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Nanni C, Deroose CM, Balogova S, Lapa C, Withofs N, Subesinghe M, Jamet B, Zamagni E, Ippolito D, Delforge M, Kraeber-Bodéré F. EANM guidelines on the use of [ 18F]FDG PET/CT in diagnosis, staging, prognostication, therapy assessment, and restaging of plasma cell disorders. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06858-9. [PMID: 39207486 DOI: 10.1007/s00259-024-06858-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/21/2024] [Indexed: 09/04/2024]
Abstract
We provide updated guidance and standards for the indication, acquisition, and interpretation of [18F]FDG PET/CT for plasma cell disorders. Procedures and characteristics are reported and different scenarios for the clinical use of [18F]FDG PET/CT are discussed. This document provides clinicians and technicians with the best available evidence to support the implementation of [18F]FDG PET/CT imaging in routine practice and future research.
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Affiliation(s)
- Cristina Nanni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Christophe M Deroose
- Nuclear Medicine, University Hospitals (UZ) Leuven, 3000, Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Sona Balogova
- Nuclear Medicine, Comenius University, Bratislava, Slovakia
- Médecine Nucléaire, Hôpital Tenon, GH AP.SU, Paris, France
| | - Constantin Lapa
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Nadia Withofs
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Liege, Belgium
- GIGA-CRC in Vivo Imaging, University of Liege, Liege, Belgium
| | - Manil Subesinghe
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Bastien Jamet
- Médecine Nucléaire, CHU Nantes, F-44000, Nantes, France
| | - Elena Zamagni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.
| | - Davide Ippolito
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy
- University of Milano-Bicocca, School of Medicine, Via Cadore 33, 20090, Monza, Italy
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2
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Colley A, Brauns T, Sluder AE, Poznansky MC, Gemechu Y. Immunomodulatory drugs: a promising clinical ally for cancer immunotherapy. Trends Mol Med 2024; 30:765-780. [PMID: 38821771 DOI: 10.1016/j.molmed.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/27/2024] [Accepted: 05/01/2024] [Indexed: 06/02/2024]
Abstract
While immunomodulatory imide drugs (IMiDs) have been authorised for treatment of haematological cancers for over two decades, the appreciation of their ability to stimulate antitumour T cell and natural killer (NK) cell responses is relatively recent. Clinical trial data increasingly show that targeted immunotherapies, such as antibodies, T cells, and vaccines, improve outcomes when delivered in combination with the IMiD derivatives lenalidomide or pomalidomide. Here, we review these clinical data to highlight the relevance of IMiDs in combinatorial immunotherapy for both haematological and solid tumours. Further research into the molecular mechanisms of IMiDs and an increased understanding of their immunomodulatory effects may refine the specific applications of IMiDs and improve the design of future clinical trials, moving IMiDs to the forefront of combinatorial cancer immunotherapy.
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Affiliation(s)
- Abigail Colley
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Oncology, University of Cambridge, Cambridge, UK
| | - Timothy Brauns
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ann E Sluder
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark C Poznansky
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yohannes Gemechu
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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3
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Mainou M, Bougioukas KI, Malandris K, Liakos A, Klonizakis P, Avgerinos I, Haidich AB, Tsapas A. Reporting of adverse events of treatment interventions in multiple myeloma: an overview of systematic reviews. Ann Hematol 2024; 103:2681-2697. [PMID: 37935924 PMCID: PMC11283434 DOI: 10.1007/s00277-023-05517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023]
Abstract
The present study is an overview of systematic reviews focusing on adverse events of antimyeloma treatments. It provides a systematic description of adverse events as they are reported in the systematic reviews as well as a critical appraisal of included reviews. We conducted a comprehensive literature search in the most widely used electronic databases looking for systematic reviews that had an adverse event of an antimyeloma treatment intervention as primary outcome. Two independent reviewers conducted selection of included studies and data extraction on predesigned online forms and assessed study quality using AMSTAR 2. Overall corrected covered area (CCA) was calculated to examine the overlap of primary studies across systematic reviews. After screening eligible studies, 23 systematic reviews were included in this overview. Seven reviews with overall CCA of 14.7% examined cardiovascular adverse events of different drugs, including immunomodulatory drugs and proteasome inhibitors (mainly carfilzomib). Nine focused on infections, presenting with overall CCA of 5.8%, each one focused on a different drug or drug class. Three studied thromboembolism in patients treated either with lenalidomide, any immunomodulatory drug, or with daratumumab and had an overall CCA equal to 1.5%. Four more reviews focused on bortezomib-associated neurotoxicity, carfilzomib-associated renal toxicity, or second primary malignancies as an adverse event of lenalidomide or anti-CD38 monoclonal antibody treatment. The quality of included studies as judged by AMSTAR 2 was mostly critically low. Absence of a priori registered protocol and formal assessment of risk of bias of included primary studies were the most common shortcomings. Reporting of antimyeloma drug-associated toxicity is supported by multiple systematic reviews; nevertheless, methodological quality of existing reviews is mostly low.
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Affiliation(s)
- Maria Mainou
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos I Bougioukas
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Konstantinos Malandris
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aris Liakos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Philippos Klonizakis
- Adult Thalassemia Unit, Second Department of Internal Medicine, Hippokration Hospital, Thessaloniki, Greece
| | - Ioannis Avgerinos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Betinna Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Harris Manchester College, University of Oxford, Oxford, UK
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4
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Alrasheed MA, Alamer KA, Albishi M, Alsuhibani AA, Almohammed OA, Alwhaibi A, Almajed AN, Guo JJ. Descriptive Analysis of Adverse Events Reported for New Multiple Myeloma Medications Using FDA Adverse Event Reporting System (FAERS) Databases from 2015 to 2022. Pharmaceuticals (Basel) 2024; 17:815. [PMID: 39065666 PMCID: PMC11279559 DOI: 10.3390/ph17070815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/09/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND New multiple myeloma (MM) medications have revolutionized the treatment landscape, but they are also associated with a range of adverse events (AEs). This study aims to provide a comprehensive overview of AEs reported for four new MM medications: daratumumab, ixazomib, elotuzumab, and panobinostat. METHODS This study uses a descriptive retrospective approach to analyze the FDA Adverse Event Reporting System (FAERS) from 2015 to 2022. It includes variables like medication names, report details, patient demographics, adverse events, and reporter types. The initial dataset consists of over 3700 adverse events, which are categorized into 21 groups for clarity and comparison. RESULTS The FAERS database revealed 367,756 adverse events (AEs) associated with novel multiple myeloma drugs from 2015-2022. Ixazomib had the highest number of reported AEs with 206,243 reports, followed by daratumumab with 98,872 reports, then elotuzumab with 26,193 AEs. Ixazomib's AE reports increased dramatically over the study period, rising approximately 51-fold from 1183 in 2015 to 60,835 in 2022. Of the medications studied, ixazomib also recorded the highest number of deaths (24,206), followed by daratumumab (11,624), panobinostat (7227), and elotuzumab (3349). The majority of AEs occurred in patients aged 55-64 and 65-74 years. CONCLUSIONS Ixazomib, a new MM medication, had the highest number of AEs reported. Also, it has the highest rate of reported deaths compared to other new MM medications. Clinicians should be aware of the potential AEs associated with this medication and further research is needed to understand the reasons for the high number of AEs and to develop mitigation strategies. More attention should also be paid to the safety of new multiple myeloma medications in younger patients.
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Affiliation(s)
- Marwan A. Alrasheed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (O.A.A.); (A.A.)
| | - Khalid A. Alamer
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia;
| | - Mashael Albishi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (O.A.A.); (A.A.)
| | - Abdulrahman A. Alsuhibani
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah 51452, Saudi Arabia;
| | - Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (O.A.A.); (A.A.)
| | - Abdulrahman Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (O.A.A.); (A.A.)
| | - Abdullah N. Almajed
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, MBC 11, P.O. Box 3354, Riyadh 11211, Saudi Arabia;
| | - Jeff J. Guo
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA;
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5
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Geraldes C, Roque A, Sarmento-Ribeiro AB, Neves M, Ionita A, Gerivaz R, Tomé A, Afonso S, Silveira MP, Sousa P, Bergantim R, João C. Practical management of disease-related manifestations and drug toxicities in patients with multiple myeloma. Front Oncol 2024; 14:1282300. [PMID: 38585008 PMCID: PMC10995327 DOI: 10.3389/fonc.2024.1282300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/07/2024] [Indexed: 04/09/2024] Open
Abstract
Multiple myeloma (MM) is a very heterogeneous disease with multiple symptoms and clinical manifestations. MM affects mainly elderly patients and is difficult to manage in the presence of comorbidities, polypharmacy, frailty and adverse events of disease-targeted drugs. The rapid changes in MM treatment resulting from constant innovations in this area, together with the introduction of numerous new drugs with distinct mechanisms of action and toxicity profiles, have led to an increased complexity in the therapeutic decision-making and patient management processes. The prolonged exposure to novel agents, sometimes in combination with conventional therapies, makes this management even more challenging. A careful balance between treatment efficacy and its tolerability should be considered for every patient. During treatment, a close monitoring of comorbidities, disease-related manifestations and treatment side effects is recommended, as well as a proactive approach, with reinforcement of information and patient awareness for the early recognition of adverse events, allowing prompt therapeutic adjustments. In this review, we discuss various issues that must be considered in the treatment of MM patients, while giving practical guidance for monitoring, prevention and management of myeloma-related manifestations and treatment-related toxicities.
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Affiliation(s)
- Catarina Geraldes
- Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Adriana Roque
- Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Institute of Physiology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Bela Sarmento-Ribeiro
- Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Manuel Neves
- Hemato-Oncology Unit, Champalimaud Foundation, Lisboa, Portugal
| | - Alina Ionita
- Hematology Department, Portuguese Institute of Oncology Francisco Gentil, Lisboa, Portugal
| | - Rita Gerivaz
- Serviço de Hemato-oncologia, Hospital Garcia de Orta, Lisboa, Portugal
| | - Ana Tomé
- Serviço de Hemato-oncologia, Hospital Garcia de Orta, Lisboa, Portugal
| | - Sofia Afonso
- Serviço de Hematologia Clínica, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Maria Pedro Silveira
- Serviço de Imuno-Hemoterapia, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Patrícia Sousa
- Serviço de Imuno-Hemoterapia, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Rui Bergantim
- Serviço de Hematologia Clínica, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
- Instituto de Investigação e Inovaçáo em Saúde, Universidade do Porto, Porto, Portugal
- Institute of Pathology and Molecular Immunology, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Cristina João
- Hemato-Oncology Unit, Champalimaud Foundation, Lisboa, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
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6
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Rana S, Maharjan S, Sookdeo SD, Schmidt P. Pain Management in Multiple Myeloma Patients: A Literature Review. Cureus 2024; 16:e55975. [PMID: 38601412 PMCID: PMC11006436 DOI: 10.7759/cureus.55975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Managing pain in cancer patients with multiple myeloma (MM) poses a considerable challenge. This review thoroughly investigates current pain management strategies, difficulties, and future directions in the field. The review divides pain treatment strategies into pharmaceutical and non-pharmacological therapies. Looking ahead, promising areas for future study and development are mentioned, such as incorporating precision medicine into pain management and investigating innovative therapeutics. Despite existing limitations, advances in pain management provide great opportunities to improve the quality of life and overall results for MM patients.
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Affiliation(s)
- Shubh Rana
- Cardiology, Maimonides Medical Center, Brooklyn, USA
| | - Suprina Maharjan
- Internal Medicine, Xavier University School of Medicine, Oranjestad, ABW
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Nadeem O, Ailawadhi S, Khouri J, Williams L, Catamero D, Maples K, Berdeja J. Management of Adverse Events Associated with Pomalidomide-Based Combinations in Patients with Relapsed/Refractory Multiple Myeloma. Cancers (Basel) 2024; 16:1023. [PMID: 38473381 DOI: 10.3390/cancers16051023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Multi-agent regimens incorporating immunomodulatory (IMiD®) agents such as thalidomide, lenalidomide, and pomalidomide have become the preferred standard of care for the treatment of patients with multiple myeloma (MM), resulting in improved survival outcomes. Currently, there are three IMiD agents approved for the treatment of MM: thalidomide, lenalidomide, and pomalidomide. Lenalidomide is commonly used to treat patients with newly diagnosed MM and as maintenance therapy following stem cell transplant or after disease relapse. Pomalidomide, the focus of this review, is approved in patients with relapsed/refractory MM (RRMM). Despite survival benefits, IMiD agents each have different safety profiles requiring consideration both prior to starting therapy and during treatment. Adverse event (AE) management is essential, not only to ensure treatment adherence and thus ensure optimal efficacy but also to maintain patient quality of life. Here, we discuss AEs associated with pomalidomide and present five clinically relevant hypothetical case studies in patients with RRMM to provide scenario-driven guidance regarding treatment selection and AE prevention and management in the clinical setting. Lastly, as new treatment approaches continue to be explored in MM, we also discuss novel cereblon E3 ligase modulator (CELMoD™) agents including iberdomide (CC-220) and mezigdomide (CC-92480).
