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Gao F, Lin MS, You JS, Zhang MY, Cheng L, Lin K, Zhao P, Chen QY. Long-term outcomes of busulfan plus melphalan-based versus melphalan 200 mg/m 2 conditioning regimens for autologous hematopoietic stem cell transplantation in patients with multiple myeloma: a systematic review and meta-analysis. Cancer Cell Int 2021; 21:601. [PMID: 34758834 PMCID: PMC8579671 DOI: 10.1186/s12935-021-02313-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/01/2021] [Indexed: 12/16/2022] Open
Abstract
Background High-dose melphalan (HDMEL, 200 mg/m2) is considered as the standard conditioning regimen for autologous hematopoietic stem cell transplantation (auto-HSCT) in multiple myeloma (MM). However, whether the combination of melphalan with busulfan (BUMEL) conditioning outperforms HDMEL remains controversy. Accordingly, a systematic review and meta-analysis was carried out to compare the outcomes of HDMEL and BUMEL-based conditioning regimens in newly diagnosed MM patients having undergone auto-HSCT. Methods A systematic literature search was conducted in PubMed, Embase and Cochrane Library database until July 31, 2021, to identify all eligible studies comparing progression-free survival (PFS), overall survival (OS), optimal treatment response after auto-HSCT, duration of stem cell engraftment and incidence of toxic events between patients undergoing BUMEL-based and HDMEL conditioning regimens. Hazard ratio (HR), mean difference (MD) or odds ratio (OR) corresponding to 95% confidence interval (CI) were determined to estimate outcomes applying RevMan 5.4 software. Publication biases were assessed by performing Egger’s test and Begg’s test by Stata 15 software. Results Ten studies with a total of 2855 MM patients were covered in the current meta-analysis. The results of this study demonstrated that patients having received BUMEL-based regimen was correlated with longer PFS (HR 0.77; 95% CI 0.67~0.89, P = 0.0002) but similar OS (HR 1.08; 95% CI 0.92~1.26, P = 0.35) compared with those having received HDMEL. The differences of best treatment response after auto-HSCT and duration of neutrophil or platelet engraftment did not have statistical significance between the two groups of patients. With respect to adverse effects, the patients in BUMEL-based group were less frequently subject to gastrointestinal toxicity while the patients in HDMEL group less often experienced mucositis and infection. No significant difference was observed in hepatic toxicity between the two groups of patients. Conclusions In the present study, BUMEL-based conditioning was identified as a favorable regimen for a better PFS and equivalent OS as compared with HDMEL, which should be balanced against higher incidences of mucositis and infection. BUMEL-based conditioning is likely to act as an alternative strategy to more effectively improve auto-HSCT outcomes in MM. Supplementary Information The online version contains supplementary material available at 10.1186/s12935-021-02313-z.
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Affiliation(s)
- Fei Gao
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu, 611130, China
| | - Mei-Si Lin
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu, 611130, China.,Sichuan Provincial Acupuncture School, Chengdu, 611731, China
| | - Jie-Shu You
- College of Pharmacy, Shenzhen Technology University, Shenzhen, 518118, Guangdong Province, China.
| | - Min-Yue Zhang
- Division of Hematology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China.
| | - Long Cheng
- Department of Cardiology, Gongli Hospital, Shanghai, 200135, China
| | - Ke Lin
- School of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu, 611130, China
| | - Peng Zhao
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu, 611130, China
| | - Qi-Yan Chen
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu, 611130, China
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2
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Ria R, Melaccio A, Racanelli V, Vacca A. Anti-VEGF Drugs in the Treatment of Multiple Myeloma Patients. J Clin Med 2020; 9:E1765. [PMID: 32517267 PMCID: PMC7355441 DOI: 10.3390/jcm9061765] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 02/07/2023] Open
Abstract
The interaction between the bone marrow microenvironment and plasma cells plays an essential role in multiple myeloma progression and drug resistance. The vascular endothelial growth factor (VEGF)/VEGF receptor (VEGFR) pathway in vascular endothelial cells activates and promotes angiogenesis. Moreover, VEGF activates and promotes vasculogenesis and vasculogenic mimicry when it interacts with VEGF receptors expressed in precursor cells and inflammatory cells, respectively. In myeloma bone marrow, VEGF and VEGF receptor expression are upregulated and hyperactive in the stromal and tumor cells. It has been demonstrated that several antiangiogenic agents can effectively target VEGF-related pathways in the preclinical phase. However, they are not successful in treating multiple myeloma, probably due to the vicarious action of other cytokines and signaling pathways. Thus, the simultaneous blocking of multiple cytokine pathways, including the VEGF/VEGFR pathway, may represent a valid strategy to treat multiple myeloma. This review aims to summarize recent advances in understanding the role of the VEGF/VEGFR pathway in multiple myeloma, and mainly focuses on the transcription pathway and on strategies that target this pathway.
