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Nadeem O, Ailawadhi S, Khouri J, Williams L, Catamero D, Maples K, Berdeja J. Management of Adverse Events Associated with Pomalidomide-Based Combinations in Patients with Relapsed/Refractory Multiple Myeloma. Cancers (Basel) 2024; 16:1023. [PMID: 38473381 DOI: 10.3390/cancers16051023] [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: 01/12/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Multi-agent regimens incorporating immunomodulatory (IMiD®) agents such as thalidomide, lenalidomide, and pomalidomide have become the preferred standard of care for the treatment of patients with multiple myeloma (MM), resulting in improved survival outcomes. Currently, there are three IMiD agents approved for the treatment of MM: thalidomide, lenalidomide, and pomalidomide. Lenalidomide is commonly used to treat patients with newly diagnosed MM and as maintenance therapy following stem cell transplant or after disease relapse. Pomalidomide, the focus of this review, is approved in patients with relapsed/refractory MM (RRMM). Despite survival benefits, IMiD agents each have different safety profiles requiring consideration both prior to starting therapy and during treatment. Adverse event (AE) management is essential, not only to ensure treatment adherence and thus ensure optimal efficacy but also to maintain patient quality of life. Here, we discuss AEs associated with pomalidomide and present five clinically relevant hypothetical case studies in patients with RRMM to provide scenario-driven guidance regarding treatment selection and AE prevention and management in the clinical setting. Lastly, as new treatment approaches continue to be explored in MM, we also discuss novel cereblon E3 ligase modulator (CELMoD™) agents including iberdomide (CC-220) and mezigdomide (CC-92480).
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Affiliation(s)
- Omar Nadeem
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Sikander Ailawadhi
- Department of Hematology & Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Jack Khouri
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Louis Williams
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | - Kathryn Maples
- Department of Pharmacy, Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Jesús Berdeja
- Greco-Hainsworth Centers for Cancer Research, Tennessee Oncology, Nashville, TN 37203, USA
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Chen MT, Huang ST, Huang HH, Chen WJ, Ko BS, Hsiao FY. Risk of thromboembolic events associated with different multiple myeloma regimens in Taiwan: a nested case-control study. J Thromb Thrombolysis 2023; 56:578-587. [PMID: 37737970 DOI: 10.1007/s11239-023-02887-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/23/2023]
Abstract
Although novel agents for multiple myeloma (MM) have a better response rate and survival in both newly diagnosed and relapsed/refractory MM patients, concerns regarding the association between MM treatments and thromboembolic events have been raised. The aim of this population-based study was to examine the association between different combinations of MM treatments and the risk of thromboembolic events. We conducted a nested case-control study using the Taiwan Cancer Registry (TCR) and National Health Insurance Research Database (NHIRD). Adult patients newly diagnosed with MM and treated with at least one of the immunomodulatory agents between 2008 and 2016 were identified. Among them, we further identified patients who developed thromboembolic events as cases and selected controls matched by age, sex and duration of MM diagnosis at a ratio of 1:5. The index date was defined as the day one year before the diagnosis date of thromboembolic events in the case group and the corresponding date in the control group. Conditional logistic regression was used to examine the association between different MM treatment regimens and the risk of thromboembolic events. A total of 4,180 newly diagnosed MM patients treated with at least one of the immunomodulatory agents were identified (mean age: 67.2 years; male: 55.7%). In this MM cohort, we further identified 388 cases and 1,940 matched controls (mean age: 71 years; male: 64.2%). The use of a thalidomide/bortezomib/steroid combination (odds ratio (OR) 2.95 [95% confidence interval (CI) 1.47-5.95]), thalidomide monotherapy (OR 3.33; 95% CI, 1.59-6.94), and a thalidomide/steroid combination (OR 4.24; 95% CI, 2.00-8.98) were associated with an increased risk of thromboembolic events. Other risk factors, particularly a history of thromboembolic events, including ischemic heart disease and pulmonary embolism, were significantly associated with increased risk of thromboembolic events. We found that the use of thalidomide alone and in specific combinations was associated with an increased risk of thromboembolic events.
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Affiliation(s)
- Mei-Tsen Chen
- Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan
| | - Huai-Hsuan Huang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Bor-Sheng Ko
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan.
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
- School of Pharmacy, National Taiwan University, Taipei, Taiwan.
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Li P, Xu B, Xu J, Wang Y, Yang Y, Wang W, Maihemaiti A, Li J, Xu T, Ren L, Lan T, Zhou C, Wang P, Liu P. Thrombosis events in Chinese patients with newly diagnosed multiple myeloma. Clin Exp Med 2023; 23:3809-3820. [PMID: 37103654 DOI: 10.1007/s10238-023-01080-7] [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: 02/26/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
A high risk of thrombosis is seen in patients with newly diagnosed multiple myeloma (NDMM), particularly those treated with immunomodulatory drugs (IMiDs). Large cohorts addressing the thrombosis issue of NDMM patients in Asia are lacking. We retrospectively analyzed the clinical information of NDMM patients diagnosed in Zhongshan Hospital Fudan University, a national medical center, from January 2013 to June 2021. Death and thrombotic events (TEs) were the endpoints. To investigate risk factors for TEs, the Fine and Gray competing risk regression models were created, in which unrelated deaths were labeled as competing risk events. A total of 931 NDMM patients were recruited in our study. The median follow-up was 23 months [interquartile range (IQR): 9-43 months]. Forty-two patients (4.51%) developed TEs, including 40 cases (4.30%) of venous thrombosis and 2 cases (0.21%) of arterial thrombosis. The median time from taking first-line treatment to TEs occurrence was 2.03 months (IQR: 0.52-5.70 months). The cumulative incidence of TEs was higher in patients treated with IMiDs than in those without IMiDs (8.25 vs. 4.32%, p = 0.038). There was no difference in the incidence of TEs between lenalidomide-based and thalidomide-based groups (7.80 vs. 8.84%, p = 0.886). Besides, TEs occurrence did not adversely affect OS (p = 0.150) or PFS (p = 0.210) in MM patients. Chinese NDMM patients have a lower incidence of thrombosis than those in western countries. The risk of thrombosis was particularly increased in patients treated with IMiDs. TEs were not associated with inferior progression-free survival or overall survival.
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Affiliation(s)
- Panpan Li
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bei Xu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiadai Xu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yawen Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Yang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenjing Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Aiziguli Maihemaiti
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Li
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianhong Xu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang Ren
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianwei Lan
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chi Zhou
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pu Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China.
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Costa TA, Felix N, Costa BA, Godoi A, Nogueira A, Rossi A. Direct oral anticoagulants versus aspirin for primary thromboprophylaxis in patients with multiple myeloma undergoing outpatient therapy: A systematic review and updated meta-analysis. Br J Haematol 2023; 203:395-403. [PMID: 37533165 DOI: 10.1111/bjh.19017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
Patients with multiple myeloma (MM) are at an elevated risk of venous thromboembolism (VTE), which is further increased for those undergoing anti-myeloma therapy. Current guidelines suggest low-dose direct oral anticoagulants (DOACs) as an alternative to aspirin for primary thromboprophylaxis in this population, but data comparing these two therapies are limited. We performed a systematic review and meta-analysis to compare DOACs with aspirin for primary thromboprophylaxis in individuals undergoing outpatient anti-myeloma therapy. Studies were selected when comparing DOACs versus aspirin for thrombotic and haemorrhagic outcomes. We included 10 randomised controlled trials and observational studies comprising 1026 patients with MM who received primary thromboprophylaxis with DOACs (n = 337) or aspirin (n = 689). DOAC thromboprophylaxis was associated with a significantly lower incidence of VTE compared with aspirin (OR 0.33; 95% CI 0.16-0.68; p < 0.001). Major, clinically relevant non-major and minor bleeding event rates did not differ significantly between groups. Overall, our meta-analysis suggests that DOACs may be a preferable option to aspirin for the prevention of MM-related thrombosis. However, these results should be interpreted in the context of heterogeneous baseline population characteristics and potential bias from including observational studies. Further research is needed to evaluate the optimal thromboprophylaxis strategy, particularly in high-risk individuals.