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Affiliation(s)
- Omar Nadeem
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Sikander Ailawadhi
- Department of Hematology & Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Jack Khouri
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Louis Williams
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | - Kathryn Maples
- Department of Pharmacy, Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Jesús Berdeja
- Greco-Hainsworth Centers for Cancer Research, Tennessee Oncology, Nashville, TN 37203, USA
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8
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Facon T, Leleu X, Manier S. How I treat multiple myeloma in geriatric patients. Blood 2024; 143:224-232. [PMID: 36693134 PMCID: PMC10808246 DOI: 10.1182/blood.2022017635] [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: 10/27/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
ABSTRACT Multiple myeloma (MM) is primarily a disease of older patients. Until recently, geriatric aspects in the context of MM have been poorly investigated. Treatment outcomes for geriatric patients with MM are often compromised by comorbidities and an enhanced susceptibility to adverse events from therapy. Assessment of patient frailty has become more frequent and will be useful in the context of significant and continuous advances in therapy. The recent emergence of immunotherapy with CD38 monoclonal antibodies and upcoming immunooncology drugs, such as bispecific antibodies, will lead to additional therapeutic progress. The applicability of these new molecules to older and frail patients is a key clinical question. Here, we present 2 patient cases derived from clinical practice. We review current frailty scores and standards of care for older, newly diagnosed patients with MM, including frail subgroups, and discuss ways to tailor treatment, as well as treatment perspectives in this population.
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Affiliation(s)
- Thierry Facon
- Department of Hematology, University of Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - Xavier Leleu
- Department of Hematology, University of Poitiers, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Salomon Manier
- Department of Hematology, University of Lille, Centre Hospitalier Universitaire Lille, Lille, France
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9
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Srivastava PK, Kittleson MM. Modern advances in heart transplantation. Prog Cardiovasc Dis 2024; 82:147-156. [PMID: 38244826 DOI: 10.1016/j.pcad.2024.01.012] [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: 01/14/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
Heart transplantation (HTx) is the only definitive therapy for patients with end stage heart disease. With the increasing global prevalence of heart failure, the demand for HTx has continued to grow and outpace supply. In this paper, we will review advances in the field of HTx along the clinical journey of a HTx recipient. Starting with the sensitized patient, we discuss current methods to define sensitization, and assays to help identify clinically relevant anti-HLA antibodies. Desensitization strategies targeting all levels of the adaptive immune system are discussed with emphasis on novel techniques such as anti-CD 38 blockade and use of the Immunoglobulin G-Degrading Enzyme of Streptococcus Pyogenes. We next discuss donor procurement and the resurgence of donation after circulatory death as a viable strategy to significantly and safely increase the donor pool. Post-transplant, we evaluate non-invasive surveillance techniques including gene expression profiling and donor-derived cell-free DNA. Last, we discuss the ground-breaking developments in the field of xenotransplantation.
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Affiliation(s)
- Pratyaksh K Srivastava
- Department of Cardiology, Smidt Heart Institute at Cedars-Sinai, Los Angeles, CA, United States of America
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute at Cedars-Sinai, Los Angeles, CA, United States of America.
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10
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Chen G, Guo H, Lin J, Luo S, Xu S. Competing risk analysis of cardiovascular mortality in multiple myeloma survivors. Transl Cancer Res 2023; 12:3314-3326. [PMID: 38197077 PMCID: PMC10774068 DOI: 10.21037/tcr-23-1213] [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: 07/13/2023] [Accepted: 11/08/2023] [Indexed: 01/11/2024]
Abstract
Background The survival of multiple myeloma (MM) patients has significantly improved, and several factors increase the risk of cardiovascular death (CVD) mortality in MM. This study aims to determine the prognostic significance of factors associated with long-term CVD risk in MM survivors. Methods The data of MM survivors whose survival time was longer than 36 months were retrieved from the Surveillance, Epidemiology, and End Result (SEER) database between 2000 and 2015. Cox proportional hazards regressions and competing risk survival analyses were utilized to assess the CVD-associated risk factors. Propensity score matching (PSM) was further conducted to ensure the comparability of cardiovascular risk factors. The nomogram was based on these epidemiological factors to estimate individualized CVD probabilities for MM survivors, and its performance was assessed by Harrell's concordance index (C-index) and calibration curve. Results A total of 32,528 survivors with MM were enrolled, and 2,061 (6.34%) suffered from CVD. In Cox proportional hazards regressions and competing risk survival analyses, age, period of diagnosis, sex, race, married status, income, chemotherapy, and radiotherapy were the independent risk factors for CVD. After PSM, there was a significant difference in cumulative incidence curves, using a competing-risks method, between the following matched groups: male vs. female group, white vs. non-white group, married vs. unmarried group, income <$75,000 vs. income ≥$75,000 group, chemotherapy vs. non-chemotherapy group, and radiotherapy vs. non-radiotherapy group. The nomogram predicted CVD probabilities with a training C-index of 0.700 and a validation C-index of 0.726. Calibration curves validated that the nomograms could accurately predict the CVD probabilities both in the training and validation group. Conclusions Among MM survivors, the mortality risk of cardiovascular diseases differs with age, sex, period at diagnosis, race/ethnicity, marital status, chemotherapy, and radiotherapy. Our nomograms, based on epidemiological variables, may be used to predict 5-, 10-, and 15-year cardiovascular disease outcomes of MM survivors.
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Affiliation(s)
- Ganxiao Chen
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, China
| | - Hongdou Guo
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, China
| | - Jiayi Lin
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, China
| | - Shunxiang Luo
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, China
| | - Shanghua Xu
- Department of Cardiology, Affiliated Nanping First Hospital, Fujian Medical University, Nanping, China
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11
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Najjar M, McCarron J, Cliff ERS, Berger K, Steensma DP, Al Hadidi S, Chakraborty R, Goodman A, Anto E, Greene T, Sborov D, Mohyuddin GR. Adverse Event Reporting in Randomized Clinical Trials for Multiple Myeloma. JAMA Netw Open 2023; 6:e2342195. [PMID: 37948080 PMCID: PMC10638643 DOI: 10.1001/jamanetworkopen.2023.42195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/28/2023] [Indexed: 11/12/2023] Open
Abstract
Importance Cancer treatment can result in burdensome toxic effects that profoundly affect patient quality of life. In seeking to emphasize the efficacy of tested treatments, clinical trial reports may use subjective or minimizing terms to describe adverse events (AEs). Objective To evaluate patterns of AE reporting in multiple myeloma (MM) randomized clinical trials (RCTs) published between 2015 and early 2023. Design, Setting, and Participants For this cohort study, the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched to assess the prevalence of minimizing terms in MM RCTs published between January 1, 2015, and March 1, 2023. Minimizing terms were defined as subjective terms used to favorably describe the safety profile of the intervention. The terms searched included convenient, manageable, acceptable, expected, well-tolerated, tolerable, favorable, and safe. Final data analysis was performed on July 21, 2023. Main Outcomes and Measures The primary outcome was the occurrence of at least 1 minimizing term in an article. Univariate logistic regression analyses were performed to evaluate the association between the presence of at least 1 minimizing term and the actual incidence of grade 3 or 4 AEs, serious AEs, or grade 5 AEs. Results Of the 65 RCTs included, 56 (86%) used minimizing terms when describing treatment-emergent AEs. The most frequently used minimizing terms were well-tolerated or tolerable in 29 trials (45%), manageable in 18 (28%), and acceptable in 16 (25%). Grade 3 or 4 AE rate in the examined RCTs ranged from 23% to 94%, with a median of 75% (IQR, 59%-82%). A univariate regression analysis demonstrated no association between the use of minimizing terms and grade 3 or 4 AE rates (odds ratio [OR], 1.35 [95% CI, 0.88-2.10] per 10% AE rate increase; P = .17) or grade 5 AE rates (OR, 3.16 [95% CI, 0.27-12.7] per 10% AE rate increase; P = .45). Conclusions and Relevance These findings suggest that trial investigators and sponsors regularly use minimizing terms to describe toxic effects in MM trials, and use of this terminology may not reflect actual AE rates in these studies. Instead of using these terms, trial investigators should highlight event rates and patient-reported outcomes, to allow clinicians and patients to better evaluate the true tolerability of AEs.
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Affiliation(s)
- Mimi Najjar
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John McCarron
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Edward R. Scheffer Cliff
- Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Samer Al Hadidi
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Rajshekhar Chakraborty
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Aaron Goodman
- Division of Hematology, University of California, San Diego
| | - Eric Anto
- Division of Biostatistics, Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Tom Greene
- Division of Biostatistics, Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Douglas Sborov
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City
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Doran S, Mysore M, Kassaian SE, Kotloff E, Kamangar F, Emadi A, Apata J, Barr B. Hypertension, smoking, and preexistence of multiple cardiac risk factors correlate with carfilzomib-induced cardiovascular adverse events in a racially diverse population. Front Cardiovasc Med 2023; 10:1129943. [PMID: 37363095 PMCID: PMC10285053 DOI: 10.3389/fcvm.2023.1129943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Background Use of the proteasome inhibitor carfilzomib has become a standard of care in patients with relapsed/refractory multiple myeloma. An association between carfilzomib and cardiovascular adverse events has been well documented, but this had not been investigated in a racially diverse population. Black patients in particular are underrepresented in the reported outcomes of treatment with carfilzomib. Objective The purpose of this study was to identify risk factors for carfilzomib-associated cardiovascular events in a diverse, single-center population. Methods We conducted a retrospective review of 161 patients with multiple myeloma treated with carfilzomib between 2011 and 2020 at the University of Maryland Medical Center. Over half (86) were Black patients, with the remainder (75) being White patients. We did a multivariate analysis to determine risk factors for developing cardiovascular events during treatment with carfilzomib. Results There was no statistically significant association with cardiotoxicity and race, gender, or age at first dose of carfilzomib. In multivariable analysis, patients with history of hypertension had a higher risk of cardiotoxicity [adjusted odds ratio (OR): 2.5; 95% CI: 1.1-5.9; P = 0.03] as did those with a history of smoking [OR: 2.8; 95% CI: 1.3-6.4; P = 0.01]. Conclusions Here we report the largest cohort of Black patients treated with carfilzomib as yet reported. The results of this single center retrospective study show history of hypertension and smoking are associated with carfilzomib associated cardiotoxicity in a diverse patient population. There is a need for well-designed prospective studies enrolling a diverse population to investigate potential interventions to prevent carfilzomib-associated cardiotoxicity.
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Affiliation(s)
- Stacey Doran
- National Cancer Institute, Bethesda, MD, United States
| | - Manu Mysore
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Seyed Ebrahim Kassaian
- Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, Washington, DC, United States
| | - Ethan Kotloff
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, United States
| | - Ashkan Emadi
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, United States
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jummai Apata
- Center for Urban Health Disparities Research & Innovation, Morgan State University, Baltimore, MD, United States
| | - Brian Barr
- Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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13
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Drummond PLM, Santos RMMD, Reis AMM, Malta JS, Silveira LP, Costa IHFD, Menezes de Pádua CA. Real-world effectiveness and safety of multiple myeloma treatments based on thalidomide and bortezomib: A retrospective cohort study from 2009 to 2020 in a Brazilian metropolis. Cancer Epidemiol 2023; 85:102377. [PMID: 37163919 DOI: 10.1016/j.canep.2023.102377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/27/2023] [Accepted: 04/29/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Multiple myeloma (MM) is an incurable cancer of plasma cells; the survival of which has improved over the years with the emergence of new treatments. In Brazil, the availability of treatment-regimens is different from developed countries. Real-world evidence with Brazilian patients is lacking. OBJECTIVES Our aim was to evaluate the effectiveness and the safety of MM treatments in a Brazilian metropolis. METHODS This was a retrospective cohort study with MM patients, beginning MM treatment from 2009 to 2020 (i.e., before bortezomib became available in public health services). Patients' medical records were revised to obtain clinical variables. The primary outcomes were Overall Survival (OS) and Progression Free Survival (PFS, measured as time to next treatment), and the secondary outcomes were Adverse Events (AE). Kaplan-Meier curves were obtained and the Cox proportional hazards model was performed for univariate and multivariate analyses. The incidence of AE was estimated and the chi-squared test was performed to evaluate the association between AE and MM regimens. RESULTS In total, 278 patients participated in the study with median age of 64 years; 50.4 % were females, 55.8 % attended a private clinic, 34.9 % received autologous stem cell transplantation (ASCT) and 32.4 % were on polypharmacy. Most patients from public services used thalidomide-based regimens (40.3 %) and at private clinics used bortezomib-based regimens (38.1 %) as first-line treatment. Patients had a median OS of 99 months. Patients had median PFS of 28 months in first-line treatment, which was significantly different for age (p = 0.0055), polypharmacy (p = 0.0094) and ASCT (p < 0.0001). PFS was independently associated to polypharmacy and ASCT. The incidence of peripheral neuropathy (39.6 %) was high. In contrast, the incidence of severe AE was low. We found significant difference between first-line T + B-based regimens and leukopenia (p = 0.012). CONCLUSION Our study showed that patients on polypharmacy and who did not receive ASCT had worse PFS. Similar to other Latin countries, most patients used thalidomide- and bortezomib-based regimens as first-line treatments having similar OS and PFS. Treatments were considered relatively safe, especially regarding serious AE.
