survival (PFS) with ixazomib-lenalidomide-dexamethasone (IRd) compared with placebo-lenalidomide-dexamethasone (placebo-Rd). This preplanned analysis assessed the efficacy and safety of IRd vs placebo-Rd according to cytogenetic risk, as assessed using fluorescence in situ hybridization. High-risk cytogenetic abnormalities were defined as del(17p), t(4;14), and/or t(14;16); additionally, patients were assessed for 1q21 amplification. Of 722 randomized patients, 552 had cytogenetic results; 137 (25%) had high-risk cytogenetic abnormalities and 172 (32%) had 1q21 amplification alone. PFS was improved with IRd vs placebo-Rd in both high-risk and standard-risk cytogenetics subgroups: in high-risk patients, the hazard ratio (HR) was 0.543 (95% confidence interval [CI], 0.321-0.918; P = .021), with median PFS of 21.4 vs 9.7 months; in standard-risk patients, HR was 0.640 (95% CI, 0.462-0.888; P = .007), with median PFS of 20.6 vs 15.6 months. This PFS benefit was consistent across subgroups with individual high-risk cytogenetic abnormalities, including patients with del(17p) (HR, 0.596; 95% CI, 0.286-1.243). PFS was also longer with IRd vs placebo-Rd in patients with 1q21 amplification (HR, 0.781; 95% CI, 0.492-1.240), and in the "expanded high-risk" group, defined as those with high-risk cytogenetic abnormalities and/or 1q21 amplification (HR, 0.664; 95% CI, 0.474-0.928). IRd demonstrated substantial benefit compared with placebo-Rd in relapsed and/or refractory MM (RRMM) patients with high-risk and standard-risk cytogenetics, and improves the poor PFS associated with high-risk cytogenetic abnormalities. This trial was registered at www.clinicaltrials.gov as #NCT01564537.
Collapse
|
30
|
Abstract
Multiple myeloma (MM) is a plasma cell neoplasm that affects elderly individuals with two-thirds of patients over 65 years at diagnosis. However, data available are derived from clinical trials conducted in younger patients. Fewer studies investigated treatment options in the elderly. This review summarizes the clinical outcomes and toxicities associated with therapeutic regimens in older patients including doublet, triplet and high dose therapyin newly diagnosed patients and relapsed patients with MM. We highlight the importance of an approach tailored to individuals, incorporates the geriatric frailty assessment, considers comorbiditiess and commits to early recognition and management of toxicities ranging from myelosuppression to polypharmacy. To date, no trial has prospectively investigated a tailored treatment paradigm in older patients based on frailty and/or comorbidities. As the population ages, the proportion of MM patients with advanced age will grow. Studies are indicated to determine optimal treatment approaches in this increasingly heterogeneous geriatric population.
Collapse
Affiliation(s)
- Evan Diamond
- a Division of Hematologic Oncology, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Oscar B Lahoud
- a Division of Hematologic Oncology, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Heather Landau
- a Division of Hematologic Oncology, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| |
Collapse
|
31
|
Ríos-Tamayo R, Martín-García A, Alarcón-Payer C, Sánchez-Rodríguez D, de la Guardia AMDVD, García Collado CG, Jiménez Morales A, Jurado Chacón M, Cabeza Barrera J. Pomalidomide in the treatment of multiple myeloma: design, development and place in therapy. Drug Des Devel Ther 2017; 11:2399-2408. [PMID: 28860711 PMCID: PMC5574598 DOI: 10.2147/dddt.s115456] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Multiple myeloma is a very heterogeneous disease with variable survival. Despite recent progress and the widespread use of new agents, patients with relapsed and refractory disease have a poor outcome. Immunomodulatory drugs play a key role in both the front-line and the relapsed/refractory setting. The combination of pomalidomide (POM) and dexamethasone is safe and effective in relapsed and refractory patients, even in those with high-risk cytogenetic features. Furthermore, it can be used in most patients without the need to adjust according to the degree of renal failure. In order to further improve the results, POM-based triplet therapies are currently used. This article highlights the most relevant issues of POM and POM-based combinations in the relapsed/refractory multiple myeloma setting, from a pharmacological and clinical point of view.
