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Dimopoulos MA, Coriu D, Delimpasi S, Špička I, Upchurch T, Fang B, Talpur R, Faber E, Beksac M, Leleu X. A.R.R.O.W.2: once- vs twice-weekly carfilzomib, lenalidomide, and dexamethasone in relapsed/refractory multiple myeloma. Blood Adv 2024; 8:5012-5021. [PMID: 39024542 DOI: 10.1182/bloodadvances.2024013101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/03/2024] [Accepted: 06/22/2024] [Indexed: 07/20/2024] Open
Abstract
ABSTRACT Twice-weekly carfilzomib (27 mg/m2) plus lenalidomide and dexamethasone (KRd27) is a standard of care in relapsed/refractory multiple myeloma (RRMM). Once-weekly carfilzomib regimens have shown clinical benefits with improved patient convenience. This open-label, phase 3, multicenter, randomized study aimed to demonstrate noninferiority of the overall response rate (ORR) for once-weekly carfilzomib (56 mg/m2) plus Rd (KRd56) vs twice-weekly KRd27 in RRMM. A total of 454 patients were randomized (1:1) to receive carfilzomib as once-weekly 30-minute infusions of 56 mg/m2 (KRd56; n = 228) or twice-weekly 10-minute infusions of 27 mg/m2 (KRd27; n = 226). Baseline characteristics were balanced between groups. ORR was 82.5% (95% confidence interval [CI], 76.9-87.2) in the once-weekly group vs 86.3% (95% CI, 81.1-90.5) in the twice-weekly group (risk ratio, 0.954 [95% CI, 0.882-1.032]) and did not meet the threshold for statistical significance of noninferiority (P = .0666). Complete response (CR) or better was obtained in 46.9% of patients in the once-weekly arm and 36.3% in the twice-weekly arm. The proportions of patients who achieved CR and were also assessed negative for minimal residual disease were 21.5% and 18.1%, respectively (odds ratio, 1.235 [95% CI, 0.775-1.970]). Progression-free survival was comparable between groups (hazard ratio, 0.945 [95% CI, 0.617-1.447]). The safety profile was similar for both groups. In conclusion, although statistical significance for noninferiority of ORR was not achieved, the efficacy and safety of once-weekly KRd56 were similar to those of twice-weekly KRd27, and once-weekly KRd56 may be an effective and convenient treatment option for patients with RRMM. This trial was registered at www.ClinicalTrials.gov as #NCT03859427.
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Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel Coriu
- Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania
- Department of Haematology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Sosana Delimpasi
- Department of Hematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - Ivan Špička
- First Department of Medicine, Department of Hematology, First Faculty of Medicine, Charles University and General Hospital, Prague, Czech Republic
| | | | | | | | | | - Meral Beksac
- Hematology, Ankara Liv Hospital, Istinye University, Ankara, Turkey
| | - Xavier Leleu
- Department of Hematology and Cellular Therapy, CIC U1402 CHU de Poitiers, Poitiers, France
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Bahlis NJ, Samaras C, Reece D, Sebag M, Matous J, Berdeja JG, Shustik J, Schiller GJ, Ganguly S, Song K, Seet CS, Acosta-Rivera M, Bar M, Quick D, Fonseca G, Liu H, Gentili C, Singh P, Siegel D. Pomalidomide/Daratumumab/Dexamethasone in Relapsed or Refractory Multiple Myeloma: Final Overall Survival From MM-014. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00285-4. [PMID: 39237427 DOI: 10.1016/j.clml.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/17/2024] [Accepted: 07/26/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Patients with relapsed or refractory multiple myeloma (RRMM) who have exhausted lenalidomide benefits require improved therapies. The 3-cohort phase 2 MM-014 trial (NCT01946477) explored pomalidomide in early lines of treatment for lenalidomide-exposed RRMM. In cohort B, pomalidomide plus daratumumab and dexamethasone (DPd) showed promising efficacy (median follow-up 28.4 months), as previously reported. Here, we report final overall survival (OS) in cohort B. METHODS Patients aged ≥ 18 years were treated in 28-day cycles: pomalidomide 4 mg orally daily from days 1 to 21; daratumumab 16 mg/kg intravenously on days 1, 8, 15, and 22 (cycles 1-2), days 1 and 15 (cycles 3-6), and day 1 (cycle ≥ 7); and dexamethasone 40 mg (age ≤ 75 years) or 20 mg (age > 75 years) orally on days 1, 8, 15, and 22. The primary endpoint was ORR. OS and safety were secondary endpoints. RESULTS Among 112 patients enrolled, 85 (75.9%) had lenalidomide-refractory disease and 27 (24.1%) had lenalidomide-relapsed disease. At a median follow-up of 41.9 months (range, 0.4-73.1), median OS was 56.7 months (95% confidence interval, 46.5-not reached). Treatment-emergent adverse events related to, and leading to discontinuation of, pomalidomide, dexamethasone, or daratumumab occurred in 7 (6.3%), 9 (8.0%), and 6 (5.4%) patients, respectively. CONCLUSION With long-term follow-up, our results show favorable OS with DPd. The safety profile was consistent with previous reports, with no new safety signals identified. IMiD agent-based therapy can still be considered in patients with RRMM who experience progressive disease on or after lenalidomide.
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Affiliation(s)
| | | | - Donna Reece
- Princess Margaret Hospital, Toronto, ON, Canada
| | - Michael Sebag
- McGill University Health Centre, Montreal, QC, Canada
| | - Jeffrey Matous
- Colorado Blood Cancer Institute, Sarah Cannon Research Institute, Denver, CO
| | | | | | | | | | - Kevin Song
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | | | | | - Donald Quick
- Joe Arrington Cancer Research and Treatment Center, Lubbock, TX
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Richardson PG, Perrot A, Miguel JS, Beksac M, Spicka I, Leleu X, Schjesvold F, Moreau P, Dimopoulos MA, Huang SY, Minarik J, Cavo M, Prince HM, Macé S, Zhang R, Dubin F, Morisse MC, Anderson KC. Isatuximab-pomalidomide-dexamethasone versus pomalidomide-dexamethasone in patients with relapsed and refractory multiple myeloma: final overall survival analysis. Haematologica 2024; 109:2239-2249. [PMID: 38299578 PMCID: PMC11215383 DOI: 10.3324/haematol.2023.284325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024] Open
Abstract
The primary and prespecified updated analyses of ICARIA-MM (clinicaltrial gov. Identifier: NCT02990338) demonstrated improved progression-free survival (PFS) and a benefit in overall survival (OS) was reported with the addition of isatuximab, an anti-CD38 monoclonal antibody, to pomalidomide-dexamethasone (Pd) in patients with relapsed/refractory multiple myeloma. Here, we report the final OS analysis. This multicenter, randomized, open-label, phase III study included patients who had received and failed ≥2 previous therapies, including lenalidomide and a proteasome inhibitor. Between January 10, 2017, and February 2, 2018, 307 patients were randomized (1:1) to isatuximab-pomalidomide-dexamethasone (Isa-Pd; N=154) or Pd (N=153), stratified based on age (<75 vs. ≥75 years) and number of previous lines of therapy (2-3 vs. >3). At data cutoff for the final OS analysis after 220 OS events (January 27, 2022), median follow-up duration was 52.4 months. Median OS was 24.6 months (95% confidence interval [CI]: 20.3-31.3) with Isa-Pd and 17.7 months (95% CI: 14.4- 26.2) with Pd (hazard ratio=0.78; 95% CI: 0.59-1.02; 1-sided P=0.0319). Despite subsequent daratumumab use in the Pd group and its potential benefit on PFS in the first subsequent therapy line, median PFS2 was significantly longer with Isa-Pd versus Pd (17.5 vs. 12.9 months; log-rank 1-sided P=0.0091). In this analysis, Isa-Pd continued to be efficacious and well tolerated after follow-up of approximately 52 months, contributing to a clinically meaningful, 6.9-month improvement in median OS in patients with relapsed/refractory multiple myeloma.
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Affiliation(s)
- Paul G Richardson
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA.
| | - Aurore Perrot
- CHU de Toulouse, IUCT-O, Université de Toulouse, UPS, Service d'Hématologie, Toulouse
| | - Jesus San Miguel
- Clínica Universidad de Navarra, Navarra, CCUN, CIMA, IDISNA, CIBER-ONC, Pamplona
| | - Meral Beksac
- Department of Hematology, Ankara University, Ankara, Turkey
| | - Ivan Spicka
- General Faculty Hospital, Prague, Czech Republic; First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, CHU and CIC Inserm 1402, Poitiers Cedex
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Department of Haematology, Oslo University Hospital, Oslo, Norway; KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | | | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Shang-Yi Huang
- Department of Hematology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiri Minarik
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Seràgnoli Institute of Hematology, and the Department of Medical and Surgical Sciences, Bologna University School of Medicine, Bologna, Italy
| | - H Miles Prince
- Immunology and Molecular Oncology, Epworth Healthcare, University of Melbourne, Melbourne, VIC, Australia
| | | | | | | | | | - Kenneth C Anderson
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
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Dimopoulos M, Sonneveld P, Manier S, Lam A, Roccia T, Schecter JM, Cost P, Pacaud L, Poirier A, Tremblay G, Lan T, Valluri S, Kumar S. Progression-free survival as a surrogate endpoint for overall survival in patients with relapsed or refractory multiple myeloma. BMC Cancer 2024; 24:541. [PMID: 38684948 PMCID: PMC11057089 DOI: 10.1186/s12885-024-12263-0] [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: 12/15/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES The goal of the research was to assess the quantitative relationship between median progression-free survival (PFS) and median overall survival (OS) specifically among patients with relapsed/refractory multiple myeloma (RRMM) based on published randomized controlled trials (RCTs). METHODS Two bibliographic databases (PubMed and Embase, 1970-2017) were systematically searched for RCTs in RRMM that reported OS and PFS, followed by an updated search of studies published between 2010 and 2022 in 3 databases (Embase, MEDLINE, and EBM Reviews, 2010-2022). The association between median PFS and median OS was assessed using the nonparametric Spearman rank and parametric Pearson correlation coefficients. Subsequently, the quantitative relationship between PFS and OS was assessed using weighted least-squares regression adjusted for covariates including age, sex, and publication year. Study arms were weighted by the number of patients in each arm. RESULTS A total of 31 RCTs (56 treatment arms, 10,450 patients with RRMM) were included in the analysis. The average median PFS and median OS were 7.1 months (SD 5.5) and 28.1 months (SD 11.8), respectively. The Spearman and Pearson correlation coefficients between median PFS and median OS were 0.80 (P < 0.0001) and 0.79 (P < 0.0001), respectively. In individual treatment arms of RRMM trials, each 1-month increase in median PFS was associated with a 1.72-month (95% CI 1.26-2.17) increase in median OS. CONCLUSION Analysis of the relationship between PFS and OS incorporating more recent studies in RRMM further substantiates the use of PFS to predict OS in RRMM.
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Affiliation(s)
- Meletios Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | | | | | - Abbey Poirier
- Cytel Inc. Health Economics & Outcomes Research, Waltham, MA, USA
| | - Gabriel Tremblay
- Cytel Inc. Health Economics & Outcomes Research, Waltham, MA, USA
| | - Tommy Lan
- Cytel Inc. Health Economics & Outcomes Research, Waltham, MA, USA
| | | | - Shaji Kumar
- Department of Hematology, Mayo Clinic, Rochester, MN, USA.
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Mol I, Hu Y, LeBlanc TW, Cappelleri JC, Chu H, Nador G, Aydin D, Schepart A, Hlavacek P. A matching-adjusted indirect comparison of the efficacy of elranatamab versus physician's choice of treatment in patients with triple-class exposed/refractory multiple myeloma. Curr Med Res Opin 2024; 40:199-207. [PMID: 38078866 DOI: 10.1080/03007995.2023.2277850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/27/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION For patients with triple-class exposed/refractory multiple myeloma (TCE/R MM), prognosis is poor and effective treatment options are limited. Elranatamab is a novel B-cell maturation antigen (BCMA)- and CD3-directed bispecific antibody which was approved by the US Food and Drug Administration in August 2023 and demonstrated safety and efficacy in patients with TCE/R MM in the phase 2, single-arm MagnetisMM-3 trial (NCT04649359). To compare the effectiveness of elranatamab vs physician's choice of treatment (PCT) in the absence of head-to-head comparative data, a matching-adjusted indirect comparison (MAIC) was conducted. METHODS Individual patient data from MagnetisMM-3 (Cohort A [BCMA-naïve] N = 123, 14.7 months of follow-up) were reweighted to match published summary data from two real-world studies of PCT in patients with TCE/R MM (LocoMMotion and MAMMOTH) using a propensity score-type logistic regression. Unanchored MAIC analyses were conducted according to National Institute for Health and Care Excellence (NICE) Decision Support Unit (DSU) 18 guidance. RESULTS Compared with PCT in LocoMMotion, elranatamab was associated with a significantly higher objective response rate (ORR rate difference: 37.52; 95% CI 26.20-48.83; odds ratio: 4.85; 95% CI 2.85-8.23) and complete or stringent complete response rate (≥CR rate difference: 42.29; 95% CI 31.84-52.74; odds ratio: 184.01; 95% CI 24.66-1372.86), longer progression-free survival (PFS HR 0.32; 95% CI 0.20-0.49), and overall survival (OS HR 0.62; 95% CI 0.40-0.94). Compared with PCT in MAMMOTH, elranatamab was associated with significantly higher ORR (rate difference: 28.14; 95% CI 16.77-39.52; odds ratio: 3.24; 95% CI 1.98-5.32) and ≥ CR (rate difference: 26.22; 95% CI 16.40-36.05; odds ratio: 5.48; 95% CI 2.88-10.44), as well as longer PFS (HR 0.25; 95% CI 0.17-0.37) and OS (HR 0.49; 95% CI 0.33-0.71). Sensitivity analysis results were consistent with the base case. CONCLUSION In the MAIC, elranatamab was consistently associated with improved rates and depth of response and significantly longer PFS and OS versus PCT in LocoMMotion and MAMMOTH.