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Affiliation(s)
- Roberto Ria
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari “Aldo Moro” Medical School, 70124 Bari, Italy; (A.M.); (V.R.); (A.V.)
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3
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Hu B, Thall P, Milton DR, Sasaki K, Bashir Q, Shah N, Patel K, Popat U, Hosing C, Nieto Y, Lin P, Delgado R, Jorgensen J, Manasanch E, Weber D, Thomas S, Orlowski RZ, Champlin R, Qazilbash MH. High-risk myeloma and minimal residual disease postautologous-HSCT predict worse outcomes. Leuk Lymphoma 2019; 60:442-452. [PMID: 30032678 DOI: 10.1080/10428194.2018.1485908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of our study was to determine the impact of high-risk disease (HRD) and MRD on outcomes in myeloma patients receiving bortezomib-based induction followed by autologous hematopoietic stem cell transplant (auto-HSCT). HRD included t(4:14), t(14;16), del 17p, del 1p and/or amplification 1q by cytogenetics/FISH; all others were standard-risk disease (SRD). A subset of 165 newly diagnosed myeloma patients in a 2:1 ratio of HRD:SRD was generated using propensity score based nearest neighbor matching. Multiparametric flow cytometry (MFC) was used to detect MRD after auto-HSCT in select patients. MRD+ status at 3 months post auto-HSCT (hazard ratio (HR = 4.23, p = .028) and HRD (HR = 1.72, p = .026) were associated with a shorter PFS. Similarly, MRD+ 3 months post auto-HSCT (HR = 6.93, p = .08) and HRD (HR = 3.54, p < .001) and were associated with a shorter OS. Despite bortezomib-based induction, upfront auto-HSCT, and use of maintenance therapy, PFS and OS remained worse in MRD+ and HRD patients.
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Affiliation(s)
- Bei Hu
- a Cancer Medicine , University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Peter Thall
- b Biostatistics , UT MD Anderson Cancer Center , Houston , TX, USA
| | - Denái R Milton
- b Biostatistics , UT MD Anderson Cancer Center , Houston , TX, USA
| | - Koji Sasaki
- c Department of Leukemia , The University of Texas, MD Anderson Cancer Center , 1515 Holcombe Blvd. Unit. 428 , Houston, TX, USA
| | - Qaiser Bashir
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Nina Shah
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Krina Patel
- f Lymphoma and Myeloma , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Uday Popat
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Chitra Hosing
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Yago Nieto
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Pei Lin
- e Hematopathology , University of Texas MD Anderson Cancer Center , Houston , TX, USA
| | - Ruby Delgado
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Jeffrey Jorgensen
- e Hematopathology , University of Texas MD Anderson Cancer Center , Houston , TX, USA
| | - Elisabet Manasanch
- f Lymphoma and Myeloma , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Donna Weber
- f Lymphoma and Myeloma , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Sheeba Thomas
- f Lymphoma and Myeloma , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Robert Z Orlowski
- f Lymphoma and Myeloma , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Richard Champlin
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
| | - Muzaffar H Qazilbash
- d Department of Stem Cell Transplantation , UT MD Anderson Cancer Center , Houston, TX, USA
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4
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Spencer A, Lentzsch S, Weisel K, Avet-Loiseau H, Mark TM, Spicka I, Masszi T, Lauri B, Levin MD, Bosi A, Hungria V, Cavo M, Lee JJ, Nooka AK, Quach H, Lee C, Barreto W, Corradini P, Min CK, Scott EC, Chanan-Khan AA, Horvath N, Capra M, Beksac M, Ovilla R, Jo JC, Shin HJ, Sonneveld P, Soong D, Casneuf T, Chiu C, Amin H, Qi M, Thiyagarajah P, Sasser AK, Schecter JM, Mateos MV. Daratumumab plus bortezomib and dexamethasone versus bortezomib and dexamethasone in relapsed or refractory multiple myeloma: updated analysis of CASTOR. Haematologica 2018; 103:2079-2087. [PMID: 30237264 PMCID: PMC6269293 DOI: 10.3324/haematol.2018.194118] [Citation(s) in RCA: 208] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/17/2018] [Indexed: 11/11/2022] Open
Abstract
