1
|
Cui L, Ning J, Yang R, Wang H. Therapeutic Effect and Adverse Event Rate of Different Treatment Methods in Patients with Multiple Myeloma and Renal Insufficiency. Int Arch Allergy Immunol 2024:1-9. [PMID: 38467118 DOI: 10.1159/000536170] [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: 11/23/2023] [Accepted: 01/04/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION This study involves the collation and analysis of clinical characteristics and laboratory findings in patients with multiple myeloma (MM) combined with renal insufficiency. The objective was to assess the impact of various treatment methods on patient outcomes and the incidence of adverse events in individuals with MM and renal insufficiency. METHODS We analyzed the correlation between clinical characteristics, gene loci, fluorescence in situ hybridization, treatment methods, and prognosis in patients with MM and renal insufficiency. The differences in hematological and therapeutic efficacy indexes between two groups subjected to different treatments were evaluated. The assessment of treatment effectiveness was based on the total effective rate, calculated as the sum of stringent CR rate, complete remission rate, very good partial remission rate, and partial remission rate. RESULTS (1) The renal insufficiency group exhibited higher percentages of bone marrow abnormal plasma cells, lactate dehydrogenase (LDH), blood calcium, white blood cell count, percentage of neutrophils, and blood β2-microglobulin (β2-MG) levels compared to the normal renal function group. Conversely, hemoglobin levels and lymphocyte percentage were lower in the renal insufficiency group. Binary logistic regression analysis identified hemoglobin, blood calcium values, blood β2-MG, and LDH as independent risk factors for the development of renal insufficiency in patients with MM (p < 0.05). (2) Based on the Durie-Salmon staging criteria, the proportion of Stage III patients was the highest (up to 81.8%), indicating that patients with MM usually suffer from insidious disease, often with high tumor load and late-disease stage at the time of consultation. International Staging System (ISS) and Revised ISS staging also revealed a higher proportion of Stage III patients in the renal insufficiency group (p < 0.05), indicating a worse long-term prognosis in patients with MM and renal insufficiency. (3) Before treatment, there was no significant difference between the two groups in the analysis of various indices. Complications such as sepsis, herpes zoster, peripheral neuropathy, thrombosis, secondary pulmonary infection, and cardiac complications were significantly lower in the BCD group (Bortezomib + Cyclophosphamide + Dexamethasone) compared to the BD group (Bortezomib + Dexamethasone) (χ2 = 6.333, p < 0.05), suggesting fewer complications with the BCD regimen. (4) The clinical treatment effects analysis indicated that the BCD group demonstrated a more significant impact than the BD group in the treatment of MM. CONCLUSION The application of the BCD regimen in the treatment of MM has shown significant efficiency, effectively alleviating clinical symptoms with fewer adverse reactions and high safety.
Collapse
Affiliation(s)
- Lijuan Cui
- Department of Hematology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jing Ning
- Department of Hematology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Rui Yang
- Department of Hematology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Hainan Wang
- Department of Hematology, General Hospital of Ningxia Medical University, Yinchuan, China
| |
Collapse
|
2
|
Chen C, Miao X, Guo X, Xu J, Liang J, Zheng Y, Chi L, Chen X, Wei L, Zhang H, Ye X, He J. Safety of selinexor as the only exportin 1 (XPO1) inhibitor so far: a post-marketing study based on the world Health Organization pharmacovigilance database (Vigibase). Expert Opin Drug Saf 2024; 23:247-255. [PMID: 37608630 DOI: 10.1080/14740338.2023.2248888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Exportin 1 (XPO1) inhibitors are being developed as a new agent for anti-cancer therapies. This study aimed to broadly portray the adverse event (AE) profile of selinexor, an XPO1 inhibitor, in actual clinical practice. RESEARCH DESIGN AND METHODS Disproportionality analyses were conducted by calculating the information component and reporting odds ratio in VigiBase over different reporting periods. All selinexor-related AEs were classified by system organ class (SOC) and preferred term (PT) according to the Medical Dictionary for Regulatory Activities. RESULTS A total of 116,443 AEs were identified in 2,608 patients that received selinexor. Patients with cardiac disorders had a higher propensity for death. Thirteen SOCs and 125 PTs were identified as having a potential connection with selinexor. Notably, 29 suspected signals detected in our study were defined as significant AEs by the European Medicines Agency, including febrile neutropenia, pancytopenia, and acute kidney injury. Attention should be paid to these AEs, despite most toxicities being manageable and reversible. CONCLUSIONS This study highlights a number of AEs associated with selinexor. Most toxicities are reversible but require careful management. The benefit of selinexor still outweighs the potential risks, indicating XPO1 inhibitors as promising agents.