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Affiliation(s)
- Isha Mol
- Cytel Inc., Rotterdam, The Netherlands
| | - Yannan Hu
- Cytel Inc., Rotterdam, The Netherlands
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Guido Nador
- Pfizer Inc., Tadworth, Surrey, United Kingdom
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Raab MS, Zamagni E, Manier S, Rodriguez‐Otero P, Schjesvold F, Broijl A. Difficult-to-treat patients with relapsed/refractory multiple myeloma: A review of clinical trial results. EJHAEM 2023; 4:1117-1131. [PMID: 38024633 PMCID: PMC10660429 DOI: 10.1002/jha2.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 12/01/2023]
Abstract
Overall outcomes for multiple myeloma have improved due to the availability of new therapies, but patients with relapsed/refractory multiple myeloma harbouring certain factors continue to pose a therapeutic challenge. These challenging features include high-risk cytogenetics, renal impairment, patient characteristics such as age and frailty, and extramedullary disease. Prior refractory status and number of prior lines add further complexity to the treatment of these patients. While newer regimens are available and have suggested efficacy in these patient populations through subgroup analyses, differences in trial definitions and cut-offs make meaningful comparisons difficult. This review aims to examine the available clinical trial data for patients with high-risk cytogenetics, renal impairment, age and frailty and extramedullary disease.
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Affiliation(s)
- Marc S. Raab
- Heidelberg Myeloma Center, Department of Medicine VUniversity HospitalHeidelbergGermany
| | - Elena Zamagni
- Seragnoli Institute of HematologyBologna University School of MedicineBolognaItaly
| | - Salomon Manier
- Department of HematologyUniversity Hospital Center of LilleLilleFrance
| | | | - Fredrik Schjesvold
- Oslo Myeloma Center, Department of HaematologyOslo University Hospital, Oslo, Norway, and KG Jebsen Center for B Cell MalignanciesUniversity of OsloOsloNorway
| | - Annemiek Broijl
- Department of HematologyErasmus MC Cancer InstituteRotterdamThe Netherlands
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Dachs LR, Gaisán CM, Bustamante G, López SG, García EG, Persona EP, González-Calle V, Auzmendi MS, Pérez JMA, González Montes Y, Ríos Tamayo R, de Miguel Llorente D, Bernal LP, Mayol AS, Caro CC, Grande M, Fernández-Nistal A, Naves A, Miguel EMOS. Assessment of the psychometric properties of the Spanish version of EORTC QLQ-MY20 and evaluation of health-related quality of Life outcomes in patients with relapsed and/or refractory multiple myeloma in the real-world setting in Spain: results from the CharisMMa study. Leuk Lymphoma 2023; 64:1847-1856. [PMID: 37539698 DOI: 10.1080/10428194.2023.2240922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
We evaluated the psychometric properties of the Spanish version of the European Organization for Research and Treatment of Multiple Myeloma (MM) specific quality-of-life (QoL) questionnaire module (QLQ-MY20) in relapsed/refractory MM (RRMM) patients. This was an observational, cross-sectional, multicenter study using EORTC QLQ-C30 and QLQ-MY20 in RRMM patients (ClinicalTrials.gov ID NCT03188536). We assessed the non-response rate, ceiling/floor effects, internal consistency, test-retest reliability, and validity. The study included 276 patients (53.3% males, mean [SD] age of 67.4 [10.5] years). The EORTC QLQ-MY20 showed a low non-response rate, very low ceiling and floor effects, and good internal consistency. The test-retest reliability assessment revealed good temporary stability, the construct validity analysis stated four main factors similar to the ones of the original version, and the criterion validity assessment showed no differences between groups. In conclusion, the Spanish version of EORTC QLQ-MY20 is a reliable and valid tool for assessing QoL in RRMM patients.
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Affiliation(s)
| | - Carmen Montes Gaisán
- Hospital Universitario Marqués de Valdecilla (IDIVAL). Universidad de Cantabria. Santander, Spain
| | | | | | | | - Ernesto Pérez Persona
- Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Spain
- Osakidetza. Hospital Universitario de Álava. Vitoria-Gasteiz, Spain
| | - Verónica González-Calle
- Hospital Universitario de Salamanca (HUS/IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red (CIBERONC), Spain
- Instituto Universitario de Biología Molecular y Celular del Cáncer - IBMCC (USAL-CSIC), Salamanca, Spain
| | | | | | | | | | | | | | | | | | - Marta Grande
- Takeda Farmacéutica España, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
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Davies FE, Leleu X, Vogel P, Dhanasiri S, Le Nouveau P, Weisel K. A Meta-Analysis of the Efficacy of Pomalidomide-Based Regimens for the Treatment of Relapsed/Refractory Multiple Myeloma After Lenalidomide Exposure. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:829-837.e1. [PMID: 37684184 DOI: 10.1016/j.clml.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION The objective was to assess the benefit of pomalidomide-based combination regimens in patients with relapsed/refractory multiple myeloma (RRMM) previously treated with lenalidomide. A pooled estimate was obtained for efficacy outcomes including overall response rate (ORR), complete response (CR) rate, and progression-free survival (PFS) based on multiple trials conducted in this patient population. PATIENTS AND METHODS A literature search was conducted on March 22, 2022 for relevant trials published between January 1, 2016 and the search date. The search identified 12 eligible trials with publications dated between 2016 and 2021. The meta-analyses were conducted among the intention-to-treat (ITT) population (patients treated in all lines of therapy) and 2 subpopulations: 2L (only patients treated in the second line [2L]) and ≥2L (patients treated in the 2L and beyond). RESULTS From the meta-analyses, ORR was 69.9% for ITT, 74.4% for ≥2L, and 87.2% for 2L. CR rate was 12.1% for ITT, 17.6% for ≥2L, and 29.7% for 2L. One-year PFS rates were 55.1% for ITT, 59.1% for ≥2L, and 74.0% for 2L. Two-year PFS rates were 29.3% for ITT, 36.0% for ≥2L, and 41.9% for 2L. CONCLUSION Pomalidomide-based combination regimens were effective in patients with RRMM previously treated with lenalidomide and tended to be associated with better outcomes when used earlier in the treatment pathway. A drug class switch may not always be necessary when making treatment decisions for patients with RRMM for whom the benefits of lenalidomide have been exhausted, although this must be supported by comparative studies.
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Affiliation(s)
| | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, Hôpital La Milétrie, CHU, Poitiers, France
| | - Prisca Vogel
- Celgene, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | | | | | - Katja Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Chen M, Jiang J, Hou J. Single-cell technologies in multiple myeloma: new insights into disease pathogenesis and translational implications. Biomark Res 2023; 11:55. [PMID: 37259170 PMCID: PMC10234006 DOI: 10.1186/s40364-023-00502-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/12/2023] [Indexed: 06/02/2023] Open
Abstract
Multiple myeloma (MM) is a hematological malignancy characterized by clonal proliferation of plasma cells. Although therapeutic advances have been made to improve clinical outcomes and to prolong patients' survival in the past two decades, MM remains largely incurable. Single-cell sequencing (SCS) is a powerful method to dissect the cellular and molecular landscape at single-cell resolution, instead of providing averaged results. The application of single-cell technologies promises to address outstanding questions in myeloma biology and has revolutionized our understanding of the inter- and intra-tumor heterogeneity, tumor microenvironment, and mechanisms of therapeutic resistance in MM. In this review, we summarize the recently developed SCS methodologies and latest MM research progress achieved by single-cell profiling, including information regarding the cancer and immune cell landscapes, tumor heterogeneities, underlying mechanisms and biomarkers associated with therapeutic response and resistance. We also discuss future directions of applying transformative SCS approaches with contribution to clinical translation.
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Affiliation(s)
- Mengping Chen
- Department of Hematology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Jinxing Jiang
- Department of Hematology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Jian Hou
- Department of Hematology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
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10
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Dimopoulos MA, San-Miguel J. Reply to S. Al Hadidi et al. J Clin Oncol 2023; 41:1789-1790. [PMID: 36626698 DOI: 10.1200/jco.22.02438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Meletios A Dimopoulos
- Meletios A. Dimopoulos, MD, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; and Jesús San-Miguel, MD, PhD, Clínica Universidad de Navarra (CCUN), Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain
| | - Jesús San-Miguel
- Meletios A. Dimopoulos, MD, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; and Jesús San-Miguel, MD, PhD, Clínica Universidad de Navarra (CCUN), Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain
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11
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Dimopoulos MA, Dytfeld D, Grosicki S, Moreau P, Takezako N, Hori M, Leleu X, LeBlanc R, Suzuki K, Raab MS, Richardson PG, Popa McKiver M, Jou YM, Yao D, Das P, San-Miguel J. Elotuzumab Plus Pomalidomide and Dexamethasone for Relapsed/Refractory Multiple Myeloma: Final Overall Survival Analysis From the Randomized Phase II ELOQUENT-3 Trial. J Clin Oncol 2023; 41:568-578. [PMID: 35960908 PMCID: PMC9870233 DOI: 10.1200/jco.21.02815] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE In the phase II ELOQUENT-3 trial (ClinicalTrials.gov identifier: NCT02654132), elotuzumab combined with pomalidomide/dexamethasone (EPd) significantly improved progression-free survival (PFS) versus pomalidomide/dexamethasone (Pd) in patients with relapsed/refractory multiple myeloma (RRMM) previously treated with lenalidomide and a proteasome inhibitor (PI). Here, we present the final overall survival (OS) results. METHODS Patients with RRMM who had received ≥ 2 prior lines of therapy, with disease refractory to last therapy and either refractory or relapsed and refractory to lenalidomide and a PI were randomly assigned (1:1) to receive EPd or Pd. The primary end point was PFS per investigator assessment. ORR and OS were secondary end points planned to be tested hierarchically. RESULTS A total of 117 patients were randomly assigned to EPd (n = 60) and Pd (n = 57). Among treated patients (EPd 60, Pd 55), there were 37 (61.7%) deaths in the EPd group and 41 (74.5%) in the Pd group, most commonly because of disease progression (EPd 41.7%, Pd 49.1%). Median (95% CI) OS was significantly improved with EPd (29.8 [22.9 to 45.7] months) versus Pd (17.4 [13.8 to 27.7] months), with a hazard ratio of 0.59 (95% CI, 0.37 to 0.93; P = .0217). OS benefit with EPd was observed in most patient subgroups. The safety profile of EPd was consistent with prior reports with no new safety signals detected. CONCLUSION EPd demonstrated a statistically significant improvement in OS versus Pd in patients with RRMM previously treated with lenalidomide and a PI who had disease refractory to last therapy. In this setting, ELOQUENT-3 is the first randomized study of a triplet regimen incorporating a monoclonal antibody and Pd to improve both PFS and OS significantly.
