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Luo Q, Jenkin D, Weber MF, Steinberg J, White K, Irving A, Rillstone H, Kelly A, Canfell K, Feletto E. Multiple myeloma incidence, mortality, and prevalence estimates and projections, Australia, 1982-2043: a statistical modelling study. Med J Aust 2024; 221:103-110. [PMID: 39003689 DOI: 10.5694/mja2.52366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/20/2023] [Indexed: 07/15/2024]
Abstract
OBJECTIVES To examine changes in multiple myeloma incidence and mortality rates during 1982-2018, and to estimate its incidence, mortality, and prevalence for 2019-2043. STUDY DESIGN Population-based statistical modelling study; analysis of and projections based on Australian Institute of Health and Welfare multiple myeloma incidence, mortality, and survival data. SETTING Australia, 1982-2018 (historical data) and projections to 2043. MAIN OUTCOME MEASURES Changes in multiple myeloma incidence and mortality rates, 1982-2018, determined by joinpoint regression analysis (age-standardised to 2021 Australian population); projection of rates to 2043 based on age-period-cohort models; estimated 5- and 30-year prevalence of multiple myeloma (modified counting method). RESULTS The incidence of multiple myeloma increased during 1982-2018 (eg, annual percentage change [APC], 2006-2018, 1.9%; 95% confidence interval [CI], 1.7-2.2%), but the mortality rate declined during 1990-2018 (APC, -0.4%; 95% CI, -0.5% to -0.2%). The age-standardised incidence rate was projected to increase by 14.9% during 2018-2043, from 8.7 in 2018 to 10.0 (95% CI, 9.4-10.7) new cases per 100 000 population in 2043; the mortality rate was projected to decline by 27.5%, from 4.0 to 2.9 (95% CI, 2.6-3.3) deaths per 100 000 population. The annual number of people newly diagnosed with multiple myeloma was estimated to increase by 89.2%, from 2120 in 2018 to 4012 in 2043; the number of deaths from multiple myeloma was projected to increase by 31.7%, from 979 to 1289. The number of people living with multiple myeloma up to 30 years after initial diagnosis was projected to increase by 163%, from 10 288 in 2018 to 27 093 in 2043, including 13 019 people (48.1%) diagnosed during the preceding five years. CONCLUSION Although the decline in the mortality rate was projected to continue, the projected increases in the incidence and prevalence of multiple myeloma in Australia over the next 25 years indicate that investment in prevention and early detection research, and planning for prolonged treatment and care, are needed.
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Affiliation(s)
- Qingwei Luo
- The Daffodil Centre, the University of Sydney, Sydney, NSW
| | - Deanne Jenkin
- The Daffodil Centre, the University of Sydney, Sydney, NSW
| | | | | | - Kate White
- The Daffodil Centre, the University of Sydney, Sydney, NSW
- Susan Wakil School of Nursing, the University of Sydney, Sydney, NSW
| | - Adam Irving
- Centre for Health Economics, Monash University, Melbourne, VIC
| | | | - Anna Kelly
- The Daffodil Centre, the University of Sydney, Sydney, NSW
| | - Karen Canfell
- The Daffodil Centre, the University of Sydney, Sydney, NSW
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2
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Ho PJ, Moore E, Wellard C, Quach H, Blacklock H, Harrrison SJ, MacDonald EJ, McQuilten ZK, Wood EM, Mollee P, Spencer A. The impact of biomarkers of malignancy (IMWG SLiM criteria) in myeloma in a real-world population: Clinical characteristics, therapy and outcomes from the Australian and New Zealand Myeloma and Related Diseases Registry (ANZ MRDR). Br J Haematol 2024. [PMID: 38965706 DOI: 10.1111/bjh.19624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
A decade after International Myeloma Working Group (IMWG) biomarkers (SLiM criteria) were introduced, this real-world study examined their impact on diagnosis, therapy and outcomes in myeloma. Using the ANZ MRDR, 3489 newly diagnosed patients from 2013 to 2023, comprising 3232 diagnosed by CRAB ('CRAB patients', including 1758 who also satisfied ≥1 SLiM criteria) and 257 by SLiM ('SLiM patients') criteria were analysed. CRAB patients had higher R-ISS and lower performance status, with no difference in cytogenetic risk. SLiM patients had improved progression-free survival (PFS, 37.5 vs. 32.2 months, hazard ratio [HR] 1.31 [1.08-1.59], p = 0.003), overall survival (80.9 vs. 73.2 months, HR 1.64 [1.26-2.13], p < 0.001) and PFS2 (54.6 vs. 40.3 months, HR 1.51 [1.22-1.86], p < 0.001) compared with CRAB patients, partially explained by earlier diagnosis, with no differential impact between the plasma cell and light-chain criteria on PFS. However, 34% of CRAB patients did not manifest SLiM characteristics, raising the possibility that SLiM features are associated with different biological behaviours contributing to a better prognosis, for example, improved PFS2 in SLiM patients suggested less disease resistance at first relapse. These data support earlier initiation of therapy by SLiM. The superior survival outcomes of SLiM versus CRAB patients highlight the importance of defining these subgroups when interpreting therapeutic outcomes at induction and first relapse.