Collapse
Affiliation(s)
- Rafael Ríos-Tamayo
- Monoclonal Gammopathies Unit
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
- Genomic Oncology Area, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Agustín Martín-García
- Department of Pharmacy
- Clinical Trials Unit, University Hospital Virgen de las Nieves, Granada, Spain
| | | | | | | | | | | | - Manuel Jurado Chacón
- Monoclonal Gammopathies Unit
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
- Genomic Oncology Area, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - José Cabeza Barrera
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Department of Pharmacy
| |
Collapse
|
32
|
Amiloride, An Old Diuretic Drug, Is a Potential Therapeutic Agent for Multiple Myeloma. Clin Cancer Res 2017; 23:6602-6615. [DOI: 10.1158/1078-0432.ccr-17-0678] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/30/2017] [Accepted: 07/28/2017] [Indexed: 11/16/2022]
|
33
|
Steinbach M, Richards T, Faiman B. Strategies for Selecting the Optimal Treatment in Newly Diagnosed Multiple Myeloma Patients. Semin Oncol Nurs 2017; 33:254-264. [PMID: 28683956 DOI: 10.1016/j.soncn.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To review the current evidence on strategies for selecting the optimal treatment for newly diagnosed patients with multiple myeloma (MM). DATA SOURCES Journal articles, research reports, state of the science papers, and clinical practice guidelines. CONCLUSION Despite the plethora of drugs to effectively treat MM, the optimal induction regimen for patients with newly diagnosed MM is unknown. Rapid control of the disease, appropriate treatment selection and effective supportive care strategies remain integral to prevention and management of the disease. Strategies for selecting the optimal treatment include considering inherent patient characteristics, frailty, and existing clinical practice guidelines. IMPLICATIONS FOR NURSING PRACTICE Nurses should provide patients with disease- and treatment-related education to enhance patient and caregiver understanding of the disease and treatment options, taking into consideration clinical data and overarching goals of treatment.
Collapse
|
34
|
A novel CXCR4 antagonist IgG1 antibody (PF-06747143) for the treatment of hematologic malignancies. Blood Adv 2017; 1:1088-1100. [PMID: 29296751 DOI: 10.1182/bloodadvances.2016003921] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/09/2017] [Indexed: 12/24/2022] Open
Abstract
The chemokine receptor CXCR4 is highly expressed and associated with poor prognosis in multiple malignancies. Upon engagement by its ligand, CXCL12, CXCR4 triggers intracellular signaling pathways that control trafficking of cells to tissues where the ligand is expressed, such as the bone marrow (BM). In hematologic cancers, CXCR4-driven homing of malignant cells to the BM protective niche is a key mechanism driving disease and therapy resistance. We developed a humanized CXCR4 immunoglobulin G1 (IgG1) antibody (Ab), PF-06747143, which binds to CXCR4 and inhibits CXCL12-mediated signaling pathways, as well as cell migration. In in vivo preclinical studies, PF-06747143 monotherapy rapidly and transiently mobilized cells from the BM into the peripheral blood. In addition, PF-06747143 effectively induced tumor cell death via its Fc constant region-mediated effector function. This Fc-mediated cell killing mechanism not only enhanced antitumor efficacy, but also played a role in reducing the duration of cell mobilization, when compared with an IgG4 version of the Ab, which does not have Fc-effector function. PF-06747143 treatment showed strong antitumor effect in multiple hematologic tumor models including non-Hodgkin lymphoma (NHL), acute myeloid leukemia (AML), and multiple myeloma (MM). Importantly, PF-06747143 synergized with standard-of-care agents in a chemoresistant AML patient-derived xenograft model and in an MM model. These findings suggest that PF-06747143 is a potential best-in-class anti-CXCR4 antagonist for the treatment of hematologic malignancies, including in the resistant setting. PF-06747143 is currently in phase 1 clinical trial evaluation (registered at www.clinicaltrials.gov as #NCT02954653).