Daratumumab, a CD38 human monoclonal antibody, demonstrated significant clinical activity in combination with bortezomib and dexamethasone versus bortezomib and dexamethasone alone in the primary analysis of CASTOR, a phase 3 study in relapsed and/or refractory multiple myeloma. A post hoc analysis based on treatment history and longer follow up is presented. After 19.4 (range: 0–27.7) months of median follow up, daratumumab plus bortezomib and dexamethasone prolonged progression-free survival (median: 16.7 versus 7.1 months; hazard ratio, 0.31; 95% confidence interval, 0.24-0.39; P<0.0001) and improved the overall response rate (83.8% versus 63.2%; P<0.0001) compared with bortezomib and dexamethasone alone. The progression-free survival benefit of daratumumab plus bortezomib and dexamethasone was most apparent in patients with 1 prior line of therapy (median: not reached versus 7.9 months; hazard ratio, 0.19; 95% confidence interval, 0.12-0.29; P<0.0001). Daratumumab plus bortezomib and dexamethasone was also superior to bortezomib and dexamethasone alone in subgroups based on prior treatment exposure (bortezomib, thalidomide, or lenalidomide), lenalidomide-refractory status, time since last therapy (≤12, >12, ≤6, or >6 months), or cytogenetic risk. Minimal residual disease–negative rates were >2.5-fold higher with daratumumab across subgroups. The safety profile of daratumumab plus bortezomib and dexamethasone remained consistent with longer follow up. Daratumumab plus bortezomib and dexamethasone demonstrated significant clinical activity across clinically relevant subgroups and provided the greatest benefit to patients treated at first relapse. Trial registration: clinicaltrials.gov identifier: 02136134.
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Affiliation(s)
- Andrew Spencer
- Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, Australia
| | - Suzanne Lentzsch
- Division of Hematology/Oncology, Columbia University, New York, NY, USA
| | - Katja Weisel
- Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tübingen, Germany
| | | | - Tomer M Mark
- Department of Medicine, University of Colorado, Aurora, CO, USA
| | - Ivan Spicka
- Clinical Department of Haematology, 1 Medical Department, Charles University in Prague, Czech Republic
| | - Tamas Masszi
- Department of Haematology and Stem Cell Transplantation, St László Hospital, 3 Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Birgitta Lauri
- Department of Hematology, Sunderbyn Hospital, Luleå, Sweden
| | - Mark-David Levin
- Albert Schweitzer Hospital Department of Internal Medicine, Dordrecht, the Netherlands
| | - Alberto Bosi
- Department of Hematology, Careggi Hospital and University of Florence, Italy
| | - Vania Hungria
- Irmandade Da Santa Casa De Misericordia De São Paulo, Brazil
| | - Michele Cavo
- "Seràgnoli" Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
| | - Ajay K Nooka
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Hang Quach
- St. Vincent's Hospital, University of Melbourne, Australia
| | - Cindy Lee
- Royal Adelaide Hospital, North Terrace, Australia
| | | | - Paolo Corradini
- Fondazione IRCCS Instituto Nazionale dei Tumori, University of Milan, Italy
| | | | - Emma C Scott
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Marcelo Capra
- Instituto do Cancer-Hospital Mae de Deus, Porto Alegre, Brazil
| | | | - Roberto Ovilla
- Hospital Angeles Lomas, Naucalpan de Juárez y alrededores, México
| | | | - Ho-Jin Shin
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | | | - David Soong
- Janssen Research & Development, LLC, Spring House, PA, USA
| | | | | | - Himal Amin
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Ming Qi
- Janssen Research & Development, LLC, Spring House, PA, USA
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5
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How I treat the young patient with multiple myeloma. Blood 2018; 132:1114-1124. [PMID: 29967130 DOI: 10.1182/blood-2017-05-693606] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/01/2018] [Indexed: 02/06/2023] Open
Abstract
The treatment landscape for multiple myeloma has been transformed by the introduction of novel agents, including immunomodulatory drugs, proteasome inhibitors, and monoclonal antibodies. These have been shown to be more effective and generally better tolerated than conventional chemotherapy, with their introduction into clinical practice leading to improved survival. Furthermore, a better understanding of disease biology, improved diagnostic criteria, and the development of sensitive and specific tools for disease prognostication have contributed to better outcome. Treatment in the younger patient can now be individualized based on host and disease features with enhanced monitoring of response and use of high-sensitivity techniques for evaluating residual disease. The current standard of care has been significantly enhanced by novel agents with a paradigm shift toward optional or delayed autologous stem cell transplant as a reasonable choice in selected patients. Conversely, extended treatment with induction of remission followed by maintenance strategies is now a standard of care, conferring prolonged disease control with more manageable toxicities in both the short and long term, as well as improved quality of life.