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Affiliation(s)
| | - Nicole Felix
- Federal University of Campina Grande, Campina Grande, Brazil
| | - Bruno Almeida Costa
- Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amanda Godoi
- Cardiff University School of Medicine, Cardiff, UK
| | - Alleh Nogueira
- Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Adriana Rossi
- Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, New York, USA
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Jiang T, Su H, Li Y, Wu Y, Ming Y, Li C, Fu R, Feng L, Li Z, Li L, Ni R, Liu Y. Post-marketing safety of immunomodulatory drugs in multiple myeloma: A pharmacovigilance investigation based on the FDA adverse event reporting system. Front Pharmacol 2022; 13:989032. [PMID: 36532784 PMCID: PMC9751748 DOI: 10.3389/fphar.2022.989032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/18/2022] [Indexed: 06/10/2024] Open
Abstract
Objective: In recent years, the emergence of immunomodulatory drugs (IMiDs) has significantly improved clinical outcomes in patients with multiple myeloma (MM); however, serious adverse events (AEs) have hindered their safe clinical application. This study aimed to characterize the safety profiles and differences in IMiDs through a disproportionality analysis using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS), a post-marketing surveillance database. Methods: This study filtered reports of thalidomide, lenalidomide, and pomalidomide as primary suspect drugs in FAERS files from January 2013 to December 2021. AEs in the reports were retrieved according to the preferred terms (PTs) of the Medical Dictionary for Regulatory Activities. Furthermore, we detected safety signals using the reporting odds ratio (ROR), proportional reporting ratio (PRR), and Bayesian belief propagation neural network (BCPNN). When all three algorithms showed an association between the target drug and the AE, a positive signal was generated. Results: We extracted 9,968 thalidomide, 231,926 lenalidomide, and 55,066 pomalidomide AE reports. AEs were more common in male patients and in those >44 years old. Important safety signals were detected based on the system organ classes (SOC), including thalidomide (cardiac disorders: ROR, 2.87; PRR, 2.79; IC 1.22), lenalidomide (gastrointestinal disorders: ROR, 2.38; PRR, 2.27; IC 0.75), and pomalidomide (respiratory, thoracic, and mediastinal disorders: ROR, 2.14; PRR, 2.09; IC 0.85). Within the PT level, we identified novel risk signals: the thalidomide-induced second primary malignancy (SPM) signal was significant; lenalidomide reduced the success rate of hematopoietic stem cell collection; and three IMiDs may cause human chorionic gonadotropin increase, but this needs to be proven by clinical data. Pneumonia, sepsis, and renal failure are common risk factors for death due to IMiDs. Compared with thalidomide and lenalidomide, pomalidomide has a lower risk of venous thromboembolism (VTE) and is beneficial to patients with renal insufficiency. Conclusion: Mining data from FAERS resulted in novel AE signals, including adenocarcinoma of colon, harvest failure of blood stem cells, and increased levels of human chorionic gonadotropin. Further investigation is required to verify the significance of these signals. Moreover, IMiDs showed differences in safety reports, which should be emphasized by clinicians.
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Affiliation(s)
- Tingting Jiang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Hui Su
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yanping Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yuanlin Wu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yue Ming
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Chen Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Ruoqiu Fu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Lu Feng
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu, China
| | - Ziwei Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Li Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Rui Ni
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yao Liu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
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Gilles F. [What a cardiologist needs to know about managing a patient with multiple myeloma]. Ann Cardiol Angeiol (Paris) 2022; 71:309-316. [PMID: 35963791 DOI: 10.1016/j.ancard.2022.07.001] [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] [Indexed: 06/15/2023]
Abstract
Multiple myeloma is one of the most frequent hematological malignancies in the elderly and corresponds to the presence of a plasma cell clone. Antitumor treatment combines different therapeutics, including alkylating agents, high-dose corticosteroids, immunomodulators and proteasome inhibitors. These treatments can have cardiovascular side effects that are important to be aware of. The role of the cardiologist is essential in preventing, detecting and managing these effects properly in order to improve the cardiological and oncological prognosis of patients.
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Affiliation(s)
- F Gilles
- Service de cardiologie, Centre Hospitalier de Versailles, André Mignot, 177 rue de Versailles 78150 Le Chesnay, France.
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Kahale LA, Matar CF, Tsolakian I, Hakoum MB, Yosuico VE, Terrenato I, Sperati F, Barba M, Hicks LK, Schünemann H, Akl EA. Antithrombotic therapy for ambulatory patients with multiple myeloma receiving immunomodulatory agents. Cochrane Database Syst Rev 2021; 9:CD014739. [PMID: 34582035 PMCID: PMC8477647 DOI: 10.1002/14651858.cd014739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Multiple myeloma is a malignant plasma cell disorder characterised by clonal plasma cells that cause end-organ damage such as renal failure, lytic bone lesions, hypercalcaemia and/or anaemia. People with multiple myeloma are treated with immunomodulatory agents including lenalidomide, pomalidomide, and thalidomide. Multiple myeloma is associated with an increased risk of thromboembolism, which appears to be further increased in people receiving immunomodulatory agents. OBJECTIVES (1) To systematically review the evidence for the relative efficacy and safety of aspirin, oral anticoagulants, or parenteral anticoagulants in ambulatory patients with multiple myeloma receiving immunomodulatory agents who otherwise have no standard therapeutic or prophylactic indication for anticoagulation. (2) To maintain this review as a living systematic review by continually running the searches and incorporating newly identified studies. SEARCH METHODS We conducted a comprehensive literature search that included (1) a major electronic search (14 June 2021) of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE via Ovid, and Embase via Ovid; (2) hand-searching of conference proceedings; (3) checking of reference lists of included studies; and (4) a search for ongoing studies in trial registries. As part of the living systematic review approach, we are running continual searches, and we will incorporate new evidence rapidly after it is identified. SELECTION CRITERIA Randomised controlled trials (RCTs) assessing the benefits and harms of oral anticoagulants such as vitamin K antagonist (VKA) and direct oral anticoagulants (DOAC), anti-platelet agents such as aspirin (ASA), and parenteral anticoagulants such as low molecular weight heparin (LMWH)in ambulatory patients with multiple myeloma receiving immunomodulatory agents. DATA COLLECTION AND ANALYSIS Using a standardised form, we extracted data in duplicate on study design, participants, interventions, outcomes of interest, and risk of bias. Outcomes of interest included all-cause mortality, symptomatic deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and minor bleeding. For each outcome we calculated the risk ratio (RR) with its 95% confidence interval (CI) and the risk difference (RD) with its 95% CI. We then assessed the certainty of evidence at the outcome level following the GRADE approach (GRADE Handbook). MAIN RESULTS We identified 1015 identified citations and included 11 articles reporting four RCTs that enrolled 1042 participants. The included studies made the following comparisons: ASA versus VKA (one study); ASA versus LMWH (two studies); VKA versus LMWH (one study); and ASA versus DOAC (two studies, one of which was an abstract). ASA versus VKA One RCT compared ASA to VKA at six months follow-up. The data did not confirm or exclude a beneficial or detrimental effect of ASA relative to VKA on all-cause mortality (RR 3.00, 95% CI 0.12 to 73.24; RD 2 more per 1000, 95% CI 1 fewer to 72 more; very low-certainty evidence); symptomatic DVT (RR 0.57, 95% CI 0.24 to 1.33; RD 27 fewer per 1000, 95% CI 48 fewer to 21 more; very low-certainty evidence); PE (RR 1.00, 95% CI 0.25 to 3.95; RD 0 fewer per 1000, 95% CI 14 fewer to 54 more; very low-certainty evidence); major bleeding (RR 7.00, 95% CI 0.36 to 134.72; RD 6 more per 1000, 95% CI 1 fewer to 134 more; very low-certainty evidence); and minor bleeding (RR 6.00, 95% CI 0.73 to 49.43; RD 23 more per 1000, 95% CI 1 fewer to 220 more; very low-certainty evidence). One RCT compared ASA to VKA at two years follow-up. The data did not confirm or exclude a beneficial or detrimental effect of ASA relative to VKA on all-cause mortality (RR 0.50, 95% CI 0.05 to 