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Affiliation(s)
- Meletios A. Dimopoulos
- National and Kapodistrian University of Athens School of Medicine, Athens, Greece,Meletios A. Dimopoulos, MD, National and Kapodistrian University of Athens School of Medicine, Alexandra Hospital, 80 Vasilissis Sofias Ave, Athens 11528, Greece; e-mail:
| | - Dominik Dytfeld
- Karol Marcinkowski University of Medical Sciences, Poznań, Poland
| | | | | | - Naoki Takezako
- National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Mitsuo Hori
- Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Xavier Leleu
- Centre Hospitalier Universitaire de Poitiers–La Milétrie, Poitiers, France
| | - Richard LeBlanc
- Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Québec, Canada
| | | | - Marc S. Raab
- Heidelberg University Hospital, Heidelberg, Germany
| | | | | | | | | | | | - Jesús San-Miguel
- Clínica Universidad de Navarra (CCUN), Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain
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12
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Gatopoulou X, Iraqi W, Morgan K, Helme K, Spain VA, Redfearn J, Gardiner B. The Burden of a Multiple Myeloma Diagnosis on Patients and Caregivers in the First Year: Western European Findings. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022; 14:731-753. [PMID: 36569430 PMCID: PMC9769147 DOI: 10.2147/ceor.s367458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022] Open
Abstract
Background This research aimed to quantify the burden of illness (BoI) in transplant eligible (TE) and transplant non-eligible (TNE) newly diagnosed multiple myeloma (NDMM) patients and their caregivers, in the first year after diagnosis: at months 0, 3, and 12. Methods Prospective, cross-sectional, observational NDMM study of TE and TNE patients and their caregivers from France, Germany, Italy, and Spain was conducted between May 2019 and January 2021. A structured, online questionnaire measuring disease burden, direct and costs, out-of-pocket expenses, and health-related quality of life (HRQoL) was used. Descriptive statistics were performed. Results A total of 164, 160, and 190 NDMM patients [>65 years; self-described healthy; not working; living with caregiver] answered at months 0, 3, and 12. Patients lost independence to perform daily activities; mean pain intensity rose and opioid utilization increased, more significantly among TNE patients. Overall health status and HRQoL remained stable. Median 3-month direct medical costs peaked at month 3. Specialist consultations and hospital admissions were the greatest cost amongst TE and TNE patients. Home adaptations increased out-of-pocket expenditures amongst TNE patients. Patients describing themselves as working spent a median 0 hours in the office at all time points. A total of 131, 122, and 124 caregivers answered at months 0, 3, and 12. Mean self-rated burden score rose. By month 12, half of caregivers developed stress, anxiety or depression. Most employed caregivers continued working. Productivity was low at month 0 with a trend of recovering at month 12. Caregivers of TNE compared to TE patients reported greater time burden. Caregivers' HRQoL was stable over time. Conclusion NDMM is burdensome for patients and caregivers in the first year after diagnosis. TNE patients are more dependent on caregivers and incur higher care costs than TE patients. Despite the financial, physical, and emotional burden, HRQoL remains stable possibly indicating resilience and illness adjustment amongst patients and caregivers.
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Affiliation(s)
- Xenia Gatopoulou
- Health Economics, Market Access and Reimbursement EMEA, Janssen Pharmaceuticals, Athens, Greece
| | - Wafae Iraqi
- Patient Engagement, Janssen Pharmaceuticals, Issy-les-Moulineaux, France,Correspondence: Wafae Iraqi, Janssen Pharmaceuticals, 1, Rue Camille Desmoulins, TSA 91003, Issy-les-Moulineaux, 92787, France, Email
| | | | - Kawitha Helme
- Health Economics, Market Access and Reimbursement EMEA, Janssen Pharmaceuticals, High Wycombe, UK
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13
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Gu J, Wu Q, Zhang Q, You Q, Wang L. A decade of approved first-in-class small molecule orphan drugs: Achievements, challenges and perspectives. Eur J Med Chem 2022; 243:114742. [PMID: 36155354 DOI: 10.1016/j.ejmech.2022.114742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 12/01/2022]
Abstract
In the past decade (2011-2020), there was a growing interest in the discovery and development of orphan drugs for the treatment of rare diseases. However, rare diseases only account for a population of 0.65‰-1‰ which usually occur with previously unknown biological mechanisms and lack of specific therapeutics, thus to increase the demands for the first-in-class (FIC) drugs with new biological targets or mechanisms. Considering the achievements in the past 10 years, a total of 410 drugs were approved by U.S. Food and Drug Administration (FDA), which contained 151 FIC drugs and 184 orphan drugs, contributing to make up significant numbers of the approvals. Notably, more than 50% of FIC drugs are developed as orphan drugs and some of them have already been milestones in drug development. In this review, we aim to discuss the FIC small molecules for the development of orphan drugs case by case and highlight the R&D strategy with novel targets and scientific breakthroughs.
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Affiliation(s)
- Jinying Gu
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of Drug Design and Optimization, China Pharmaceutical University, Nanjing, 210009, China; Department of Medicinal Chemistry, School of Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Qiuyu Wu
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of Drug Design and Optimization, China Pharmaceutical University, Nanjing, 210009, China; Department of Medicinal Chemistry, School of Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Qiuyue Zhang
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of Drug Design and Optimization, China Pharmaceutical University, Nanjing, 210009, China; Department of Medicinal Chemistry, School of Pharmacy, China Pharmaceutical University, Nanjing, 210009, China
| | - Qidong You
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of Drug Design and Optimization, China Pharmaceutical University, Nanjing, 210009, China; Department of Medicinal Chemistry, School of Pharmacy, China Pharmaceutical University, Nanjing, 210009, China.
| | - Lei Wang
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of Drug Design and Optimization, China Pharmaceutical University, Nanjing, 210009, China; Department of Medicinal Chemistry, School of Pharmacy, China Pharmaceutical University, Nanjing, 210009, China.
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Treatment Options for Patients With Heavily Pretreated Relapsed and Refractory Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:460-473. [PMID: 35148975 DOI: 10.1016/j.clml.2022.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 01/02/2023]
Abstract
Despite the increasing number of treatment options available for multiple myeloma, relapse is still inevitable and there remains a critical unmet need for treatments for patients with late-stage, highly refractory disease. In this review, we discuss currently approved treatment options for heavily pretreated patients with relapsed and refractory multiple myeloma, with a focus on the optimal management of patients with MM refractory to lenalidomide, bortezomib, and in some cases, daratumumab or an anti-CD38 monoclonal antibody. Data from recent clinical trials of immunomodulatory agents (pomalidomide), proteasome inhibitors (PIs; carfilzomib and ixazomib), monoclonal antibodies (elotuzumab, daratumumab, and isatuximab), and other novel therapies (including panobinostat-based therapy) are summarized. We also provide potential therapeutic strategies for patients according to different treatment histories, and include case studies to illustrate the practical use of various treatment options in a clinical setting. Regimens containing pomalidomide, elotuzumab, next-generation PIs, panobinostat, or selinexor may provide effective treatment options in patients with triple-refractory disease. The choice of agents used, and combinations thereof should be individualized as well as strategically planned from early- to late-stage relapse.
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15
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Nathwani N, Bell J, Cherepanov D, Sowell FG, Shah R, McCarrier K, Hari P. Patient perspectives on symptoms, health-related quality of life, and treatment experience associated with relapsed/refractory multiple myeloma. Support Care Cancer 2022; 30:5859-5869. [PMID: 35364733 PMCID: PMC9135799 DOI: 10.1007/s00520-022-06979-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/10/2022] [Indexed: 12/15/2022]
Abstract
Purpose This study aimed to better understand the patient perspective and treatment experience of relapsed and/or refractory multiple myeloma (RRMM). Methods This qualitative study enrolled adult RRMM patients from 6 US clinics who had ≥ 3 months of life expectancy, ≤ 6 prior lines of therapy, and ≥ 1 treatment regimen with a proteasome inhibitor and immunomodulator, or a CD38 monoclonal antibody or an alkylating agent, and a steroid. In-person semi-structured qualitative interviews were conducted to capture concepts that were relevant and important to patients. Topics included RRMM symptoms and impacts and the mode of administration, frequency, duration, convenience, side effects, and overall experience with RRMM treatment. Results A total of 22 patients completed interviews. At enrollment, 59.1% of participants were using regimens containing dexamethasone, 36.4% daratumumab, 27.3% carfilzomib, and 18.2% lenalidomide. More participants had experience using intravenous or injectable therapy alone (40.9%) than oral therapy alone (18.2%). Back pain and fatigue were the most frequently reported symptoms (40.9% each); 27.3% reported no symptoms. Most participants reported physical function limitations (86.4%), emotional impacts (77.3%), MM-related activity limitations (72.7%), and sleep disturbances (63.6%). Most participants perceived treatment effectiveness based on physician-explained clinical signs (68.2%) and symptom relief (40.9%). Participants experienced gastrointestinal adverse events (59.1%), fatigue (59.1%), sleep disturbances (31.8%), and allergic reactions (31.8%) with treatment. Key elements of treatment burden included the duration of a typical treatment day (68.2%), treatment interfering with daily activities (54.5%), and infusion duration (50.0%). Conclusions These results provide treatment experience–related data to further understand RRMM treatment burden and better inform treatment decision-making. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-06979-7.
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Affiliation(s)
- Nitya Nathwani
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope Medical Center, Duarte, CA, USA.
| | - Jill Bell
- Takeda Development Center Americas, Inc (TDCA), Lexington, MA, USA
| | - Dasha Cherepanov
- Takeda Development Center Americas, Inc (TDCA), Lexington, MA, USA
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16
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Gasparetto C, Bowles KM, Abdallah AO, Morris L, Mander G, Coppola S, Wang J, Ross JA, Bueno OF, Arriola E, Mateos MV. A Phase II Study of Venetoclax in Combination With Pomalidomide and Dexamethasone in Relapsed/Refractory Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:775-784. [PMID: 34551886 DOI: 10.1016/j.clml.2021.07.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/29/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Venetoclax is a selective BCL-2 inhibitor with clinical activity in relapsed/refractory multiple myeloma (RRMM). Combinations of venetoclax with agents that have complementary mechanisms of action may improve venetoclax efficacy in RRMM. This study evaluated venetoclax with pomalidomide and dexamethasone (VenPd) in RRMM. PATIENTS AND METHODS This phase II open label study (NCT03567616) evaluated VenPd in patients with RRMM who had received ≥ 1 prior therapy and were refractory to lenalidomide. Venetoclax was administered orally daily for days 1 to 28, pomalidomide was administered orally daily for days 1 to 21, and dexamethasone was administered weekly for each 28-day cycle. The primary objective was to characterize the safety and tolerability of VenPd. The secondary objectives were to evaluate the efficacy and pharmacokinetics. The study was terminated early due to partial clinical hold and decision to pursue biomarker driven strategy. RESULTS Eight patients were enrolled. Patients had a median age of 67.5 years. All patients received 400 mg venetoclax; 4 patients experienced dose-limiting toxicities and the dose was not escalated. All patients had a grade ≥ 3 adverse event, and the most common was neutropenia (n = 6); cytopenias were the most prevalent adverse events. Five patients (63%) had a confirmed response, and the median duration of response was 12.9 months. The median progression-free survival was 10.5 months. CONCLUSIONS Given the limited enrollment, no clear safety or efficacy conclusions about VenPd can be drawn. Preliminary safety data, particularly the occurrence of cytopenias, can be used to guide dosing strategies for future combinations of venetoclax with immunomodulatory agents.
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Affiliation(s)
| | - Kristian M Bowles
- Department of Haematology, Norfolk and Norwich University Hospitals NHS Trust, and Norwich Medical School, Norwich, United Kingdom
| | - Al-Ola Abdallah
- Division of Hematological Malignancies and Cellular Therapeutics, University of Kansas, Lawrence, KS
| | | | | | | | | | | | | | | | - Maria Victoria Mateos
- Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Instituto de Biología Molecular y Celular del Cáncer (Universidad de Salamanca-Consejo Superior de Investigaciones Científicas), CIBERONC, Salamanca, Spain
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17
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Xu J, Bai R. Effects of comprehensive care in patients with multiple myeloma with cardiac dysfunction. Am J Transl Res 2021; 13:4844-4851. [PMID: 34150066 PMCID: PMC8205761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the effect of comprehensive care on cardiac and renal function indices, treatment compliance, self-care ability and quality of life in patients with multiple myeloma combined with cardiac dysfunction. METHODS A total of 53 patients diagnosed with multiple myeloma combined with cardiac dysfunction admitted to our hospital were enrolled and divided into the control group (n=25) and the experimental group (n=28) by the method of random number table. Patients in the control group were given routine nursing care, while patients in the experimental group were given comprehensive care on the basis of the routine nursing care of the control group. The changes in cardiac and renal function indices, treatment compliance, self-care ability, and quality of life were observed after intervention of different nursing methods in the two groups. RESULTS The levels of left ventricular ejection fraction, brain natriuretic peptide, N-terminal pro-brain natriuretic peptide, glomerular filtration rate, serum creatinine, and uric acid in the experimental group were significantly improved after intervention, showing significant differences between the two groups (P<0.05). The treatment compliance in the experimental group (92.86%) was significantly higher than that in the control group (68%). The scores of self-care ability and quality of life in the experimental group were significantly higher than those in the control group after intervention (P<0.05). CONCLUSION Comprehensive care can significantly help to improve cardiac and renal functions, treatment compliance, self-care ability and quality of life in patients with multiple myeloma combined with cardiac dysfunction, which is of great clinical significance.