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6
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Holstein SA, McCarthy PL. Immunomodulatory Drugs in Multiple Myeloma: Mechanisms of Action and Clinical Experience. Drugs 2017; 77:505-520. [PMID: 28205024 PMCID: PMC5705939 DOI: 10.1007/s40265-017-0689-1] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Over the last two decades, the outcomes for patients with multiple myeloma, a plasma cell malignancy, have dramatically improved. The development of the immunomodulatory drugs (IMiDs), which include thalidomide, lenalidomide, and pomalidomide, has contributed significantly to these improved outcomes. While thalidomide is now less commonly prescribed, lenalidomide is widely used in the treatment of newly diagnosed transplant-eligible and transplant-ineligible patients, in the maintenance setting post-transplant and in the relapsed/refractory setting, while pomalidomide is currently utilized in the relapsed/refractory setting. The IMiDs have been reported to have a multitude of activities, including anti-angiogenic, cytotoxic, and immunomodulatory. However, the more recent discoveries that the IMiDs bind to cereblon and thus regulate the ubiquitination of key transcription factors including IKZF1 and IKZF3 have provided greater insight into their mechanism of action. Here, the clinical efficacy of these agents in myeloma is reviewed and the structure-function relationship, the molecular mechanisms of action, and the association of IMiDs with second primary malignancies and thrombosis are discussed.
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Affiliation(s)
- Sarah A Holstein
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Philip L McCarthy
- Department of Medicine, Blood and Marrow Transplant Center, Roswell Park Cancer Institute, Buffalo, NY, USA.
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7
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McCarthy PL, Holstein SA. Role of stem cell transplant and maintenance therapy in plasma cell disorders. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:504-511. [PMID: 27913522 PMCID: PMC6142442 DOI: 10.1182/asheducation-2016.1.504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Autologous stem cell transplant (ASCT) has been an important component of therapy for myeloma patients eligible for high-dose chemotherapy. Recent studies comparing early transplant to low-dose chemotherapy support the continued use of ASCT as consolidation following induction therapy, even in the era of immunomodulatory drugs, proteasome inhibitors, and other novel agents. Despite the marked improvements in outcomes with this approach, most patients will eventually experience disease progression. Thus, inclusion of post-ASCT consolidation/maintenance strategies is used to improve long-term disease control. Multiple randomized studies support the use of lenalidomide maintenance therapy following ASCT. The next generation of clinical trials will incorporate novel agents such as monoclonal antibodies, proteasome inhibitors, and other novel pathway modulatory agents into post-ASCT treatment strategies with the goal of achieving even deeper responses and longer durations of disease control.
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Affiliation(s)
- Philip L. McCarthy
- Department of Medicine, Blood and Marrow Transplant Program, Roswell Park Cancer Institute, Buffalo, NY; and
| | - Sarah A. Holstein
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE
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8
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Abstract
AbstractAutologous stem cell transplant (ASCT) has been an important component of therapy for myeloma patients eligible for high-dose chemotherapy. Recent studies comparing early transplant to low-dose chemotherapy support the continued use of ASCT as consolidation following induction therapy, even in the era of immunomodulatory drugs, proteasome inhibitors, and other novel agents. Despite the marked improvements in outcomes with this approach, most patients will eventually experience disease progression. Thus, inclusion of post-ASCT consolidation/maintenance strategies is used to improve long-term disease control. Multiple randomized studies support the use of lenalidomide maintenance therapy following ASCT. The next generation of clinical trials will incorporate novel agents such as monoclonal antibodies, proteasome inhibitors, and other novel pathway modulatory agents into post-ASCT treatment strategies with the goal of achieving even deeper responses and longer durations of disease control.