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Affiliation(s)
- P Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Elizabeth Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hang Quach
- St. Vincent's Hospital, Melbourne and University of Melbourne, Melbourne, Australia
| | | | - Simon J Harrrison
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | | | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Mollee
- Princess Alexandra Hospital and University of Queensland, Brisbane, Australia
| | - Andrew Spencer
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, Australia
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3
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Bevel N, Thorpe M, Vanniasinkam T. Is drug interference still an issue for pretransfusion testing of patients on anti CD38 and other monoclonal antibody therapies? Vox Sang 2024. [PMID: 38705581 DOI: 10.1111/vox.13649] [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: 01/02/2024] [Revised: 03/03/2024] [Accepted: 03/28/2024] [Indexed: 05/07/2024]
Abstract
Certain therapies that target CD markers on some blood cells can affect pretransfusion testing. Key examples are anti-CD38, CD47 monoclonal antibody (mAb) therapies such as daratumumab (DARA) and magrolimab, which have presented a challenge for transfusion medicine laboratories around the globe. Scientists have been faced with not only introducing a protocol to provide safe blood to patients but also investigating the most effective method to remove the pretransfusion pan-agglutinating interference caused. A number of papers in the last 5 years have reported on various methods to remove pretransfusion interference; however, most of these studies have been conducted only in a few countries. Most recent reviews on this topic have focused on techniques and reagents to remove pretransfusion interference, and dithiothreitol is currently the gold standard for removing DARA interference. However, it was clear from this review that while many laboratories have developed processes for addressing interference in pretransfusion testing, and DARA interference may not be a major issue, there are still laboratories around the world, that may not have adequately addressed this issue. In addition, the impact of mAb interference on widely used techniques such as flow cytometry is unclear.
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Affiliation(s)
- Nichole Bevel
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
- Transfusion Medicine Laboratory, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Meagan Thorpe
- Transfusion Medicine Laboratory, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Thiru Vanniasinkam
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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4
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Zeissig MN, Hewett DR, Mrozik KM, Panagopoulos V, Wallington-Gates CT, Spencer A, Dold SM, Engelhardt M, Vandyke K, Zannettino ACW. Expression of the chemokine receptor CCR1 decreases sensitivity to bortezomib in multiple myeloma cell lines. Leuk Res 2024; 139:107469. [PMID: 38479337 DOI: 10.1016/j.leukres.2024.107469] [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] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The proteasome inhibitor bortezomib is one of the primary therapies used for the haematological malignancy multiple myeloma (MM). However, intrinsic or acquired resistance to bortezomib, via mechanisms that are not fully elucidated, is a barrier to successful treatment in many patients. Our previous studies have shown that elevated expression of the chemokine receptor CCR1 in MM plasma cells in newly diagnosed MM patients is associated with poor prognosis. Here, we hypothesised that the poor prognosis conferred by CCR1 expression is, in part, due to a CCR1-mediated decrease in MM plasma cell sensitivity to bortezomib. METHODS In order to investigate the role of CCR1 in MM cells, CCR1 was knocked out in human myeloma cell lines OPM2 and U266 using CRISPR-Cas9. Additionally, CCR1 was overexpressed in the mouse MM cell line 5TGM1. The effect of bortezomib on CCR1 knockout or CCR1-overexpressing cells was then assessed by WST-1 assay, with or without CCL3 siRNA knockdown or addition of recombinant human CCL3. NSG mice were inoculated intratibially with OPM2-CCR1KO cells and were treated with 0.7 mg/kg bortezomib or vehicle twice per week for 3 weeks and GFP+ tumour cells in the bone marrow were quantitated by flow cytometry. The effect of CCR1 overexpression or knockout on unfolded protein response pathways was assessed using qPCR for ATF4, HSPA5, XBP1, ERN1 and CHOP and Western blot for IRE1α and p-Jnk. RESULTS Using CCR1 overexpression or CRIPSR-Cas9-mediated CCR1 knockout in MM cell lines, we found that CCR1 expression significantly decreases sensitivity to bortezomib in vitro, independent of the CCR1 ligand CCL3. In addition, CCR1 knockout rendered the human MM cell line OPM2 more sensitive to bortezomib in an intratibial MM model in NSG mice in vivo. Moreover, CCR1 expression negatively regulated the expression of the unfolded protein response receptor IRE1 and downstream target gene XBP1, suggesting this pathway may be responsible for the decreased bortezomib sensitivity of CCR1-expressing cells. CONCLUSIONS Taken together, these studies suggest that CCR1 expression may be associated with decreased response to bortezomib in MM cell lines.