Collapse
Affiliation(s)
- Chenxin Chen
- Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Xiaoyong Miao
- Department of Anesthesiology, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Xiaojing Guo
- Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Jinfang Xu
- Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Jizhou Liang
- Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Yi Zheng
- Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Lijie Chi
- Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Xiao Chen
- Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Lianhui Wei
- Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Hewei Zhang
- Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Xiaofei Ye
- Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, China
| | - Jia He
- Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, China
| |
Collapse
|
3
|
Niu J, Yu J, Huang H, Shi J, Zheng D, Qiu J. Cystatin C and eGFR CKD-EPI-CysC: novel biomarkers for renal impairment diagnosis and two-year progression-free survival in multiple myeloma. Scand J Clin Lab Invest 2023; 83:599-603. [PMID: 38145311 DOI: 10.1080/00365513.2023.2297364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
To evaluate cystatin C (CysC) and estimation of glomerular filtration rate (GFR) calculated using the formula, CKD-EPI-CysC (eGFRCKD-EPI-CysC) for renal impairment diagnosis and predicting the prognosis of patients with multiple myeloma (MM). One hundred-fourteen patients with MM and 38 healthy individuals were recruited for the study. Data on clinical characteristics and renal function-related biochemical indicators were collected and analyzed. Patients with MM had increased levels of CysC (1.25 (0.97-2.31) vs. 0.84 (0.80-0.92), respectively, p < 0.001) and decreased levels of eGFRCKD-EPI-CysC (53.0 (24.4-81.1) vs. 97.2 (87.0-104.5), respectively, p < 0.001), compared with healthy individuals. There were significantly more patients with elevated CysC levels than with elevated sCr levels (64.9% vs. 41.2%, respectively, p < 0.001). The CKD-EPI-CysC formula detected more patients with eGFR < 60 ml/(min × 1.73 m2) than the CKD-EPI-sCr formula (52.63% vs. 37.72%, respectively, p < 0.001). Correlation analysis found that only CysC, eGFRCKD-EPI-CysC, and eGFRCKD-EPI-sCr-CysC strongly correlated with β2-microglobulin in group ISS-I. Logistic regression analysis was used to screen CysC (OR = 1.495, 95% CI = 1.097-2.038, p = 0.011) and eGFRCKD-EPI-CysC (OR = 0.980, 95% CI = 0.967-0.993, p = 0.003) as independent prognostic indicators for 2-year-progression-free survival (PFS) of patients with MM. Receiver operating characteristic curve analysis found that CysC values >1.70 mg/L had 67.6% sensitivity and 65.2% specificity and eGFRCKD-EPI-CysC values <38.62 ml/(min × 1.73 m2) had 65.2% sensitivity and 67.6% specificity for 2-year PFS of patients with MM. In summary, CysC and eGFRCKD-EPI-CysC were more sensitive than sCr and eGFRCKD-EPI-sCr for predicting renal impairment in patients newly diagnosed with MM. Increased CysC and decreased eGFRCKD-EPI-CysC levels were effective predictors of 2-year PFS of patients with MM.