Collapse
|
35
|
Herrero AB, Gutiérrez NC. Targeting Ongoing DNA Damage in Multiple Myeloma: Effects of DNA Damage Response Inhibitors on Plasma Cell Survival. Front Oncol 2017; 7:98. [PMID: 28580318 PMCID: PMC5437203 DOI: 10.3389/fonc.2017.00098] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/01/2017] [Indexed: 11/20/2022] Open
Abstract
Human myeloma cell lines (HMCLs) and a subset of myeloma patients with poor prognosis exhibit high levels of replication stress (RS), leading to DNA damage. In this study, we confirmed the presence of DNA double-strand breaks (DSBs) in several HMCLs by measuring γH2AX and RAD51 foci and analyzed the effect of various inhibitors of the DNA damage response on MM cell survival. Inhibition of ataxia telangiectasia and Rad3-related protein (ATR), the main kinase mediating the response to RS, using the specific inhibitor VE-821 induced more cell death in HMCLs than in control lymphoblastoid cells and U266, an HMCL with a low level of DNA damage. The absence of ATR was partially compensated by ataxia telangiectasia-mutated protein (ATM), since chemical inhibition of both kinases using VE-821 and KU-55933 significantly increased the death of MM cells with DNA damage. We found that ATM and ATR are involved in DSB repair by homologous recombination (HR) in MM. Inhibition of both kinases resulted in a stronger inhibition that may underlie cell death induction, since abolition of HR using two different inhibitors severely reduced survival of HMCLs that exhibit DNA damage. On the other hand, inhibition of the other route involved in DSB repair, non-homologous end joining (NHEJ), using the DNA-PK inhibitor NU7441, did not affect MM cell viability. Interestingly, we found that NHEJ inhibition did not increase cell death when HR was simultaneously inhibited with the RAD51 inhibitor B02, but it clearly increased the level of cell death when HR was inhibited with the MRE11 inhibitor mirin, which interferes with recombination before DNA resection takes place. Taken together, our results demonstrate for the first time that MM cells with ongoing DNA damage rely on an intact HR pathway, which thereby suggests therapeutic opportunities. We also show that inhibition of HR after the initial step of end resection might be more appropriate for inducing MM cell death, since it prevents the occurrence of a compensatory NHEJ repair mechanism. These preclinical observations provide the rationale for its clinical evaluation.
Collapse
Affiliation(s)
- Ana Belén Herrero
- Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Norma Carmen Gutiérrez
- Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Hematology Department, University Hospital of Salamanca, Salamanca, Spain
| |
Collapse
|
36
|
Chen JF, Xiao LF, Zhang R, Zeng ZH, Li YX, Meng XY. Bortezomib, Thalidomide, and Dexamethasone (VTD) Induction Results in Better Overall Survival than Adriamycin, Thalidomide, and Dexamethasone (ATD) Induction in Previously Untreated Myeloma Patients Eligible for Transplants. Acta Haematol 2017; 137:207-208. [PMID: 28472803 DOI: 10.1159/000471839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Jia-Feng Chen
- Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College of Wuhan University, Wuhan, China
| | | | | | | | | | | |
Collapse
|
37
|
Lu J, Lee JH, Huang S, Qiu L, Lee J, Liu T, Yoon S, Kim K, Shen ZX, Eom HS, Chen WM, Min CK, Kim HJ, Lee JO, Kwak JY, Yiu W, Chen G, Ervin‐Haynes A, Hulin C, Facon T. Continuous treatment with lenalidomide and low-dose dexamethasone in transplant-ineligible patients with newly diagnosed multiple myeloma in Asia: subanalysis of the FIRST trial. Br J Haematol 2017; 176:743-749. [PMID: 28106903 PMCID: PMC5324608 DOI: 10.1111/bjh.14465] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/20/2016] [Indexed: 02/05/2023]
Abstract
The phase 3 FIRST (Frontline Investigation of REVLIMID + Dexamethasone Versus Standard Thalidomide) trial demonstrated that lenalidomide plus low-dose dexamethasone (Rd) until disease progression (Rd continuous) is an effective treatment option for transplant-ineligible patients with newly diagnosed multiple myeloma (NDMM). Given genetic differences between Asian and Western populations, this subanalysis of the FIRST trial examined the safety and efficacy of Rd (given continuously or for 18 cycles [Rd18]) and MPT (melphalan, prednisone, thalidomide) in 114 Asian patients from Mainland China, South Korea and Taiwan. Efficacy and safety with Rd continuous in Asian patients were consistent with those in the overall study population. The overall response rates were 77·8% for Rd continuous, 57·5% for MPT and 65·8% for Rd18. The risk of progression or death was reduced by 39% with Rd continuous versus MPT and by 35% with Rd continuous versus Rd18. Rd continuous improved the 3-year survival rate compared with MPT (70·2% vs. 56·4%) and Rd18 (58·1%). Common grade 3/4 adverse events in the Rd continuous and MPT arms were neutropenia (25·0% vs. 43·6%), infection (19·4% vs. 28·2%) and anaemia (19·4% vs. 15·4%), respectively. Thromboembolic event rates were low, and no second primary malignancies were observed. Rd continuous is safe and effective in transplant-ineligible Asian patients with NDMM.