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Affiliation(s)
- P L M Drummond
- Faculty of Pharmacy, Universidade Federal de Minas Gerais, Brazil; Ezequiel Dias Foundation, Brazil
| | | | | | | | - Lívia Pena Silveira
- Faculty of Pharmacy, Universidade Federal de Minas Gerais, Brazil; Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil
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Arp CJ, Reynders M, Sreekanth V, Kokkonda P, Pagano M, Choudhary A, Trauner D. Photoswitchable Molecular Glues Enable Optical Control of Transcription Factor Degradation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.09.536172. [PMID: 37066279 PMCID: PMC10104231 DOI: 10.1101/2023.04.09.536172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Immunomodulatory drugs (IMiDs), which include thalidomide and its derivatives, have emerged as the standard of care against multiple myeloma. They function as molecular glues that bind to the E3 ligase cereblon (CRBN) and induce protein interactions with neosubstrates, including the transcription factors Ikaros (IKZF1) and Aiolos (IKZF3). The subsequent ubiquitylation and degradation of these transcription factors underlies the antiproliferative activity of IMiDs. Here, we introduce photoswitchable immunomodulatory drugs (PHOIMiDs) that can be used to degrade Ikaros and Aiolos in a light-dependent fashion. Our lead compound shows minimal activity in the dark and becomes an active degrader upon irradiation with violet light. It shows high selectivity over other transcription factors, regardless of its state, and could therefore be used to control the levels of Ikaros and Aiolos with high spatiotemporal precision.
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Affiliation(s)
- Christopher J Arp
- Department of Chemistry, New York University, 100 Washington Sq E, New York, New York 10003, United States
| | - Martin Reynders
- Department of Chemistry, New York University, 100 Washington Sq E, New York, New York 10003, United States
| | - Vedagopuram Sreekanth
- Chemical Biology and Therapeutics Science, Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA 02142, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
- Divisions of Renal Medicine and Engineering, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Praveen Kokkonda
- Chemical Biology and Therapeutics Science, Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA 02142, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
| | - Michele Pagano
- Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, NY 10016, United States
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY 10016, United States
- Howard Hughes Medical Institute, New York University School of Medicine, New York, NY 10016, United States
| | - Amit Choudhary
- Chemical Biology and Therapeutics Science, Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA 02142, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
- Divisions of Renal Medicine and Engineering, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Dirk Trauner
- Department of Chemistry, University of Pennsylvania, College of Arts and Sciences, 231 South 34 Street, Philadelphia, PA 19104-6323, United States
- Department of Chemistry, New York University, 100 Washington Sq E, New York, New York 10003, United States
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15
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Holler M, Ihorst G, Reinhardt H, Rösner A, Braun M, Möller MD, Dreyling E, Schoeller K, Scheubeck S, Wäsch R, Engelhardt M. An objective assessment in newly diagnosed multiple myeloma to avoid treatment complications and strengthen therapy adherence. Haematologica 2023; 108:1115-1126. [PMID: 36325890 PMCID: PMC10071131 DOI: 10.3324/haematol.2022.281489] [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: 05/30/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
In heterogeneous multiple myeloma (MM) patients treatment decisions are challenging. The hypothesis was that adaptation of treatment intensity (dose reduction [DR] vs. none) according to an objective risk score (revised-myeloma comorbidity index [R-MCI]) rather than physician judgement alone may improve therapy efficacy and avoid toxicities. We performed this study in 250 consecutive MM patients who underwent a prospective fitness assessment at our center, after having received induction protocols based on physicians' judgement. DR, serious adverse events (SAE), response, progression-free survival (PFS) and overall survival (OS) were compared in fitness (fit, intermediate-fit, frail), age (<60, ≥70 years [y]) and therapy intensity subgroups at baseline and follow-up. Fit and <60 y patients were mostly treated with full intensity, whereas frail and ≥70 y patients usually received DR. Hematological and non-hematological SAE were more frequently seen in frail versus ≥70 y patients. Dose adaptations were mainly necessary in frail patients. OS and PFS were similar in fit and intermediate-fit but significantly worse in frail patients (P=0.0245/P<0.0001), whereas in age-based subgroups, OS and PFS differences did not reach significance (P=0.1362/P=0.0569). Non-hematological SAE were another negative predictor for impaired OS and PFS (P=0.0054/P=0.0021). In the follow-up performed at a median of 11 months after the first fitness assessment, the R-MCI improved or remained stable in 90% versus deteriorated in only 10% of patients. In conclusion, separation by R-MCI/frailty-defined subgroups was superior to age-based subgroups and can be used to improve tailored treatment. Fitter patients benefit from intensive therapies, whereas frail patients bear a need for initial DR.
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Affiliation(s)
- Maximilian Holler
- Department of Medicine I Hematology and Oncology, Medical Center -University of Freiburg, Faculty of Medicine, Germany; Comprehensive Cancer Center Freiburg (CCCF), Medical Center -University of Freiburg, Faculty of Medicine
| | - Gabriele Ihorst
- Clinical Trials Unit, Medical Center -University of Freiburg, Faculty of Medicine
| | - Heike Reinhardt
- Department of Medicine I Hematology and Oncology, Medical Center -University of Freiburg, Faculty of Medicine, Germany; Comprehensive Cancer Center Freiburg (CCCF), Medical Center -University of Freiburg, Faculty of Medicine
| | - Amelie Rösner
- Department of Medicine I Hematology and Oncology, Medical Center -University of Freiburg, Faculty of Medicine, Germany; Comprehensive Cancer Center Freiburg (CCCF), Medical Center -University of Freiburg, Faculty of Medicine
| | - Magdalena Braun
- Department of Medicine I Hematology and Oncology, Medical Center -University of Freiburg, Faculty of Medicine, Germany; Comprehensive Cancer Center Freiburg (CCCF), Medical Center -University of Freiburg, Faculty of Medicine
| | - Mandy-Deborah Möller
- Department of Medicine I Hematology and Oncology, Medical Center -University of Freiburg, Faculty of Medicine, Germany; Comprehensive Cancer Center Freiburg (CCCF), Medical Center -University of Freiburg, Faculty of Medicine
| | - Esther Dreyling
- Department of Medicine I Hematology and Oncology, Medical Center -University of Freiburg, Faculty of Medicine, Germany; Comprehensive Cancer Center Freiburg (CCCF), Medical Center -University of Freiburg, Faculty of Medicine
| | - Katja Schoeller
- Department of Medicine I Hematology and Oncology, Medical Center -University of Freiburg, Faculty of Medicine, Germany; Comprehensive Cancer Center Freiburg (CCCF), Medical Center -University of Freiburg, Faculty of Medicine
| | - Sophia Scheubeck
- Department of Medicine I Hematology and Oncology, Medical Center -University of Freiburg, Faculty of Medicine, Germany; Comprehensive Cancer Center Freiburg (CCCF), Medical Center -University of Freiburg, Faculty of Medicine
| | - Ralph Wäsch
- Department of Medicine I Hematology and Oncology, Medical Center -University of Freiburg, Faculty of Medicine, Germany; Comprehensive Cancer Center Freiburg (CCCF), Medical Center -University of Freiburg, Faculty of Medicine
| | - Monika Engelhardt
- Department of Medicine I Hematology and Oncology, Medical Center -University of Freiburg, Faculty of Medicine, Germany; Comprehensive Cancer Center Freiburg (CCCF), Medical Center -University of Freiburg, Faculty of Medicine.
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16
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Okolo O, Wertheim BC, Larsen A, Sweeney NW, Ahlstrom JM, Gowin K. Integrative medicine in multiple myeloma and plasma cell disorders. Complement Ther Med 2023; 73:102939. [PMID: 36868288 DOI: 10.1016/j.ctim.2023.102939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/20/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION Integrative Medicine (IM) use and efficacy is poorly defined in those with plasma cell disorders (PCD). A 69-question survey on the subject was hosted on HealthTree.org for 3 months. METHOD The survey included questions about complementary practice use, PHQ-2 score, quality of life, and more. Mean outcome values were compared between IM users and non-users. Proportions of supplement users and IM patients were compared between patients currently on myeloma specific treatment and patients not currently on treatment. RESULTS The top 10 IM modalities reported among 178 participants were aerobic exercise (83 %), nutrition (67 %), natural products (60 %), strength exercise (52 %), support groups (48 %), breathing exercises (44 %), meditation (42 %), yoga (40 %), mindfulness-based stress reduction (38 %), and massage (38 %). The survey showed most patients participated in IM modalities, though they felt uncomfortable discussing them with their oncologist. Participant characteristics were compared between groups (users and non-users) using two-sample t-tests and chi-square tests. Use of vitamin C (3.6 vs. 2.7; p = 0.01), medical marijuana (4.0 vs. 2.9; p = 0.03), support groups (3.4 vs. 2.7; p = 0.04), and massage (3.5 vs. 2.7; p = 0.03) were associated with a higher quality of life scores on MDA-SI MM. There were no other significant associations between supplement use or IM practices and the MDA-SI MM, brief fatigue inventory, or PHQ-2. CONCLUSION This study provides a foundation in the understanding of IM use in PCD, but more research is needed to evaluate individual IM interventions and their efficacy.
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Affiliation(s)
- Onyemaechi Okolo
- University of Arizona, Department of Hematology Oncology, Tucson, AZ, USA
| | | | - Ashley Larsen
- University of Arizona, Department of Medicine, Tucson, AZ, USA
| | - Nathan W Sweeney
- HealthTree Foundation, HealthTree for Multiple Myeloma, Lehi, UT, USA
| | | | - Krisstina Gowin
- University of Arizona, Department of Hematology Oncology, Tucson, AZ, USA.
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Sharma KK, Fatima N, Ali Z, Moshin M, Chandra P, Verma A, Goshain O, Kumar G. Neuropathy, its Profile and Experimental Nerve Injury Neuropathic Pain Models: A Review. Curr Pharm Des 2023; 29:3343-3356. [PMID: 38058089 DOI: 10.2174/0113816128274200231128065425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Abstract
Neuropathy is a terrible disorder that has a wide range of etiologies. Drug-induced neuropathy, which happens whenever a chemical agent damages the peripheral nerve system, has been linked here to the iatrogenic creation of some drugs. It is potentially permanent and causes sensory impairments and paresthesia that typically affects the hands, feet, and stockings; motor participation is uncommon. It might appear suddenly or over time, and the long-term outlook varies. The wide range of chronic pain conditions experienced by people has been one of the main obstacles to developing new, more effective medications for the treatment of neuropathic pain. Animal models can be used to examine various neuropathic pain etiologies and symptoms. Several models investigate the peripheral processes of neuropathic pain, whereas some even investigate the central mechanisms, such as drug induce models like vincristine, cisplatin, bortezomib, or thalidomide, etc., and surgical models like sciatic nerve chronic constriction injury (CCI), sciatic nerve ligation through spinal nerve ligation (SNL), sciatic nerve damage caused by a laser, SNI (spared nerve injury), etc. The more popular animal models relying on peripheral nerve ligatures are explained. In contrast to chronic sciatic nerve contraction, which results in behavioral symptoms of less reliable stressful neuropathies, (SNI) spared nerve injury generates behavioral irregularities that are more feasible over a longer period. This review summarizes the latest methods models as well as clinical ideas concerning this mechanism. Every strongest current information on neuropathy is discussed, along with several popular laboratory models for causing neuropathy.