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Affiliation(s)
- Jinglu Xu
- Department of Hematology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou UniversityHuzhou 313000, Zhejiang Province, China
| | - Ru Bai
- Department of Cardiology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou UniversityHuzhou 313000, Zhejiang Province, China
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18
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Alsouqi A, Khan M, Dhakal B, Du L, Harrell S, Hari P, Cornell RF. KD-PACE Salvage Therapy for Aggressive Relapsed Refractory Multiple Myeloma, Plasma Cell Leukemia and Extramedullary Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:526-535. [PMID: 33985931 DOI: 10.1016/j.clml.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patients with advanced/aggressive multiple myeloma have limited treatment options to achieve rapid disease control. In eligible patients, bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide is often used. However, many patients are refractory to or have toxicities from bortezomib and there is a need for bridging therapy. We have used a modified regimen incorporating the second-generation proteasome inhibitor carfilzomib (carfilzomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide [KD-PACE]) instead of bortezomib for relapsed/refractory multiple myeloma. PATIENTS AND METHODS This 2-center retrospective study included consecutive patients receiving KD-PACE for relapsed or refractory multiple myeloma, plasma cell leukemia, or extramedullary myeloma. The primary outcome was the feasibility of KD-PACE as a bridging therapy to a more definitive treatment option. RESULTS Fifty-two patients were included. The median age was 57 years, and 67% were male. Thirty-one patients were bridged with KD-PACE to autologous hematopoietic stem cell transplant (29%), allogenic hematopoietic stem cell transplant (27%), or a clinical trial (12%). Patients bridged to autologous hematopoietic stem cell transplant, allogenic hematopoietic stem cell transplant, or a clinical trial had a superior progression-free survival (8.3 months vs 2.3 months in the nonbridged group; P < .001) and overall survival (median, 16.7 months vs 4.3 months in the nonbridged group; P < .001). No unexpected toxicities occurred from the treatment regimen. CONCLUSION KD-PACE is a promising treatment option for select patients with advanced/aggressive forms of myeloma requiring rapid disease control before a more definitive salvage therapy such as auto/allotransplantation or a clinical trial.
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Affiliation(s)
- Aseel Alsouqi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Muhammad Khan
- Department of Medicine, Division of Hematology and Oncology Medical College of Wisconsin, Milwaukee, WI, USA
| | - Binod Dhakal
- Department of Medicine, Division of Hematology and Oncology Medical College of Wisconsin, Milwaukee, WI, USA
| | - Liping Du
- Department of Biostatistics, Vanderbilt Center for Quantitative Sciences, Nashville, TN, USA
| | - Shelton Harrell
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Parameswaran Hari
- Department of Medicine, Division of Hematology and Oncology Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert F Cornell
- Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
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Richter J, Ramasamy K, Rasche L, Bladé J, Zweegman S, Davies F, Dimopoulos M. Management of patients with difficult-to-treat multiple myeloma. Future Oncol 2021; 17:2089-2105. [PMID: 33706558 DOI: 10.2217/fon-2020-1280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Newer treatments for multiple myeloma (MM) have improved response rates and survival for many patients. However, MM remains challenging to treat due to the propensity for multiple relapses, cumulative and emergent toxicities from prior therapies and increasing genomic complexity that arises due to clonal evolution. In particular, patients with relapsed/refractory MM often require increased complexity of treatment, yet still experience poorer outcomes compared with patients who are newly diagnosed. Additionally, several patient subgroups, including those with extramedullary disease and patients who are frail and/or have multiple comorbidities, have an unfavorable prognosis and remain undertreated. This review (based on an Updates-in-Hematology session at the 25th European Hematology Association Annual Congress 2020) discusses the management of these difficult-to-treat patients with MM.
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Affiliation(s)
- Joshua Richter
- Icahn School of Medicine at Mount Sinai Tisch Cancer Institute, NY 10029, USA
| | - Karthik Ramasamy
- Department of Clinical Haematology, Oxford University Hospitals, NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Leo Rasche
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, 97080, Germany
| | - Joan Bladé
- Department of Hematology, Hospital Clinic, Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Sonja Zweegman
- Department of Haematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, 1081 HV, The Netherlands
| | - Faith Davies
- Perlmutter Cancer Center, NYU Langone Health, NY 10016, USA
| | - Meletios Dimopoulos
- Department of Clinical Therapeutics, Hematology & Medical Oncology, National & Kapodistrian University of Athens, School of Medicine, Athens, 157 72, Greece
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20
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Siegel DS, Schiller GJ, Samaras C, Sebag M, Berdeja J, Ganguly S, Matous J, Song K, Seet CS, Talamo G, Acosta-Rivera M, Bar M, Quick D, Anz B, Fonseca G, Reece D, Pierceall WE, Chung W, Zafar F, Agarwal A, Bahlis NJ. Pomalidomide, dexamethasone, and daratumumab in relapsed refractory multiple myeloma after lenalidomide treatment. Leukemia 2020; 34:3286-3297. [PMID: 32376855 PMCID: PMC7685974 DOI: 10.1038/s41375-020-0813-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/06/2020] [Accepted: 03/20/2020] [Indexed: 12/16/2022]
Abstract
Patients with multiple myeloma who have relapsed after or become refractory to lenalidomide in early treatment lines represent a clinically important population in need of effective therapies. The safety and efficacy of pomalidomide, low-dose dexamethasone, and daratumumab was evaluated in lenalidomide-pretreated patients with relapsed or refractory multiple myeloma (RRMM) after one to two prior treatment lines in the phase 2 MM-014 study. Patients received pomalidomide 4 mg daily from days 1-21 and dexamethasone 40 mg weekly (28-day cycles). Daratumumab 16 mg/kg was administered per label. Primary endpoint was overall response rate (ORR); secondary endpoints included progression-free survival (PFS) and safety. Per protocol, all patients (N = 112) had received lenalidomide in their most recent prior regimen (75.0% lenalidomide refractory). ORR was 77.7% (76.2% in lenalidomide-refractory patients); median follow-up was 17.2 months. Median PFS was not reached (1-year PFS rate 75.1%). The most common hematologic grade 3/4 treatment-emergent adverse event was neutropenia (62.5%). Grade 3/4 infections were reported in 31.3% of patients, including 13.4% with grade 3/4 pneumonia. These results demonstrate the safety and efficacy of pomalidomide-based therapy as early as second line in patients with RRMM, even immediately after lenalidomide failure, indicating that switching from the immunomodulatory agent class is not necessary.
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Affiliation(s)
- David S Siegel
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA.
| | - Gary J Schiller
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | | | - Michael Sebag
- McGill University Health Centre, Montreal, QC, Canada
| | | | | | | | - Kevin Song
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Christopher S Seet
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | | | | | | | - Donald Quick
- Joe Arrington Cancer Research and Treatment Center, Lubbock, TX, USA
| | | | | | - Donna Reece
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | - Nizar J Bahlis
- Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada
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Leleu X, Beksac M, Chou T, Dimopoulos M, Yoon SS, Prince HM, Pour L, Shelekhova T, Chari A, Khurana M, Zhang J, Obreja M, Qi M, Oriol A, Siegel D. Efficacy and safety of weekly carfilzomib (70 mg/m 2), dexamethasone, and daratumumab (KdD70) is comparable to twice-weekly KdD56 while being a more convenient dosing option: a cross-study comparison of the CANDOR and EQUULEUS studies. Leuk Lymphoma 2020; 62:358-367. [PMID: 33112184 DOI: 10.1080/10428194.2020.1832672] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The regimen of carfilzomib, daratumumab, and dexamethasone (KdD) shows activity in patients with relapsed/refractory multiple myeloma. KdD at the twice-weekly 56 mg/m2 carfilzomib dose (KdD56) was used in the randomized phase 3 CANDOR study (NCT03158688), whereas KdD at the once-weekly 70 mg/m2 carfilzomib dose (KdD70) was used in the phase 1 b EQUULEUS study (NCT01998971). We analyzed efficacy data from comparable CANDOR and EQUULEUS patients using inverse probability of treatment weighting (IPTW)-adjusted models. These weights were calculated from propensity scores derived to balance prespecified baseline covariates. The side-by-side and adjusted comparisons showed similar efficacy for overall response rates and progression-free survival in the two groups, with a series of sensitivity analyses showing consistent findings. Safety data were generally consistent with the known safety profiles of each individual drug. Once-weekly KdD70 is comparable to twice-weekly KdD56 in terms of efficacy and safety while being a more convenient dosing option.
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Affiliation(s)
- Xavier Leleu
- Service d'Hématologie et Thérapie cellulaire, CHU and Inserm, Poitiers, France
| | - Meral Beksac
- Department of Hematology, Ankara University, Ankara, Turkey
| | - Takaaki Chou
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Meletios Dimopoulos
- Hematology and Medical Oncology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - H Miles Prince
- Epworth Healthcare and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Ajai Chari
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Khurana
- Clinical Development, Oncology, Amgen Inc., Thousand Oaks, CA, USA
| | - Jianqi Zhang
- Global Biostatistical Science, Amgen Inc., Thousand Oaks, CA, USA
| | - Mihaela Obreja
- Global Biostatistical Science, Amgen Inc., Thousand Oaks, CA, USA
| | - Ming Qi
- Hematology and Oncology, Janssen Research and Development, LLC, Spring House, PA, USA
| | - Albert Oriol
- Institut Català d'Oncologia and Josep Carreras Research Leukaemia Institute, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - David Siegel
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
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22
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Outcomes of Daratumumab, Pomalidomide, and Dexamethasone, Followed by High-dose Chemotherapy and Autologous Stem Cell Transplantation, in Patients With Relapsed/Refractory Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e212-e219. [PMID: 33051166 DOI: 10.1016/j.clml.2020.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/03/2020] [Accepted: 08/29/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The number of therapeutic options for patients with relapsed/refractory multiple myeloma (RRMM) has increased significantly. Our institute treated a series of patients with RRMM using DPd (daratumumab, pomalidomide, dexamethasone) as salvage therapy, followed by high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT). PATIENTS AND METHODS We treated 18 patients with RRMM from May 2016 to April 2020, with DPd as salvage therapy, followed by HDCT and ASCT. DPd was administered as daratumumab 16 mg/kg weekly for cycles 1 and 2, every 2 weeks for cycles 3 to 6, and then every 4 weeks. Pomalidomide was given at 4 mg orally on days 1 to 21 of a 28-day cycle, and dexamethasone at 20 or 40 mg weekly. RESULTS The patients had received a median of 2 (range, 1-4) previous regimens. Of the 18 patients, 13 (72%) had received ASCT before this treatment. In addition, 78% had disease refractory to proteasome inhibitors, 78% refractory to immunomodulatory agents, and 72% double refractory to immunomodulatory agents and proteasome inhibitors. The overall response rate after salvage treatment with DPd was 100% and at day 100 after ASCT was 100%; 67% had achieved a complete response or better and 78% had achieved a very good partial response or better. No treatment-related mortality had occurred by day 100. The 2-year progression-free and overall survival rates were 83.3% and 94.4%, respectively. The most common grade ≥ 3 adverse events were thrombocytopenia (100%), neutropenia (100%), and neutropenic fever (67%). CONCLUSIONS DPd as salvage therapy, followed by HDCT and ASCT, demonstrated deep, durable, and clinically meaningful responses with a manageable safety profile in patients with RRMM.
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23
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Pomalidomide, bortezomib, and dexamethasone for multiple myeloma previously treated with lenalidomide (OPTIMISMM): outcomes by prior treatment at first relapse. Leukemia 2020; 35:1722-1731. [PMID: 32895455 PMCID: PMC8179841 DOI: 10.1038/s41375-020-01021-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/14/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
In the phase 3 OPTIMISMM trial, pomalidomide, bortezomib, and dexamethasone (PVd) demonstrated superior efficacy vs bortezomib and dexamethasone (Vd) in patients with relapsed or refractory multiple myeloma previously treated with lenalidomide, including those refractory to lenalidomide. This analysis evaluated outcomes in patients at first relapse (N = 226) by lenalidomide-refractory status, prior bortezomib exposure, and prior stem cell transplant (SCT). Second-line PVd significantly improved PFS vs Vd in lenalidomide-refractory (17.8 vs 9.5 months; P = 0.0276) and lenalidomide-nonrefractory patients (22.0 vs 12.0 months; P = 0.0491), patients with prior bortezomib (17.8 vs 12.0 months; P = 0.0068), and patients with (22.0 vs 13.8 months; P = 0.0241) or without (16.5 vs 9.5 months; P = 0.0454) prior SCT. In patients without prior bortezomib, median PFS was 20.7 vs 9.5 months (P = 0.1055). Significant improvement in overall response rate was also observed with PVd vs Vd in lenalidomide-refractory (85.9% vs 50.8%; P < 0.001) and lenalidomide-nonrefractory (95.7% vs 60.0%; P < 0.001) patients, with similar results regardless of prior bortezomib or SCT. No new safety signals were observed. These data demonstrate the benefit of PVd at first relapse, including immediately after upfront lenalidomide treatment failure and other common first-line treatments.