5.47; RD 5 fewer per 1000, 95% CI 9 fewer to 41 more; very low-certainty evidence); symptomatic DVT (RR 0.71, 95% CI 0.35 to 1.44; RD 22 fewer per 1000, 95% CI 50 fewer to 34 more; very low-certainty evidence); and PE (RR 1.00, 95% CI 0.25 to 3.95; RD 0 fewer per 1000, 95% CI 14 fewer to 54 more; very low-certainty evidence). ASA versus LMWH Two RCTs compared ASA to LMWH at six months follow-up. The pooled data did not confirm or exclude a beneficial or detrimental effect of ASA relative to LMWH on all-cause mortality (RR 1.00, 95% CI 0.06 to 15.81; RD 0 fewer per 1000, 95% CI 2 fewer to 38 more; very low-certainty evidence); symptomatic DVT (RR 1.23, 95% CI 0.49 to 3.08; RD 5 more per 1000, 95% CI 11 fewer to 43 more; very low-certainty evidence); PE (RR 7.71, 95% CI 0.97 to 61.44; RD 7 more per 1000, 95% CI 0 fewer to 60 more; very low-certainty evidence); major bleeding (RR 6.97, 95% CI 0.36 to 134.11; RD 6 more per 1000, 95% CI 1 fewer to 133 more; very low-certainty evidence); and minor bleeding (RR 1.42, 95% CI 0.35 to 5.78; RD 4 more per 1000, 95% CI 7 fewer to 50 more; very low-certainty evidence). One RCT compared ASA to LMWH at two years follow-up. The pooled data did not confirm or exclude a beneficial or detrimental effect of ASA relative to LMWH on all-cause mortality (RR 1.00, 95% CI 0.06 to 15.89; RD 0 fewer per 1000, 95% CI 4 fewer to 68 more; very low-certainty evidence); symptomatic DVT (RR 1.20, 95% CI 0.53 to 2.72; RD 9 more per 1000, 95% CI 21 fewer to 78 more; very low-certainty evidence); and PE (RR 9.00, 95% CI 0.49 to 166.17; RD 8 more per 1000, 95% CI 1 fewer to 165 more; very low-certainty evidence). VKA versus LMWH One RCT compared VKA to LMWH at six months follow-up. The data did not confirm or exclude a beneficial or detrimental effect of VKA relative to LMWH on all-cause mortality (RR 0.33, 95% CI 0.01 to 8.10; RD 3 fewer per 1000, 95% CI 5 fewer to 32 more; very low-certainty evidence); symptomatic DVT (RR 2.32, 95% CI 0.91 to 5.93; RD 36 more per 1000, 95% CI 2 fewer to 135 more; very low-certainty evidence); PE (RR 8.96, 95% CI 0.49 to 165.42; RD 8 more per 1000, 95% CI 1 fewer to 164 more; very low-certainty evidence); and minor bleeding (RR 0.33, 95% CI 0.03 to 3.17; RD 9 fewer per 1000, 95% CI 13 fewer to 30 more; very low-certainty evidence). The study reported that no major bleeding occurred in either arm. One RCT compared VKA to LMWH at two years follow-up. The data did not confirm or exclude a beneficial or detrimental effect of VKA relative to LMWH on all-cause mortality (RR 2.00, 95% CI 0.18 to 21.90; RD 5 more per 1000, 95% CI 4 fewer to 95 more; very low-certainty evidence); symptomatic DVT (RR 1.70, 95% CI 0.80 to 3.63; RD 32 more per 1000, 95% CI 9 fewer to 120 more; very low-certainty evidence); and PE (RR 9.00, 95% CI 0.49 to 166.17; RD 8 more per 1000, 95% CI 1 fewer to 165 more; very low-certainty evidence). ASA versus DOAC One RCT compared ASA to DOAC at six months follow-up. The data did not confirm or exclude a beneficial or detrimental effect of ASA relative to DOAC on DVT, PE, and major bleeding and minor bleeding (minor bleeding: RR 5.00, 95% CI 0.31 to 79.94; RD 4 more per 1000, 95% CI 1 fewer to 79 more; very low-certainty evidence). The study reported that no DVT, PE, or major bleeding events occurred in either arm. These results did not change in a meta-analysis including the study published as an abstract. AUTHORS' CONCLUSIONS The certainty of the available evidence for the comparative effects of ASA, VKA, LMWH, and DOAC on all-cause mortality, DVT, PE, or bleeding was either low or very low. People with multiple myeloma considering antithrombotic agents should balance the possible benefits of reduced thromboembolic complications with the possible harms and burden of anticoagulants. Editorial note: This is a living systematic review. Living systematic reviews offer a new approach to review updating in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Lara A Kahale
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Charbel F Matar
- Department of Internal Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Ibrahim Tsolakian
- Department of Obstertrics and Gynaecology, University of Toledo College of Medicine and Life Sciences, Ohio, USA
| | - Maram B Hakoum
- Department of Family Medicine, Cornerstone Care Teaching Health Center, Mount Morris, Pennsylvania, USA
| | | | - Irene Terrenato
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sperati
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lisa K Hicks
- Medicine, St. Michael's Hospital and the University of Toronto, Toronto, Canada
| | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Elie A Akl
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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8
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Venous thromboembolism in relapsed or refractory multiple myeloma patients treated with lenalidomide plus dexamethasone. Int J Hematol 2018; 109:79-90. [DOI: 10.1007/s12185-018-2540-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 01/06/2023]
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9
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Zoppellaro G, Veronese N, Granziera S, Gobbi L, Stubbs B, Cohen AT. Primary thromboembolic prevention in multiple myeloma patients: An exploratory meta-analysis on aspirin use. Semin Hematol 2018; 55:182-184. [DOI: 10.1053/j.seminhematol.2017.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/18/2017] [Accepted: 08/05/2017] [Indexed: 12/22/2022]
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Aapro M, Beguin Y, Bokemeyer C, Dicato M, Gascón P, Glaspy J, Hofmann A, Link H, Littlewood T, Ludwig H, Österborg A, Pronzato P, Santini V, Schrijvers D, Stauder R, Jordan K, Herrstedt J. Management of anaemia and iron deficiency in patients with cancer: ESMO Clinical Practice Guidelines. Ann Oncol 2018; 29:iv96-iv110. [PMID: 29471514 DOI: 10.1093/annonc/mdx758] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- M Aapro
- Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - Y Beguin
- University of Liège, Liège
- CHU of Liège, Liège, Belgium
| | - C Bokemeyer
- Department of Oncology, Hematology and BMT with Section Pneumology, University of Hamburg, Hamburg, Germany
| | - M Dicato
- Hématologie-Oncologie, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - P Gascón
- Department of Haematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - J Glaspy
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - A Hofmann
- Medical Society for Blood Management, Laxenburg, Austria
| | - H Link
- Klinik für Innere Medizin I, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - T Littlewood
- Department of Haematology, John Radcliffe Hospital, Oxford, UK
| | - H Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - A Österborg
- Karolinska Institute and Karolinska Hospital, Stockholm, Sweden
| | - P Pronzato
- Medica Oncology, IRCCS Asiana Pedaliter Universitaria San Martino - IST, Institutor Nazionale per la Ricercars sol Chancre, Genova
| | - V Santini
- Department of Experimental and Clinical Medicine, Haematology, University of Florence, Florence, Italy
| | - D Schrijvers
- Department of Medical Oncology, Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium
| | - R Stauder
- Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - K Jordan
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - J Herrstedt
- Department of Oncology, Zealand University Hospital Roskilde, Roskilde
- University of Copenhagen, Copenhagen, Denmark
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11
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Fan Y, Lu H, Liang W, Hu W, Zhang J, Chen YE. Krüppel-like factors and vascular wall homeostasis. J Mol Cell Biol 2018; 9:352-363. [PMID: 28992202 DOI: 10.1093/jmcb/mjx037] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/22/2017] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular diseases (CVDs) are major causes of death worldwide. Identification of promising targets for prevention and treatment of CVDs is paramount in the cardiovascular field. Numerous transcription factors regulate cellular function through modulation of specific genes and thereby are involved in the physiological and pathophysiological processes of CVDs. Although Krüppel-like factors (KLFs) have a similar protein structure with a conserved zinc finger domain, they possess distinct tissue and cell distribution patterns as well as biological functions. In the vascular system, KLF activities are regulated at both transcriptional and posttranscriptional levels. Growing in vitro, in vivo, and genetic epidemiology studies suggest that specific KLFs play important roles in vascular wall biology, which further affect vascular diseases. KLFs regulate various functional aspects such as cell growth, differentiation, activation, and development through controlling a whole cluster of functionally related genes and modulating various signaling pathways in response to pathological conditions. Therapeutic targeting of selective KLF family members may be desirable to achieve distinct treatment effects in the context of various vascular diseases. Further elucidation of the association of KLFs with human CVDs, their underlying molecular mechanisms, and precise protein structure studies will be essential to define KLFs as promising targets for therapeutic interventions in CVDs.