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Affiliation(s)
- Krishana Kumar Sharma
- Department of Pharmacology, Teerthanker Mahaveer College of Pharmacy, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh 244001, India
| | - Nishat Fatima
- Department of Pharmacology, Teerthanker Mahaveer College of Pharmacy, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh 244001, India
| | - Zeeshan Ali
- Department of Pharmacology, Teerthanker Mahaveer College of Pharmacy, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh 244001, India
| | - Mohd Moshin
- Department of Pharmacology, Teerthanker Mahaveer College of Pharmacy, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh 244001, India
| | - Phool Chandra
- Department of Pharmacology, Teerthanker Mahaveer College of Pharmacy, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh 244001, India
| | - Anurag Verma
- Department of Pharmacology, Teerthanker Mahaveer College of Pharmacy, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh 244001, India
| | - Omprakash Goshain
- Department of Pharmacology, Teerthanker Mahaveer College of Pharmacy, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh 244001, India
| | - Gajendra Kumar
- Department of Chemistry, Constituent Government College (M.J.P.R.U.), Hasanpur, Uttar Pradesh 244241, India
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Song Z, Ma L, Bao L, Ma Y, Yang P, Jiang D, Liu A, Zhang L, Li Y, Cheng Y, Dong F, Zhao R, Jing H. Toward Therapeutic Drug Monitoring of Lenalidomide in Hematological Malignancy? Results of an Observational Study of the Exposure-Safety Relationship. Front Pharmacol 2022; 13:931495. [PMID: 35814199 PMCID: PMC9259783 DOI: 10.3389/fphar.2022.931495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: Continuous lenalidomide (LEN) therapy is important to achieve a therapeutic effect in patients with multiple myeloma (MM) and non-Hodgkin lymphoma (NHL). However, despite dose adjustment according to kidney function, many patients discontinue LEN therapy because of hematological toxicity. To date, therapeutic drug monitoring (TDM) of LEN has not been performed in oncology, and no target concentration level has been yet defined. The aim of this study was to evaluate the exposure-safety relationship of LEN and determine the target concentration for toxicity. Materials and Methods: A prospective observational study was designed and implemented. Blood samples were collected at 0.5 h (trough concentration, Cmin) before oral administration and 1 h (C1h) thereafter on the day. Clinical data were gathered from patients’ medical records and laboratory reports. Outcome measures of hematological toxicity were defined by the Common Terminology Criteria for Adverse Events. The concentration values were dichotomized by receiver operating characteristic (ROC) curve analysis, and the association between exposure and outcome was determined using the logistic regression model. Results: Out of the 61 patients enrolled in this study, 40 (65.57%) had MM, and 21 (34.43%) had NHL. Hematological toxicity was reported in 15 (24.59%) patients. The LEN Cmin showed remarkable differences (p = 0.031) among patients with or without hematological toxicity, while no association between C1h values and toxicity was noted (p>0.05). By ROC analysis, a Cmin threshold of 10.95 ng/mL was associated with the best sensitivity/specificity for toxicity events (AUC = 0.687; sensitivity = 0.40; specificity = 0.935). By multivariate logistic regression, an LEN Cmin below 10.95 ng/mL was associated with a markedly decreased risk of hematological toxicity (<10.95 ng/mL vs. >10.95 ng/mL: OR = 0.023, 95% CI = 0.002–0.269; p = 0.003). Conclusions: We demonstrate that the LEN trough concentration correlates with hematological toxicity, and the Cmin threshold for hematological toxicity (10.95 ng/mL) is proposed. Altogether, LEN TDM appears to be a new approach to improve medication safety and achieve continuous treatment for patients with NHL or MM in routine clinical care.
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Affiliation(s)
- Zaiwei Song
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Lan Ma
- Department of Hematology, Peking University Third Hospital, Beijing, China
| | - Li Bao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Yi Ma
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Ping Yang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Dan Jiang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Aijun Liu
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lu Zhang
- Department of Hematology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Li
- Department of Hematology, Peking University Third Hospital, Beijing, China
| | - Yinchu Cheng
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Fei Dong
- Department of Hematology, Peking University Third Hospital, Beijing, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
- *Correspondence: Rongsheng Zhao, ; Hongmei Jing,
| | - Hongmei Jing
- Department of Hematology, Peking University Third Hospital, Beijing, China
- *Correspondence: Rongsheng Zhao, ; Hongmei Jing,
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19
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Das A, Dasgupta S, Gong Y, Shah UA, Fradley MG, Cheng RK, Roy B, Guha A. Cardiotoxicity as an adverse effect of immunomodulatory drugs and proteasome inhibitors in multiple myeloma: A network meta-analysis of randomized clinical trials. Hematol Oncol 2022; 40:233-242. [PMID: 34940983 PMCID: PMC9423942 DOI: 10.1002/hon.2959] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/01/2021] [Accepted: 12/12/2021] [Indexed: 01/21/2023]
Abstract
We aim to determine the cumulative and comparative risk of cardiovascular events associated with different Immunomodulatory Drugs (iMiDs) and Proteasome Inhibitor (PIs) in Multiple Myeloma (MM) patients through pairwise and network meta-analysis. Electronic searches were conducted using Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and Clinical Trial Registry (Clinical Trials.gov) up to May 2021. Phase 3 randomized clinical trials (RCTs) reporting cardiotoxicity in MM patients (newly diagnoses and/or relapsed) treated with iMiD and/or PI. Studies, where iMiD or PI was used alongside the chemotherapy versus placebo or no additional drugs (control) in the other arm were included. The primary outcome was the presence of cardiotoxicity after follow-up. Pairwise meta-analysis and network meta-analysis were performed using the frequentist's approach to estimate the odds ratio (OR). Twenty RCTs with 10,373 MM patients were included in this analysis. Eleven studies compared iMiDs with control, seven studies compared PIs with control, and two studies compared bortezomib against carfilzomib. CTACE high-grade (≥grade 3) cardiotoxic events were increased with iMiDs compared to their control counterpart (OR 2.05; 95% CI 1.30-3.26). Similar high-grade cardiotoxicity was also noted more frequently with PI use when compared to the control group (OR 1.67; 95% CI 1.17-2.40). Among the PIs, carfilzomib was associated with a maximum risk of cardiotoxicity (OR 2.68; 95% CI 1.63-4.40). There was no evidence of publication bias among studies. iMiDs and PIs, particularly carfilzomib, appear to be associated with increased risk of high-grade cardiovascular events in MM patients.
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Affiliation(s)
- Avash Das
- Department of Molecular Genetics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Subhajit Dasgupta
- Department of Molecular Genetics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael G Fradley
- Division of Cardiology, Department of Medicine, University of Pennsylvania, PA, USA
| | - Richard K Cheng
- Cardiology Division, University of Washington, Seattle, WA, USA
| | - Bhaskar Roy
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Avirup Guha
- Harrington Heart and Vascular Institute, UH Cleveland Medical Center, Cleveland, OH, USA
- Division of Cardiology, Department of Medicine, Augusta University, Augusta, GA, USA
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20
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Henze L, Buhl C, Sandherr M, Cornely OA, Heinz WJ, Khodamoradi Y, Kiderlen TR, Koehler P, Seidler A, Sprute R, Schmidt-Hieber M, von Lilienfeld-Toal M. Management of herpesvirus reactivations in patients with solid tumours and hematologic malignancies: update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) on herpes simplex virus type 1, herpes simplex virus type 2, and varicella zoster virus. Ann Hematol 2022; 101:491-511. [PMID: 34994811 PMCID: PMC8810475 DOI: 10.1007/s00277-021-04746-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/19/2021] [Indexed: 12/14/2022]
Abstract
Clinical reactivations of herpes simplex virus or varicella zoster virus occur frequently among patients with malignancies and manifest particularly as herpes simplex stomatitis in patients with acute leukaemia treated with intensive chemotherapy and as herpes zoster in patients with lymphoma or multiple myeloma. In recent years, knowledge on reactivation rates and clinical manifestations has increased for conventional chemotherapeutics as well as for many new antineoplastic agents. This guideline summarizes current evidence on herpesvirus reactivation in patients with solid tumours and hematological malignancies not undergoing allogeneic or autologous hematopoietic stem cell transplantation or other cellular therapy including diagnostic, prophylactic, and therapeutic aspects. Particularly, strategies of risk adapted pharmacological prophylaxis and vaccination are outlined for different patient groups. This guideline updates the guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) from 2015 "Antiviral prophylaxis in patients with solid tumours and haematological malignancies" focusing on herpes simplex virus and varicella zoster virus.
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Affiliation(s)
- Larissa Henze
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, University of Rostock, Ernst-Heydemann-Str. 6, 18055, Rostock, Germany.
| | - Christoph Buhl
- Department of Medicine, Clinic III - Oncology, Hematology, Immunoncology and Rheumatology/Clinical Immunology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Michael Sandherr
- Gemeinschaftspraxis für Hämatologie und Onkologie, 82362, Weilheim, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Herderstraße 52, 50931, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Herderstraße 52, 50931, Cologne, Germany
| | - Werner J Heinz
- Medical Clinic II, Caritas Hospital Bad Mergentheim, Uhlandstr, 7D-97980, Bad Mergentheim, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany
| | - Til Ramon Kiderlen
- Clinic for Hematology, Oncology, Palliative Medicine, Vivantes Klinikum Neukölln, Rudower Str. 48, 12359, Berlin, Germany
- Clinic for Hematology, Oncology and Tumor Immunology, Charité Universitätsmedizin Berlin, Campus Mitte Charitéplatz 1, 10117, Berlin, Germany
- Pharmaceutical Research Associates GmbH, Gottlieb-Daimler-Str. 10, 68165, Mannheim, Germany
| | - Philipp Koehler
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Herderstraße 52, 50931, Cologne, Germany
| | | | - Rosanne Sprute
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Herderstraße 52, 50931, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Herderstraße 52, 50931, Cologne, Germany
| | - Martin Schmidt-Hieber
- Department of Hematology and Oncology, Carl-Thiem-Klinikum Cottbus, Thiemstr. 111, 03048, Cottbus, Germany
| | - Marie von Lilienfeld-Toal
- Department of Hematology and Medical Oncology, Clinic for Internal Medicine II, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Adolf-Reichwein-Str. 23, 07745, Jena, Germany
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Epstein M, Morrison C. Practical guidance for new multiple myeloma treatment regimens: A nursing perspective. Semin Oncol 2022; 49:103-117. [PMID: 35197198 PMCID: PMC9149030 DOI: 10.1053/j.seminoncol.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/23/2022] [Indexed: 11/11/2022]
Abstract
As is the case for solid tumors, treatment paradigms have shifted from non-specific chemotherapeutic agents towards novel targeted drugs in the treatment of patients with multiple myeloma (MM). Currently, multiple targeted therapies are available to treat patients augmenting the arsenal of modalities which also includes chemotherapy, immunotherapy, radiation therapy, hematopoietic stem cell transplantation (HSCST) and chimeric antigen T-cell therapy (CAR-T). These novel, targeted agents have dramatically increased optimism for patients, who may now be treated over many years with successive regimens. As fortunate as we are to have these new therapies available for our patients, this advantage is juxtaposed with the challenges involved with delivering them safely. While each class of agents has demonstrated efficacy, in terms of response rates and survival, they also exert class effects which pose risks for toxicity. In addition, newer generation agents within the classes often have slightly different toxicity profiles than did their predecessors. These factors must be addressed, and their risks mitigated by the multidisciplinary team. This review presents a summary of the evolution of drug development for MM. For each targeted agent, the efficacy data from pivotal trials and highlights of the risks that were demonstrated in trials, as well as during post-marketing surveillance, are presented. Specific risks associated with agents within the classes, that are not shared with all new class members, are described. A table presenting these potential risks, with recommended nursing actions to mitigate toxicity, is provided as a quick reference that nurses may use during the planning, and provision, of patient care.
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Affiliation(s)
- Monica Epstein
- National Cancer Institute, Office of Research Nursing, Bethesda, MD.
| | - Candis Morrison
- United States Food and Drug Administration, 10903 New Hampshire Ave, Building 22 Room 2319 Silver Spring Maryland 20993
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Aggarwal M, Amjad MS, Khandelwal A, Kumar P, Dhawan R, Dass J, Ganesh KV, Khanna P, Singh AK, Soni KD, Agarwal R, Bairwa M, Selvi A, Tyagi S, Seth T, Mahapatra M, Wig N, Trikha A. COVID-19 infection in patients with haematological disease - A tertiary centre experience from north India. Indian J Med Res 2022; 155:570-574. [PMID: 35975348 PMCID: PMC9807201 DOI: 10.4103/ijmr.ijmr_1180_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This retrospective study was aimed to understand the clinical, laboratory, radiological parameters and the outcome of COVID-19 patients with underlying haematological disease. All patients with known haematological disease admitted with COVID-19-positive status from April to August 2020 in the COVID-19 facility of a tertiary care centre in north India, were included. Their medical records were analyzed for outcome and mortality risk factors. Fifty four patients, 37 males, were included in the study. Of these, 36 patients had haematological malignancy and 18 had benign disorder. Fever (95.5%), cough (59.2%) and dyspnoea (31.4%) were the most common symptoms. Nine patients had severe disease at diagnosis, mostly malignant disorders. Overall mortality rate was 37.0 per cent, with high mortality seen in patients with aplastic anaemia (50.0%), acute myeloid (46.7%) and lymphoblastic leukaemia (40.0%). On univariate analysis, Eastern Cooperative Oncology Group performance status >2 [odd ratio (OR) 11.6], COVID-19 severity (OR 8.2), dyspnoea (OR 5.7) and blood product transfusion (OR 6.4) were the predictors of mortality. However, the presence of moderate or severe COVID-19 (OR 16.6, confidence interval 3.8-72.8) was found significant on multivariate analysis. The results showed that patients with haematological malignancies and aplastic anaemia might be at increased risk of getting severe COVID-19 infection and mortality as compared to the general population.