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24
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Di Bacco A, Bahlis NJ, Munshi NC, Avet‐Loiseau H, Masszi T, Viterbo L, Pour L, Ganly P, Cavo M, Langer C, Kumar SK, Rajkumar SV, Keats JJ, Berg D, Lin J, Li B, Badola S, Shen L, Zhang J, Esseltine D, Luptakova K, van de Velde H, Richardson PG, Moreau P. c-MYC expression and maturity phenotypes are associated with outcome benefit from addition of ixazomib to lenalidomide-dexamethasone in myeloma. Eur J Haematol 2020; 105:35-46. [PMID: 32145111 PMCID: PMC7317705 DOI: 10.1111/ejh.13405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/26/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES In the TOURMALINE-MM1 phase 3 trial in relapsed/refractory multiple myeloma, ixazomib-lenalidomide-dexamethasone (IRd) showed different magnitudes of progression-free survival (PFS) benefit vs placebo-Rd according to number and type of prior therapies, with greater benefit seen in patients with >1 prior line of therapy or 1 prior line of therapy without stem cell transplantation (SCT). METHODS RNA sequencing data were used to investigate the basis of these differences. RESULTS The PFS benefit of IRd vs placebo-Rd was greater in patients with tumors expressing high c-MYC levels (median not reached vs 11.3 months; hazard ratio [HR] 0.42; 95% CI, 0.26, 0.66; P < .001) compared with in those expressing low c-MYC levels (median 20.6 vs 16.6 months; HR 0.75; 95% CI, 0.42, 1.2). Expression of c-MYC in tumors varied based on the number and type of prior therapy received, with the lowest levels observed in tumors of patients who had received 1 prior line of therapy including SCT. These tumors also had higher expression levels of CD19 and CD81. CONCLUSIONS PFS analyses suggest that lenalidomide and ixazomib target tumors with different levels of c-MYC, CD19, and CD81 expression, thus providing a potential rationale for the differential benefits observed in the TOURMALINE-MM1 study. This trial was registered at www.clinicaltrials.gov as: NCT01564537.
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Affiliation(s)
- Alessandra Di Bacco
- Millennium Pharmaceuticals, Inc. (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited)CambridgeMAUSA
| | - Nizar J. Bahlis
- Southern Alberta Cancer Research InstituteUniversity of CalgaryCalgaryABCanada
| | | | | | - Tamás Masszi
- Department of Haematology and Stem Cell TransplantationSt. István and St. László Hospital of BudapestBudapestHungary
- 3rd Department of Internal MedicineSemmelweis UniversityBudapestHungary
| | - Luísa Viterbo
- Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial (IPOPFG, EPE)PortoPortugal
| | - Ludek Pour
- Hematology and OncologyUniversity Hospital BrnoBrnoCzech Republic
| | - Peter Ganly
- Department of HaematologyChristchurch HospitalChristchurchNew Zealand
| | - Michele Cavo
- Institute of Hematology and Medical Oncology "Seràgnoli"Bologna University School of MedicineS.Orsola's University HospitalBolognaItaly
| | | | | | | | | | - Deborah Berg
- Millennium Pharmaceuticals, Inc. (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited)CambridgeMAUSA
| | - Jianchang Lin
- Millennium Pharmaceuticals, Inc. (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited)CambridgeMAUSA
| | - Bin Li
- Millennium Pharmaceuticals, Inc. (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited)CambridgeMAUSA
| | - Sunita Badola
- Millennium Pharmaceuticals, Inc. (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited)CambridgeMAUSA
| | - Lei Shen
- Millennium Pharmaceuticals, Inc. (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited)CambridgeMAUSA
| | - Jacob Zhang
- Millennium Pharmaceuticals, Inc. (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited)CambridgeMAUSA
| | - Dixie‐Lee Esseltine
- Millennium Pharmaceuticals, Inc. (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited)CambridgeMAUSA
| | - Katarina Luptakova
- Millennium Pharmaceuticals, Inc. (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited)CambridgeMAUSA
| | - Helgi van de Velde
- Millennium Pharmaceuticals, Inc. (a wholly owned subsidiary of Takeda Pharmaceutical Company Limited)CambridgeMAUSA
| | | | - Philippe Moreau
- Department of HematologyUniversity Hospital Hôtel DieuUniversity of NantesNantesFrance
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25
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Checkpoint Inhibitors and Engineered Cells: New Weapons for Natural Killer Cell Arsenal Against Hematological Malignancies. Cells 2020; 9:cells9071578. [PMID: 32610578 PMCID: PMC7407972 DOI: 10.3390/cells9071578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023] Open
Abstract
Natural killer (NK) cells represent one of the first lines of defense against malignant cells. NK cell activation and recognition are regulated by a balance between activating and inhibitory receptors, whose specific ligands can be upregulated on tumor cells surface and tumor microenvironment (TME). Hematological malignancies set up an extensive network of suppressive factors with the purpose to induce NK cell dysfunction and impaired immune-surveillance ability. Over the years, several strategies have been developed to enhance NK cells-mediated anti-tumor killing, while other approaches have arisen to restore the NK cell recognition impaired by tumor cells and other cellular components of the TME. In this review, we summarize and discuss the strategies applied in hematological malignancies to block the immune check-points and trigger NK cells anti-tumor effects through engineered chimeric antigen receptors.
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26
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Faridizadeh M, Alavi Majd H, Parkhideh S, Hajifathali A, Raei M, Ramezani N, Saeedi A, Baghestani AR. Analyzing Survival Rate of Leukemia Patients Applying Long Term Exponential Model. Asian Pac J Cancer Prev 2020; 21:1539-1543. [PMID: 32592346 PMCID: PMC7568893 DOI: 10.31557/apjcp.2020.21.6.1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Making progressin treatment of all branches of cancers has increasedthe percent of patients that never experience the event of interest. These cases are called immune or cure and models for handling the data included cure fraction rate, are referred to as cure model or long-term survival models. METHODS The data for this historical cohort study, were collected from leukemia patients diagnosed between 2007 to 2014 and followed up until 2016 in Taleghani hospital and received BMT (Bone Marrow Transplant). Some data had to be excluded because of incomplete information. Using recorded files mostly and phone calls rarely, were made to confirm whether the patients were still alive or not. Death due to leukemia was regarded as interested event. Analysis were performed by R version 3.4.1and Stata version 14. RESULTS Number of recurrents after receiving BMT, pre-transplant Hb and age at diagnosis were found as significant prognostics of survival time. HD patients had the highest 5-years overall survival in category of diagnosis type with 81.3%. Cure fraction was estimated to be 64.1%. CONCLUSION According to high percentage of censoring, using long-term model had better fit.
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Affiliation(s)
- Mostafa Faridizadeh
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayeh Parkhideh
- Taleghani Bone Marrow Transplantation Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Abbas Hajifathali
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Raei
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Nazanin Ramezani
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Saeedi
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Baghestani
- Physiotherapy Research Center, Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Li H, Yin L, Wang Y, Wang X, Shi M, Cao J, Yan Z, Sang W, Cheng H, Zhu F, Sun H, Li D, Jing G, Zheng J, Li Z, Xu K. Safety and efficacy of chimeric antigen receptor T-cell therapy in relapsed/refractory multiple myeloma with renal impairment. Bone Marrow Transplant 2020; 55:2215-2218. [PMID: 32388534 DOI: 10.1038/s41409-020-0930-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Hujun Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
| | - Lingling Yin
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
| | - Ying Wang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
| | - Xiangmin Wang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
| | - Ming Shi
- Center of Clinical Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Cacer Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jiang Cao
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
| | - Zhiling Yan
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
| | - Wei Sang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
| | - Hai Cheng
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
| | - Feng Zhu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
| | - Haiying Sun
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
| | - Depeng Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China
| | | | - Junnian Zheng
- Center of Clinical Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China. .,Cacer Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China.
| | - Zhenyu Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China. .,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China. .,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China.
| | - Kailin Xu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China. .,Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu, China. .,Jiangsu Key Laboratory of Bone Marrow Stem Cells, Xuzhou, Jiangsu, China.
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28
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Erath A, Patel DA, Hosack EA, Patanella JE, Ibach DM, Kassim AA. Overcoming Proteasome Inhibitor-Refractory Multiple Myeloma With Elotuzumab, Bortezomib, Nelfinavir, and Dexamethasone. World J Oncol 2020; 11:33-36. [PMID: 32095187 PMCID: PMC7011904 DOI: 10.14740/wjon1241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/22/2019] [Indexed: 11/21/2022] Open
Abstract
Multiple myeloma is a common plasma cell malignancy with a median overall survival of fewer than 10 years. Proteasome inhibitors comprise an important part of the treatment regimen for this disease. The present study reports the case of a 57-year-old man who experienced a second relapse of multiple myeloma 6 years after initial treatment with bortezomib, lenalidomide, dexamethasone (VRD) followed by autologous hematopoietic cell transplant. The first relapse had been successfully treated with VRD, but this approach failed to control his second relapse. Given the lack of response to VRD therapy and relapse while on bortezomib maintenance, the patient was deemed proteasome inhibitor-refractory and received a new treatment of elotuzumab, lenalidomide, and dexamethasone. Four and a half cycles were completed before the treatment was stopped due to grade 4 cytopenias. The patient received a novel combination of elotuzumab, bortezomib, nelfinavir, and dexamethasone. After six cycles, the serum M-protein level was improved to 0.6 g/dL and the kappa light chains dropped from 3.49 to 1.04 mg/dL. A bone marrow biopsy conducted after five treatment cycles demonstrated < 1% plasma cells by immunohistochemistry and achievement of minimal residual disease status. Overall, this case study suggests that proteasome inhibitor-refractory multiple myeloma may be successfully re-treated with proteasome inhibitors when co-administered with nelfinavir.
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Affiliation(s)
- Alexandra Erath
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dilan A Patel
- Department of Hematology and Bone Marrow Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - James E Patanella
- Vanderbilt Ingram Cancer Center, 1301 Medical Center Drive #1710, Nashville, TN 37232, USA
| | | | - Adetola A Kassim
- Department of Hematology and Bone Marrow Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
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29
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Park JJ, Huang E, Monteleone CA, Kane MP, Cooper DL. Pomalidomide desensitization for hypersensitivity: A case report. J Oncol Pharm Pract 2019; 26:1244-1247. [PMID: 31822201 DOI: 10.1177/1078155219889676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Pomalidomide is an immunomodulating agent that is used to treat relapsed and/or refractory multiple myeloma. Although the incidence of hypersensitivity with pomalidomide is not well documented, the most common type of hypersensitivity involves a cutaneous reaction. Previous reports have successfully utilized a desensitization protocol in patients who developed hypersensitivity to pomalidomide. Here we describe a case of a patient who developed urticaria on pomalidomide and successfully underwent a desensitization using the previously reported method in a case report. CASE REPORT A 68-year-old woman with relapsed multiple myeloma and no known drug allergies developed urticaria a day after taking the first dose of pomalidomide. MANAGEMENT AND OUTCOME The patient underwent a 10-step desensitization process in the medical intensive care unit without any reported adverse events. The following day in the medical intensive care unit, the patient was able to tolerate a full dose of pomalidomide with no further reactions and was discharged with instructions to take a full dose of pomalidomide daily for 21 days out of a 28-day cycle. The patient was followed up in the outpatient clinic and noted no further reactions from pomalidomide at the three-month visit. DISCUSSION The 10-step desensitization protocol with pomalidomide was well tolerated in the patient with hypersensitivity to pomalidomide. Whether this approach would work in patients with more severe reactions such as anaphylaxis and angioedema is still unknown.
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Affiliation(s)
- Jiyeon J Park
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | - Esther Huang
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Catherine A Monteleone
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michael P Kane
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Dennis L Cooper
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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30
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Dashputre AA, S Gatwood K, Schmidt J, Gatwood J. Impact of oral oncolytic initiation on medication adherence for pre-existing comorbid chronic conditions. J Oncol Pharm Pract 2019; 26:835-845. [PMID: 31575355 DOI: 10.1177/1078155219875206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Oral oncolytics have improved survival in hematological cancers like chronic myeloid leukemia, chronic lymphocytic leukemia/small lymphocytic lymphoma, and multiple myeloma; however, it is unclear of the extent to which initiating these treatments might impact adherence to oral therapies for pre-existing comorbid chronic conditions. METHODS Adults diagnosed with and prescribed oral oncolytics for chronic myeloid leukemia, chronic lymphocytic leukemia/small lymphocytic lymphoma, or multiple myeloma between 2013 and 2016 and with continuous eligibility six months before and after oral oncolytic initiation were identified from the Truven Health MarketScan databases. Among those identified, patients with pre-existing diabetes, hypertension, and/or hyperlipidemia with ≥1 fill for oral comorbid therapies were selected. Adherence to oral oncolytics and comorbid therapies was measured using the proportion of days covered metric. Wilcoxon signed-rank tests assessed changes in adherence for comorbid therapies after initiation of an oral oncolytic. Unadjusted difference-in-difference models assessed the impact of adherence to oral oncolytics on changes in adherence to comorbid therapies. RESULTS Significant reductions in adherence after oncolytic initiation were observed across the comorbid therapies and were highest for patients taking lipid-lower agents (10.7-15.6%). Unadjusted difference-in-difference models revealed consistent and significantly lower reductions in adherence for those taking antihypertensives (chronic myeloid leukemia: p = 0.03; chronic lymphocytic leukemia/small lymphocytic lymphoma: p = 0.007; multiple myeloma: p = 0.09) and adherent to oral oncolytics. CONCLUSION Initiation of oral oncolytics may negatively impact adherence to oral therapies for chronic comorbid conditions, necessitating the need for medication management strategies to help patients adhere to their entire medication regimen.