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Affiliation(s)
- Yanbo Fan
- Cardiovascular Center, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Haocheng Lu
- Cardiovascular Center, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Wenying Liang
- Cardiovascular Center, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Wenting Hu
- Cardiovascular Center, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Jifeng Zhang
- Cardiovascular Center, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Y Eugene Chen
- Cardiovascular Center, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
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Holstein SA, Suman VJ, McCarthy PL. Update on the role of lenalidomide in patients with multiple myeloma. Ther Adv Hematol 2018; 9:175-190. [PMID: 30013765 DOI: 10.1177/2040620718775629] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/06/2018] [Indexed: 11/15/2022] Open
Abstract
Lenalidomide is a derivative of thalidomide and belongs to the class of drugs known as the immunomodulatory drugs (IMiDs). The IMiDs have played a large role in improving the survival outcomes of patients with multiple myeloma. In particular, lenalidomide is currently standard of care in the newly diagnosed setting, in the maintenance setting post-autologous stem cell transplant, as well as in the relapsed/refractory setting. While the combination of lenalidomide and various proteasome inhibitors has proven particularly effective, there are emerging data demonstrating the effectiveness of lenalidomide in combination with other important classes of drugs including the monoclonal antibodies. Recent studies have provided insight into the molecular target of lenalidomide and the other IMiDs, although there is still much to be learned regarding the mechanisms by which lenalidomide affects the myeloma cell and the immune system. Here we review the molecular mechanisms of action, side effects, and the results of the clinical trials which have led to the widespread incorporation of lenalidomide into the myeloma therapeutic armamentarium.
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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
| | - Vera J Suman
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Philip L McCarthy
- Department of Medicine, Blood and Marrow Transplant Center, Roswell Park Comprehensive Cancer Center, Buffalo, Elm and Carlton Streets, CSC 815, NY 14263, USA
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Annibali O, Napolitano M, Avvisati G, Siragusa S. Incidence of venous thromboembolism and use of anticoagulation in hematological malignancies: Critical review of the literature. Crit Rev Oncol Hematol 2018; 124:41-50. [PMID: 29548485 DOI: 10.1016/j.critrevonc.2018.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/04/2017] [Accepted: 02/01/2018] [Indexed: 12/21/2022] Open
Abstract
Venous Thromboembolism (VTE) frequently complicates the course of hematologic malignancies (HM) and its incidence is similar to that observed in high-risk solid tumors. Despite that, pharmacologic prophylaxis and treatment of VTE in patients with HM is challenging, mainly because a severe thrombocytopenia frequently complicates the course of treatments or may be present since diagnosis, thus increasing the risk of bleeding. Therefore, in this setting, safe and effective methods of VTE prophylaxis and treatment have not been well defined and hematologists generally refer to guidelines produced for cancer patients that give indications on anticoagulation in patients with thrombocytopenia. In this review, besides to summarize the incidence and the available data on prophylaxis and treatment of VTE in HM, we give some advices on how to use antithrombotic drugs in patients with HM according to platelets count.
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Affiliation(s)
- Ombretta Annibali
- Hematology and Stem Cell Transplantation Unit, University Campus Bio-Medico, Italy
| | - Mariasanta Napolitano
- Hematology Unit, Reference Regional Center for Thrombosis and Haemostasis, University of Palermo, Italy.
| | - Giuseppe Avvisati
- Hematology and Stem Cell Transplantation Unit, University Campus Bio-Medico, Italy
| | - Sergio Siragusa
- Hematology Unit, Reference Regional Center for Thrombosis and Haemostasis, University of Palermo, Italy
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Rodon P, Hulin C, Daley L, Dauriac C, Hacini M, Decaux O, Eisemann JC, Fitoussi O, Lioure B, Voillat L, Slama B, Al Jijakli A, Benramdane R, Chaleteix C, Costello R, Thyss A, Mathiot C, Eileen B, Maloisel F, Stoppa AM, Kolb B, Michallet M, Lamblin A, Natta P, Facon T, Elalamy I, Fermand JP, Moreau P, Leleu X. MELISSE, a large multicentric observational study to determine risk factors of venous thromboembolism in patients with multiple myeloma treated with immunomodulatory drugs. Thromb Haemost 2017; 110:844-51. [DOI: 10.1160/th13-02-0140] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/22/2013] [Indexed: 01/06/2023]
Abstract
SummaryImmunomodulatory drugs (IMiDs) are associated with an increased risk of venous thromboembolism (VTE) in multiple myeloma (MM) patients. We designed MELISSE, a multicentre prospective observational study, to evaluate VTE incidence and identify risk factors in IMiDstreated MM. Our objective was to determine the real-life practice of VTE prophylaxis strategy. A total of 524 MM patients were included, and we planned to collect information at baseline, at four and at 12 months, on MM therapy, on VTE risk factors and management. VTE incidence was 7% (n=31), including 2.5% pulmonary embolism (PE) (n=11), similar at four or 12 months. VTE was observed at all risk assessment levels, although the increased risk assessment level correlated to a lower rate of VTE, maybe due to the implemented thromboprophylaxis strategy. VTE occurred in 7% on aspirin vs 3% on lowmolecular- weight heparin (LMWH) prophylaxis, and none on vitamin K antagonists (VKA). New risk factors for VTE in IMiDs-treated MM were identified. In conclusion, VTE prophylaxis is compulsory in IMiDstreated MM, based on individualised VTE risk assessment. Anticoagulation prophylaxis with LMWH should clearly be prioritised in MM patients with high VTE risk, along with VKA. Further prospective studies will identify most relevant VTE risk factors in IMiDs-treated MM to select accurately which MM patients should receive LMWH prophylaxis and for which duration to optimise VTE risk reduction.
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Chang HM, Okwuosa TM, Scarabelli T, Moudgil R, Yeh ETH. Cardiovascular Complications of Cancer Therapy: Best Practices in Diagnosis, Prevention, and Management: Part 2. J Am Coll Cardiol 2017; 70:2552-2565. [PMID: 29145955 PMCID: PMC5825188 DOI: 10.1016/j.jacc.2017.09.1095] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 02/08/2023]
Abstract
In this second part of a 2-part review, we will review cancer or cancer therapy-associated systemic and pulmonary hypertension, QT prolongation, arrhythmias, pericardial disease, and radiation-induced cardiotoxicity. This review is based on a MEDLINE search of published data, published clinical guidelines, and best practices in major cancer centers. Newly developed targeted therapy can exert off-target effects causing hypertension, thromboembolism, QT prolongation, and atrial fibrillation. Radiation therapy often accelerates atherosclerosis. Furthermore, radiation can damage the heart valves, the conduction system, and pericardium, which may take years to manifest clinically. Management of pericardial disease in cancer patients also posed clinical challenges. This review highlights the unique opportunity of caring for cancer patients with heart problems caused by cancer or cancer therapy. It is an invitation to action for cardiologists to become familiar with this emerging subspecialty.
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Affiliation(s)
- Hui-Ming Chang
- Center for Precision Medicine, Department of Medicine, University of Missouri, Columbia, Missouri
| | - Tochukwu M Okwuosa
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Tiziano Scarabelli
- Division of Cardiology, Virginia Common Wealth University, Richmond, Virginia
| | - Rohit Moudgil
- Department of Cardiology, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Edward T H Yeh
- Center for Precision Medicine, Department of Medicine, University of Missouri, Columbia, Missouri.
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Sethi TK, Basdag B, Bhatia N, Moslehi J, Reddy NM. Beyond Anthracyclines: Preemptive Management of Cardiovascular Toxicity in the Era of Targeted Agents for Hematologic Malignancies. Curr Hematol Malig Rep 2017; 12:257-267. [PMID: 28233150 DOI: 10.1007/s11899-017-0369-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Advances in drug discovery have led to the use of effective targeted agents in the treatment of hematologic malignancies. Drugs such as proteasome inhibitors in multiple myeloma and tyrosine kinase inhibitors in chronic myeloid leukemia and non-Hodgkin lymphoma have changed the face of treatment of hematologic malignancies. There are several reports of cardiovascular adverse events related to these newer agents. Both "on-target" and "off-target" effects of these agents can cause organ-specific toxicity. The need for long-term administration for most of these agents requires continued monitoring of toxicity. Moreover, the patient population is older, often over 50 years of age, making them more susceptible to cardiovascular side effects. Additional factors such as prior exposure to anthracyclines often add to this toxicity. In light of their success and widespread use, it is important to recognize and manage the unique side effect profile of targeted agents used in hematologic malignancies. In this article, we review the current data for the incidence of cardiovascular side effects of targeted agents in hematologic malignancies and discuss a preemptive approach towards managing these toxicities.