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Affiliation(s)
- Mukul Aggarwal
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Mirza Saleem Amjad
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Khandelwal
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Kumar
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Dhawan
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Jasmita Dass
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Punit Khanna
- Department of Anaesthesia, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Akhil Kant Singh
- Department of Anaesthesia, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Trauma Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Agarwal
- Department of Trauma Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mohan Bairwa
- Center for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arul Selvi
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Tyagi
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Tulika Seth
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoranjan Mahapatra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India,For correspondence: Dr Manoranjan Mahapatra, Department of Hematology, All India Institute of Medical Sciences, New Delhi 110 029, India e-mail:
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesia, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Li Y, Tang M, Zhong L, Wei S, Song J, Liu H, Sun C, Wang J. Incidence of Arrhythmias and Their Prognostic Value in Patients With Multiple Myeloma. Front Cardiovasc Med 2021; 8:753918. [PMID: 34869663 PMCID: PMC8634844 DOI: 10.3389/fcvm.2021.753918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Arrhythmias are common cardiovascular complications in multiple myeloma (MM) patients and are related to a poor prognosis. Objective: This study aimed to assess the burden of arrhythmias and their prognostic value in patients with MM. Methods: This was a retrospective study of patients with MM between January 2015 and April 2020 at the First Affiliated Hospital of Xi'an Jiaotong University. The incidence of arrhythmia and associated risk factors were evaluated. The relationship between the type of arrhythmia and survival was analyzed. Results: A total of 319 patients with MM were identified, and 48.0% (153/319) had arrhythmias. The most common type of arrhythmia was sinus tachycardia (ST) (15.0%, 48/319), followed by sinus bradycardia (SB) (14.4%, 46/319), premature atrial contractions (PACs) (6.3%, 20/319), conduction disorders (CDs) (6.0%, 19/319), atrial fibrillation (AF) (6.0%, 19/319), premature ventricular contractions (PVCs) (4.4%, 14/319) and paroxysmal supraventricular tachycardia (PSVT) (0.6%, 2/319). The patients with arrhythmias had higher levels of log NT-proBNP and creatinine, greater bortezomib use, and a higher incidence of diabetes than those without arrhythmias (P < 0.05). The all-cause mortality rates of patients without arrhythmias and those with AF, ST, PACs, CDs, SB, and PVCs were 50.6% (84/166), 73.7% (14/19), 60.4% (29/48), 60.0% (12/20), 52.6% (10/19), 34.8% (16/46), and 28.6% (4/14), respectively. In a subgroup analysis of patients experiencing different types of arrhythmias, patients with SB had lower all-cause mortality than patients with AF (P < 0.01). Univariate and multivariate Cox analyses showed that there was a positive statistically significant association between SB and survival (HR: 0.592 [0.352–0.998], P = 0.049) in a subgroup analysis of different arrhythmias. Conclusions: Patients with MM had a heavy arrhythmia burden, and in this study, approximately half of MM patients had arrhythmias. MM patients with SB were associated with lower all-cause mortality than those with AF. SB might be an independent positive factor for prognosis.
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Affiliation(s)
- Yongxin Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Manyun Tang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liang Zhong
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Suhua Wei
- Department of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingzhuo Song
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hui Liu
- Biobank, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chaofeng Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jie Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Virdis P, Migheli R, Bordoni V, Fiorentino FP, Sanna L, Marchesi I, Pintore G, Galleri G, Muroni MR, Bagella L, Fozza C, De Miglio MR, Podda L. Clarifying the molecular mechanism of tomentosin‑induced antiproliferative and proapoptotic effects in human multiple myeloma via gene expression profile and genetic interaction network analysis. Int J Mol Med 2021; 48:213. [PMID: 34643251 PMCID: PMC8522960 DOI: 10.3892/ijmm.2021.5046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/02/2021] [Indexed: 12/29/2022] Open
Abstract
Multiple myeloma (MM) is an aggressive B cell malignancy. Substantial progress has been made in the therapeutic context for patients with MM, however it still represents an incurable disease due to drug resistance and recurrence. Development of more effective or synergistic therapeutic approaches undoubtedly represents an unmet clinical need. Tomentosin is a bioactive natural sesquiterpene lactone extracted by various plants with therapeutic properties, including anti‑neoplastic effects. In the present study, the potential antitumor activity of tomentosin was evaluated on the human RPMI‑8226 cell line, treated with increasing tomentosin concentration for cytotoxicity screening. The data suggested that both cell cycle arrest and cell apoptosis could explain the antiproliferative effects of tomentosin and may result in the inhibition of RPMI‑8226 cell viability. To assess differentially expressed genes contributing to tomentosin activity and identify its mechanism of action, a microarray gene expression profile was performed, identifying 126 genes deregulated by tomentosin. To address the systems biology and identify how tomentosin deregulates gene expression in MM from a systems perspective, all deregulated genes were submitted to enrichment and molecular network analysis. The Protein‑Protein Interaction (PPI) network analysis showed that tomentosin in human MM induced the downregulation of genes involved in several pathways known to lead immune‑system processes, such as cytokine‑cytokine receptor interaction, chemokine or NF‑κB signaling pathway, as well as genes involved in pathways playing a central role in cellular neoplastic processes, such as growth, proliferation, migration, invasion and apoptosis. Tomentosin also induced endoplasmic reticulum stress via upregulation of cyclic AMP‑dependent transcription factor ATF‑4 and DNA damage‑inducible transcript 3 protein genes, suggesting that in the presence of tomentosin the protective unfolded protein response signaling may induce cell apoptosis. The functional connections analysis executed using the Connectivity Map tool, suggested that the effects of tomentosin on RPMI‑8226 cells might be similar to those exerted by heat shock proteins inhibitors. Taken together, these data suggested that tomentosin may be a potential drug candidate for the treatment of MM.
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Affiliation(s)
- Patrizia Virdis
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, I-07100 Sassari, Sardinia, Italy
| | - Rossana Migheli
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, I-07100 Sassari, Sardinia, Italy
| | - Valentina Bordoni
- Department of Biomedical Sciences, University of Sassari, I-07100 Sassari, Sardinia, Italy
| | | | - Luca Sanna
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, I-07100 Sassari, Sardinia, Italy
| | - Irene Marchesi
- Kitos Biotech Srls, Porto Conte Ricerche, I-07100 Sassari, Sardinia, Italy
| | - Giorgio Pintore
- Department of Chemistry and Pharmacy, University of Sassari, I-07100 Sassari, Sardinia, Italy
| | - Grazia Galleri
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, I-07100 Sassari, Sardinia, Italy
| | - Maria Rosaria Muroni
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, I-07100 Sassari, Sardinia, Italy
| | - Luigi Bagella
- Department of Biomedical Sciences, University of Sassari, I-07100 Sassari, Sardinia, Italy
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
| | - Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, I-07100 Sassari, Sardinia, Italy
| | - Maria Rosaria De Miglio
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, I-07100 Sassari, Sardinia, Italy
| | - Luigi Podda
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, I-07100 Sassari, Sardinia, Italy
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25
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Bahlis NJ, Baz R, Harrison SJ, Quach H, Ho SJ, Vangsted AJ, Plesner T, Moreau P, Gibbs SD, Coppola S, Yang X, Al Masud A, Ross JA, Bueno O, Kaufman JL. Phase I Study of Venetoclax Plus Daratumumab and Dexamethasone, With or Without Bortezomib, in Patients With Relapsed or Refractory Multiple Myeloma With and Without t(11;14). J Clin Oncol 2021; 39:3602-3612. [PMID: 34388020 PMCID: PMC8577687 DOI: 10.1200/jco.21.00443] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Venetoclax is an oral BCL-2 inhibitor with single-agent activity in patients with relapsed or refractory multiple myeloma (RRMM) with t(11;14) translocation. Venetoclax efficacy in RRMM may be potentiated through combination with agents including bortezomib, dexamethasone, and daratumumab. METHODS This phase I study (NCT03314181) evaluated venetoclax with daratumumab and dexamethasone (VenDd) in patients with t(11;14) RRMM and VenDd with bortezomib (VenDVd) in cytogenetically unselected patients with RRMM. Primary objectives included expansion-phase dosing, safety, and overall response rate. Secondary objectives included further safety analysis, progression-free survival, duration of response, time to progression, and minimal residual disease negativity. RESULTS Forty-eight patients were enrolled, 24 each in parts 1 (VenDd) and 2 (VenDVd). There was one dose-limiting toxicity in part 1 (grade 3 febrile neutropenia, 800 mg VenDd). Common adverse events with VenDd and VenDVd included diarrhea (63% and 54%) and nausea (50% and 50%); grade ≥ 3 adverse events were observed in 88% in the VenDd group and 71% in the VenDVd group. One treatment-emergent death occurred in part 2 (sepsis) in the context of progressive disease, with no other infection-related deaths on study with medians of 20.9 and 20.4 months of follow-up in parts 1 and 2, respectively. The overall response rate was 96% with VenDd (all very good partial response or better [≥ VGPR]) and 92% with VenDVd (79% ≥ VGPR). The 18-month progression-free survival rate was 90.5% (95% CI, 67.0 to 97.5) with VenDd and 66.7% (95% CI, 42.5 to 82.5) with VenDVd. CONCLUSION VenDd and VenDVd produced a high rate of deep and durable responses in patients with RRMM. These results support continued evaluation of venetoclax with daratumumab regimens to treat RRMM, particularly in those with t(11;14).
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Affiliation(s)
- Nizar J Bahlis
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rachid Baz
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Simon J Harrison
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Hang Quach
- St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Torben Plesner
- University of Southern Denmark, Vejle Hospital, Vejle, Denmark
| | - Philippe Moreau
- Department of Hematology, University Hospital, Nantes, France
| | - Simon D Gibbs
- Box Hill Hospital, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
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Ebied M, Chan V. Multidisciplinary Professional Roles Addressing Needs in Multiple Myeloma: An Innovative 'Virtual' Pharmacist Surveillance Clinic. Semin Oncol Nurs 2021; 37:151173. [PMID: 34334291 DOI: 10.1016/j.soncn.2021.151173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Advances in pharmacologic options has rendered multiple myeloma a chronic disease for most patients. This article explores the role of the pharmacist in new therapy start counseling, supportive care, and patient navigation in people affected by multiple myeloma. The role of the pharmacist in the pharmacist-led 'Virtual Multiple Myeloma Clinic' and the foundations guiding pharmacist prescribing are described in detail. Directions for future patient-centered research and opportunities in multiple myeloma are explored, specific to this jurisdiction. DATA SOURCES These include academic databases (PubMed, MedLine), professional guideline documents, and first-person experience. CONCLUSION Although the treatment landscape for multiple myeloma therapy is rapidly evolving, the survival of patients with multiple myeloma has greatly increased, rendering this largely a chronic disease. Accordingly, the role of the clinical pharmacist in multiple myeloma clinics is extensive. Counseling on first-time therapies, supportive care (adverse events management, bone health, and vaccinations), and seamless patient care across local pharmacies and health care facilities are explored. The hematology pharmacist-led Virtual Multiple Myeloma Clinic, providing individualized efficacy monitoring and counseling to patients with stable multiple myeloma on oral immunomodulatory therapy, has been pivotal in optimizing clinic workload management. IMPLICATIONS FOR NURSING PRACTICE Possessing additional prescribing authority is paramount to the efficiency of pharmacists in clinic. Outside of pharmacy, prescribers in community treatment centers require education on the management of novel multiple myeloma therapies. Family physicians and nurses may also benefit from an overview of common issues that patients may experience because of their multiple myeloma treatments, which may enable them to better manage side effects or complications resulting from treatment.