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Affiliation(s)
- Ankur A Dashputre
- Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Katie S Gatwood
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jillian Schmidt
- College of Pharmacy, University of Tennessee Health Science Center, TN, USA
| | - Justin Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, TN, USA
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31
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Dimopoulos MA, Moreau P, Iida S, Huang SY, Takezako N, Chng WJ, Zahlten-Kumeli A, Sersch MA, Li J, Huang M, Lee JH. Outcomes for Asian patients with multiple myeloma receiving once- or twice-weekly carfilzomib-based therapy: a subgroup analysis of the randomized phase 3 ENDEAVOR and A.R.R.O.W. Trials. Int J Hematol 2019; 110:466-473. [DOI: 10.1007/s12185-019-02704-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
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32
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Goswami C, Poonia S, Kumar L, Sengupta D. Staging System to Predict the Risk of Relapse in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation. Front Oncol 2019; 9:633. [PMID: 31355145 PMCID: PMC6640159 DOI: 10.3389/fonc.2019.00633] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023] Open
Abstract
Over the last decade autologous stem cell transplantation (ASCT) has emerged as the standard of care in the management of Multiple Myeloma (MM). However, the cases of early relapse (within 36 months) after the stem cell rescue remains a significant challenge. For a lot of practical purposes, it is crucial to identify whether a patient undergoing ASCT falls into the high-risk group (likely to relapse within 36 months) or a low risk one. Our analysis showed that existing MM staging systems (International Staging System or ISS and Durie Salmon Staging or DSS) are not sufficient to discriminate between the risk groups significantly. To address this, we gathered a total of 39 clinical and laboratory parameters of 347 patients from the Department of Medical Oncology of All India Institute of Medical Sciences (AIIMS). We employed a stacked machine learning model consisting spectral clustering and Fast and Frugal Tree (FFT) technique to come up with a 3-factor multivariate 2-stage staging scheme, which turns out to be extremely decisive about the outcome of the stem cell rescue. Our model comes up with a three-factor (1. if patients has relapsed following remission, 2. response to induction, 3. pre-transplant Glomerular Filtration Rate or GFR) staging scheme. The resulting model stratifies patients into high-risk and low-risk groups with markedly distinct progression-free (median survival—24 months vs. 91 months) and overall survival (median survival—51 months vs. 135 months) patterns.
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Affiliation(s)
- Chitrita Goswami
- Department of Computer Science and Engineering, Indraprastha Institute of Information Technology, New Delhi, India
| | - Sarita Poonia
- Department of Computational Biology, Indraprastha Institute of Information Technology, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Debarka Sengupta
- Department of Computer Science and Engineering, Indraprastha Institute of Information Technology, New Delhi, India.,Department of Computational Biology, Indraprastha Institute of Information Technology, New Delhi, India.,Infosys Center for Artificial Intelligence, Indraprastha Institute of Information Technology, New Delhi, India
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Gassiot S, González Y, Morgades M, Motlló C, Clapés V, Maluquer C, Ibarra G, Abril L, Ribera JM, Oriol A. Response to First Cycle Is the Major Predictor of Long-Term Response to Lenalidomide and Dexamethasone Therapy in Relapsed and Refractory Multiple Myeloma: Can We Spare Patients the Toxicity and Costs of Additional Agents? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:585-592.e1. [PMID: 31255588 DOI: 10.1016/j.clml.2019.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/30/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Lenalidomide plus dexamethasone (Ld) is still considered an option of care for some selected patients with relapsed or refractory multiple myeloma (RRMM), despite the proven superiority of lenalidomide-based triplet therapy. Up to 20% of patients obtain long-term benefit from Ld alone. The aim of this multicenter retrospective study was to identify and characterize those with good response to Ld salvage therapy, defined as progression-free survival lasting more than 24 months. PATIENTS AND METHODS Patients treated with Ld in a consortium of 3 tertiary-care hospitals (Institut Català d'Oncologia) between 2009 and 2016 were prospectively registered; 227 patients had evaluable data. RESULTS In multivariate analysis, obtaining partial response after the first therapy cycle was the main independent factor associated with progression-free survival lasting more than 24 months. Together with standard risk cytogenetics, partial response after first cycle was also independently associated with a higher rate of complete response. Previous plasma-cell dyscrasia remained as the only baseline characteristic independently associated with long-lasting responses. High-risk cytogenetics and no history of monoclonal gammopathy of undetermined significance were the only statistically significant negative prognostic factors for overall survival. Patients who had received only one prior therapy showed a trend toward higher overall survival. CONCLUSION If Ld is to be considered a treatment choice, at least a partial response should be obtained after the first therapy cycle to maintain double-agent therapy safely.
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Affiliation(s)
- Susanna Gassiot
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Yolanda González
- Institut Català d'Oncologia, Hospital Josep Trueta, Girona, Spain
| | - Mireia Morgades
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Cristina Motlló
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Victòria Clapés
- Institut Català d'Oncologia, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Llobregat, Spain
| | - Clara Maluquer
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Gladys Ibarra
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Laura Abril
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Josep-Maria Ribera
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Oriol
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Mohty M, Cavo M, Fink L, Gonzalez-McQuire S, Leleu H, Mateos MV, Raab MS, Schoen P, Yong K. Understanding mortality in multiple myeloma: Findings of a European retrospective chart review. Eur J Haematol 2019; 103:107-115. [PMID: 31112311 PMCID: PMC6851592 DOI: 10.1111/ejh.13264] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/13/2022]
Abstract
Objectives This study aimed to provide real‐world data on the characteristics and treatment of patients with multiple myeloma (MM) at the time of death. Methods The study was a retrospective patient chart review across France, Germany, Italy, Spain and the UK during 2016, and included patients who had died in the 3 months before the index date. Results Data from 786 patients were reviewed. At the time of death, 37% of patients were receiving active treatment, 12% were in a treatment‐free interval and 51% were receiving only supportive care. Death before and during active first‐line treatment was not uncommon (6% and 24% of patients, respectively) but these deaths were often not solely due to disease progression; factors such as renal failure and infection frequently played a role (in 30% and 20% of patients at first‐line, respectively). Most deaths at later lines were due to progressive disease. Cox model results suggested that early deaths were associated with advanced disease stage, high‐risk cytogenetics and poor response and relapse profiles. Conclusions These real‐world data could be used to help develop strategies for improving survival in patients with MM and to support management tailored to the stage of disease.
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Affiliation(s)
- Mohamad Mohty
- Department of Haematology, Hôpital Saint-Antoine, Universite Pierre & Marie Curie, INSERM UMRs 938, Paris, France
| | - Michele Cavo
- Seràgnoli Institute of Haematology and Medical Oncology, Bologna University School of Medicine, Bologna, Italy
| | | | | | | | - Maria-Victoria Mateos
- Haematology Department, University Hospital of Salamanca/Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Marc S Raab
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Kwee Yong
- Department of Haematology, University College London, London, UK
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The first-in-human study of the pan-PIM kinase inhibitor PIM447 in patients with relapsed and/or refractory multiple myeloma. Leukemia 2019; 33:2924-2933. [PMID: 31092894 DOI: 10.1038/s41375-019-0482-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 12/27/2022]
Abstract
PIM447, a novel pan-PIM inhibitor, has shown preclinical activity in multiple myeloma (MM). In the multicenter, open-label, first-in-human study, patients with relapsed and/or refractory MM were enrolled to determine the maximum-tolerated dose (MTD) or recommended dose (RD), safety, pharmacokinetics, and preliminary anti-myeloma activity of PIM447. PIM447 was administered in escalating oral doses of 70-700 mg once daily (q.d.) for 28-day continuous cycles. Seventy-nine patients with a median of four prior therapies were enrolled. Seventy-seven patients (97.5%) had an adverse event (AE) suspected as treatment related, with treatment-related grade 3/4 AEs being mostly hematologic. Eleven dose-limiting toxicities occurred, and an MTD of 500 mg q.d. and an RD of 300 mg q.d. were established. The main reason for discontinuation was disease progression in 54 patients (68.4%). In the entire study population, a disease control rate of 72.2%, a clinical benefit rate of 25.3%, and an overall response rate of 8.9% were observed per modified International Myeloma Working Group criteria. Median progression-free survival at the RD was 10.9 months. PIM447 was well tolerated and demonstrated single-agent antitumor activity in relapsed/refractory MM patients, providing proof of principle for Pim (Proviral Insertions of Moloney Murine leukemia virus) kinase inhibition as a novel therapeutic approach in MM.
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Youssef M, Arnesen C, Arledge C, Langley C, Sylvester D, Sikora J, Marques MB, Long Zheng X, Williams LA. Validation and cost-effectiveness of an in-house dithiothreitol (DTT) treatment protocol for daratumumab patients in a large tertiary care hospital provides gateway for implementation in smaller community hospitals. Transfus Apher Sci 2019; 58:152-155. [DOI: 10.1016/j.transci.2018.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/31/2018] [Accepted: 12/31/2018] [Indexed: 01/12/2023]
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Indatuximab Ravtansine (BT062) Monotherapy in Patients With Relapsed and/or Refractory Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:372-380. [PMID: 30930134 DOI: 10.1016/j.clml.2019.02.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/11/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Indatuximab ravtansine (BT062) is an antibody-drug conjugate that binds to CD138, which is overexpressed on multiple myeloma (MM) cells. PATIENTS AND METHODS We report from 2 clinical studies of patients with relapsed and/or refractory MM previously treated with an immunomodulatory drug and a proteasome inhibitor. Single- and multi-dosing schedules were investigated to define dose-limiting toxicities, maximum tolerated dose (MTD), recommended phase II dose, and to describe safety, efficacy, and pharmacokinetics. RESULTS In the first-in-human study, indatuximab ravtansine was administered to 32 patients on day 1 of each 21-day cycle. The MTD was 160 mg/m2. In the phase I/IIa study, indatuximab ravtansine was administered to 35 patients on days 1, 8, and 15 of each 28-day cycle, and the MTD/recommended phase II dose was 140 mg/m2. Most (88%) adverse events were grade 1 or 2, the most common being diarrhea and fatigue. There was rapid clearance of indatuximab ravtansine and no relevant accumulation. Over 75% of heavily pretreated patients achieved stable disease or better. With the multi-dose schedule, minor and partial responses occurred in 14.7% of patients, the median time to progression was 3 months, and the median overall survival was 26.7 months. CONCLUSION Our data support further investigation of indatuximab ravtansine as part of a combination regimen for relapsed and/or refractory MM.
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Hulin C, de la Rubia J, Dimopoulos MA, Terpos E, Katodritou E, Hungria V, De Samblanx H, Stoppa A, Aagesen J, Sargin D, Sioni A, Belch A, Diels J, Olie RA, Robinson D, Potamianou A, van de Velde H, Delforge M. Bortezomib retreatment for relapsed and refractory multiple myeloma in real-world clinical practice. Health Sci Rep 2019; 2:e104. [PMID: 30697597 PMCID: PMC6346989 DOI: 10.1002/hsr2.104] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 01/03/2023] Open
Abstract
AIMS Studies have shown that bortezomib retreatment is effective in relapsed/refractory multiple myeloma (MM). The observational, prospective electronic VELCADE® OBservational Study (eVOBS) study assessed bortezomib-based therapies for patients with MM in everyday practice. Here, we report on those patients receiving retreatment with bortezomib. METHODS Consenting adults scheduled to receive bortezomib for MM were enrolled at 162 sites across Europe, Canada, Brazil, Russia, and Turkey between 2006 and 2010. Retrospective data on prior therapies and prospective observational data after bortezomib initiation were captured electronically at baseline, after every bortezomib cycle, and every 12 weeks after discontinuation or progression. Investigator-assessed responses and adverse events (AEs) were evaluated. RESULTS Ninety-six of 873 patients enrolled to eVOBS received bortezomib as first retreatment for progressive disease during the prospective observation period. Median age was 62 years, 53% were male, and median number of prior therapies at retreatment was 4. Overall, 41% of patients initiated bortezomib retreatment in combination with dexamethasone, 16% in combination with lenalidomide, and 21% received monotherapy. Rate of partial response or better (≥PR) was 75% at initial bortezomib therapy, including 44% complete response (CR)/near CR (nCR); at retreatment, ≥PR rate was 46%, including 15% CR/nCR. Median progression-free survival was 11.4 months (95% confidence interval [CI]: 9.1-12.7) from start of initial bortezomib treatment and 6.4 months (95% CI: 4.4-7.2) from start of retreatment. Median overall survival from start of retreatment was 17.6 months (95% CI: 14.4-23.5). Of the 96 patients retreated with bortezomib, 77% reported an AE. Peripheral neuropathy during bortezomib retreatment occurred in 49% of patients, including 10% grade 3/4. CONCLUSION These data suggest that retreatment with bortezomib is a feasible option for patients with relapsed/refractory MM.