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Affiliation(s)
- Tarsheen K Sethi
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, 3927 The Vanderbilt Clinic, Nashville, TN, USA
| | - Basak Basdag
- Division of Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nirmanmoh Bhatia
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Javid Moslehi
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nishitha M Reddy
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, 3927 The Vanderbilt Clinic, Nashville, TN, USA.
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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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Qiao SK, Guo XN, Ren JH, Ren HY. Efficacy and Safety of Lenalidomide in the Treatment of Multiple Myeloma: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Chin Med J (Engl) 2016; 128:1215-22. [PMID: 25947406 PMCID: PMC4831550 DOI: 10.4103/0366-6999.156134] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Lenalidomide has emerged as an important treatment for patients with multiple myeloma (MM). However, its role in the management of MM is still controversial and requires further clarification. The aim of this study was to evaluate efficacy and safety of lenalidomide for MM using a meta-analysis. METHODS We searched the electronic databases including: PubMed, EMBASE and the Cochrane Center Register of Controlled Trials. Seven randomized clinical trials were identified, which included a total of 2357 patients with MM who received lenalidomide-containing, noncontaining lenalidomide regimens or placebo as induction therapy or maintenance therapy. The outcomes included overall response (OR) rate, complete response (CR) rate, 3-year progression-free survival (PFS) rate, 3-year overall survival (OS) rate, and different types of treatment-related adverse events. We calculated the risk ratios (RRs) as well as their 95% confidence intervals of these outcomes and pooled the results using RevMan 5.2 software. RESULTS For patients with previously untreated MM, OR rate and CR rate was significantly higher in lenalidomide-containing group than the control group. For relapsed or refractory MM patients, lenalidomide-containing regimens significantly improved the OR rate, CR rate, 3-year PFS rate and 3-year OS rate. With regard to MM patients after autologous stem cell transplantation, lenalidomide maintenance therapy significantly improved 3-year PFS rate but did not result in improved 3-year OS rate. In terms of toxicities, lenalidomide therapy has a higher rate of Grade 3-4 grade cytopenias, infection, deep-vein thrombosis, and diarrhea. Furthermore, the incidence of second primary malignancies was significantly higher in the lenalidomide group. CONCLUSIONS The lenalidomide-containing regimens as induction therapy clearly increased response rates and improved intervals of survival with acceptable toxicity rates for patients with MM. However, when physicians choose to use the lenalidomide as maintenance therapy, whether the benefits outweigh the risks should be taken into account.
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Affiliation(s)
| | - Xiao-Nan Guo
- Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
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Jiang X, Zhao M, Wang Y, Zhu H, Zhao S, Wu J, Song Y, Peng S. RGD(F/S/V)-Dex: towards the development of novel, effective, and safe glucocorticoids. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1059-76. [PMID: 27022245 PMCID: PMC4789840 DOI: 10.2147/dddt.s99568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Dexamethasone (Dex) is an effective glucocorticoid in treating inflammation and preventing rejection reaction. However, the side effects limit its clinical application. To improve its druggable profile, the conjugates of RGD-peptide-modified Dex were presented and their enhanced anti-inflammation activity, minimized osteoporotic action, and nanoscaled assembly were explored. (RGD stands for Arg-Gly-Asp. Standard single letter biochemical abbreviations for amino acids have been used throughout this paper.) In respect of the rejection reaction, the survival time of the implanted myocardium of the mice treated with 1.43 µmol/kg/d of the conjugates for 15 consecutive days was significantly longer than that of the mice treated with 2.5 µmol/kg/d of Dex, and the conjugates, but not Dex, exhibited no toxic action. At a single dose of 14.3 µmol/kg (100 times minimal effective dose, 0.143 µmol/kg), the conjugates induced no liver, kidney, or systemic toxicity. At the dose of 1.43 µmol/kg, the conjugates, but not Dex, prolonged the bleeding time of the mice, and inhibited the thrombosis of the rats. In water and rat plasma, the conjugates formed nanoparticles of 14-250 and 101-166 nm in diameter, respectively. Since the nanoparticles of ~100 nm in size cannot be entrapped by macrophages in the circulation, RGDF-Dex would particularly be worthy of development, since its nanoparticle diameter is 101 nm.
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Affiliation(s)
- Xueyun Jiang
- Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, Beijing Laboratory of Biomedical Materials, College of Pharmaceutical Sciences, Capital Medical University, Beijing, People's Republic of China
| | - Ming Zhao
- Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, Beijing Laboratory of Biomedical Materials, College of Pharmaceutical Sciences, Capital Medical University, Beijing, People's Republic of China; Faculty of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuji Wang
- Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, Beijing Laboratory of Biomedical Materials, College of Pharmaceutical Sciences, Capital Medical University, Beijing, People's Republic of China
| | - Haimei Zhu
- Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, Beijing Laboratory of Biomedical Materials, College of Pharmaceutical Sciences, Capital Medical University, Beijing, People's Republic of China
| | - Shurui Zhao
- Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, Beijing Laboratory of Biomedical Materials, College of Pharmaceutical Sciences, Capital Medical University, Beijing, People's Republic of China
| | - Jianhui Wu
- Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, Beijing Laboratory of Biomedical Materials, College of Pharmaceutical Sciences, Capital Medical University, Beijing, People's Republic of China
| | - Yuanbo Song
- Guangxi Pusen Biotechnology Co. Ltd., Nanning, Guangxi, People's Republic of China
| | - Shiqi Peng
- Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, Beijing Laboratory of Biomedical Materials, College of Pharmaceutical Sciences, Capital Medical University, Beijing, People's Republic of China
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Raghupathy R, Ayyappan S, Prabhakar D, Campagnaro EL, Mo FKF, Li W, Hui EP, Chan ATC, Lei KIK. Retrospective study of the incidence and patterns of arterial and venous thrombosis in Chinese versus African American patients with multiple myeloma. Br J Haematol 2016; 176:315-317. [PMID: 26814167 DOI: 10.1111/bjh.13942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Radha Raghupathy
- Partner State Key Laboratory of Oncology in South China, Sir Y K Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Sabarish Ayyappan
- Department of Hematology and Oncology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Dhivya Prabhakar
- Department of Hematology and Oncology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Erica L Campagnaro
- Department of Hematology and Oncology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Frankie K F Mo
- Partner State Key Laboratory of Oncology in South China, Sir Y K Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Wa Li
- Partner State Key Laboratory of Oncology in South China, Sir Y K Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Edwin P Hui
- Partner State Key Laboratory of Oncology in South China, Sir Y K Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Anthony T C Chan
- Partner State Key Laboratory of Oncology in South China, Sir Y K Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Kenny I K Lei
- Partner State Key Laboratory of Oncology in South China, Sir Y K Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Role of inflammation in the aging bones. Life Sci 2014; 123:25-34. [PMID: 25510309 DOI: 10.1016/j.lfs.2014.11.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/03/2014] [Accepted: 11/17/2014] [Indexed: 12/15/2022]
Abstract
Chronic inflammation in aging is characterized by increased inflammatory cytokines, bone loss, decreased adaptation, and defective tissue repair in response to injury. Aging leads to inherent changes in mesenchymal stem cell (MSC) differentiation, resulting in impaired osteoblastogenesis. Also, the pro-inflammatory cytokines increase with aging, leading to enhanced myelopoiesis and osteoclastogenesis. Bone marrow macrophages (BMMs) play pivotal roles in osteoblast differentiation, the maintenance of hematopoietic stem cells (HSCs), and subsequent bone repair. However, during aging, little is known about the role of macrophages in the differentiation and function of MSC and HSC. Aged mammals have higher circulating pro-inflammatory cytokines than young adults, supporting the hypothesis of increased inflammation with aging. This review will aid in the understanding of the potential role(s) of pro-inflammatory (M1) and anti-inflammatory (M2) macrophages in differentiation and function of osteoblasts and osteoclasts in relation to aging.