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Affiliation(s)
- Mara N Zeissig
- Myeloma Research Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Duncan R Hewett
- Myeloma Research Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Krzysztof M Mrozik
- Myeloma Research Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Vasilios Panagopoulos
- Myeloma Research Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Craig T Wallington-Gates
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Andrew Spencer
- Department of Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - Sandra M Dold
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Monika Engelhardt
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kate Vandyke
- Myeloma Research Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - Andrew C W Zannettino
- Myeloma Research Laboratory, School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia; Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia; Central Adelaide Local Health Network, Adelaide, Australia
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5
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Lim KJC, Wellard C, Talaulikar D, Tan JLC, Loh J, Puvanakumar P, Kuzich JA, Ho M, Murphy M, Zeglinas N, Low MSY, Routledge D, Lim ABM, Gibbs SD, Quach H, Morgan S, Moore E, Ninkovic S. The prognostic impact of t(11;14) in multiple myeloma: A real-world analysis from the Australian Lymphoma Leukaemia Group (ALLG) and the Australian Myeloma and Related Diseases Registry (MRDR). EJHAEM 2023; 4:639-646. [PMID: 37601874 PMCID: PMC10435683 DOI: 10.1002/jha2.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 08/22/2023]
Abstract
The prognostic impact of t(11;14) in multiple myeloma (MM) needs to be better understood to inform future treatment decisions. The Australian Lymphoma Leukaemia Group embarked on a retrospective, observational cohort study using real-world data to interrogate treatment patterns and outcomes in 74 MM patients with t(11;14) [t(11;14)-MM] diagnosed over 10 years. This was compared to 159 and 111 MM patients with high-risk IgH translocations (IgH HR-MM) and hyperdiploidy (Hyperdiploid-MM), respectively, from the Australian Myeloma and Related Diseases Registry. No appreciable differences in age, gender, ISS, LDH levels, 1q21 or del(17p) status, or treatment patterns were observed between groups. Median PFS-1 was not different between groups but both t(11;14)-MM and IgH HR-MM had an inferior PFS-2 vs. Hyperdiploid-MM: median PFS-2 8.2 months, 10.0 months, and 19.8 months (p = 0.002), respectively. The 3-year OS were 69%, 71%, and 82% (p = 0.026), respectively. In the t(11;14)-MM group, gain or amplification of 1q21 at diagnosis predicted for poorer OS (HR 3.46, p = 0.002). Eleven patients had received venetoclax with 45% achieving better than a very good partial response. Results suggest that t(11;14) MM may confer an unfavorable risk profile and that the use of targeted therapies such as venetoclax earlier in the treatment algorithm should be explored.