Collapse
Affiliation(s)
- Jian Niu
- Center of Clinical Laboratory, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiajia Yu
- Center of Clinical Laboratory, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huifang Huang
- Center of Clinical Laboratory, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinfang Shi
- Center of Clinical Laboratory, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dong Zheng
- Center of Clinical Laboratory, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Qiu
- Center of Clinical Laboratory, the First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
4
|
Hu Y, Yang H, Fu S, Wu J. Therapeutic Plasma Exchange: For Cancer Patients. Cancer Manag Res 2022; 14:411-425. [PMID: 35140519 PMCID: PMC8818550 DOI: 10.2147/cmar.s340472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/25/2021] [Indexed: 11/23/2022] Open
Abstract
Therapeutic plasma exchange is used as a trial method for the treatment of cancer patients. Therapeutic plasma exchange uses in vitro technology to remove pathogenic factors in the plasma, returning the replacement and remaining components to the patient to facilitate cure. In the effort to explore new methods of cancer treatment, the introduction of therapeutic plasma exchange brings new hope for cancer treatment; however, the current evidence supporting therapeutic plasma exchange is controversial, and most of the evidence comes from observational studies, lacking large prospective randomized trials. Therefore, this review attempts to focus on the main indications of therapeutic plasma exchange for the treatment of tumors and their complications, including hematological tumors (multiple myeloma cast nephropathy and hyperviscosity syndrome), nervous system tumors (myasthenia gravis associated with thymoma, paraneoplastic neurological syndrome, Lambert–Eaton myasthenia syndrome, and anti-N-methyl-D-aspartate receptor encephalitis), overdose of chemotherapy drugs. In addition, the issues of side-effects and safety in the use of therapeutic plasma exchange are also discussed. However, well-designed prospective trials are needed to better define the role of therapeutic plasma exchange in cancer.
Collapse
Affiliation(s)
- Yuru Hu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Hanshan Yang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Shaozhi Fu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
| | - Jingbo Wu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China
- Correspondence: Jingbo Wu; Shaozhi Fu, Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China, Tel +8613980257136, Email ;
| |
Collapse
|
5
|
Ren B, Kwah MXY, Liu C, Ma Z, Shanmugam MK, Ding L, Xiang X, Ho PCL, Wang L, Ong PS, Goh BC. Resveratrol for cancer therapy: Challenges and future perspectives. Cancer Lett 2021; 515:63-72. [PMID: 34052324 DOI: 10.1016/j.canlet.2021.05.001] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 12/20/2022]
Abstract
Resveratrol (3,4',5-trihydroxy-trans-stilbene) has been expected to ameliorate cancer and foster breakthroughs in cancer therapy. Despite thousands of preclinical studies on the anticancer activity of resveratrol, little progress has been made in translational research and clinical trials. Most studies have focused on its anticancer effects, cellular mechanisms, and signal transduction pathways in vitro and in vivo. In this review, we aimed to discern the causes that prevent resveratrol from being used in cancer treatment. Among the various limitations, poor pharmacokinetics and low potency seem to be the two main bottlenecks of resveratrol. In addition, resveratrol-induced nephrotoxicity in multiple myeloma patients hinders its further development as an anticancer drug. New insights and strategies have been proposed to accelerate the conversion of resveratrol from bench to bedside. In the interim, the most promising approach is to enhance the bioavailability of resveratrol with new formulations. Alternatively, more potent analogues of resveratrol could be developed to augment its anticancer potency. Given all the gaps mentioned, much work remains to be done. However, if remarkable progress can be made, resveratrol may finally be used for cancer therapy.
Collapse
Affiliation(s)
- Boxu Ren
- School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, 434023, China
| | - Marabeth Xin-Yi Kwah
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, 117543, Singapore
| | - Cuiliu Liu
- School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, 434023, China
| | - Zhaowu Ma
- School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, 434023, China
| | - Muthu K Shanmugam
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
| | - Lingwen Ding
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore
| | - Xiaoqiang Xiang
- Department of Clinical Pharmacy, School of Pharmacy, Fudan University, Shanghai, 201203, China
| | - Paul Chi-Lui Ho
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, 117543, Singapore
| | - Lingzhi Wang
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore.
| | - Pei Shi Ong
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, 117543, Singapore.
| | - Boon Cher Goh
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117600, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599, Singapore; Department of Haematology-Oncology, National University Cancer Institute, Singapore, 119228, Singapore.
| |
Collapse
|
6
|
Multiple Myeloma Mimicking a Small Vessel Vasculitis Presentation. Case Rep Rheumatol 2020; 2020:9146842. [PMID: 32099712 PMCID: PMC7037530 DOI: 10.1155/2020/9146842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/24/2022] Open
Abstract
Multiple myeloma can have different clinical manifestations, and not all patients present with classic CRAB component. We describe a 46-year-old woman admitted to our hospital with a complaint of a bluish-to-black discoloration of the second toe that was rapidly progressive and acute kidney injury. We documented a Kappa light chain monoclonal gammopathy, increased presence of plasmacytes in bone marrow aspiration, and multiple lytic bone lesions, which led to a diagnosis of multiple myeloma. Although multiple myeloma presenting with blue finger syndrome is uncommon, it must always be considered as a differential diagnosis with this clinical finding.