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9
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Wilk CM, Heinzler N, Boquoi A, Cadeddu RP, Strapatsas T, Dienst A, Majidi F, Deenen R, Bruns I, Schroeder T, Köhrer K, Haas R, Kobbe G, Fenk R. Lenalidomide consolidation treatment in patients with multiple myeloma suppresses myelopoieses but spares erythropoiesis. Int J Cancer 2016; 139:2343-52. [PMID: 27389073 DOI: 10.1002/ijc.30257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 06/07/2016] [Indexed: 12/15/2022]
Abstract
New drugs for the treatment of multiple myeloma (MM) comprise immunomodulatory substances such as lenalidomide and related compounds. While lenalidomide has found its way into first-line treatment as well as into relapse therapy, little is known about lenalidomide effects on normal hematopoietic stem and progenitor cells (HSPCs). In this study, we investigated whether HSPCs are influenced by lenalidomide on a phenotypic, functional and gene expression level. For that purpose, samples from patients with MM were obtained who underwent equivalent first-line treatment including induction therapy, cytotoxic stem cell mobilization and high-dose melphalan therapy followed by autologous blood stem cell transplantation and a subsequent uniform lenalidomide consolidation treatment within a prospective clinical trial. We found that after six months of lenalidomide therapy, the number of CD34(+) HSPCs decreased. Additionally, lenalidomide affects the numerical composition of hematopoietic cells in the bone marrow while it does not affect long-term HSPC proliferation in vitro. We found a significant amplification of fetal hemoglobin (HbF) expression on a transcriptional level and can confirm a stimulated erythropoiesis on a phenotypic level. These effects were accompanied by silencing of the TGF-β signaling pathway on the gene expression and protein level that is known to be amplified in active MM. However, these pleiotropic effects gave no evidence for mutagenic potential. In conclusion, lenalidomide does not exert long-term effects on proliferation of HSPCs but instead promotes erythropoiesis by shifting hemoglobin expression toward HbF and by silencing the TGF-β signaling pathway.
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Affiliation(s)
- Christian Matthias Wilk
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.,Hematology, University and University Hospital Zurich, Zurich, Switzerland
| | - Niklas Heinzler
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Amelie Boquoi
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Ron-Patrick Cadeddu
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Tobias Strapatsas
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.,Division of Emergency Care, Helios Klinikum Wuppertal, Wuppertal, Germany
| | - Ariane Dienst
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Fatemeh Majidi
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - René Deenen
- Biologisch-Medizinisches Forschungszentrum (BMFZ), Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Ingmar Bruns
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, New York
| | - Thomas Schroeder
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Karl Köhrer
- Biologisch-Medizinisches Forschungszentrum (BMFZ), Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Rainer Haas
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Roland Fenk
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
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10
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Weisel K, Doyen C, Dimopoulos M, Yee A, Lahuerta JJ, Martin A, Travers K, Druyts E, Toor K, Abildgaard N, Lu J, Van Droogenbroeck J, Geraldes C, Petrini M, Voillat L, Voog E, Facon T. A systematic literature review and network meta-analysis of treatments for patients with untreated multiple myeloma not eligible for stem cell transplantation. Leuk Lymphoma 2016; 58:153-161. [PMID: 27124703 DOI: 10.1080/10428194.2016.1177772] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In newly diagnosed multiple myeloma (MM), patients ineligible for front-line autologous stem cell transplantation (ASCT), melphalan and prednisone (MP) with thalidomide (MPT) or bortezomib (VMP) are standard first-line therapeutic options. Despite new treatment regimens incorporating bortezomib or lenalidomide, MM remains incurable. The FIRST study demonstrated significant improvement in progression-free survival (PFS) and overall survival (OS) for the combination of lenalidomide and low-dose dexamethasone (Rd) until progression vs. MPT in transplant-ineligible ndMM patients. However, to date no head-to-head randomized controlled trials (RCTs) have compared Rd or MPT versus VMP. We conducted a network meta-analysis using RCTs identified through a systematic literature review to evaluate the relative efficacy of Rd versus other regimens on survival endpoints in previously untreated MM patients ineligible for ASCT. In this analysis, Rd was associated with a significant PFS and survival advantage versus other first-line treatments (VMP, MPT, MP), challenging the role of alkylators in this setting.