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Affiliation(s)
- Kenneth JC Lim
- Department of HaematologySt Vincent's Hospital MelbourneMelbourneAustralia
- Victorian Cancer Cytogenetics ServiceSt. Vincent's Hospital MelbourneMelbourneAustralia
| | - Cameron Wellard
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Dipti Talaulikar
- Department of HaematologyThe Canberra HospitalCanberraAustralia
- Department of MedicineThe Australian National UniversityCanberraAustralia
| | - Joanne LC Tan
- Department of HaematologyThe Alfred HospitalMelbourneAustralia
| | - Joanna Loh
- Department of HaematologyMonash HealthMelbourneAustralia
| | - Pratheepan Puvanakumar
- Clinical HaematologyPeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneAustralia
| | - James A Kuzich
- Department of HaematologyAustin Health and Olivia Newton John Cancer Research InstituteMelbourneAustralia
| | - Michelle Ho
- Department of HaematologyThe Canberra HospitalCanberraAustralia
| | - Matthew Murphy
- Department of HaematologyEastern HealthMelbourneAustralia
| | - Nicole Zeglinas
- Department of HaematologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - Michael SY Low
- Department of HaematologyMonash HealthMelbourneAustralia
| | - David Routledge
- Clinical HaematologyPeter MacCallum Cancer Centre and Royal Melbourne HospitalMelbourneAustralia
- Department of MedicineUniversity of MelbourneMelbourneAustralia
| | - Andrew BM Lim
- Department of HaematologyAustin Health and Olivia Newton John Cancer Research InstituteMelbourneAustralia
| | - Simon D Gibbs
- Department of HaematologyEastern HealthMelbourneAustralia
- Department of HaematologyMonash UniversityMelbourneAustralia
| | - Hang Quach
- Department of HaematologySt Vincent's Hospital MelbourneMelbourneAustralia
- Department of MedicineUniversity of MelbourneMelbourneAustralia
| | - Sue Morgan
- Department of HaematologyThe Alfred HospitalMelbourneAustralia
| | - Elizabeth Moore
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Slavisa Ninkovic
- Department of HaematologySt Vincent's Hospital MelbourneMelbourneAustralia
- Victorian Cancer Cytogenetics ServiceSt. Vincent's Hospital MelbourneMelbourneAustralia
- Department of MedicineUniversity of MelbourneMelbourneAustralia
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6
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Smith LE, Li VY, Chan S. Tetraplegic spinal cord injury as a presentation of multiple myeloma: A case report. Clin Case Rep 2023; 11:e7667. [PMID: 37469367 PMCID: PMC10352540 DOI: 10.1002/ccr3.7667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023] Open
Abstract
Spinal cord injury is a devastating complication of cancers that exert physical compression on the spinal cord. Multiple myeloma is known predominantly as a condition that involves bony structures and can manifest with complications such as pathological fractures. However, involvement of other structures including spinal cord is a possible complication, with potentially catastrophic consequences. We describe a case of multiple myeloma presenting initially as severe paraplegia secondary to spinal cord compression in a 79-year-old man.
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Affiliation(s)
- Leon Edward Smith
- Department of Rehabilitation and Aged CareHornsby and Ku‐ring‐gai HospitalHornsbyNew South WalesAustralia
| | - Vicky Ying Li
- Department of Rehabilitation and Aged CareHornsby and Ku‐ring‐gai HospitalHornsbyNew South WalesAustralia
| | - Simon Chan
- Department of Rehabilitation and Aged CareHornsby and Ku‐ring‐gai HospitalHornsbyNew South WalesAustralia
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7
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Mithraprabhu S, Reynolds J, Turner R, Quach H, Horvath N, Kerridge I, Kalff A, Bergin K, Hocking J, Yuen F, Khong T, Durie BM, Spencer A. Circulating tumour DNA analysis predicts relapse and improves risk stratification in primary refractory multiple myeloma. Blood Cancer J 2023; 13:25. [PMID: 36781844 PMCID: PMC9925790 DOI: 10.1038/s41408-023-00796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Affiliation(s)
- Sridurga Mithraprabhu
- Australian Centre for Blood Diseases, Alfred Health-Monash University, Melbourne, VIC, Australia. .,Department of Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, VIC, Australia.
| | - John Reynolds
- Australian Centre for Blood Diseases, Alfred Health-Monash University, Melbourne, VIC, Australia.,Department of Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, VIC, Australia
| | - Rose Turner
- Department of Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, VIC, Australia
| | - Hang Quach
- St.Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | | | - Ian Kerridge
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Anna Kalff
- Department of Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, VIC, Australia
| | - Krystal Bergin
- Australian Centre for Blood Diseases, Alfred Health-Monash University, Melbourne, VIC, Australia.,Department of Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, VIC, Australia
| | - Jay Hocking
- Department of Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, VIC, Australia
| | - Flora Yuen
- Department of Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, VIC, Australia
| | - Tiffany Khong
- Australian Centre for Blood Diseases, Alfred Health-Monash University, Melbourne, VIC, Australia.,Department of Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, VIC, Australia
| | - Brian M Durie
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Andrew Spencer
- Australian Centre for Blood Diseases, Alfred Health-Monash University, Melbourne, VIC, Australia. .,Department of Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, VIC, Australia.