Collapse
|
7
|
Giri S, Zhu W, Wang R, Zeidan A, Podoltsev N, Gore SD, Neparidze N, Ma X, Gross CP, Davidoff AJ, Huntington SF. Underutilization of guideline-recommended supportive care among older adults with multiple myeloma in the United States. Cancer 2019; 125:4084-4095. [PMID: 31381151 DOI: 10.1002/cncr.32428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/20/2019] [Accepted: 06/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND With improving survival for patients with multiple myeloma (MM), supportive care that is focused on optimizing quality of life and minimizing treatment-related toxicities is increasingly important. The extent to which patients with MM are receiving recommended supportive care is unknown. METHODS This study used the Surveillance, Epidemiology, and End Results-Medicare database to identify older adults (age ≥66 years) diagnosed with MM in 2008-2013 who had received active treatment and survived 1 year or longer after their diagnosis. Outcomes of interest included guideline-recommended supportive care, which was defined as 1) bone-modifying drugs (BMDs) within the 12 months after the diagnosis, 2) influenza vaccination in the first season after the diagnosis, and 3) concomitant use of prophylactic antivirals with proteasome inhibitors. Multivariable logistic regression models were used to evaluate associations between patient/facility-level characteristics and supportive care use. RESULTS Among 1996 patients receiving MM-directed therapy, 64%, 52%, and 49% received BMDs, an influenza vaccination, and antiviral prophylaxis, respectively. Non-Hispanic black patients (odds ratio [OR] vs white patients, 0.63; 95% confidence interval [CI], 0.46-0.88) and patients with baseline renal impairment (OR, 0.43; 95% CI, 0.34-0.54) had lower odds of BMDs. Non-Hispanic blacks (OR, 0.52; 95% CI, 0.37-0.73) and those with dual Medicaid enrollment (OR, 0.76; 95% CI, 0.58-0.99) had lower odds of influenza vaccination. Treatment in a community-based setting was associated with reduced odds of antiviral prophylaxis (OR, 0.58; 95% CI, 0.46-0.72). CONCLUSIONS Substantial underutilization of guideline-recommended supportive care was observed among older adults with MM in the United States, and this was associated with both patient and facility characteristics. Targeted interventions are needed to improve supportive care for patients with MM.
Collapse
Affiliation(s)
- Smith Giri
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Weiwei Zhu
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Amer Zeidan
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Nikolai Podoltsev
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Steven D Gore
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Natalia Neparidze
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Cary P Gross
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Amy J Davidoff
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Scott F Huntington
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| |
Collapse
|
8
|
Okazuka K, Ishida T. Proteasome inhibitors for multiple myeloma. Jpn J Clin Oncol 2018; 48:785-793. [PMID: 30102324 DOI: 10.1093/jjco/hyy108] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/10/2018] [Indexed: 02/06/2023] Open
Abstract
Therapeutic strategies for multiple myeloma have dramatically changed in the last two decades, especially after the introduction of proteasome inhibitors. The first-in-class proteasome inhibitor, bortezomib, was approved by the US Food and Drug Administration in 2003. Since then, it has been a backbone therapy for not only relapsed or refractory myeloma patients but also newly diagnosed multiple myeloma patients. Second-generation proteasome inhibitors, such as carfilzomib and ixazomib, have been approved, and three proteasome inhibitors were incorporated into several regimens with other cytotoxic agents, such as alkylating agents, immunomodulatory drugs and monoclonal antibodies. Because each proteasome inhibitor shows different properties with respect to adverse events, understanding and managing each adverse event of proteasome inhibitors are necessary for the continuation of therapy with minimal interruption of treatment. This review summarizes the recent advances in proteasome inhibitors used in the treatment of multiple myeloma.