Collapse
Affiliation(s)
- Jin Lu
- Peking University People's HospitalBeijingChina
| | - Jae H. Lee
- Gachon University Gil HospitalIncheonKorea
| | | | - Lugui Qiu
- Institute of Haematology and Blood Diseases HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinChina
| | - Je‐Jung Lee
- Chonnam National University Hwasun HospitalHwasun‐gunJeonnamKorea
| | - Ting Liu
- West China Hospital of Sichuan UniversityChengduChina
| | | | - Kihyun Kim
- Sungkyunkwan UniversitySamsung Medical CentreSeoulKorea
| | - Zhi X. Shen
- Ruijin HospitalShanghai Jiaotong UniversityShanghaiChina
| | | | | | | | - Hyo J. Kim
- Hallym University Sacred Heart HospitalAnyangKorea
| | - Jeong O. Lee
- Seoul National University Bundang HospitalSeongnamKorea
| | - Jae Y. Kwak
- Chonbuk National University HospitalJeonjuKorea
| | - Wai Yiu
- Celgene CorporationSummitNJUSA
| | | | | | | | - Thierry Facon
- Service des Maladies du SangHôpital Claude HuriezLilleFrance
| |
Collapse
|
38
|
Flores-Montero J, Sanoja-Flores L, Paiva B, Puig N, García-Sánchez O, Böttcher S, van der Velden VHJ, Pérez-Morán JJ, Vidriales MB, García-Sanz R, Jimenez C, González M, Martínez-López J, Corral-Mateos A, Grigore GE, Fluxá R, Pontes R, Caetano J, Sedek L, Del Cañizo MC, Bladé J, Lahuerta JJ, Aguilar C, Bárez A, García-Mateo A, Labrador J, Leoz P, Aguilera-Sanz C, San-Miguel J, Mateos MV, Durie B, van Dongen JJM, Orfao A. Next Generation Flow for highly sensitive and standardized detection of minimal residual disease in multiple myeloma. Leukemia 2017; 31:2094-2103. [PMID: 28104919 PMCID: PMC5629369 DOI: 10.1038/leu.2017.29] [Citation(s) in RCA: 417] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/24/2016] [Accepted: 01/03/2017] [Indexed: 12/20/2022]
Abstract
Flow cytometry has become a highly valuable method to monitor minimal residual disease (MRD) and evaluate the depth of complete response (CR) in bone marrow (BM) of multiple myeloma (MM) after therapy. However, current flow-MRD has lower sensitivity than molecular methods and lacks standardization. Here we report on a novel next generation flow (NGF) approach for highly sensitive and standardized MRD detection in MM. An optimized 2-tube 8-color antibody panel was constructed in five cycles of design-evaluation-redesign. In addition, a bulk-lysis procedure was established for acquisition of ⩾107 cells/sample, and novel software tools were constructed for automatic plasma cell gating. Multicenter evaluation of 110 follow-up BM from MM patients in very good partial response (VGPR) or CR showed a higher sensitivity for NGF-MRD vs conventional 8-color flow-MRD -MRD-positive rate of 47 vs 34% (P=0.003)-. Thus, 25% of patients classified as MRD-negative by conventional 8-color flow were MRD-positive by NGF, translating into a significantly longer progression-free survival for MRD-negative vs MRD-positive CR patients by NGF (75% progression-free survival not reached vs 7 months; P=0.02). This study establishes EuroFlow-based NGF as a highly sensitive, fully standardized approach for MRD detection in MM which overcomes the major limitations of conventional flow-MRD methods and is ready for implementation in routine diagnostics.