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Affiliation(s)
- Marina Ebied
- Hematology Pharmacist, Cross Cancer Institute, Edmonton, Alberta, Canada.
| | - Valerie Chan
- Hematology Pharmacist, Cross Cancer Institute, Edmonton, Alberta, Canada
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Gay F, Günther A, Offidani M, Engelhardt M, Salvini M, Montefusco V, Patriarca F, Aquino S, Pönisch W, Spada S, Schub N, Gentili S, Wäsch R, Corradini P, Straka C, Palumbo A, Einsele H, Boccadoro M, Sonneveld P, Gramatzki M. Carfilzomib, bendamustine, and dexamethasone in patients with advanced multiple myeloma: The EMN09 phase 1/2 study of the European Myeloma Network. Cancer 2021; 127:3413-3421. [PMID: 34181755 DOI: 10.1002/cncr.33647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/22/2021] [Accepted: 04/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Combined therapy with carfilzomib, bendamustine, and dexamethasone was evaluated in this multicenter phase 1/2 trial conducted within the European Myeloma Network (EMN09 trial). METHODS Sixty-three patients with relapsed/refractory multiple myeloma who had received ≥2 lines of prior therapy were included. The phase 1 portion of the study determined the maximum tolerated dose of carfilzomib with bendamustine set at 70 mg/m2 on days 1 and 8. After 8 cycles, responding patients received maintenance therapy with carfilzomib and dexamethasone until progression. RESULTS On the basis of the phase 1 results, the recommended phase 2 dose for carfilzomib was 27 mg/m2 twice weekly in weeks 1, 2, and 3. Fifty-two percent of patients achieved a partial response or better, and 32% reached a very good partial response or better. The clinical benefit rate was 93%. After a median follow-up of 21.9 months, the median progression-free survival was 11.6 months, and the median overall survival was 30.4 months. The reported grade ≥3 hematologic adverse events (AEs) were lymphopenia (29%), neutropenia (25%), and thrombocytopenia (22%). The main nonhematologic grade ≥3 AEs were pneumonia, thromboembolic events (10%), cardiac AEs (8%), and hypertension (2%). CONCLUSIONS In heavily pretreated patients who have relapsed/refractory multiple myeloma, combined carfilzomib, bendamustine, and dexamethasone is an effective treatment option administered in the outpatient setting. Infection prophylaxis and attention to patients with cardiovascular predisposition are required.
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Affiliation(s)
- Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Andreas Günther
- Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany
| | - Massimo Offidani
- Hematology Clinic, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Monika Engelhardt
- Department for Hematology and Oncology, University of Freiburg, Faculty of Freiburg, Freiburg, Germany
| | - Marco Salvini
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Vittorio Montefusco
- Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Sara Aquino
- Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Wolfram Pönisch
- Department of Hematology, University of Leipzig, Leipzig, Germany
| | - Stefano Spada
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Natalie Schub
- Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany
| | | | - Ralph Wäsch
- Department for Hematology and Oncology, University of Freiburg, Faculty of Freiburg, Freiburg, Germany
| | - Paolo Corradini
- Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Christian Straka
- Department of Hematology and Oncology, Munich Clinic Schwabing, Munich, Germany
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Hermann Einsele
- Department of Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Pieter Sonneveld
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Martin Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany
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Jones MR, Urits I, Wolf J, Corrigan D, Colburn L, Peterson E, Williamson A, Viswanath O. Drug-Induced Peripheral Neuropathy: A Narrative Review. ACTA ACUST UNITED AC 2021; 15:38-48. [PMID: 30666914 PMCID: PMC7365998 DOI: 10.2174/1574884714666190121154813] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/03/2018] [Accepted: 01/11/2019] [Indexed: 11/22/2022]
Abstract
Background Peripheral neuropathy is a painful condition deriving from many and varied etiologies. Certain medications have been implicated in the iatrogenic development of Drug Induced Peripheral Neuropathy (DIPN) and include chemotherapeutic agents, antimicrobials, cardiovascular drugs, psychotropic, anticonvulsants, among others. This review synthesizes current clinical concepts regarding the mechanism, common inciting medications, and treatment options for drug-induced peripheral neuropathy. Methods The authors undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The most relevant and up to date research was included. Results Drug-induced peripheral neuropathy is a common and painful condition caused by many different and frequently prescribed medications. Most often, DIPN is seen in chemotherapeutic agents, antimicrobials, cardiovascular drugs, psychotropic, and anticonvulsant drugs. Certain drugs exhibit more consistent neuropathic side effects, such as the chemotherapeutic compounds, but others are more commonly prescribed by a larger proportion of providers, such as the statins. DIPN is more likely to occur in patients with concomitant risk factors such as preexisting neuropathy, diabetes, and associated genetically predisposing diseases. DIPN is often difficult to treat, however medications including duloxetine, and gabapentin are shown to reduce neuropathic pain. Advanced techniques of neuromodulation offer promise though further randomized and controlled studies are needed to confirm efficacy. Conclusion Awareness of the drugs covered in this review and their potential for adverse neuropathic effect is important for providers caring for patients who report new onset symptoms of pain, paresthesia, or weakness. Prevention of DIPN is especially important because treatment often proves challenging. While many pharmacologic therapies have demonstrated analgesic potential in the pain caused by DIPN, many patients remain refractive to treatment. More studies are needed to elucidate the effectiveness of interventional, neuromodulating therapies.
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Affiliation(s)
- Mark R Jones
- Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, MA, 02118, United States
| | - Ivan Urits
- Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Boston, MA, 02118, United States
| | - John Wolf
- Creighton University School of Medicine-Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, United States
| | - Devin Corrigan
- Creighton University School of Medicine-Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, United States
| | - Luc Colburn
- Creighton University School of Medicine-Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, United States
| | - Emily Peterson
- Creighton University School of Medicine-Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, United States
| | - Amber Williamson
- Creighton University School of Medicine-Phoenix Regional Campus, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, United States
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Phoenix, AZ, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Omaha, NE, United States
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Improved survival in multiple myeloma during the 2005-2009 and 2010-2014 periods. Leukemia 2021; 35:3600-3603. [PMID: 34099876 DOI: 10.1038/s41375-021-01250-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 12/27/2022]
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Cerchione C, Nappi D, Martinelli G. Pegfilgrastim for primary prophylaxis of febrile neutropenia in multiple myeloma. Support Care Cancer 2021; 29:6973-6980. [PMID: 33990881 PMCID: PMC8464555 DOI: 10.1007/s00520-021-06266-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/30/2021] [Indexed: 11/01/2022]
Abstract
Multiple myeloma (MM) survival rates have been substantially increased thanks to novel agents that have improved survival outcomes and shown better tolerability than treatments of earlier years. These new agents include immunomodulating imide drugs (IMiD) thalidomide and lenalidomide, the proteasome inhibitor bortezomib (PI), recently followed by new generation IMID pomalidomide, monoclonal antibodies daratumumab and elotuzumab, and next generation PI carfilzomib and ixazomib. However, even in this more promising scenario, febrile neutropenia remains a severe side effect of antineoplastic therapies and can lead to a delay and/or dose reduction in subsequent cycles. Supportive care has thus become key in helping patients to obtain the maximum benefit from novel agents. Filgrastim is a human recombinant subcutaneous preparation of G-CSF, largely adopted in hematological supportive care as "on demand" (or secondary) prophylaxis to recovery from neutropenia and its infectious consequences during anti-myeloma treatment. On the contrary, pegfilgrastim is a pegylated long-acting recombinant form of granulocyte colony-stimulating factor (G-CSF) that, given its extended half-life, can be particularly useful when adopted as "primary prophylaxis," therefore before the onset of neutropenia, along chemotherapy treatment in multiple myeloma patients. There is no direct comparison between the two G-CSF delivery modalities. In this review, we compare data on the two administrations' modality, highlighting the efficacy of the secondary prophylaxis over multiple myeloma treatment. Advantage of pegfilgrastim could be as follows: the fixed administration rather than multiple injections, reduction in neutropenia and febrile neutropenia rates, and, finally, a cost-effectiveness advantage.
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Affiliation(s)
- Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori "Dino Amadori" (IRST), IRCCS, Via Piero Maroncelli 40, Meldola, (FC), 47014, Italy.
| | - Davide Nappi
- Department of Hematology and Cell Bone Marrow Transplantation (CBMT), Ospedale di Bolzano, Bolzano, Italy
| | - Giovanni Martinelli
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori "Dino Amadori" (IRST), IRCCS, Via Piero Maroncelli 40, Meldola, (FC), 47014, Italy
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Pomalidomide Plus Low-Dose Dexamethasone in Relapsed/Refractory Multiple Myeloma Patients: Results of the Real-World "POWERFUL" Study. J Clin Med 2021; 10:jcm10071509. [PMID: 33916376 PMCID: PMC8038613 DOI: 10.3390/jcm10071509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 02/05/2023] Open
Abstract
The “POWERFUL” multicenter, retrospective, and prospective study investigated the effectiveness of pomalidomide plus low-dose dexamethasone (POM/LoDex) therapy in relapsed/refractory multiple myeloma in routine care in Greece. Ninety-nine eligible adult patients treated with POM/LoDex according to the approved label after having received ≥2 prior therapies, including lenalidomide and bortezomib, were consecutively enrolled between 16 November 2017 and 21 February 2019 in 18 hematology departments. Fifty patients (50.5%) started POM/LoDex as third-line treatment. During the treatment period (median: 8.3 months; range: 0.3–47.6 months), the median POM dose was 4 mg/day, and 31.3% of the patients received additional antimyeloma agents. The overall response rate was 32.3%. During a median follow-up period of 13.8 months (Kaplan–Meier estimate), the median progression-free survival (PFS) was 10.5 months (95% CI: 7.4–14.4). The PFS was not significantly different between patients receiving POM/LoDex in the third versus later line of therapy, nor between patients receiving concomitant antimyeloma therapy versus POM/LoDEx doublet. During the prospective safety data collection period (median: 7.6 months) among patients with prospective follow-up (N = 75), POM-related adverse event incidence rate was 42.7% (serious: 18.7%; grade ≥ 3 hematological POM-related adverse events: 8.0%). Only neutropenia (13.3%) was reported at a frequency ≥10%. In conclusion, in this real-world study, POM/LoDex displayed a long PFS with no new safety signals emerging.
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Non-invasive detection of corneal sub-basal nerve plexus changes in multiple myeloma patients by confocal laser scanning microscopy. Biosci Rep 2021; 40:226598. [PMID: 33026069 PMCID: PMC7578619 DOI: 10.1042/bsr20193563] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 09/17/2020] [Accepted: 10/06/2020] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Confocal laser scanning microscopy (CLSM) is a non-invasive technique for cellular in vivo imaging of the human cornea. CLSM screening was evaluated for early detection of corneal nerve morphology changes and neuropathogenic events in different stage multiple myeloma (MM) patients. As MM patients show disease as well as therapy-related neuropathological symptoms, CLSM potentially provides a tool for non-invasive early detection of neuropathogenic events. CLSM findings were compared with the severity of peripheral neuropathic (PNP) symptoms. METHODS The study enrolled 25 MM patients in which bilateral ophthalmologic examination was performed including unilateral CLSM. Further peripheral nerve function was clinically evaluated using the conventional neuropathy symptom and neuropathy deficit scores (NDSs). RESULTS In 18/25 MM patients, CLSM detected atypical morphological appearance of bulb-like enlarged nerve endings in the corneal sub-basal nerve plexus. These neuromas were only found in patients showing moderate to severe PNP, in patients with mild or lacking PNP neuromas were absent. CONCLUSIONS CLSM provides a novel non-invasive diagnostic tool for identification of neuromas in cancer patients affected by therapy or disease-related neuropathologies, perspectival allowing early neuronal degenerative process detection and monitoring.
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Manji F, Puckrin R, Stewart DA. Novel synthetic drugs for the treatment of non-Hodgkin lymphoma. Expert Opin Pharmacother 2021; 22:1417-1427. [PMID: 33711241 DOI: 10.1080/14656566.2021.1902988] [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: 12/31/2022]
Abstract
Introduction: Over the past two decades, deeper understanding of B-cell signaling pathways and other mechanisms of lymphomagenesis have yielded promising targets for novel drugs in the treatment of non-Hodgkin lymphoma.Areas covered: This article provides a comprehensive review of approved synthetic drugs targeting the BTK, PI3K, immunomodulation, proteasome, HDAC, EZH2, and nuclear export pathways in non-Hodgkin lymphoma. The review includes coverage of the pharmacology, efficacy, toxicity, and active areas of research for each drug. The authors also provide their expert perspectives on the field and their opinions for the future.Expert opinion: Although novel synthetic drugs have generally not impacted clinical practice to the same extent as immune and cellular therapies, there remains an important role for targeted drugs in the treatment of non-Hodgkin lymphoma, particularly in the relapsed setting and for patients ineligible for more intensive therapies. Clinical outcomes and tolerability may improve further with the development of newer generations of synthetic drugs and emerging combination regimens with other targeted and immune therapies.