Collapse
Affiliation(s)
- Kiyoshi Okazuka
- Department of Hematology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| | - Tadao Ishida
- Department of Hematology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| |
Collapse
|
9
|
Kim C, Hernandez RK, Cyprien L, Liede A, Cheng PC. Patterns of bisphosphonate treatment among patients with multiple myeloma treated at oncology clinics across the USA: observations from real-world data. Support Care Cancer 2018; 26:2833-2841. [PMID: 29516168 PMCID: PMC6018581 DOI: 10.1007/s00520-018-4133-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 02/25/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Current guidelines recommend that intravenous bisphosphonates be initiated in all patients with multiple myeloma for management of bone disease. The objective of this study was to describe real-world bisphosphonate treatment patterns. METHODS This was a retrospective observational study using oncology electronic health record (EHR) data contained in Amgen's Oncology Services Comprehensive Electronic Records (OSCER) database, generated by Flatiron Health (New York, NY), representing over 1.5 million US oncology patients. Patients were newly diagnosed with multiple myeloma between January 1, 2009 and April 30, 2016. Timing of bisphosphonate administration, frequency, schedule, changes in dosing schedule, and discontinuations were calculated. Bisphosphonate treatment relative to renal function and anti-multiple myeloma therapy regimens were also assessed. RESULTS A total of 11,112 patients were enrolled in the study with a median follow-up of 687 days. Sixty-three percent received ≥ 1 bisphosphonate administration, primarily every 4 weeks (67.7%). Mean time from diagnosis to bisphosphonate administration was 106 days (median, 29). Most patients (58.2%) initiated treatment in first year after diagnosis and about half (51.9%) either discontinued or changed dosing. Patients with poorer renal function by estimated glomerular filtration rate (eGFR) stage at baseline were less likely to receive bisphosphonates (eGFR stage 5 vs 1: 24 vs 72%) and more likely to have delayed initiation of bisphosphonate treatment from diagnosis (eGFR stage 5 vs 1: median 70 vs 25 days). CONCLUSIONS Real-world data from US oncology practices indicate that many patients with multiple myeloma may not receive optimal therapy for bone disease, particularly those with renal impairment.
Collapse
Affiliation(s)
- Christopher Kim
- Amgen Inc., 1 Amgen Center Dr, Thousand Oaks, CA, 91320, USA.
| | | | | | | | - Paul C Cheng
- Amgen Inc., 1 Amgen Center Dr, Thousand Oaks, CA, 91320, USA
| |
Collapse
|
10
|
Waszczuk-Gajda A, Lewandowski Z, Drozd-Sokołowska J, Boguradzki P, Dybko J, Wróbel T, Basak GW, Jurczyszyn A, Mądry K, Snarski E, Frączak E, Charliński G, Feliksbrot-Bratosiewicz M, Król M, Matuszkiewicz-Rowińska J, Klinger M, Krajewska M, Augustyniak-Bartosik H, Kościelska M, Rusicka P, Dwilewicz-Trojaczek J, Wiktor Jędrzejczak W. Autologous peripheral blood stem cell transplantation in dialysis-dependent multiple myeloma patients-DAUTOS Study of the Polish Myeloma Study Group. Eur J Haematol 2018; 101:475-485. [DOI: 10.1111/ejh.13101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Anna Waszczuk-Gajda
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Zbigniew Lewandowski
- Department of Epidemiology and Biostatistics; Warsaw Medical University; Warsaw Poland
| | - Joanna Drozd-Sokołowska
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Piotr Boguradzki
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Jarosław Dybko
- Department and Clinic of Haematology, Blood Neoplasms and Bone Marrow Transplantation; Wroclaw Medical University; Warsaw Poland
| | - Tomasz Wróbel
- Department and Clinic of Haematology, Blood Neoplasms and Bone Marrow Transplantation; Wroclaw Medical University; Warsaw Poland
| | - Grzegorz Władysław Basak
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Artur Jurczyszyn
- Department of Haematology; Jagiellonian University; Kraków Poland
| | - Krzysztof Mądry
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Emilian Snarski
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Ewa Frączak
- Department and Clinic of Haematology, Blood Neoplasms and Bone Marrow Transplantation; Wroclaw Medical University; Warsaw Poland
| | - Grzegorz Charliński
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
- Department of Haematology; Nicolaus Copernicus Specialist Municipal Hospital; Toruń Poland
| | | | - Małgorzata Król
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | | | - Marian Klinger
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wrocław Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wrocław Poland
| | | | - Małgorzata Kościelska
- Department of Nephrology and Internal Diseases; Medical University of Warsaw; Warsaw Poland
| | - Patrycja Rusicka
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | | | | |
Collapse
|
11
|
Abstract
Increasing epidemiological and experimental evidence has demonstrated an inverse relationship between the consumption of plant foods and the incidence of chronic diseases, including cancer. Microcomponents that are naturally present in such foods, especially polyphenols, are responsible for the benefits to human health. Resveratrol is a diet-derived cancer chemopreventive agent with high therapeutic potential, as demonstrated by different authors. The aim of this review is to collect and present recent evidence from the literature regarding resveratrol and its effects on cancer prevention, molecular signaling (especially regarding the involvement of p53 protein), and therapeutic perspectives with an emphasis on clinical trial results to date.