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Kovacs MJ, Davies GA, Chapman JAW, Bahlis N, Voralia M, Roy J, Kouroukis CT, Chen C, Belch A, Reece D, Zhu L, Meyer RM, Shepherd L, Stewart KA. Thalidomide-prednisone maintenance following autologous stem cell transplant for multiple myeloma: effect on thrombin generation and procoagulant markers in NCIC CTG MY.10. Br J Haematol 2014; 168:511-7. [PMID: 25302852 DOI: 10.1111/bjh.13176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 09/12/2014] [Indexed: 12/21/2022]
Abstract
Venous thromboembolism (VTE) has an increased incidence in patients with multiple myeloma (MM), especially during chemotherapy. Mechanisms including upregulation of procoagulant factors, such as factor VIII, have been postulated. The National Cancer Institute of Canada Clinical Trials Group MY.10 phase III clinical trial compared thalidomide-prednisone to observation for 332 patients with MM post-autologous stem cell transplantation (ASCT), with a primary endpoint of overall survival and various secondary endpoints including the incidence of VTE. One hundred and fifty-three patients had biomarker data, including D-dimer, factor VIII and thrombin anti-thrombin (TAT) levels collected post-ASCT at baseline and 2 months after intervention investigating in-vivo thrombin generation. Differences between the time-points included a significant reduction over time in D-dimer, factor VIII and TAT levels in the observation group and sustained elevation of D-dimer, significant increase in factor VIII and reduction in TAT levels in the thalidomide-prednisone group. Eight VTE events were reported in this subset of study patients, all in the thalidomide-prednisone arm, with a trend to increase in D-dimer levels over time in those patients with VTE. This study provides physiological and clinical evidence for an increased risk of VTE associated with thalidomide-prednisone maintenance therapy post-ASCT for MM.
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Boyle EM, Fouquet G, Manier S, Gauthier J, Noel MP, Borie C, Facon T, Elalamy I, Leleu X. Immunomodulator drug-based therapy in myeloma and the occurrence of thrombosis. Expert Rev Hematol 2014; 5:617-26; quiz 627. [DOI: 10.1586/ehm.12.52] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Aikens GB, Rivey MP, Hansen CJ. Primary venous thromboembolism prophylaxis in ambulatory cancer patients. Ann Pharmacother 2013; 47:198-209. [PMID: 23386067 DOI: 10.1345/aph.1r335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To summarize and review current medical literature regarding the efficacy and safety of antithrombotic therapy for primary venous thromboembolism (VTE) prophylaxis in various ambulatory cancer populations. DATA SOURCES A literature search was conducted in PubMed (1966-September 2012) and International Pharmaceutical Abstracts (1970-September 2012) using the terms venous thromboembolism, primary prophylaxis, anticoagulation, antithrombotic agents, cancer, and ambulatory. The bibliographies of pertinent studies and topic articles were reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION All English-language articles were evaluated for inclusion. All randomized trials were included in the review. DATA SYNTHESIS Malignancy has been identified as a major independent risk factor for the development of VTE in the surgical, medically ill, and ambulatory populations. Primary VTE prophylaxis has been identified as an area of great impact in cancer patients because of the difficulties associated with the treatment of VTE and the greater risk for its recurrence in this population. Although primary VTE prophylaxis is recommended in all surgical and hospitalized cancer patients without contraindications to anticoagulants, its role in ambulatory cancer patients is less certain because of varying patient, cancer, and treatment-related factors. Fourteen randomized studies have investigated the use of antithrombotic agents for primary VTE prophylaxis in ambulatory cancer patients. Strong evidence for primary prophylaxis exists for several populations with advanced or metastatic cancer considered to be at high risk, including those with pancreatic cancer, lung cancer, or multiple myeloma. Evidence is inconsistent or lacking for lower risk cancer populations, such as those with breast cancer, or for those with malignant glioma, which carries a high risk for VTE and bleeding relative to the general ambulatory cancer population. CONCLUSIONS Use of antithrombotic agents has reduced the rate of primary VTE, with minimal increases in bleeding risk in specific ambulatory cancer populations. Further investigation is needed to guide and narrow recommendations for primary VTE prophylaxis in ambulatory cancer patients.
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Affiliation(s)
- Garrett B Aikens
- Department of Pharmacy Practice and Community Medical Center, The University of Montana, Missoula, MT, USA.
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Kato A, Takano H, Ichikawa A, Koshino M, Igarashi A, Hattori K, Nagata K. A retrospective cohort study of venous thromboembolism(VTE) in 1035 Japanese myeloma patients treated with thalidomide; lower incidence without statistically significant association between specific risk factors and development of VTE and effects of thromboprophylaxis with aspirin and warfarin. Thromb Res 2013; 131:140-4. [DOI: 10.1016/j.thromres.2012.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/07/2012] [Accepted: 11/19/2012] [Indexed: 01/06/2023]
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Pomalidomide plus low-dose dexamethasone is active and well tolerated in bortezomib and lenalidomide-refractory multiple myeloma: Intergroupe Francophone du Myélome 2009-02. Blood 2013; 121:1968-75. [PMID: 23319574 DOI: 10.1182/blood-2012-09-452375] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The combination of pomalidomide and dexamethasone can be safely administered to patients with multiple myeloma (MM) and has significant efficacy, although the optimal regimen remains to be determined. Patients with MM whose disease progressed after multiple lines of therapy have limited treatment options. We designed a multicenter, phase 2 randomized study assessing two different dose regimens of pomalidomide and dexamethasone in advanced MM. Treatment response was assessed centrally. Pomalidomide (4 mg) was given orally on days 1 to 21 (arm 21/28) or continuously (arm 28/28) over a 28-day cycle, plus dexamethasone given weekly. Eighty-four patients (43, arm 21/28 and 41, arm 28/28) were randomized. The median number of prior lines was 5. Overall response rate was 35% (arm 21/28) and 34% (arm 28/28), independent of the number of prior lines and level of refractoriness. Median duration of response, time to disease progression, and progression-free survival was 7.3, 5.4, and 4.6 months, respectively, which was similar across cohorts. At 23 months follow-up, median overall survival was 14.9 months, with 44% of the patients alive at 18 months. Toxicity consisted primarily of myelosuppression, which was manageable. The efficacy and safety data presented here, along with data from other phase 2 trials, suggest that pomalidomide 4 mg per day on days 1 to 21 of 28 with dexamethasone should be investigated in future trials. This trial is registered at ClinicalTrials.gov (No. NCT01053949).
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Chalayer E, Augeul-Meunier K, Tardy-Poncet B, Cathebras P, Guyotat D, Tardy B. Myélome multiple de novo : faut-il proposer une prophylaxie antithrombotique ? Rev Med Interne 2012; 33:693-6. [DOI: 10.1016/j.revmed.2012.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 05/06/2012] [Indexed: 10/27/2022]
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Alexander M, Teoh KC, Lingaratnam S, Kirsa S, Mellor JD. Thromboprophylaxis prescribing and thrombotic event rates in multiple myeloma patients treated with lenalidomide or thalidomide at a specialist cancer hospital. Asia Pac J Clin Oncol 2012; 9:169-75. [DOI: 10.1111/ajco.12013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Marliese Alexander
- Pharmacy Department; Peter MacCallum Cancer Centre; East Melbourne; Victoria
| | - Khai C Teoh
- School of Pharmacy; University of Queensland; Brisbane; Queensland; Australia
| | - Senthil Lingaratnam
- Pharmacy Department; Peter MacCallum Cancer Centre; East Melbourne; Victoria
| | - Sue Kirsa
- Pharmacy Department; Peter MacCallum Cancer Centre; East Melbourne; Victoria
| | - James D Mellor
- Pharmacy Department; Peter MacCallum Cancer Centre; East Melbourne; Victoria
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Alexander M, Kirsa S, Mellor JD. Thalidomide thromboprophylaxis in multiple myeloma: a review of current evidence. Asia Pac J Clin Oncol 2012; 8:319-24. [PMID: 22897571 DOI: 10.1111/j.1743-7563.2011.01511.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Currently multiple antithrombotic agents are used for thalidomide thromboprophylaxis in multiple myeloma patients. Agents used include low-dose aspirin, fixed low-dose and therapeutic warfarin and prophylactic low molecular weight heparin. To evaluate the evidence for the efficacy and safety of aspirin, warfarin and low molecular weight heparin thromboprophylaxis in multiple myeloma patients on thalidomide a literature search was conducted in May and June 2011. Databases searched included the Cochrane Database of Systemic Reviews and the Database of Abstracts of Reviews of Effects, Evidence Based Medicine Reviews and Ovid MEDLINE. The search was restricted to English language articles and limited to articles published from 2005 to 2011. Most studies consisted of small prospective cohort studies not originally designed to assess thromboprophylaxis as an outcome. A single comparative randomized trial, several retrospective review articles, two meta-analyses and two clinical practice guidelines were also identified. Current evidence fails to demonstrate a clear advantage of any particular thromboprophylaxis strategy. Results from the only prospective comparative randomized trial found no significant differences among aspirin, warfarin and low molecular weight heparin. More studies are required that consider not only efficacy and safety, but also costs, lifestyle burden and patient preference.
