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Richardson PG, Facon T, Venner CP, Bahlis NJ, Offner F, White D, Karlin L, Benboubker L, Voog E, Yoon S, Suzuki K, Shibayama H, Zhang X, Villarreal M, Twumasi‐Ankrah P, Labotka R, Rifkin RM, Lonial S, Kumar SK, Rajkumar SV, Moreau P. Late versus early response and depth of response are associated with improved outcomes in patients with newly diagnosed multiple myeloma enrolled in the TOURMALINE-MM2 trial. EJHAEM 2023; 4:995-1005. [PMID: 38024593 PMCID: PMC10660432 DOI: 10.1002/jha2.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 12/01/2023]
Abstract
Deeper responses are associated with longer survival in multiple myeloma (MM); however, limited data exist on the impact of response kinetics on outcomes. We investigated progression-free survival (PFS) and duration of response (DOR) by response depth and in early (best confirmed response 0-4 months; n = 424) versus late responders (best confirmed response >4 months; n = 281). Newly diagnosed patients enrolled in TOURMALINE-MM2 receiving ixazomib-lenalidomide-dexamethasone (IRd) (n = 351) or placebo-Rd (n = 354) were evaluated post hoc. Deeper responses were associated with longer PFS (complete response [CR] not reached [NR], very good partial response [VGPR] 37.2 months, partial response [PR] 16.4 months) and DOR (CR NR, VGPR 42.6 months, PR 15.4 months). Among patients with a PFS (n = 511) or DOR (n = 484) of ≥6 months who achieved ≥PR, median PFS was prolonged among late versus early responders receiving IRd (59.7 vs. 17.9 months) or placebo-Rd (56.6 vs. 12.4 months), as was median DOR (IRd, NR vs. 20.9 months; placebo-Rd, 58.2 vs. 11.7 months). While the treatment paradigm for newly diagnosed MM is treatment to progression, our findings suggest slowness of response to a proteasome inhibitor-immunomodulatory drug-steroid combination is not a negative predictor of outcome.
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Affiliation(s)
- Paul G. Richardson
- Harvard Medical SchoolJerome Lipper Multiple Myeloma Center, Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Thierry Facon
- Centre Hospitalier Universitaire (CHU) LilleService des Maladies du Sang, University of LilleLilleFrance
| | - Christopher P. Venner
- Cross Cancer InstituteUniversity of AlbertaEdmontonAlbertaCanada
- BC Cancer Vancouver CentreUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Nizar J. Bahlis
- Arnie Charbonneau Cancer InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Darrell White
- QEII Health Sciences Center and Dalhousie UniversityHalifaxNova ScotiaCanada
| | | | | | | | - Sung‐Soo Yoon
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
| | | | | | - Xiaoquan Zhang
- Takeda Development Center Americas, Inc. (TDCA)LexingtonMassachusettsUSA
| | - Miguel Villarreal
- Takeda Development Center Americas, Inc. (TDCA)LexingtonMassachusettsUSA
| | | | - Richard Labotka
- Takeda Development Center Americas, Inc. (TDCA)LexingtonMassachusettsUSA
| | - Robert M. Rifkin
- US Oncology Research – Rocky Mountain Cancer CentersDenverColoradoUSA
| | - Sagar Lonial
- Department of Hematology and Medical OncologyWinship Cancer InstituteEmory University School of MedicineAtlantaGeorgiaUSA
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Bao L, Wang YT, Lu MQ, Chu B, Shi L, Gao S, Fang LJ, Xiang QQ, Ding YH, Liu X, Zhao X, Wang MZ, Chen Y, Hu WK. Vitamin D deficiency linked to abnormal bone and lipid metabolism predicts high-risk multiple myeloma with poorer prognosis. Front Endocrinol (Lausanne) 2023; 14:1157969. [PMID: 37181039 PMCID: PMC10173308 DOI: 10.3389/fendo.2023.1157969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Purpose Vitamin D deficiency is frequent in patients with multiple myeloma (MM), however, its prognostic relevance in MM was rather inconclusive. We first investigated the association of vitamin D deficiency with abnormal bone and lipid metabolism in newly diagnosed multiple myeloma (NDMM), and next assessed the impact of serum ratio of vitamin D to carboxy-terminal telopeptide of type I collagen (β-CTX) on progression-free survival (PFS) and overall free survival (OS) in patients with NDMM. Methods The data of 431 consecutive patients with NDMM at Beijing Jishuitan Hospital from September 2013 to December 2022 were collected and retrospectively reviewed through our electronic medical record system. The measurement of 25-hydroxyvitamin D in the blood is an indicator of an individual's overall vitamin D status. Results The serum levels of vitamin D were negatively correlated with β-CTX in NDMM patients. Of note, positive correlation between vitamin D and cholesterol levels in the serum was found in this study. The cohort (n = 431) was divided into two groups based on the serum ratio of vitamin D to β-CTX. Compared to the group with a higher vitamin D to β-CTX ratio, the group with a lower vitamin D to β-CTX ratio (n = 257, 60%) exhibited hypocholesterolemia, inferior PFS and OS, along with increased cases of ISS stage-III and R-ISS stage-III, a higher number of plasma cells in the bone marrow, and elevated serum calcium levels. Consistent with this, multivariate analysis confirmed that the vitamin D to β-CTX ratio was an independent unfavorable indicator for survival in NDMM patients. Conclusion Our data demonstrated the ratio of vitamin D to β-CTX in the serum is a unique biomarker for NDMM patients to identify the high-risk cases with poor prognosis, which is superior to vitamin D itself for predicting PFS and OS in NDMM. Also, it is worth mentioning that our data on the connection between vitamin D deficiency and hypocholesterolemia might help clarify novel mechanistic aspects of myeloma development.