Collapse
|
12
|
Population pharmacokinetics of lenalidomide in multiple myeloma patients. Cancer Chemother Pharmacol 2016; 79:189-200. [PMID: 28039509 DOI: 10.1007/s00280-016-3228-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/13/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Lenalidomide disease-specific toxicity profiles and potentially life-threatening adverse events support the consideration of diversity in starting doses. The aim of this study was to conduct a population pharmacokinetic analysis of lenalidomide in multiple myeloma patients to identify and evaluate non-studied covariates that could be used for dose individualization. METHODS Blood samples were collected from 15 multiple myeloma patients. Nonlinear mixed-effects modeling was used to develop a population pharmacokinetic model and perform covariate analysis. The developed model was used to simulate dose schedules in order to explore the need of different dosing regimens in patients with different covariate values. RESULTS The data were accurately described by a one-compartment model with first-order elimination. Absorption was best described using three transit compartments. Creatinine clearance and body surface area were identified as covariates affecting apparent clearance and apparent volume of distribution, respectively. Simulations revealed that lower starting doses than the standard 25 mg/daily could be used in patients with body surface area below 1.8 m2 and even higher doses might be necessary for patients with normal renal function and large body surface area. CONCLUSIONS This study identified creatinine clearance and body surface area as covariates that have a clinically relevant impact on lenalidomide pharmacokinetics using population pharmacokinetics. In addition, the developed population pharmacokinetic model can be used to individualize lenalidomide dose in multiple myeloma patients, taking into account not only creatinine clearance but also body surface area.
Collapse
|
13
|
Pharmacokinetics, safety, and efficacy of lenalidomide plus dexamethasone in patients with multiple myeloma and renal impairment. Cancer Chemother Pharmacol 2016; 78:173-82. [PMID: 27286995 DOI: 10.1007/s00280-016-3068-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Renal impairment (RI) is a common comorbidity in multiple myeloma (MM). Current dose adjustments recommended for renally excreted lenalidomide are based on data from noncancer patients. This study evaluated the pharmacokinetics, safety, efficacy, and exposure-response for lenalidomide plus dexamethasone in patients with relapsed/refractory MM and stable RI using the recommended dose adjustments. METHODS This phase 2 multicenter, open-label study stratified patients into 5 groups based on creatinine clearance (CrCl) calculated by Cockcroft-Gault equation: normal renal function (CrCl > 80 mL/min), mild RI (50 ≤ CrCl ≤ 80 mL/min), moderate RI (30 ≤ CrCl < 50 mL/min), severe RI (CrCl < 30 mL/min), and end-stage renal disease requiring hemodialysis. Dosing was based on the lenalidomide label. RESULTS Among 38 patients, the median age was 68 (range 62-74) years, and poorer renal function was associated with older age, more advanced disease, and more lines of prior therapy. Lenalidomide clearance declined with decreased CrCl. Mean lenalidomide area under plasma concentration-time curve (AUC) was within ±25 % of the target AUC in each group. Overall response was 76 %, and safety profiles were similar across groups, with no exposure-dependent trend in efficacy or toxicity. Estimated glomerular filtration rates calculated using the simplified Modification of Diet in Renal Disease equation highly correlated with lenalidomide clearance and, in 87 % of patients, would lead to assigning the same starting dose of lenalidomide as CrCl. CONCLUSIONS In patients with stable renal function, the recommended dose adjustments achieved proper plasma exposure and similar safety and efficacy across renal groups.