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Affiliation(s)
- Marliese Alexander
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria 3002, Australia.
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Rushworth GF, Leslie SJ, Forsyth P, Vincent C. Evidence-based case report: multiple thrombotic episodes associated with lenalidomide and dexamethasone therapy for multiple myeloma. Ther Adv Drug Saf 2012; 3:115-22. [PMID: 25083230 DOI: 10.1177/2042098611433773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Lenalidomide in combination with dexamethasone is a treatment for patients with relapsed or refractory myeloma. Although this combination demonstrates a high level of efficacy, it further exacerbates the hypercoaguable state that exists within myeloma. Thromboprophylactic regimen require careful selection and if warfarin is chosen, assiduous monitoring is required to ensure it will be clinically effective. We report the case of one patient who experienced multiple thrombotic events despite anticoagulant or antiplatelet thromboprophylaxis and review the contributing factors.
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Affiliation(s)
- Gordon F Rushworth
- Advanced Pharmacist Clinical Research, Highland Clinical Research Facility, Centre for Health Science, Old Perth Road, Inverness IV2 3JH, UK
| | - Stephen J Leslie
- NHS Highland, Raigmore Hospital, and University of Stirling, Inverness, UK
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Aspirin or enoxaparin thromboprophylaxis for patients with newly diagnosed multiple myeloma treated with lenalidomide. Blood 2012; 119:933-9; quiz 1093. [DOI: 10.1182/blood-2011-03-344333] [Citation(s) in RCA: 218] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Lenalidomide plus dexamethasone is effective in the treatment of multiple myeloma (MM) but is associated with an increased risk of venous thromboembolism (VTE). This prospective, open-label, randomized substudy of a phase 3 trial compared the efficacy and safety of thromboprophylaxis with low-dose aspirin (ASA) or low-molecular-weight heparin (LMWH) in patients with newly diagnosed MM, treated with lenalidomide and low-dose dexamethasone induction and melphalan-prednisone-lenalidomide consolidation. Overall, 342 patients who did not have clinical indications or contraindications to antiplatelet or anticoagulant therapy were randomly assigned to receive ASA 100 mg/d (n = 176) or LMWH enoxaparin 40 mg/d (n = 166). The incidence of VTE was 2.27% in the ASA group and 1.20% in the LMWH group. Compared with LMWH, the absolute difference in the proportion of VTE was 1.07% (95% confidence interval, −1.69-3.83; P = .452) in the ASA group. Pulmonary embolism was observed in 1.70% of patients in the ASA group and none in the LMWH group. No arterial thrombosis, acute cardiovascular events, or sudden deaths were reported. No major hemorrhagic complications were reported. In previously untreated patients with MM receiving lenalidomide with a low thromboembolic risk, ASA could be an effective and less-expensive alternative to LMWH thromboprophylaxis. This study was registered at www.clinicaltrials.gov as #NCT00551928.
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Nayak L, Lin Z, Jain MK. "Go with the flow": how Krüppel-like factor 2 regulates the vasoprotective effects of shear stress. Antioxid Redox Signal 2011; 15:1449-61. [PMID: 20919941 PMCID: PMC3144441 DOI: 10.1089/ars.2010.3647] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Laminar shear stress is known to confer potent anti-inflammatory, antithrombotic, and antiadhesive effects by differentially regulating endothelial gene expression. The identification of Krüppel-like factor 2 as a flow-responsive molecule has greatly advanced our understanding of molecular mechanisms governing vascular homeostasis. This review summarizes the current understanding of Krüppel-like factor 2 action in endothelial gene expression and function.
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Affiliation(s)
- Lalitha Nayak
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, University Hospitals, Case Western Reserve University, Cleveland, Ohio 44106, USA
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Zangari M, Berno T, Zhan F, Boucher KM, Tricot G, Fink L. Activated protein C resistance as measured by residual factor V after Russell's viper venom and activated protein C treatment analyzed as a continuous variable in multiple myeloma and normal controls. Blood Coagul Fibrinolysis 2011; 22:420-3. [PMID: 21537162 DOI: 10.1097/mbc.0b013e3283464f6a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Increased risk of venous thromboembolism (VTE) has been described in multiple myeloma patients, particularly when exposed to immunomodulatory drugs. Epidemiological studies have shown that monoclonal gammopathy of undetermined significance (MGUS) patients also have an increased risk of VTE compared with normal individuals. Acquired activated protein C resistance (APC-R) is an independent risk factor for VTE in hematologic malignancies. We reviewed the records of patients with multiple myeloma and MGUS for APC-R by PEFAKIT APC-R test and compared them to normal individuals. We excluded from the analysis patients with a documented factor V Leiden mutation. The PEFAKIT APC-R is a plasma-based functional prothrombin assay based on ratio of patient clotting time with and without APC. Thirty-three MGUS and 93 multiple myeloma patients were compared with 39 normal individuals. Baseline characteristics from the three groups were similar in terms of age, sex, and performance status. The median APC-R for multiple myeloma, MGUS, and controls were 1, 1.06, and 1.1, respectively. Multiple myeloma patients compared to normal individuals had significantly shorter APC-R (P=0.0012). No significant difference was observed between MGUS and normal individuals (P=0.17). After analyzing APC-R values and multiple coagulation parameters, a significant inverse correlation was found between APC-R and fibrinogen (P=0.0000001) and D-dimer (P=0.045) serum levels and a direct correlation with prothrombin time value (P=0.034). The Pefakit APC-R test measured as continuous variable shows a statistically significant decrease in patients with myeloma compared to normal individuals.
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Affiliation(s)
- Maurizio Zangari
- Myeloma Program, Division of Hematology, University of Utah, Salt Lake City, Utah, USA.
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Association study of selected genetic polymorphisms and occurrence of venous thromboembolism in patients with multiple myeloma who were treated with thalidomide. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:414-20. [PMID: 21859556 DOI: 10.1016/j.clml.2011.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 03/04/2011] [Accepted: 03/07/2011] [Indexed: 11/23/2022]
Abstract
INTRODUCTION/BACKGROUND Venous thromboembolism (VTE), with the subsequent risk of pulmonary embolism, is a common adverse effect of thalidomide treatment in patients with multiple myeloma (MM). In our retrospective study, we analyzed candidate single-nucleotide polymorphisms (SNP), CINP (rs7011), CETP (rs289747), ALDH1A1 (rs610529), CDKN1A (rs3829963), GAN (rs2608555), vascular endothelial growth factor (rs699947), and ALDH1A1 (rs168351), previously identified in a large association study based on the hypothesis-driven candidate gene approach nominated by the International Myeloma Foundation "Bank On A Cure" (3404 SNPs). In that study, the researchers built a classification tree that enables prediction of individual risk of VTE in patients with MM. PATIENTS AND METHODS Genotypes of these SNPs were determined in an independent cohort of 111 patients with MM through TaqMan real-time polymerase chain reaction (PCR) allelic discrimination and were used for prediction of individual VTE risk. RESULTS The results of this study did not confirm the ability of this classification tree to predict VTE risk in patients with MM from the Czech Republic; of these patients, 21 (19%) developed high-grade VTE. However, in patients with VTE, we found higher frequency of the AC genotype in the CDKN1A gene (42.9% vs. 16.7%; odds ratio 3.64) in comparison with the CC genotype (P = .015). SNPs of other genes as well as age and sex of the patients had no statistically significant influence on the risk of VTE. CONCLUSION Further studies are needed to confirm the initial analysis that provided predictive information of genetic variations in patients with myeloma that may influence risk of VTE.