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Affiliation(s)
- Katja Weisel
- a Division of Haematology/Oncology, University Hospital Tubingen, University of Tübingen , Tübingen , Germany
| | | | | | - Adrian Yee
- d BC Cancer Agency , British Columbia , Canada
| | | | | | | | | | | | | | - Jin Lu
- i Peking University Institute of Hematology, People's Hospital , Beijing , China
| | | | | | - Mario Petrini
- l Chiara Dip. Oncologia , A.O. Universitaria Ospedale S , Pisa , Italy
| | | | - Eric Voog
- n Centre Jean Bernard , Le Mans , France
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11
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Taverna JA, Yun S, Jonnadula J, Saleh A, Riaz IB, Abraham I, Yeager AM, Persky DO, McBride A, Haldar S, Anwer F. Role of Maintenance Therapy after High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation in Aggressive Lymphomas: A Systematic Review. Biol Blood Marrow Transplant 2016; 22:1182-1196. [PMID: 26899562 DOI: 10.1016/j.bbmt.2016.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/08/2016] [Indexed: 11/29/2022]
Abstract
Significant uncertainty exists in regard to the efficacy of maintenance therapy after high-dose chemotherapy (HDC) as well as autologous stem cell transplantation (ASCT) for the treatment of patients with aggressive lymphoma. A systematic review was performed to evaluate the effectiveness of post-ASCT maintenance therapy in patients with relapsed/refractory lymphoma. A comprehensive literature search yielded 4476 studies and a total of 42 studies (11 randomized controlled trials [RCT], 9 retrospective comparative studies, and 22 single-arm studies) were included in the systematic review. There was significant heterogeneity in study design, chemotherapeutic regimens, post-ASCT maintenance strategies, patient enrollment criteria, and study endpoints. Our findings suggest that post-ASCT maintenance immune-targeting strategies, including PD-1/PD-L1 blocking antibodies, rituximab, and brentuximab, may improve progression-free survival but not overall survival. Collectively, the results indicate a need for testing new strategies with well-designed and adequately powered RCTs to better address the role of post-ASCT maintenance in relapsed/refractory lymphomas.
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Affiliation(s)
- Josephine A Taverna
- Department of Medicine, University of Arizona, Tucson, Arizona; Department of Hematology and Oncology, Blood and Marrow Transplantation Program, University of Arizona, Tucson, Arizona; Department of Hematology and Oncology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Seongseok Yun
- Department of Medicine, University of Arizona, Tucson, Arizona
| | | | - Ahlam Saleh
- Arizona Health Sciences Library, University of Arizona, Tucson, Arizona
| | - Irbaz Bin Riaz
- Department of Medicine, University of Arizona, Tucson, Arizona
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, Arizona; Arizona Cancer Center, Tucson, Arizona
| | - Andrew M Yeager
- Department of Medicine, University of Arizona, Tucson, Arizona; Department of Hematology and Oncology, Blood and Marrow Transplantation Program, University of Arizona, Tucson, Arizona; Arizona Cancer Center, Tucson, Arizona
| | - Daniel O Persky
- Department of Medicine, University of Arizona, Tucson, Arizona; Department of Hematology and Oncology, Blood and Marrow Transplantation Program, University of Arizona, Tucson, Arizona; Arizona Cancer Center, Tucson, Arizona
| | - Ali McBride
- Department of Hematology and Oncology, Blood and Marrow Transplantation Program, University of Arizona, Tucson, Arizona; Arizona Cancer Center, Tucson, Arizona
| | - Subrata Haldar
- Department of Hematology and Oncology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Faiz Anwer
- Department of Medicine, University of Arizona, Tucson, Arizona; Department of Hematology and Oncology, Blood and Marrow Transplantation Program, University of Arizona, Tucson, Arizona; Arizona Cancer Center, Tucson, Arizona.