Collapse
|
14
|
Challenges in Analyzing the Biological Effects of Resveratrol. Nutrients 2016; 8:nu8060353. [PMID: 27294953 PMCID: PMC4924194 DOI: 10.3390/nu8060353] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 12/28/2022] Open
Abstract
The suggested health effects (e.g., disease prevention) of dietary bioactive compounds such as resveratrol are challenging to prove in comparison to man-made drugs developed for therapeutic purposes. Dietary bioactive compounds have multiple cellular targets and therefore have a variety of biological effects. Extrapolating the biological effects of dietary compounds from in vitro and in vivo animal experiments to humans may lead to over- or under-estimation of the effect and role of these compounds. The present paper will discuss a few of these challenges and suggest directions for future research. Questions we address include: (1) Is the combinatorial effect of resveratrol and other compounds real? (2) What are the real and relevant doses of resveratrol after administration? and (3) Is it possible to estimate the preventive effect of resveratrol by clinical trials using standard experimental designs? The examples concerning resveratrol taken from the scientific literature are mainly from 2010 and later. The challenges pointed out in this review are similar to most naturally occurring bioactive compounds.
Collapse
|
15
|
Could renal impairment be a positive predictor of outcome in autografts for myeloma? Bone Marrow Transplant 2016; 51:1305-1306. [PMID: 27183097 DOI: 10.1038/bmt.2016.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 11/09/2022]
|
16
|
Sweiss K, Patel S, Culos K, Oh A, Rondelli D, Patel P. Melphalan 200 mg/m2 in patients with renal impairment is associated with increased short-term toxicity but improved response and longer treatment-free survival. Bone Marrow Transplant 2016; 51:1337-1341. [DOI: 10.1038/bmt.2016.136] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 11/09/2022]
|
17
|
Laforet M, Jourde-Chiche N, Haddad F, Sallee M, Stoppa AM, Brunet P, Dussol B, Burtey S, Gondouin B. Evolution in the treatment of multiple myeloma and impact on dialysis independence: data from a French cohort from 1999 to 2014. Blood Cancer J 2016; 6:e409. [PMID: 27015286 PMCID: PMC4817100 DOI: 10.1038/bcj.2016.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- M Laforet
- Centre de Nephrologie et Transplantation Rénale, Hopital La Conception, Marseille, France
| | - N Jourde-Chiche
- Centre de Nephrologie et Transplantation Rénale, Hopital La Conception, Marseille, France.,Vascular Research Center of Marseille, Faculté de Pharmacie, Aix-Marseille Université, Marseille, France
| | - F Haddad
- Centre de Nephrologie et Transplantation Rénale, Hopital La Conception, Marseille, France
| | - M Sallee
- Centre de Nephrologie et Transplantation Rénale, Hopital La Conception, Marseille, France.,Vascular Research Center of Marseille, Faculté de Pharmacie, Aix-Marseille Université, Marseille, France
| | - A M Stoppa
- Department of Hematology, Institut Paoli Calmette, Marseille, France
| | - P Brunet
- Centre de Nephrologie et Transplantation Rénale, Hopital La Conception, Marseille, France.,Vascular Research Center of Marseille, Faculté de Pharmacie, Aix-Marseille Université, Marseille, France
| | - B Dussol
- Centre de Nephrologie et Transplantation Rénale, Hopital La Conception, Marseille, France.,Vascular Research Center of Marseille, Faculté de Pharmacie, Aix-Marseille Université, Marseille, France
| | - S Burtey
- Centre de Nephrologie et Transplantation Rénale, Hopital La Conception, Marseille, France.,Vascular Research Center of Marseille, Faculté de Pharmacie, Aix-Marseille Université, Marseille, France
| | - B Gondouin
- Centre de Nephrologie et Transplantation Rénale, Hopital La Conception, Marseille, France.,Vascular Research Center of Marseille, Faculté de Pharmacie, Aix-Marseille Université, Marseille, France
| |
Collapse
|
18
|
Cheson BD, Brugger W, Damaj G, Dreyling M, Kahl B, Kimby E, Ogura M, Weidmann E, Wendtner CM, Zinzani PL. Optimal use of bendamustine in hematologic disorders: Treatment recommendations from an international consensus panel - an update. Leuk Lymphoma 2015; 57:766-82. [PMID: 26592922 PMCID: PMC4840280 DOI: 10.3109/10428194.2015.1099647] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Bendamustine has achieved widespread international regulatory approval and is a standard agent for the treatment for chronic lymphocytic leukemia (CLL), indolent non-Hodgkin lymphoma and multiple myeloma. Since approval, the number of indications for bendamustine has expanded to include aggressive non-Hodgkin lymphoma and Hodgkin lymphoma and novel targeted therapies, based on new bendamustine regimens/combinations, are being developed against CLL and lymphomas. In 2010, an international panel of bendamustine experts met and published a set of recommendations on the safe and effective use of bendamustine in patients suffering from hematologic disorders. In 2014, this panel met again to update these recommendations since the clarification of issues including optimal dosing and management of bendamustine-related toxicities. The aim of this report is to communicate the latest consensus on the use of bendamustine, permitting the expansion of its safe and effective administration, particularly in new combination therapies.