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Affiliation(s)
- Farheen Manji
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontaria, Canada
| | - Robert Puckrin
- Postgraduate Medical Education, University of Calgary, Calgary, Alberta, Canada
| | - Douglas A Stewart
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
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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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Richter J, Anupindi VR, Yeaw J, Kudaravalli S, Zavisic S, Shah D. Real-world treatment patterns in relapsed/refractory multiple myeloma: Clinical and economic outcomes in patients treated with pomalidomide or daratumumab. J Oncol Pharm Pract 2021; 28:395-409. [PMID: 33611973 DOI: 10.1177/1078155221995532] [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: 11/16/2022]
Abstract
INTRODUCTION Real-world evidence on later line treatment of relapsed/refractory multiple myeloma (RRMM) is sparse. We evaluated clinical outcomes among RRMM patients in the 1-year following treatment with pomalidomide or daratumumab and compared economic outcomes between RRMM patients and non-MM patients. PATIENT AND METHODS Adult patients with ≥1 claim of pomalidomide or daratumumab were identified between January 2012 and February 2018 using IQVIA PharMetrics® Plus US claims database. Patients were required to have a diagnosis or treatment for MM and a claim of any immunomodulatory drugs and proteasome inhibitors before the index date. Mean time to new therapy, overall survival (OS) using Kaplan-Meier curve and adverse events (AEs) were reported over the 1-year post-index period. RRMM patients were also matched to a non-MM comparator cohort and economic outcomes were compared between the two cohorts. RESULTS 289 RRMM patients were matched to 1,445 patients without MM. Most prevalent hematological AE was anemia (72.0%) and non-hematological AE was infections (75.4%). Mean (SD) time to a new treatment was 4.7 (5.3) months and median OS was 14.6 months. RRMM patients had significantly higher hospitalizations and physician office visits (Both P < .0001) compared to non-MM patients. Adjusting for baseline characteristics, patients with RRMM had 4.9 times (95% CI 3.8-6.4, P < .0001) the total healthcare costs compared with patients without MM. The major driver of total costs among RRMM patients was pharmacy costs (67.3%). CONCLUSION RRMM patients showed a high frequency of AEs, low OS, and a substantial economic burden suggesting need for effective treatment options.
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Affiliation(s)
- Joshua Richter
- Tisch Cancer institute at Mount Sinai Medical Center, New York, NY, USA
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Wang H, Liu H, Sun C, Liu C, Jiang T, Yin Y, Xu A, Pang Z, Zhang B, Hu Y. Nanoparticles Dual Targeting Both Myeloma Cells and Cancer-Associated Fibroblasts Simultaneously to Improve Multiple Myeloma Treatment. Pharmaceutics 2021; 13:pharmaceutics13020274. [PMID: 33670464 PMCID: PMC7922689 DOI: 10.3390/pharmaceutics13020274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/24/2021] [Accepted: 02/10/2021] [Indexed: 12/13/2022] Open
Abstract
Cancer-associated fibroblasts (CAFs) and myeloma cells could mutually drive myeloma progression, indicating that drug delivery to kill both CAFs and myeloma cells simultaneously could achieve better therapeutic benefits than to kill each cell type alone. Here, we designed a dual-targeting drug delivery system by conjugating paclitaxel (PTX)-loaded poly(ethylene glycol)-poly(lactic acid) nanoparticles (NPs) with a cyclic peptide (CNPs-PTX) with a special affinity with platelet-derived growth factor/platelet-derived growth factor receptor (PDGFR-β) overexpressed on both CAFs and myeloma cells. Cellular uptake experiments revealed that the cyclic peptide modification on CNPs could significantly enhance CNPs uptake by both CAFs and myeloma cells compared with unmodified NPs. Cytotoxicity tests showed that CNPs-PTX was more toxic to both CAFs and myeloma cells compared with its counterpart PTX-loaded conventional NPs (NPs-PTX). In vivo imaging and biodistribution experiments showed that CNPs could abundantly accumulate in tumors and were highly co-localized with CAFs and myeloma cells. The in vivo anti-tumor experiments confirmed that the anti-myeloma efficacy of CNPs-PTX was significantly stronger than that of NPs-PTX and free drugs. In summary, it is the first time that a dual-targeting strategy was utilized in the field of myeloma treatment through targeting both CAFs and myeloma cells simultaneously, which harbors a high potential of clinical translation for myeloma treatment.
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Affiliation(s)
- Honglan Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, China; (H.W.); (H.L.); (C.S.); (T.J.); (Y.Y.); (A.X.)
| | - Huiwen Liu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, China; (H.W.); (H.L.); (C.S.); (T.J.); (Y.Y.); (A.X.)
| | - Chunyan Sun
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, China; (H.W.); (H.L.); (C.S.); (T.J.); (Y.Y.); (A.X.)
| | - Chunying Liu
- Key Laboratory of Smart Drug Delivery, Ministry of Education, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China;
| | - Ting Jiang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, China; (H.W.); (H.L.); (C.S.); (T.J.); (Y.Y.); (A.X.)
| | - Yanxue Yin
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, China; (H.W.); (H.L.); (C.S.); (T.J.); (Y.Y.); (A.X.)
| | - Aoshuang Xu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, China; (H.W.); (H.L.); (C.S.); (T.J.); (Y.Y.); (A.X.)
| | - Zhiqing Pang
- Key Laboratory of Smart Drug Delivery, Ministry of Education, School of Pharmacy, Fudan University, 826 Zhangheng Road, Shanghai 201203, China;
- Correspondence: (Z.P.); (B.Z.); (Y.H.); Tel.: +86-21-51980069 (Z.P.); +86-27-85726007 (B.Z.); +86-27-85726335 (Y.H.); Fax: +86-21-51980069 (Z.P.); +86-27-85726387 (B.Z.); +86-27-85776343 (Y.H.)
| | - Bo Zhang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, China; (H.W.); (H.L.); (C.S.); (T.J.); (Y.Y.); (A.X.)
- Correspondence: (Z.P.); (B.Z.); (Y.H.); Tel.: +86-21-51980069 (Z.P.); +86-27-85726007 (B.Z.); +86-27-85726335 (Y.H.); Fax: +86-21-51980069 (Z.P.); +86-27-85726387 (B.Z.); +86-27-85776343 (Y.H.)
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, China; (H.W.); (H.L.); (C.S.); (T.J.); (Y.Y.); (A.X.)
- Correspondence: (Z.P.); (B.Z.); (Y.H.); Tel.: +86-21-51980069 (Z.P.); +86-27-85726007 (B.Z.); +86-27-85726335 (Y.H.); Fax: +86-21-51980069 (Z.P.); +86-27-85726387 (B.Z.); +86-27-85776343 (Y.H.)
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Naimi A, Safaei S, Entezari A, Solali S, Hassanzadeh A. Knockdown of Enhancer of Zeste Homolog 2 Affects mRNA Expression of Genes Involved in the Induction of Resistance to Apoptosis in MOLT-4 Cells. Anticancer Agents Med Chem 2021; 20:571-579. [PMID: 32000648 DOI: 10.2174/1871520620666200130091955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/06/2019] [Accepted: 12/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Enhancer of Zeste Homolog 2 (EZH2) is a subunit of the polycomb repressive complex 2 that silences the gene transcription via H3K27me3. Previous studies have shown that EZH2 has an important role in the induction of the resistance against the Tumor necrosis factor-Related Apoptosis-Inducing Ligand (TRAIL)-Induced Apoptosis (TIA) in some leukemia cells. OBJECTIVE The aim of this study was to determine the effect of silencing EZH2 gene expression using RNA interference on the expression of death receptors 4 and 5 (DR4/5), Preferentially expressed Antigen in Melanoma (PRAME), and TRAIL human lymphoid leukemia MOLT-4 cells. METHODS Quantitative RT-PCR was used to detect the EZH2 expression and other candidate genes following the siRNA knockdown in MOLT-4 cells. The toxicity of the EZH2 siRNA was evaluated using Annexin V/PI assay following the transfection of the cells by 80 pM EZH2 siRNA at 48 hours. RESULTS Based on the flow-cytometry results, the EZH2 siRNA had no toxic effects on MOLT-4 cells. Also, the EZH2 inhibition increased the expression of DR4/5 but reduced the PRAME gene expression at the mRNA levels. Moreover, the EZH2 silencing could not change the TRAIL mRNA in the transfected cells. CONCLUSION Our results revealed that the down-regulation of EZH2 in MOLT-4 cells was able to affect the expression of important genes involved in the induction of resistance against TIA. Hence, we suggest that the silencing of EZH2 using RNA interference can be an effective and safe approach to help defeat the MOLT-4 cell resistance against TIA.
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Affiliation(s)
- Adel Naimi
- Cellular and Molecular Research Center, Sabzevar University of Medical Science, Sabzevar, Iran.,Department of Medical Laboratory Sciences, Faculty of Paramedicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Sahar Safaei
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atefeh Entezari
- Department of Medical Genetics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Solali
- Department of Immunology, Division of Hematology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Hassanzadeh
- Department of Immunology, Division of Hematology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Bergin K, Wellard C, Moore E, McQuilten Z, Blacklock H, Harrison SJ, Ho PJ, King T, Quach H, Mollee P, Walker P, Wood E, Spencer A. The Myeloma Landscape in Australia and New Zealand: The First 8 Years of the Myeloma and Related Diseases Registry (MRDR). CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e510-e520. [PMID: 33785297 DOI: 10.1016/j.clml.2021.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Real-world multiple myeloma (MM) data are scarce, with most data originating from clinical trials. The Myeloma and Related Diseases Registry (MRDR) is a prospective clinical-quality registry of newly diagnosed cases of plasma cell disorders established in 2012 and operating at 44 sites in Australia and New Zealand as of April 2020. METHODS We reviewed all patients enrolled onto the MRDR between June 2012 and April 2020. Baseline characteristics, treatment, and outcome data were reviewed for MM patients with comparisons made by chi-square tests (categorical variables) and rank sum tests (continuous variables). Kaplan-Meier analysis was used to estimate progression-free survival and overall survival (OS). RESULTS As of April 2020, a total of 2405 MM patients were enrolled (median age, 67 years, with 40% aged > 70 years). High-risk features were present in 13% to 31% of patients: fluorescence in-situ hybridization (FISH) ≥ 1 of t(4;14), t(14;16), or del(17p) 18%, International Staging System (ISS)-3 31%, and Revised ISS (R-ISS)-3 13%. Cytogenetic/FISH analyses were performed in 50% and 68% of patients, respectively, with an abnormal karyotype result in 34%. Bortezomib-containing therapy was the most common first-line therapy (79.3%, n = 1706). Patients not receiving bortezomib were older (median age, 76 vs 65 years, P < .001) with inferior performance status (Eastern Cooperative Oncology Group performance status ≥ 2, 41% vs 18%, P < .001). Median progression-free survival and OS were 30.8 and 65.8 months, respectively. Younger patients had superior OS (76.3 vs 46.7 months, P < .001, < 70 and ≥ 70 years, respectively). R-ISS score was available in 50.7% (n = 1220) of patients, and higher R-ISS was associated with inferior OS (R-ISS-1 vs R-ISS-2 vs R-ISS-3: not reached vs 68.1 months vs 33.2 months, respectively, P < .001). CONCLUSION Clinical registries provide a more complete picture of MM diagnosis and treatment, and highlight the challenges of adhering to best practices in a real-world context.
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Affiliation(s)
- Krystal Bergin
- Department of Haematology, Alfred Health-Monash University, Melbourne, Victoria, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zoe McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hilary Blacklock
- Clinical Haematology, Middlemore Hospital, Middlemore, Auckland, New Zealand
| | - Simon J Harrison
- Clinical Haematology, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Melbourne, Victoria, Australia; Clinical Haematology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - P Joy Ho
- Royal Prince Alfred Hospital, Camperdown, and University of Sydney, Sydney, New South Wales, Australia
| | - Tracy King
- Royal Prince Alfred Hospital, Camperdown, and University of Sydney, Sydney, New South Wales, Australia
| | - Hang Quach
- Clinical Haematology, University of Melbourne and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter Mollee
- Clinical Haematology, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Patricia Walker
- Clinical Haematology, Peninsula Health, Frankston, Victoria, Australia
| | - Erica Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Spencer
- Department of Haematology, Alfred Health-Monash University, Melbourne, Victoria, Australia.
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Abstract
Multiple myeloma is the second most common haematological malignancy in high-income countries, and typically starts as asymptomatic precursor conditions-either monoclonal gammopathy of undetermined significance or smouldering multiple myeloma-in which initiating genetic abnormalities, such as hyperdiploidy and translocations involving the immunoglobulin heavy chain, are already present. The introduction of immunomodulatory drugs, proteasome inhibitors, and CD38-targeting antibodies has extended survival, but ultimately the majority of patients will die from their disease, and some from treatment-related complications. Disease progression and subsequent relapses are characterised by subclonal evolution and increasingly resistant disease. Patients with multiple myeloma usually have hypercalcaemia, renal failure, anaemia, or osteolytic bone lesions-and a detailed diagnostic investigation is needed to differentiate between symptomatic multiple myeloma that requires treatment, and precursor states. Risk stratification using both patient-specific (eg, performance status) and disease-specific (eg, presence of high-risk cytogenetic abnormalities) is important for prognosis and to define the best treatment strategy. Current research strategies include the use of minimal residual disease assays to guide therapy, refining immunotherapeutic approaches, and intercepting disease early in smouldering multiple myeloma.