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Affiliation(s)
- Cyrille Hulin
- Service d'Hématologie Hôpital Haut‐LévêqueCHUBordeauxFrance
| | - Javier de la Rubia
- Department of Hematology, Hospital Dr PesetUniversidad Católica de ValenciaValenciaSpain
| | - Meletios A. Dimopoulos
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Evangelos Terpos
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Eirini Katodritou
- Department of Hematology, Theagenion Cancer CentreThessalonikiGreece
| | - Vania Hungria
- Santa Casa de São Paulo Medical SchoolSão PauloBrazil
| | | | - Anne‐Marie Stoppa
- Département D'Onco‐HématologieInstitut Paoli‐CalmettesMarseillesFrance
| | - Jesper Aagesen
- Department of Medicine, Ryhov County HospitalJönköpingSweden
| | - Deniz Sargin
- Division of Hematology, Department of Internal MedicineIstanbul UniversityIstanbulTurkey
| | - Anastasia Sioni
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Andrew Belch
- Department of OncologyCross Cancer InstituteEdmontonABCanada
| | - Joris Diels
- Janssen Research and Development, Division of Janssen Pharmaceutica NVBeerseBelgium
| | | | | | | | - Helgi van de Velde
- Millennium Pharmaceuticals, Inc., Cambridge, MA, USAa wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Michel Delforge
- Department of HematologyUniversity Hospital LeuvenLeuvenBelgium
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Goldschmidt H, Ashcroft J, Szabo Z, Garderet L. Navigating the treatment landscape in multiple myeloma: which combinations to use and when? Ann Hematol 2019; 98:1-18. [PMID: 30470875 PMCID: PMC6334731 DOI: 10.1007/s00277-018-3546-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/06/2018] [Indexed: 12/31/2022]
Abstract
Multiple myeloma is one of the most common hematological malignancies, affecting mainly elderly patients. The treatment landscape for the management of this disease has evolved significantly over the past 15 years, and a vast array of therapeutics is now available, including immunomodulatory drugs, proteasome inhibitors, histone deacetylase inhibitors, and monoclonal antibodies. As a result, deciding which drugs to use and when, and whether these should be used in a particular order or combination, can be challenging. Although combination regimens are often associated with deeper responses and better long-term outcomes than monotherapy, and are becoming the standard of care, they may result in significant incremental toxicity; hence, a sequential approach may be more appropriate for some patients. In particular, treatment choices can vary depending on whether the patient has newly diagnosed multiple myeloma, is eligible for transplant, has relapsed and/or refractory multiple myeloma, or is considered to have high-risk disease. In this review, we discuss factors to be taken into account when making treatment decisions in each of these settings. We also briefly discuss possible therapeutic strategies involving agents that may become available in the future.
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Affiliation(s)
- Hartmut Goldschmidt
- Internal Medicine V and National Center for Tumor Diseases (NCT), University Clinic Heidelberg, 69120, Heidelberg, Germany.
| | - John Ashcroft
- Department of Haematology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Zsolt Szabo
- Clinical Development, Amgen (Europe) GmbH, Zug, Switzerland
| | - Laurent Garderet
- INSERM, UMR_S 938, Proliferation and Differentiation of Stem Cells, Paris, 75012, France
- AP-HP, Hôpital Saint Antoine, Département d'hématologie et de thérapie cellulaire, Sorbonne Université, Paris 6, Paris, France
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Heckmann MB, Doroudgar S, Katus HA, Lehmann LH. Cardiovascular adverse events in multiple myeloma patients. J Thorac Dis 2018; 10:S4296-S4305. [PMID: 30701098 PMCID: PMC6328391 DOI: 10.21037/jtd.2018.09.87] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/18/2018] [Indexed: 12/15/2022]
Abstract
Multiple myeloma is a malignant disease, caused by an uncontrolled clonal proliferation of a specific group of white blood cells, the plasma cells. Clinical manifestations include bone pain due to osteolysis, hypercalcemia, anemia, and renal insufficiency. Proteasome inhibitors have substantially improved survival of patients suffering from multiple myeloma, providing an efficient treatment option mainly for relapsed and refractory multiple myeloma. Although constituting one substance class, bortezomib, carfilzomib, and ixazomib differ greatly regarding their non-hematologic side effects. This article reviews the clinical and preclinical data on approved proteasome inhibitors in an attempt to decipher the underlying pathomechanisms related to cardiovascular adverse events seen in clinical trials.
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Affiliation(s)
- Markus B. Heckmann
- Department of Cardiology, Angiology, and Pneumology, Internal Medicine III, University Hospital Heidelberg, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Shirin Doroudgar
- Department of Cardiology, Angiology, and Pneumology, Internal Medicine III, University Hospital Heidelberg, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Hugo A. Katus
- Department of Cardiology, Angiology, and Pneumology, Internal Medicine III, University Hospital Heidelberg, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Lorenz H. Lehmann
- Department of Cardiology, Angiology, and Pneumology, Internal Medicine III, University Hospital Heidelberg, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
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Dimopoulos MA, Dytfeld D, Grosicki S, Moreau P, Takezako N, Hori M, Leleu X, LeBlanc R, Suzuki K, Raab MS, Richardson PG, Popa McKiver M, Jou YM, Shelat SG, Robbins M, Rafferty B, San-Miguel J. Elotuzumab plus Pomalidomide and Dexamethasone for Multiple Myeloma. N Engl J Med 2018; 379:1811-1822. [PMID: 30403938 DOI: 10.1056/nejmoa1805762] [Citation(s) in RCA: 365] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The immunostimulatory monoclonal antibody elotuzumab plus lenalidomide and dexamethasone has been shown to be effective in patients with relapsed or refractory multiple myeloma. The immunomodulatory agent pomalidomide plus dexamethasone has been shown to be effective in patients with multiple myeloma that is refractory to lenalidomide and a proteasome inhibitor. METHODS Patients with multiple myeloma that was refractory or relapsed and refractory to lenalidomide and a proteasome inhibitor were randomly assigned to receive elotuzumab plus pomalidomide and dexamethasone (elotuzumab group) or pomalidomide and dexamethasone alone (control group). The primary end point was investigator-assessed progression-free survival. RESULTS A total of 117 patients were randomly assigned to the elotuzumab group (60 patients) or the control group (57 patients). After a minimum follow-up period of 9.1 months, the median progression-free survival was 10.3 months in the elotuzumab group and 4.7 months in the control group. The hazard ratio for disease progression or death in the elotuzumab group as compared with the control group was 0.54 (95% confidence interval [CI], 0.34 to 0.86; P=0.008). The overall response rate was 53% in the elotuzumab group as compared with 26% in the control group (odds ratio, 3.25; 95% CI, 1.49 to 7.11). The most common grade 3 or 4 adverse events were neutropenia (13% in the elotuzumab group vs. 27% in the control group), anemia (10% vs. 20%), and hyperglycemia (8% vs. 7%). A total of 65% of the patients in each group had infections. Infusion reactions occurred in 3 patients (5%) in the elotuzumab group. CONCLUSIONS Among patients with multiple myeloma in whom treatment with lenalidomide and a proteasome inhibitor had failed, the risk of progression or death was significantly lower among those who received elotuzumab plus pomalidomide and dexamethasone than among those who received pomalidomide plus dexamethasone alone. (Funded by Bristol-Myers Squibb and AbbVie Biotherapeutics; ELOQUENT-3 ClinicalTrials.gov number, NCT02654132 .).
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Affiliation(s)
- Meletios A Dimopoulos
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Dominik Dytfeld
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Sebastian Grosicki
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Philippe Moreau
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Naoki Takezako
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Mitsuo Hori
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Xavier Leleu
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Richard LeBlanc
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Kenshi Suzuki
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Marc S Raab
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Paul G Richardson
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Mihaela Popa McKiver
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Ying-Ming Jou
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Suresh G Shelat
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Michael Robbins
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Brian Rafferty
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
| | - Jesús San-Miguel
- From the National and Kapodistrian University of Athens, Athens (M.A.D.); Karol Marcinkowski University of Medical Sciences, Poznań (D.D.), and Silesian Medical University, Katowice (S.G.) - both in Poland; University Hospital, Nantes (P.M.), and Centre Hospitalier Universitaire de Poitiers-La Milétrie, Poitiers (X.L.) - both in France; National Hospital Organization Disaster Medical Center (N.T.) and the Japanese Red Cross Medical Center (K.S.), Tokyo, and Ibaraki Prefectural Central Hospital, Kasama (M.H.) - all in Japan; Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal (R.L.); Heidelberg University Hospital, Heidelberg, Germany (M.S.R.); Dana-Farber Cancer Institute, Boston (P.G.R.); Bristol-Myers Squibb, Princeton, NJ (M.P.M., Y.-M.J., S.G.S., M.R., B.R.); and Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain (J.S.-M.)
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Moghnieh R, Abdallah D, Awad L, Jisr T, Mugharbil A, Youssef A, Tamim H, Khaldieh S, Massri O, Rashini N, Hamdan Y, Ibrahim A. Bacteraemia post-autologous haematopoietic stem cell transplantation in the absence of antibacterial prophylaxis: a decade's experience from Lebanon. Infection 2018; 46:823-835. [PMID: 30143988 DOI: 10.1007/s15010-018-1200-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE In this study, we assessed the incidence, contributing factors and outcome of prolonged neutropenia above 7 days and of bacteraemia in patients with lymphoma and multiple myeloma who underwent autologous haematopoietic stem cell transplantation (AHSCT) without antibacterial prophylaxis. METHODS This is a retrospective chart review of 190 adult patients who underwent AHSCT between 2005 and 2015 at a Lebanese hospital. RESULTS Neutropenia of 7 days duration and longer was documented in 66% of the patient population. Through univariate analysis, patients with lymphoma were significantly more likely to have prolonged neutropenia (≥ 7 days) compared to those with myeloma. Mucositis above grade 3, diarrhoea and fever were more likely to occur in patients with prolonged neutropenia. Bacteraemia was documented in 12.6% of the patients. Total mortality rate was 3.7%, and that attributed to bacteraemia was 12.5% in the bacteraemia subgroup. Among bacterial isolates recovered from clinical specimens (89 isolates), 70% were Gram-negative, of which 57% were fluoroquinolone susceptible. Ninety-five percent of the Gram-negative bacteria causing bacteraemia were susceptible to fluoroquinolones. CONCLUSION Bacterial pathogens causing bacteraemia were still highly susceptible to fluoroquinolones, despite the high prevalence of fluoroquinolone-resistant strains in the general bacterial ecology. Accordingly, the pertinence of fluoroquinolone prophylaxis in the AHSCT setting warrants further investigation. Moreover, continuous surveillance of local antibiograms in this patient population has become a must in an era of preponderant antibiotic resistance.