Collapse
Affiliation(s)
- J Flores-Montero
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain (USAL)
| | - L Sanoja-Flores
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain (USAL)
| | - B Paiva
- Clinica Universidad de Navarra; Applied Medical Research Center (CIMA), IDISNA, Pamplona, Spain (UNAV)
| | - N Puig
- Department of Hematology, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain (HUSAL)
| | - O García-Sánchez
- Department of Hematology, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain (HUSAL)
| | - S Böttcher
- Second Department of Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany (UNIKIEL)
| | - V H J van der Velden
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (EMC)
| | - J-J Pérez-Morán
- Department of Hematology, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain (HUSAL)
| | - M-B Vidriales
- Department of Hematology, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain (HUSAL)
| | - R García-Sanz
- Department of Hematology, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain (HUSAL)
| | - C Jimenez
- Department of Hematology, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain (HUSAL)
| | - M González
- Department of Hematology, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain (HUSAL)
| | | | - A Corral-Mateos
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain (USAL)
| | | | - R Fluxá
- Cytognos SL, Salamanca, Spain
| | - R Pontes
- Faculty of Medicine, Federal University of Rio de Janeiro and Institute of Pediatrics and Childhood Care, Rio de Janeiro, Brazil
| | - J Caetano
- Department of Hematology, Portuguese Institute of Oncology, Lisbon, Portugal (IPOLFG)
| | - L Sedek
- Department of Pediatric Hematology and Oncology, Medical University of Silesia in Katowice, Zabrze, Poland (SUM)
| | - M-C Del Cañizo
- Department of Hematology, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain (HUSAL)
| | - J Bladé
- Department of Hematology, Hospital Clinic I Provincial, Barcelona, Spain
| | - J-J Lahuerta
- Department of Hematology, Hospital 12 de Octubre, Madrid, Spain
| | - C Aguilar
- Department of Hematology, Hospital General de Santa Bárbara, Soria, Spain
| | - A Bárez
- Department of Hematology, Complejo Asistencial de Ávila, Ávila, Spain
| | - A García-Mateo
- Department of Hematology, Complejo Asistencial de Segovia, Segovia, Spain
| | - J Labrador
- Hematology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - P Leoz
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain (USAL)
| | - C Aguilera-Sanz
- Department of Hematology, Hospital El Bierzo, Ponferrada, Spain
| | - J San-Miguel
- Clinica Universidad de Navarra; Applied Medical Research Center (CIMA), IDISNA, Pamplona, Spain (UNAV)
| | - M-V Mateos
- Department of Hematology, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain (HUSAL)
| | - B Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, CA, USA
| | - J J M van Dongen
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (EMC).,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - A Orfao
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain (USAL)
| |
Collapse
|
39
|
Functional role and therapeutic targeting of p21-activated kinase 4 in multiple myeloma. Blood 2017; 129:2233-2245. [PMID: 28096095 DOI: 10.1182/blood-2016-06-724831] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/16/2016] [Indexed: 02/08/2023] Open
Abstract
Dysregulated oncogenic serine/threonine kinases play a pathological role in diverse forms of malignancies, including multiple myeloma (MM), and thus represent potential therapeutic targets. Here, we evaluated the biological and functional role of p21-activated kinase 4 (PAK4) and its potential as a new target in MM for clinical applications. PAK4 promoted MM cell growth and survival via activation of MM survival signaling pathways, including the MEK-extracellular signal-regulated kinase pathway. Furthermore, treatment with orally bioavailable PAK4 allosteric modulator (KPT-9274) significantly impacted MM cell growth and survival in a large panel of MM cell lines and primary MM cells alone and in the presence of bone marrow microenvironment. Intriguingly, we have identified FGFR3 as a novel binding partner of PAK4 and observed significant activity of KPT-9274 against t(4;14)-positive MM cells. This set of data supports PAK4 as an oncogene in myeloma and provide the rationale for the clinical evaluation of PAK4 modulator in myeloma.