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8
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Tan JLC, Wellard C, Moore EM, Mollee P, Rajagopal R, Quach H, Harrison SJ, McDonald EJ, Ho PJ, Prince HM, Augustson BM, Campbell P, McQuilten ZK, Wood EM, Spencer A. The second revision of the International Staging System (R2-ISS) stratifies progression-free and overall survival in multiple myeloma: Real world data results in an Australian and New Zealand Population. Br J Haematol 2023; 200:e17-e21. [PMID: 36321478 DOI: 10.1111/bjh.18536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Joanne L C Tan
- The Alfred Hospital, Monash University and Australian Centre for Blood Diseases, Melbourne, Victoria, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth M Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Mollee
- Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Hang Quach
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Simon James Harrison
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - P Joy Ho
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - H Miles Prince
- Epworth Healthcare and Sir Peter MacCallum Department of Oncology University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Spencer
- The Alfred Hospital, Monash University and Australian Centre for Blood Diseases, Melbourne, Victoria, Australia
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9
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Ibrahim A, Chamseddine N, El-cheikh J, Hanna C, Moukadem W, Nasr F, Younis A, Bazarbachi A. Management of Multiple Myeloma in the Middle East: Unmet Needs, Challenges and Perspective. Clin Hematol Int 2022; 4:127-132. [PMID: 36040650 PMCID: PMC9763519 DOI: 10.1007/s44228-022-00017-3] [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: 04/10/2022] [Accepted: 06/04/2022] [Indexed: 01/07/2023] Open
Abstract
Multiple myeloma (MM) is a prevalent hematological malignancy. Resource-constrained settings such as the Middle East are particularly burdened by the increasing trends in MM morbidity and mortality in addition to challenges in the management of MM. It thus becomes necessary to identify and address debatable areas of current practice and gaps in the management of MM in the Middle East. With a special focus on the Lebanese situation, the first-line treatment of the very elderly (> 80 years old) is discussed, in addition to the impact of relapse type (biochemical or clinical relapse) on maintenance therapy, the choice of first relapse therapy in relation to maintenance therapy, and the role of MRD in the MM treatment landscape. The need for realistic management guidelines accounting for local resources and expertise, in addition to the reflection of drug accessibility and cost on clinical practice are recognized.
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Affiliation(s)
- Ahmad Ibrahim
- Department of Hematology-Oncology, Makassed University Hospital, Beirut, Lebanon ,School of Medicine, National Lebanese University, Hadath, Lebanon ,Department of Hematology-Oncology, Middle East Institute of Health, Beirut, Lebanon
| | - Nabil Chamseddine
- Department of Hematology-Oncology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Jean El-cheikh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Colette Hanna
- Department of Hematology-Oncology, Clemenceau Medical Center, Beirut, Lebanon ,Department of Hematology-Oncology, Hôtel-Dieu de France Medical Center, Beirut, Lebanon ,Department of Hematology-Oncology, Mount Lebanon Hospital, Hazmieh, Lebanon
| | - Walid Moukadem
- Department of Hematology-Oncology, Haykel Hospital, Tripoli, Lebanon
| | - Fady Nasr
- Department of Hematology-Oncology, Hôtel-Dieu de France Medical Center, Beirut, Lebanon ,Department of Hematology-Oncology, Mount Lebanon Hospital, Hazmieh, Lebanon
| | - Ahmad Younis
- Department of Hematology-Oncology, Military Hospital, Beirut, Lebanon
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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10
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Moore EM, Blacklock H, Wellard C, Spearing R, Merriman L, Poplar S, George A, Baker B, Chan H, McQuilten ZK, Wood EM, Spencer A. Māori and Pacific Peoples With Multiple Myeloma in New Zealand are Younger and Have Inferior Survival Compared to Other Ethnicities: A Study From the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR). CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e762-e769. [PMID: 35501256 DOI: 10.1016/j.clml.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Māori and Pacific peoples (MPP) in New Zealand (NZ) have poorer health outcomes than other ethnicities. However, this has not been clinically investigated in multiple myeloma (MM). Using data from the Australian and NZ Myeloma and Related Diseases Registry for all participating centers in NZ, we compared MPP demographics, clinical characteristics, diagnostics, treatment, and outcomes to non-MPP. PATIENTS AND METHODS MPP were defined as having ≥1 grandparent of this heritage. We tested ethnicity as a predictor of overall survival (OS) with multivariable Cox regression. RESULTS Of 568 NZ patients with MM (September 2012 to April 2021) and ethnicity data, 138 were MPP. They were diagnosed younger than non-MPP (median age 63 [IQR: 57-72] vs. 70y [62-77], P < .001). Obesity (53 vs. 27%, P < .001), diabetes (24 vs. 8%, P < .001), renal insufficiency (28 vs. 17%, P = .005), pulmonary disease (10 vs. 5%, P = .02) and FISH abnormalities (54 vs. 42%, P = .04) were more common in MPP, and a lower proportion received first-line drug therapy (88 vs. 94%, P = .03) and autologous stem cell transplant (ASCT) (age <70y: 56 vs. 70%, P = .03). OS for MPP was shorter than non-MPP even after adjusting for age, comorbidities, disease stage, performance status, FISH abnormalities and treatment (HR 1.58 [1.04-2.39], P = .03). CONCLUSION MPP with MM in NZ were younger, a greater proportion had comorbidities and FISH abnormalities at diagnosis, fewer received first-line treatment and/or ASCT, and they had poorer OS than non-MPP. Investigation of modifiable factors to improve outcomes and discern why MM occurs at a younger age in MPP is needed.