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Carrier M, Le Gal G, Tay J, Wu C, Lee AY. Rates of venous thromboembolism in multiple myeloma patients undergoing immunomodulatory therapy with thalidomide or lenalidomide: a systematic review and meta-analysis. J Thromb Haemost 2011; 9:653-63. [PMID: 21255254 DOI: 10.1111/j.1538-7836.2011.04215.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The incidence of venous thromboembolism (VTE) in patients with multiple myeloma (MM) treated with thalidomide- and lenalidomide-based regimens is high. Recent observational studies have suggested that thromboprophylaxis might be efficacious in decreasing the risk of VTE in this population. PURPOSE To determine the absolute rates of VTE with and without different thromboprophylactic agents in patients with newly diagnosed or previously treated MM receiving thalidomide- or lenalidomide-based regimens. RESULTS Patients with newly diagnosed MM treated with thalidomide in combination with dexamethasone have a VTE risk of 4.1 (95% CI, 2.8-5.9) per 100 patient-cycles. Therapeutic doses of anticoagulants seem to provide the largest absolute risk reduction of VTE. The rate of VTE in patients with previously treated MM receiving thalidomide in combination with dexamethasone is 0.8 (95% CI, 0.1-2.1) per 100 patient-months. A combination of lenalidomide and dexamethasone is associated with of risk of VTE of 0.8 (95% CI, 0.07-2.0) per 100 patient-cycles and 0.7 (95% CI, 0.4-0.9) per 100 patient-cycles in patients with newly diagnosed and previously treated MM, respectively. Similarly, the rates of VTE in patients also receiving thromboprophylaxis with aspirin were 0.9 (95% CI, 0.5-1.5) and 0.6 (95% CI, 0.01-2.1), respectively. CONCLUSION Patients with newly diagnosed or previously treated MM receiving thalidomide- or lenalidomide-based regimens in combination with dexamethasone are at high risk of VTE. The benefit of various types of thromboprophylaxis is difficult to quantify in patients with MM receiving immunomodulatory therapy, especially in those receiving lenalidomide-based therapy or who have previously treated MM. Randomized controlled trials are needed to address this important clinical need.
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Affiliation(s)
- M Carrier
- Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Palumbo A, Cavo M, Bringhen S, Zamagni E, Romano A, Patriarca F, Rossi D, Gentilini F, Crippa C, Galli M, Nozzoli C, Ria R, Marasca R, Montefusco V, Baldini L, Elice F, Callea V, Pulini S, Carella AM, Zambello R, Benevolo G, Magarotto V, Tacchetti P, Pescosta N, Cellini C, Polloni C, Evangelista A, Caravita T, Morabito F, Offidani M, Tosi P, Boccadoro M. Aspirin, Warfarin, or Enoxaparin Thromboprophylaxis in Patients With Multiple Myeloma Treated With Thalidomide: A Phase III, Open-Label, Randomized Trial. J Clin Oncol 2011; 29:986-93. [DOI: 10.1200/jco.2010.31.6844] [Citation(s) in RCA: 249] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose In patients with myeloma, thalidomide significantly improves outcomes but increases the risk of thromboembolic events. In this randomized, open-label, multicenter trial, we compared aspirin (ASA) or fixed low-dose warfarin (WAR) versus low molecular weight heparin (LMWH) for preventing thromboembolism in patients with myeloma treated with thalidomide-based regimens. Patients and Methods A total of 667 patients with previously untreated myeloma who received thalidomide-containing regimens and had no clinical indication or contraindication for a specific antiplatelet or anticoagulant therapy were randomly assigned to receive ASA (100 mg/d), WAR (1.25 mg/d), or LMWH (enoxaparin 40 mg/d). A composite primary end point included serious thromboembolic events, acute cardiovascular events, or sudden deaths during the first 6 months of treatment. Results Of 659 analyzed patients, 43 (6.5%) had serious thromboembolic events, acute cardiovascular events, or sudden death during the first 6 months (6.4% in the ASA group, 8.2% in the WAR group, and 5.0% in the LMWH group). Compared with LMWH, the absolute differences were +1.3% (95% CI, −3.0% to 5.7%; P = .544) in the ASA group and +3.2% (95% CI, −1.5% to 7.8%; P = .183) in the WAR group. The risk of thromboembolism was 1.38 times higher in patients treated with thalidomide without bortezomib. Three major (0.5%) and 10 minor (1.5%) bleeding episodes were recorded. Conclusion In patients with myeloma treated with thalidomide-based regimens, ASA and WAR showed similar efficacy in reducing serious thromboembolic events, acute cardiovascular events, and sudden deaths compared with LMWH, except in elderly patients where WAR showed less efficacy than LMWH.
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Affiliation(s)
- Antonio Palumbo
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Michele Cavo
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Sara Bringhen
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Elena Zamagni
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Alessandra Romano
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Francesca Patriarca
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Davide Rossi
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Fabiana Gentilini
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Claudia Crippa
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Monica Galli
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Chiara Nozzoli
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Roberto Ria
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Roberto Marasca
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Vittorio Montefusco
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Luca Baldini
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Francesca Elice
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Vincenzo Callea
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Stefano Pulini
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Angelo M. Carella
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Renato Zambello
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Giulia Benevolo
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Valeria Magarotto
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Paola Tacchetti
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Norbert Pescosta
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Claudia Cellini
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Claudia Polloni
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Andrea Evangelista
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Tommaso Caravita
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Fortunato Morabito
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Massimo Offidani
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Patrizia Tosi
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Mario Boccadoro
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
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Shen Y, Zhou X, Wang Z, Yang G, Jiang Y, Sun C, Wang J, Tong Y, Guo H. Coagulation profiles and thromboembolic events of bortezomib plus thalidomide and dexamethasone therapy in newly diagnosed multiple myeloma. Leuk Res 2010; 35:147-51. [PMID: 20832859 DOI: 10.1016/j.leukres.2010.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 07/05/2010] [Accepted: 08/15/2010] [Indexed: 11/17/2022]
Abstract
Patients with multiple myeloma (MM) are at relatively high risk of developing thromboembolic event (TEE), especially during treatment with immunomodulatory agents. We characterized coagulation profiles and evaluate the incidence of TEE associated with the combination therapy of bortezomib-thalidomide-dexamethasone (VTD) in Chinese patients with newly diagnosed MM. The results indicated that the platelet count and platelet aggregation induced by the agonists were decreased after a short exposure to bortezomib in vivo. The incidence of TEE was low in VTD therapy for an overall rate of 3%. We do not recommend routine thromboprophylaxis for VTD therapy in Chinese patients with MM.
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Affiliation(s)
- Yunfeng Shen
- Department of Hematology, Wuxi People's Hospital, Nanjing Medical University, 299 Qingyang Road, Wuxi 214023, China
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Uaprasert N, Voorhees PM, Mackman N, Key NS. Venous thromboembolism in multiple myeloma: Current perspectives in pathogenesis. Eur J Cancer 2010; 46:1790-9. [PMID: 20385482 DOI: 10.1016/j.ejca.2010.03.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 03/01/2010] [Accepted: 03/11/2010] [Indexed: 12/11/2022]
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Musallam KM, Taher AT. Re: Anti-angiogenic therapy using thalidomide combined with chemotherapy in small cell lung cancer: a randomized, double-blind, placebo-controlled trial. J Natl Cancer Inst 2009; 101:1657; author reply 1657-8. [PMID: 19858426 DOI: 10.1093/jnci/djp371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hiroi T, Deming CB, Zhao H, Hansen BS, Arkenbout EK, Myers TJ, McDevitt MA, Rade JJ. Proteasome inhibitors enhance endothelial thrombomodulin expression via induction of Krüppel-like transcription factors. Arterioscler Thromb Vasc Biol 2009; 29:1587-93. [PMID: 19661484 DOI: 10.1161/atvbaha.109.191957] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Impairment of the thrombomodulin-protein C anticoagulant pathway has been implicated in pathological thrombosis associated with malignancy. Patients who receive proteasome inhibitors as part of their chemotherapeutic regimen appear to be at decreased risk for thromboembolic events. We investigated the effects of proteasome inhibitors on endothelial thrombomodulin expression and function. METHODS AND RESULTS Proteasome inhibitors as a class markedly induced the expression of thrombomodulin and enhanced the protein C activating capacity of endothelial cells. Thrombomodulin upregulation was independent of NF-kappaB signaling, a principal target of proteasome inhibitors, but was instead a direct consequence of increased expression of the Krüppel-like transcription factors, KLF2 and KLF4. These effects were confirmed in vivo, where systemic administration of a proteasome inhibitor enhanced thrombomodulin expression that was paralleled by changes in the expression of KLF2 and KLF4. CONCLUSIONS These findings identify a novel mechanism of action of proteasome inhibitors that may help to explain their clinically observed thromboprotective effects.
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Affiliation(s)
- Toyoko Hiroi
- Department of Medicine, Johns Hopkins School of Medicine, Ross 1165, 720 Rutland Avenue, Baltimore, MD 21205, USA
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