Collapse
|
40
|
Rosko A, Giralt S, Mateos MV, Dispenzieri A. Myeloma in Elderly Patients: When Less Is More and More Is More. Am Soc Clin Oncol Educ Book 2017; 37:575-585. [PMID: 28561667 PMCID: PMC6619424 DOI: 10.1200/edbk_175171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Multiple myeloma is a plasma cell malignancy that occurs among older adults and accounts for 15% of all hematologic malignancies in the United States. Thirty-five percent of patients are diagnosed at age 75 or older. Novel therapeutics and routine use of autologous stem cell transplantation (ASCT) have led to substantial improvements in patient survival, although improvements have been more impressive among patients younger than age 65. Finding the balance between under- and overtreating elderly patients is one of the biggest challenges specific to them as a subgroup of patients with MM. Decision making about which therapies and their dose intensity and duration should be influenced by a patient's functional status, personal preferences, disease characteristics, and ability to tolerate therapy. ASCT should be considered for all patients younger than age 80, assuming that they are not frail. The attainment of a stringent complete response and minimal residual disease negativity is associated with improved progression-free and overall survival. Again, consideration of quality of life for these patients is paramount. Although there is a growing list of tools to sort through these issues, a fully integrated approach has not yet been finely tuned, leaving additional work to be done for the treatment of elderly patients with MM.
Collapse
Affiliation(s)
- Ashley Rosko
- From The Ohio State University, Columbus, OH; Memorial Sloan Kettering Cancer Center, New York, NY; University Hospital of Salamanca, Salamanca, Spain; Mayo Clinic, Rochester, MN
| | - Sergio Giralt
- From The Ohio State University, Columbus, OH; Memorial Sloan Kettering Cancer Center, New York, NY; University Hospital of Salamanca, Salamanca, Spain; Mayo Clinic, Rochester, MN
| | - Maria-Victoria Mateos
- From The Ohio State University, Columbus, OH; Memorial Sloan Kettering Cancer Center, New York, NY; University Hospital of Salamanca, Salamanca, Spain; Mayo Clinic, Rochester, MN
| | - Angela Dispenzieri
- From The Ohio State University, Columbus, OH; Memorial Sloan Kettering Cancer Center, New York, NY; University Hospital of Salamanca, Salamanca, Spain; Mayo Clinic, Rochester, MN
| |
Collapse
|
41
|
García-Sanz R, Corchete LA, Alcoceba M, Chillon MC, Jiménez C, Prieto I, García-Álvarez M, Puig N, Rapado I, Barrio S, Oriol A, Blanchard MJ, de la Rubia J, Martínez R, Lahuerta JJ, González Díaz M, Mateos MV, San Miguel JF, Martínez-López J, Sarasquete ME. Prediction of peripheral neuropathy in multiple myeloma patients receiving bortezomib and thalidomide: a genetic study based on a single nucleotide polymorphism array. Hematol Oncol 2016; 35:746-751. [PMID: 27605156 DOI: 10.1002/hon.2337] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 06/24/2016] [Accepted: 07/03/2016] [Indexed: 11/11/2022]
Abstract
Bortezomib- and thalidomide-based therapies have significantly contributed to improved survival of multiple myeloma (MM) patients. However, treatment-induced peripheral neuropathy (TiPN) is a common adverse event associated with them. Risk factors for TiPN in MM patients include advanced age, prior neuropathy, and other drugs, but there are conflicting results about the role of genetics in predicting the risk of TiPN. Thus, we carried out a genome-wide association study based on more than 300 000 exome single nucleotide polymorphisms in 172 MM patients receiving therapy involving bortezomib and thalidomide. We compared patients developing and not developing TiPN under similar treatment conditions (GEM05MAS65, NCT00443235). The highest-ranking single nucleotide polymorphism was rs45443101, located in the PLCG2 gene, but no significant differences were found after multiple comparison correction (adjusted P = .1708). Prediction analyses, cytoband enrichment, and pathway analyses were also performed, but none yielded any significant findings. A copy number approach was also explored, but this gave no significant results either. In summary, our study did not find a consistent genetic component associated with TiPN under bortezomib and thalidomide therapies that could be used for prediction, which makes clinical judgment essential in the practical management of MM treatment.