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Affiliation(s)
- Elizabeth M Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | | | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Anup George
- Wellington Hospital, Wellington, New Zealand
| | - Bart Baker
- Palmerston North Hospital, Palmerston North, New Zealand
| | - Henry Chan
- North Shore Hospital, Auckland, New Zealand; University of Auckland, Auckland, New Zealand
| | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Spencer
- Alfred Hospital, Monash University, Melbourne, Australia
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Beer H, Routledge D, Joyce T, Furphy EJ, Combe N, Ritchie D, Khot A, Lim SM, Montalto M, Harrison SJ. The development of a home-based therapeutic platform for multiple myeloma. Expert Rev Hematol 2021; 14:1129-1135. [PMID: 34936527 DOI: 10.1080/17474086.2021.2022471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Multiple Myeloma (MM) accounts for 1-2% of all malignancies but is the second commonest haematological malignancy. It is characterized by a proliferation of malignant plasma cells. The treatment paradigm of MM in Australia is traditionally hospital-based, complex and costly. While MM comprises 1-2% of cancer diagnoses, it appears in the top ten cancer diagnoses requiring hospital admission. The cumulative time spent receiving treatment is a significant burden for patients. The ability to receive treatment at home and maximize time away from hospital-based settings is a key preference for patients receiving anticancer therapies over a prolonged period of time. METHODS The Peter MacCallum Cancer Centre and Royal Melbourne Hospital's combined Clinical Hematology Unit has collaborated with their Hospital in the Home departments to develop several innovative programs to address this. RESULTS We describe our current active programs and potential developments in home-based MM therapy. CONCLUSION We have enabled large numbers of patients to receive complex therapies in their own home and the COVID-19 pandemic has increased the pace of the roll out without any compromise in safety. We anticipate that the next raft of immunotherapies will be able to transition into the @Home treatment setting in the coming years.
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Affiliation(s)
- Hayley Beer
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - David Routledge
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Australia
| | - Trish Joyce
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Emma-Jane Furphy
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Nella Combe
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - David Ritchie
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Australia
| | - Amit Khot
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Australia
| | - Seok Ming Lim
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | | | - Simon J Harrison
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Australia
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Boyle S, Wellard C, Moore EM, Blacklock H, Harrison SJ, Ho PJ, Hocking J, McQuilten ZK, Quach H, Spearing R, Wood EM, Spencer A, Mollee P. Receiving four or fewer cycles of therapy predicts poor survival in newly diagnosed transplant-ineligible patients with myeloma who are treated with bortezomib-based induction. Eur J Haematol 2021; 107:497-499. [PMID: 34129711 DOI: 10.1111/ejh.13677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Stephen Boyle
- Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth M Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Simon J Harrison
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Phoebe Joy Ho
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jay Hocking
- Box Hill Hospital, Melbourne, VIC, Australia
| | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hang Quach
- University of Melbourne, St. Vincent's Hospital, Melbourne, VIC, Australia
| | | | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew Spencer
- The Alfred Hospital, Monash University and Australian Centre for Blood Diseases, Melbourne, VIC, Australia
| | - Peter Mollee
- Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
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