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12
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Wang Y, Yang F, Shen Y, Zhang W, Wang J, Chang VT, Andersson BS, Qazilbash MH, Champlin RE, Berenson JR, Guan X, Wang ML. Maintenance Therapy With Immunomodulatory Drugs in Multiple Myeloma: A Meta-Analysis and Systematic Review. J Natl Cancer Inst 2015; 108:djv342. [PMID: 26582244 DOI: 10.1093/jnci/djv342] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/15/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Immunomodulatory drugs (IMiDs) and proteasome inhibitors have dramatically changed management of multiple myeloma (MM). While MM remains incurable, consolidation and maintenance therapy aimed at improving duration of response can potentially improve survival outcomes. A majority of randomized controlled trials (RCTs) have demonstrated benefit of IMiD-based maintenance therapy in delaying disease progression; however, whether this therapy can lead to improved survival remains controversial. METHODS PubMed and abstract databases of major hematology and/or oncology meetings were searched for RCTs that studied maintenance therapy with IMiDs in MM. A meta-analysis was conducted to systematically evaluate the impact of IMiD-based maintenance therapy on survival outcomes and serious adverse events associated with the therapy. All statistical tests were two-sided. RESULTS Eighteen phase 3 RCTs enrolling 7730 patients were included. IMiD-based maintenance therapy statistically significantly prolonged progression-free survival (PFS; hazard ratio (HR) = 0.62, 95% confidence interval (CI) = 0.57 to 0.67, P < .001) but failed to improve overall survival (OS; HR = 0.93, 95% CI = 0.85 to 1.01, P = .082). Stratified analyses demonstrated that both thalidomide and lenalidomide provided PFS but not OS benefit in transplantation as well as nontransplantation settings. IMiD-based maintenance therapy in MM led to a higher risk of grade 3-4 thromboembolism (risk ratio = 2.52, 95% CI = 1.41 to 4.52, P = .002). Thalidomide maintenance therapy increased the risk of peripheral neuropathy; lenalidomide maintenance therapy increased the risks of myelosuppression and second primary hematological malignancies. CONCLUSIONS Thalidomide- or lenalidomide-based maintenance therapy improves PFS but not OS in MM and increases risks of grade 3-4 adverse events, including thromboembolism, peripheral neuropathy, neutropenia, and infection.
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Affiliation(s)
- Yucai Wang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Fang Yang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Yan Shen
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Wenwen Zhang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Jacqueline Wang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Victor T Chang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Borje S Andersson
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Muzaffar H Qazilbash
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Richard E Champlin
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - James R Berenson
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB)
| | - Xiaoxiang Guan
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB).
| | - Michael L Wang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ (YW, VTC); Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China (FY, YS, WZ, XG); Department of Medicine, University of Chicago, Chicago, IL (JW); Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ (VTC); Department of Stem Cell Transplantation and Cellular Therapy (BSA, MHQ, REC) and Department of Lymphoma/Myeloma (MLW), The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Myeloma & Bone Cancer Research, West Hollywood, CA (JRB).
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Iriuchishima H, Ozaki S, Konishi J, Matsumoto M, Murayama K, Nakamura F, Yamamoto G, Handa H, Saitoh T, Nagura E, Shimizu K, Nojima Y, Murakami H. Primary Plasma Cell Leukemia in the Era of Novel Agents: A Multicenter Study of the Japanese Society of Myeloma. Acta Haematol 2015; 135:113-21. [PMID: 26505781 DOI: 10.1159/000439424] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/16/2015] [Indexed: 11/19/2022]
Abstract
We investigated the treatment and outcome of Japanese patients with primary plasma cell leukemia (pPCL) in the era of novel agents and analyzed the risk factors affecting survival. Among 3,318 patients with symptomatic multiple myeloma (MM), 38 patients were diagnosed with pPCL. The median overall survival (OS) of the pPCL patients was 2.85 years, which was significantly extended compared with that in previous reports. The proportion of patients treated with novel agents was 61%. The OS of the patients treated with novel agents was significantly extended compared with that of patients treated without novel agents according to the generalized Wilcoxon test (2.85 vs. 1.16 years, p = 0.049). This statistical finding suggests that treatment with novel agents could have prevented early death in the patients with pPCL. Age was the only statistically significant prognostic factor associated with an inferior OS (hazard ratio 4.57). Five patients received maintenance therapy with novel agents, and their OS tended to be longer than that of the other patients without maintenance (4.45 vs. 2.85 years). Unlike MM, OS for pPCL has not been improved significantly over the last decade, especially in elderly patients. Therefore, it is important to establish the treatment strategy, particularly after induction treatment.
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Affiliation(s)
- Hirono Iriuchishima
- Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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