Collapse
Affiliation(s)
- Ramón García-Sanz
- Hospital Universitario de Salamanca-IBSAL, IBMCC-CSIC, Salamanca, Spain
| | | | - Miguel Alcoceba
- Hospital Universitario de Salamanca-IBSAL, IBMCC-CSIC, Salamanca, Spain
| | | | - Cristina Jiménez
- Hospital Universitario de Salamanca-IBSAL, IBMCC-CSIC, Salamanca, Spain
| | - Isabel Prieto
- Hospital Universitario de Salamanca-IBSAL, IBMCC-CSIC, Salamanca, Spain
| | | | - Noemi Puig
- Hospital Universitario de Salamanca-IBSAL, IBMCC-CSIC, Salamanca, Spain
| | | | | | | | | | | | | | | | | | | | - Jesús Fernando San Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, Pamplona, Spain
| | | | | | | |
Collapse
|
42
|
Periago A, Campillo JA, Mrowiec A, Gimeno L, Montes NR, Martínez-Sánchez MV, Cabañas-Perianes V, García-Garay C, Bolarin JM, Blasco-Mogorrón A, Muro M, Berenguer M, Moraleda JM, ••• GA, Minguela A. Circulating aberrant plasma cells allows risk stratification of patients with myeloma. Am J Hematol 2016; 91:E353-E355. [PMID: 27220360 DOI: 10.1002/ajh.24431] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/19/2016] [Accepted: 05/22/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Adela Periago
- Hematology Service, Hospital Rafael Méndez; Lorca , Murcia Spain
| | - José A. Campillo
- Immunology Service, Instituto Murciano De Investigación Biosanitaria (IMIB) and Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas (CIBERehd), Hospital Clínico Universitario Virgen De La Arrixaca (HCUVA); Murcia Spain
| | - Anna Mrowiec
- Immunology Service, Instituto Murciano De Investigación Biosanitaria (IMIB) and Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas (CIBERehd), Hospital Clínico Universitario Virgen De La Arrixaca (HCUVA); Murcia Spain
| | - Lourdes Gimeno
- Immunology Service, Instituto Murciano De Investigación Biosanitaria (IMIB) and Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas (CIBERehd), Hospital Clínico Universitario Virgen De La Arrixaca (HCUVA); Murcia Spain
| | - Natividad R. Montes
- Immunology Service, Instituto Murciano De Investigación Biosanitaria (IMIB) and Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas (CIBERehd), Hospital Clínico Universitario Virgen De La Arrixaca (HCUVA); Murcia Spain
| | - María V. Martínez-Sánchez
- Immunology Service, Instituto Murciano De Investigación Biosanitaria (IMIB) and Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas (CIBERehd), Hospital Clínico Universitario Virgen De La Arrixaca (HCUVA); Murcia Spain
| | | | - Carmen García-Garay
- Hematology Service, Hospital General Universitario Santa Lucía; Cartagena Murcia Spain
| | - José M. Bolarin
- Immunology Service, Instituto Murciano De Investigación Biosanitaria (IMIB) and Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas (CIBERehd), Hospital Clínico Universitario Virgen De La Arrixaca (HCUVA); Murcia Spain
| | - Adela Blasco-Mogorrón
- Immunology Service, Instituto Murciano De Investigación Biosanitaria (IMIB) and Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas (CIBERehd), Hospital Clínico Universitario Virgen De La Arrixaca (HCUVA); Murcia Spain
| | - Manuel Muro
- Immunology Service, Instituto Murciano De Investigación Biosanitaria (IMIB) and Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas (CIBERehd), Hospital Clínico Universitario Virgen De La Arrixaca (HCUVA); Murcia Spain
| | | | | | - García-Alonso •••
- Immunology Service, Instituto Murciano De Investigación Biosanitaria (IMIB) and Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas (CIBERehd), Hospital Clínico Universitario Virgen De La Arrixaca (HCUVA); Murcia Spain
| | - Alfredo Minguela
- Immunology Service, Instituto Murciano De Investigación Biosanitaria (IMIB) and Centro De Investigación Biomédica En Red De Enfermedades Hepáticas Y Digestivas (CIBERehd), Hospital Clínico Universitario Virgen De La Arrixaca (HCUVA); Murcia Spain
| |
Collapse
|