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Kegyes D, Constantinescu C, Vrancken L, Rasche L, Gregoire C, Tigu B, Gulei D, Dima D, Tanase A, Einsele H, Ciurea S, Tomuleasa C, Caers J. Patient selection for CAR T or BiTE therapy in multiple myeloma: Which treatment for each patient? J Hematol Oncol 2022; 15:78. [PMID: 35672793 PMCID: PMC9171942 DOI: 10.1186/s13045-022-01296-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/22/2022] [Indexed: 01/09/2023] Open
Abstract
Multiple myeloma (MM) is a plasma cell malignancy that affects an increasing number of patients worldwide. Despite all the efforts to understand its pathogenesis and develop new treatment modalities, MM remains an incurable disease. Novel immunotherapies, such as CAR T cell therapy (CAR) and bispecific T cell engagers (BiTE), are intensively targeting different surface antigens, such as BMCA, SLAMF7 (CS1), GPRC5D, FCRH5 or CD38. However, stem cell transplantation is still indispensable in transplant-eligible patients. Studies suggest that the early use of immunotherapy may improve outcomes significantly. In this review, we summarize the currently available clinical literature on CAR and BiTE in MM. Furthermore, we will compare these two T cell-based immunotherapies and discuss potential therapeutic approaches to promote development of new clinical trials, using T cell-based immunotherapies, even as bridging therapies to a transplant.
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Affiliation(s)
- David Kegyes
- grid.411040.00000 0004 0571 5814Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ,grid.411040.00000 0004 0571 5814Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Catalin Constantinescu
- grid.411040.00000 0004 0571 5814Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ,grid.411040.00000 0004 0571 5814Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Louise Vrancken
- grid.4861.b0000 0001 0805 7253Laboratory of Hematology, University of Liège, Liège, Belgium ,grid.411374.40000 0000 8607 6858Department of Hematology, CHU de Liège, Liège, Belgium
| | - Leo Rasche
- grid.8379.50000 0001 1958 8658Department of Internal Medicine II, University of Würzburg, Würzburg, Germany
| | - Celine Gregoire
- grid.4861.b0000 0001 0805 7253Laboratory of Hematology, University of Liège, Liège, Belgium ,grid.411374.40000 0000 8607 6858Department of Hematology, CHU de Liège, Liège, Belgium
| | - Bogdan Tigu
- grid.411040.00000 0004 0571 5814Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Gulei
- grid.411040.00000 0004 0571 5814Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ,grid.411040.00000 0004 0571 5814Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Alina Tanase
- grid.415180.90000 0004 0540 9980Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Hermann Einsele
- grid.8379.50000 0001 1958 8658Department of Internal Medicine II, University of Würzburg, Würzburg, Germany
| | - Stefan Ciurea
- grid.266093.80000 0001 0668 7243Hematopoietic Stem Cell Transplantation and Cellular Therapy Program, Division of Hematology/Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, USA
| | - Ciprian Tomuleasa
- grid.411040.00000 0004 0571 5814Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ,grid.411040.00000 0004 0571 5814Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Jo Caers
- grid.4861.b0000 0001 0805 7253Laboratory of Hematology, University of Liège, Liège, Belgium ,grid.411374.40000 0000 8607 6858Department of Hematology, CHU de Liège, Liège, Belgium
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Jiang Y, Lin W, Zhu L. Targeted Drug Delivery for the Treatment of Blood Cancers. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27041310. [PMID: 35209102 PMCID: PMC8880555 DOI: 10.3390/molecules27041310] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 01/11/2023]
Abstract
Blood cancers are a type of liquid tumor which means cancer is present in the body fluid. Multiple myeloma, leukemia, and lymphoma are the three common types of blood cancers. Chemotherapy is the major therapy of blood cancers by systemic administration of anticancer agents into the blood. However, a high incidence of relapse often happens, due to the low efficiency of the anticancer agents that accumulate in the tumor site, and therefore lead to a low survival rate of patients. This indicates an urgent need for a targeted drug delivery system to improve the safety and efficacy of therapeutics for blood cancers. In this review, we describe the current targeting strategies for blood cancers and recently investigated and approved drug delivery system formulations for blood cancers. In addition, we also discuss current challenges in the application of drug delivery systems for treating blood cancers.
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Affiliation(s)
- Yao Jiang
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK;
- Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Weifeng Lin
- Department of Molecular Chemistry and Materials Science, Weizmann Institute of Sciences, Rehovot 761001, Israel;
| | - Linyi Zhu
- Arthritis Research UK Centre for Osteoarthritis Pathogenesis, Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, UK
- Correspondence:
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