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Affiliation(s)
- Rima Moghnieh
- Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Tarik Al Jadida, Riad El-Solh, PO Box 11-6301, Beirut, 1107 2210, Lebanon.
| | - Dania Abdallah
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Lyn Awad
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Tamima Jisr
- Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Anas Mugharbil
- Division of Hematology-Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Ali Youssef
- Division of Hematology-Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Samer Khaldieh
- Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Oula Massri
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Najat Rashini
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Youssef Hamdan
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Ahmad Ibrahim
- Division of Hematology-Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
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Moreau P, Mateos MV, Berenson JR, Weisel K, Lazzaro A, Song K, Dimopoulos MA, Huang M, Zahlten-Kumeli A, Stewart AK. Once weekly versus twice weekly carfilzomib dosing in patients with relapsed and refractory multiple myeloma (A.R.R.O.W.): interim analysis results of a randomised, phase 3 study. Lancet Oncol 2018; 19:953-964. [DOI: 10.1016/s1470-2045(18)30354-1] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 01/20/2023]
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Clark CA, Mosse CA, Chen H, Byrne M, Chinratanalab W, Engelhardt BG, Goodman SA, Harrell SL, Kassim AA, Savani BN, Sengsayadeth S, Jagasia M, Cornell RF. Prospective trial of minimal residual disease assessment by multiparametric flow cytometry for multiple myeloma in the era of bortezomib-based chemotherapy. Bone Marrow Transplant 2018; 53:1589-1592. [PMID: 29915217 DOI: 10.1038/s41409-018-0241-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/06/2018] [Accepted: 05/11/2018] [Indexed: 12/31/2022]
Affiliation(s)
- C Amos Clark
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Claudio A Mosse
- Department of Hematopathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heidi Chen
- Division of Biostatistics and Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael Byrne
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wichai Chinratanalab
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian G Engelhardt
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stacey A Goodman
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shelton L Harrell
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adetola A Kassim
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bipin N Savani
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Salyka Sengsayadeth
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Madan Jagasia
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - R Frank Cornell
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Spinal metastases in multiple myeloma: A high-risk subgroup for ISS III patients. Surg Oncol 2018; 27:321-326. [DOI: 10.1016/j.suronc.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/10/2018] [Accepted: 05/02/2018] [Indexed: 11/21/2022]
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Gandhi UH, Senapedis W, Baloglu E, Unger TJ, Chari A, Vogl D, Cornell RF. Clinical Implications of Targeting XPO1-mediated Nuclear Export in Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2018; 18:335-345. [PMID: 29610030 DOI: 10.1016/j.clml.2018.03.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/26/2018] [Accepted: 03/08/2018] [Indexed: 12/30/2022]
Abstract
Multiple myeloma (MM) is a malignancy of plasma cells that is typically chronic, and relapse is common. Current therapeutic strategies include combination and sequential treatments with corticosteroids, alkylating agents, proteasomal inhibitors, immunomodulators, and monoclonal antibodies. These drugs prolong survival but ultimately become ineffective. Exportin 1 (XPO1), a nuclear export protein, is overexpressed in MM cells, and knockdown studies have suggested that XPO1 is essential for MM cell survival. Selective inhibitor of nuclear export (SINE) compounds are novel, orally bioavailable class of agents that specifically inhibit XPO1. Selinexor (KPT-330) is the first-in-human SINE compound. Early phase clinical trials have established the safety profile of this agent and have shown promising efficacy in combination with low-dose dexamethasone and other anti-MM agents. The combination of selinexor and dexamethasone has demonstrated activity in "penta-refractory" MM, (ie, MM refractory to the 5 most active anti-MM agents currently used in treatment). We have reviewed the available data on the molecular implications of XPO1 inhibition in MM. We also reviewed the pertinent early phase clinical data with SINE compounds and discuss management strategies for common toxicities encountered with use of selinexor.
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Affiliation(s)
- Ujjawal H Gandhi
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Ajai Chari
- Division of Hematology and Oncology, Mount Sinai Hospital, New York, NY
| | - Dan Vogl
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA
| | - Robert F Cornell
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN.
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Lenalidomide vs bortezomib maintenance choice post-autologous hematopoietic cell transplantation for multiple myeloma. Bone Marrow Transplant 2018; 53:701-707. [PMID: 29703965 DOI: 10.1038/s41409-018-0177-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/18/2018] [Accepted: 03/23/2018] [Indexed: 12/22/2022]
Abstract
Maintenance therapy post-autologous hematopoietic cell transplantation (AHCT) with either lenalidomide or bortezomib for multiple myeloma (MM) have separately been shown to improve progression-free survival (PFS), but have never been directly compared. We performed a retrospective study to investigate progression-free and overall survival outcomes and toxicities of lenalidomide maintenance therapy compared with bortezomib maintenance in MM patients post-AHCT. This study included 156 patients who received post-AHCT lenalidomide or bortezomib maintenance therapy for MM. The primary outcome was PFS. Ninety-two patients received lenalidomide maintenance and 64 received bortezomib maintenance post-AHCT. By multivariable analysis, maintenance therapy choice and cytogenetics risk did not impact PFS or OS. Staging by International Staging System and pre-maintenance disease response were the greatest predictors for PFS. Treatment-related toxicities were as anticipated with 5.4% of patients receiving maintenance lenalidomide experiencing secondary primary malignancies (SPMs) compared with 3% for bortezomib. These findings suggest there were no differences in PFS or OS between lenalidomide and bortezomib maintenance therapy options for post-transplantation MM patients. These data should be validated in a larger, prospective cohort to determine if maintenance choice should be guided by side effect profile and patient anticipated tolerance rather than by disease biology alone.
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Chari A, Larson S, Holkova B, Cornell RF, Gasparetto C, Karanes C, Matous JV, Niesvizky R, Valent J, Lunning M, Usmani SZ, Anderson LD, Chang L, Lee Y, Pak Y, Salman Z, Graef T, Bilotti E, Chhabra S. Phase 1 trial of ibrutinib and carfilzomib combination therapy for relapsed or relapsed and refractory multiple myeloma. Leuk Lymphoma 2018; 59:2588-2594. [PMID: 29616843 DOI: 10.1080/10428194.2018.1443337] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This phase 1, dose-finding study investigated ibrutinib and carfilzomib ± dexamethasone in patients with relapsed or relapsed/refractory multiple myeloma (≥2 lines of therapy including bortezomib and an immunomodulatory agent). Of 43 patients enrolled, 74% were refractory to bortezomib and 23% had high-risk cytogenetics. No dose-limiting toxicities were observed. The recommended phase 2 dose was ibrutinib 840 mg and carfilzomib 36 mg/m2 with dexamethasone. The most common ≥ grade 3 (>10%) treatment-emergent adverse events were hypertension, anemia, pneumonia, fatigue, diarrhea, and thrombocytopenia. Overall response rate was 67% (very good partial response, 21%; stringent complete response, 2%), with an additional 9% minimal response. Median progression-free survival was 7.2 months and was not inferior in refractory nor high-risk patients. Median overall survival was not reached. Ibrutinib plus carfilzomib demonstrated encouraging responses with a manageable safety profile in this advanced population.
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Affiliation(s)
- Ajai Chari
- a Icahn School of Medicine at Mount Sinai , Tisch Cancer Institute , New York , NY , USA
| | - Sarah Larson
- b University of California , Los Angeles , CA , USA
| | - Beata Holkova
- c Virginia Commonwealth University Medical Center , Richmond , VA , USA
| | | | | | | | | | | | - Jason Valent
- i Cleveland Clinic , Taussig Cancer Institute , Cleveland , OH , USA
| | | | - Saad Z Usmani
- k Levine Cancer Institute/Carolinas Healthcare System , Charlotte , NC , USA
| | - Larry D Anderson
- l Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Lipo Chang
- m Pharmacyclics LLC, an AbbVie Company , Sunnyvale , CA , USA
| | - Yihua Lee
- m Pharmacyclics LLC, an AbbVie Company , Sunnyvale , CA , USA
| | - Yvonne Pak
- m Pharmacyclics LLC, an AbbVie Company , Sunnyvale , CA , USA
| | - Zeena Salman
- m Pharmacyclics LLC, an AbbVie Company , Sunnyvale , CA , USA
| | - Thorsten Graef
- m Pharmacyclics LLC, an AbbVie Company , Sunnyvale , CA , USA
| | | | - Saurabh Chhabra
- n Medical University of South Carolina , Charleston , SC , USA
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Iannaccone A, Bruno G, Ravera A, Gay F, Salvini M, Bringhen S, Sabia L, Avenatti E, Veglio F, Milan A. Evaluation of Cardiovascular Toxicity Associated with Treatments Containing Proteasome Inhibitors in Multiple Myeloma Therapy. High Blood Press Cardiovasc Prev 2018; 25:209-218. [PMID: 29582365 DOI: 10.1007/s40292-018-0256-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/19/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Recently new treatment options have substantially increased survival for patients with relapsed and/or refractory multiple myeloma (RRMM). Among these, proteasome inhibitors (PI), such as bortezomib and carfilzomib, offer high response rate and prolonged survival. These agents are generally well tolerated but demonstrated a significant cardiovascular toxicity, mostly for regimen containing carfilzomib. AIM To assess the cardiovascular damage in patients treated with PI for RRMM. METHODS 28 consecutive subjects treated with PI for RRMM were evaluated and compared with a population of 22 control (Con) subjects, matched for age, sex and mean 24 h blood pressure (24hMBP). All individuals underwent trans-thoracic echocardiography, ambulatory blood pressure monitoring and pulse wave velocity (PVW) study. RESULTS PI patients did not have significant differences in blood pressure load and PWV compared to controls. Among echocardiographic parameters, the global longitudinal strain (GLS) was significantly decreased in PI subjects (p = 0.02). The GLS was significantly lower also considering only patients treated with carfilzomib. Moreover, among carfilzomib patients, we found increase values of left ventricle mass indexed by BSA (LVMi; p = 0.047). After correction for age, sex, BSA, 24hMBP and morphological and functional parameters of LV, treatment with PI and carfilzomib were significantly associated with GLS (p = 0.01; p = 0.036, respectively). CONCLUSIONS PI treatment is associated with subclinical LV dysfunction in patients with RRMM compared to controls, as demonstrated by lower GLS values. These results are confirmed also considering patients treated with carfilzomib. Moreover, in this subgroup of patients, the LVMi is also increased, suggesting higher cardiotoxicity with this treatment.
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Affiliation(s)
- Andrea Iannaccone
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy.
| | - G Bruno
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy
| | - A Ravera
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy
| | - F Gay
- Myeloma Unit, Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University Hospital 'Città della Salute e della Scienza di Torino', University of Torino, Turin, Italy
| | - M Salvini
- Myeloma Unit, Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University Hospital 'Città della Salute e della Scienza di Torino', University of Torino, Turin, Italy
| | - S Bringhen
- Myeloma Unit, Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University Hospital 'Città della Salute e della Scienza di Torino', University of Torino, Turin, Italy
| | - L Sabia
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy
| | - E Avenatti
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy
| | - F Veglio
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy
| | - A Milan
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University Hospital "Città della Salute e della Scienza", University of Torino, Turin, Italy
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Siegel DS, Dimopoulos MA, Ludwig H, Facon T, Goldschmidt H, Jakubowiak A, San-Miguel J, Obreja M, Blaedel J, Stewart AK. Improvement in Overall Survival With Carfilzomib, Lenalidomide, and Dexamethasone in Patients With Relapsed or Refractory Multiple Myeloma. J Clin Oncol 2018; 36:728-734. [DOI: 10.1200/jco.2017.76.5032] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose In the ASPIRE study of carfilzomib, lenalidomide, and dexamethasone (KRd) versus lenalidomide plus dexamethasone (Rd) in patients with relapsed or refractory multiple myeloma, progression-free survival was significantly improved in the carfilzomib group (hazard ratio, 0.69; two-sided P < .001). This prespecified analysis reports final overall survival (OS) data and updated safety results. Patients and Methods Adults with relapsed multiple myeloma (one to three prior lines of therapy) were eligible and randomly assigned at a one-to-one ratio to receive KRd or Rd in 28-day cycles until withdrawal of consent, disease progression, or occurrence of unacceptable toxicity. After 18 cycles, all patients received Rd only. Progression-free survival was the primary end point; OS was a key secondary end point. OS was compared between treatment arms using a stratified log-rank test. Results Median OS was 48.3 months (95% CI, 42.4 to 52.8 months) for KRd versus 40.4 months (95% CI, 33.6 to 44.4 months) for Rd (hazard ratio, 0.79; 95% CI, 0.67 to 0.95; one-sided P = .0045). In patients receiving one prior line of therapy, median OS was 11.4 months longer for KRd versus Rd; it was 6.5 months longer for KRd versus Rd among patients receiving ≥ two prior lines of therapy. Rates of treatment discontinuation because of adverse events (AEs) were 19.9% (KRd) and 21.5% (Rd). Grade ≥ 3 AE rates were 87.0% (KRd) and 83.3% (Rd). Selected grade ≥ 3 AEs of interest (grouped terms; KRd v Rd) included acute renal failure (3.8% v 3.3%), cardiac failure (4.3% v 2.1%), ischemic heart disease (3.8% v 2.3%), hypertension (6.4% v 2.3%), hematopoietic thrombocytopenia (20.2% v 14.9%), and peripheral neuropathy (2.8% v 3.1%). Conclusion KRd demonstrated a statistically significant and clinically meaningful reduction in the risk of death versus Rd, improving survival by 7.9 months. The KRd efficacy advantage is most pronounced at first relapse.
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Affiliation(s)
- David S. Siegel
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Meletios A. Dimopoulos
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Heinz Ludwig
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Thierry Facon
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Hartmut Goldschmidt
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Andrzej Jakubowiak
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Jesus San-Miguel
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Mihaela Obreja
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Julie Blaedel
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - A. Keith Stewart
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
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