Collapse
Affiliation(s)
- Bruce D Cheson
- a Lombardi Comprehensive Cancer Center, Georgetown University Hospital , Washington , DC , USA
| | - Wolfram Brugger
- b Schwarzwald-Baar Clinic, University of Freiburg , Villingen-Schwenningen , Germany
| | - Gandhi Damaj
- c University Hospital, University of Basse-Normandie , Caen , France
| | - Martin Dreyling
- d Medical Clinic, University Hospital of Munich , Munich , Germany
| | - Brad Kahl
- e University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - Eva Kimby
- f Center for Hematology, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Michinori Ogura
- g Department of Hematology , Tokai Central Hospital , Gifu , Japan
| | - Eckhart Weidmann
- h Department of Oncology and Hematology , Krankenhaus Nordwest , Frankfurt , Germany
| | | | | |
Collapse
|
19
|
Richardson PG, Harvey RD, Laubach JP, Moreau P, Lonial S, San-Miguel JF. Panobinostat for the treatment of relapsed or relapsed/refractory multiple myeloma: pharmacology and clinical outcomes. Expert Rev Clin Pharmacol 2015; 9:35-48. [DOI: 10.1586/17512433.2016.1096773] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
20
|
Chen JH, Hsu SN, Huang TC, Wu YY, Lin C, Chang PY, Chen YC, Ho CL. Prognostic Significance of Initial Serum Albumin and 24 Hour Daily Protein Excretion before Treatment in Multiple Myeloma. PLoS One 2015; 10:e0128905. [PMID: 26053837 PMCID: PMC4459796 DOI: 10.1371/journal.pone.0128905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/02/2015] [Indexed: 11/23/2022] Open
Abstract
Renal failure is a common morbidity in multiple myeloma (MM). Although proteinuria has been increasingly reported in malignancies, it is not routinely used to refine risk estimates of survival outcomes in patients with MM. Here we aimed to investigate initial serum albumin and 24-hour daily protein excretion (24-h DPE) before treatment as prognostic factors in patients with MM. We conducted a retrospective analysis of 102 patients with myeloma who were ineligible for haematopoietic stem cell transplantation between October 2000 and December 2012. Initial proteinuria was assessed before treatment by quantitative analysis of 24-hour urine samples. The demographic and laboratory characteristics, survival outcome, and significance of pre-treatment 24-h DPE and albumin in the new staging system of MM were analyzed. Pre-treatment proteinuria (>300 mg/day) was present in 66 patients (64.7%). The optimal cut-off value of 24-h DPE before treatment was 500 mg/day. Analysis of the time-dependent area under the curve showed that the serum albumin and 24-h DPE before treatment were better than 24-h creatinine clearance rate and β2-microglobulin. A subgroup analysis showed that an initial excess proteinuria (24-h DPE ≥ 500 mg) was associated with poor survival status (17.51 vs. 34.24 months, p = 0.002). Furthermore, initial serum albumin was an independent risk factor on multivariate analysis (<2.8 vs. ≥ 2.8, hazard ratio = 0.486, p = 0.029). Using the A-DPE staging system, there was a significant survival difference among patients with stage I, II, and III MM (p < 0.001). Initial serum albumin and 24-h DPE before treatment showed significant prognostic factors in patients with MM, and the new A-DPE staging system may be utilized instead of the International Staging System. Its efficacy should be evaluated by further large prospective studies.
Collapse
Affiliation(s)
- Jia-Hong Chen
- Division of Hematology-Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shun-Neng Hsu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tzu-Chuan Huang
- Division of Hematology-Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Ying Wu
- Division of Hematology-Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin Lin
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ping-Ying Chang
- Division of Hematology-Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yeu-Chin Chen
- Division of Hematology-Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Liang Ho
- Division of Hematology-Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|