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Affiliation(s)
- Niels W C J van de Donk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Charlotte Pawlyn
- The Institute of Cancer Research, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Kwee L Yong
- University College London Cancer Institute, London, UK.
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Steinmetz TH, Singh M, Lebioda A, Fink L, Schoehl M, Rieth A, Gonzalez-McQuire S, Engelhardt M. Healthcare resource utilization and costs among patients with relapsed and/or refractory multiple myeloma treated with proteasome inhibitors in real-world clinical practice in Germany. J Med Econ 2021; 24:114-122. [PMID: 33390079 DOI: 10.1080/13696998.2020.1867469] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS To assess the real-world healthcare resource utilization (HRU) and costs associated with different proteasome inhibitors (PIs) for the treatment of patients with relapsed and/or refractory multiple myeloma (RRMM) in Germany. METHODS We conducted a retrospective medical chart review of treatment patterns, outcomes, and HRU for patients with RRMM treated with bortezomib, carfilzomib, or ixazomib in second- or third-line (2L or 3L) therapy in Germany. Data were collected between 1 January 2017 and 30 June 2017. Costs were calculated based on drug prices and unit costs in Germany. RESULTS Physicians provided data on 302 patients. Mean monthly total direct costs per patient receiving PI-based therapy were €7,925 and €10,693 for 2L and 3L, respectively, of which approximately 90% was anti-myeloma drug costs. Overall, the highest costs were associated with patients receiving 3L therapy. Regardless of treatment line, costs were higher for patients who had received a stem cell transplant (SCT) in a previous treatment line than for those who had not; the data suggest that this reflects the use of triplet regimens following a SCT. Patients with a complete response (CR) experienced no unplanned hospitalizations during the study period, whereas patients with progressive disease experienced the highest number of unplanned and planned hospitalizations. In 2L therapy, the highest proportion of patients with a CR was observed in those receiving carfilzomib (12% carfilzomib; 4% bortezomib; 0% ixazomib). LIMITATIONS Patients with missing or incomplete follow-up data were included in the study and were accounted for using monthly cost estimates. CONCLUSIONS Anti-myeloma drugs were the main contributor to total HRU costs associated with RRMM in Germany. Improved treatment response was associated with lower costs and reduced hospitalizations.
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Affiliation(s)
| | | | | | - Leah Fink
- Kantar, Health Division, Paris, France
| | | | | | | | - Monika Engelhardt
- Faculty of Freiburg, University Hospital of Freiburg, Freiburg, Germany
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Tournaire G, Conte C, Perrot A, Lapeyre-Mester M, Despas F. Vaccination during the First Diagnosis of Multiple Myeloma: A Cohort Study of the French National Health Insurance Database. Vaccines (Basel) 2020; 8:vaccines8040722. [PMID: 33276450 PMCID: PMC7712872 DOI: 10.3390/vaccines8040722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose: Infections are frequent and often result in serious complications in patients with multiple myeloma (MM). Prophylactic vaccination is recommended for influenza virus, Streptococcus pneumoniae (SP), and Hemophilus influenzaeb (Hib). The aims of this study were to measure the vaccination rates within 24 months after the diagnosis of multiple myeloma and to identify factors associated with vaccine use. Methods: MM patients were selected through the French national health insurance database from 1 January 2010 to 31 December 2015. Patients with a previous history of MM were excluded. Results: Vaccination rates against influenza, SP, and Hib among 22,831 newly diagnosed MM patients were, respectively, 28.5%, 10.3%, and 1.4%. Only 0.7% received all three vaccines. Factors associated with vaccination were young age, male gender, an absence of comorbidity, a history of higher medication and vaccine consumption, Herpes simplex virus (HSV), Varicella zoster virus (VZV), and the use of pneumocystis prophylaxis. Conclusion: The low rates of vaccination indicate the need to improve physician and MM patient adherence and education regarding vaccination.
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Affiliation(s)
- Guilhem Tournaire
- Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, 31000 Toulouse, France; (G.T.); (C.C.); (M.L.-M.)
| | - Cécile Conte
- Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, 31000 Toulouse, France; (G.T.); (C.C.); (M.L.-M.)
- UMR1027, Inserm, Université Paul Sabatier, 31330 Toulouse, France
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Université Paul Sabatier, 31000 Toulouse, France
- Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France
| | - Aurore Perrot
- Département d’Hématologie et de médecine Interne, Institut Universitaire du Cancer-Oncopole, CHU de Toulouse, 31000 Toulouse, France;
| | - Maryse Lapeyre-Mester
- Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, 31000 Toulouse, France; (G.T.); (C.C.); (M.L.-M.)
- UMR1027, Inserm, Université Paul Sabatier, 31330 Toulouse, France
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Université Paul Sabatier, 31000 Toulouse, France
- Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France
- INSERM Centre d’Investigation Clinique 1436 Toulouse, Centre d’Investigation Clinique de Toulouse, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France
| | - Fabien Despas
- Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, 31000 Toulouse, France; (G.T.); (C.C.); (M.L.-M.)
- UMR1027, Inserm, Université Paul Sabatier, 31330 Toulouse, France
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Université Paul Sabatier, 31000 Toulouse, France
- Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France
- INSERM Centre d’Investigation Clinique 1436 Toulouse, Centre d’Investigation Clinique de Toulouse, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France
- Correspondence: ; Tel.: +33-561-145-961; Fax: +33-561-145-642
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Zhang C, Chu M, Fan Y, Wu L, Li Z, Ma X, Zhuang W. Long non-coding RNA T-cell factor 7 in multiple myeloma: A potential biomarker for deteriorated clinical features and poor prognosis. J Clin Lab Anal 2020; 34:e23400. [PMID: 32578294 PMCID: PMC7521284 DOI: 10.1002/jcla.23400] [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: 09/28/2019] [Revised: 01/15/2020] [Accepted: 02/21/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study aimed to investigate the correlation of long non-coding RNA T-cell factor 7 (lnc-TCF7) with clinical features and prognosis in patients with multiple myeloma (MM). METHODS Totally, 216 newly diagnosed symptomatic MM patients and 60 healthy controls (HCs) were enrolled. Bone marrow samples were collected from patients before treatment and from HCs on donation to detect lnc-TCF7 expression in plasma cells by reverse transcription quantitative polymerase chain reaction. Besides, clinical response, progression-free survival (PFS), and overall survival (OS) of patients were assessed. RESULTS Lnc-TCF7 expression was increased in patients with MM compared with HCs. Lnc-TCF7 expression was highest in international staging system (ISS) stage III patients, followed by ISS stage II patients, and then ISS stage I patients, while lnc-TCF7 expression was similar in patients with different immunoglobulin subtypes and Durie-Salmon stages. Regarding chromosomal abnormalities, lnc-TCF7 expression positively correlated with t(4; 14) and Del(17p), whereas no correlation of lnc-TCF7 expression with t(14; 16), 1q21 amplification, Del(13q), or hyperdiploid was observed in patients with MM. Furthermore, lnc-TCF7 expression positively correlated with serum creatinine, beta-2-microglobulin, and lactate dehydrogenase in patients. Besides, lnc-TCF7 was negatively associated with complete response but not overall response rate in patients. Additionally, patients with lnc-TCF7 high expression exhibited shorter PFS and OS compared to patients with lnc-TCF7 low expression. CONCLUSION Lnc-TCF7 might have clinical value in aiding disease management and prognosis prediction of MM.
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Affiliation(s)
- Cui Zhang
- Department of Medical LaboratoryShidong Hospital of Yangpu DistrictShanghaiChina
| | - Min Chu
- Department of Medical LaboratoryShidong Hospital of Yangpu DistrictShanghaiChina
| | - Yingchao Fan
- Department of Medical LaboratoryShidong Hospital of Yangpu DistrictShanghaiChina
| | - Liting Wu
- Department of Medical LaboratoryShidong Hospital of Yangpu DistrictShanghaiChina
| | - Zhumeng Li
- Department of Medical LaboratoryShidong Hospital of Yangpu DistrictShanghaiChina
| | - Xiaoyan Ma
- Department of Medical LaboratoryShidong Hospital of Yangpu DistrictShanghaiChina
| | - Wenfang Zhuang
- Department of Medical LaboratoryShidong Hospital of Yangpu DistrictShanghaiChina
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Gavriatopoulou M, Chari A, Chen C, Bahlis N, Vogl DT, Jakubowiak A, Dingli D, Cornell RF, Hofmeister CC, Siegel D, Berdeja JG, Reece D, White D, Lentzsch S, Gasparetto C, Huff CA, Jagannath S, Baz R, Nooka AK, Richter J, Abonour R, Parker TL, Yee AJ, Moreau P, Lonial S, Tuchman S, Weisel KC, Mohty M, Choquet S, Unger TJ, Li K, Chai Y, Li L, Shah J, Shacham S, Kauffman MG, Dimopoulos MA. Integrated safety profile of selinexor in multiple myeloma: experience from 437 patients enrolled in clinical trials. Leukemia 2020; 34:2430-2440. [PMID: 32094461 PMCID: PMC7449872 DOI: 10.1038/s41375-020-0756-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 12/23/2022]
Abstract
Selinexor is an oral, small molecule inhibitor of the nuclear export protein exportin 1 with demonstrated activity in hematologic and solid malignancies. Side effects associated with selinexor include nausea, vomiting, fatigue, diarrhea, decreased appetite, weight loss, thrombocytopenia, neutropenia, and hyponatremia. We reviewed 437 patients with multiple myeloma treated with selinexor and assessed the kinetics of adverse events and impact of supportive care measures. Selinexor reduced both platelets and neutrophils over the first cycle of treatment and reached a nadir between 28 and 42 days. Platelet transfusions and thrombopoietin receptor agonists were effective at treating thrombocytopenia, and granulocyte colony stimulating factors were effective at resolving neutropenia. The onset of gastrointestinal side effects (nausea, vomiting, and diarrhea) was most common during the first 1-2 weeks of treatment. Nausea could be mitigated with 5-HT3 antagonists and either neurokinin 1 receptor antagonists, olanzapine, or cannbainoids. Loperamide and bismuth subsalicylate ameliorated diarrhea. The primary constitutional side effects of fatigue and decreased appetite could be managed with methylphenidate, megestrol, cannabinoids or olanzapine, respectively. Hyponatremia was highly responsive to sodium replacement. Selinexor has well-established adverse effects that mainly occur within the first 8 weeks of treatment, are reversible, and respond to supportive care.
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Affiliation(s)
- Maria Gavriatopoulou
- Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Ajai Chari
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christine Chen
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Nizar Bahlis
- Charbonneau Cancer Research Institute, Calgary, AB, Canada
| | - Dan T Vogl
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Craig C Hofmeister
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - David Siegel
- Department of Hematology, John Theurer Cancer Center, Hackensack, NJ, USA
| | | | - Donna Reece
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Darrell White
- QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Suzanne Lentzsch
- Department of Medicine, Division of Hematology/Oncology, Columbia University, New York, NY, USA
| | | | | | - Sundar Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachid Baz
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ajay K Nooka
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Joshua Richter
- Department of Hematology, John Theurer Cancer Center, Hackensack, NJ, USA
| | - Rafat Abonour
- Indiana University Cancer Center, Indianapolis, IN, USA
| | | | - Andrew J Yee
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | - Sagar Lonial
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Sascha Tuchman
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Katja C Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - T J Unger
- Karyopharm Therapeutics, Newton, MA, USA
| | - Kai Li
- Karyopharm Therapeutics, Newton, MA, USA
| | - Yi Chai
- Karyopharm Therapeutics, Newton, MA, USA
| | | | - Jatin Shah
- Karyopharm Therapeutics, Newton, MA, USA
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Steinmetz HT, Singh M, Lebioda A, Gonzalez-McQuire S, Rieth A, Schoehl M, Poenisch W. Patient Characteristics and Outcomes of Relapsed/Refractory Multiple Myeloma in Patients Treated with Proteasome Inhibitors in Germany. Oncol Res Treat 2020; 43:449-459. [PMID: 32694243 DOI: 10.1159/000509018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/28/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Real-world data reflects treatments and outcomes in clinical practice in contrast with controlled clinical trials. This study evaluates real-life multiple myeloma (MM) patients receiving proteasome inhibitor (PI)-based treatments in the second or third therapy line in 2017 in Germany. METHODS This is a retrospective chart review on adult relapsed/refractory MM patients treated with ≥1 dose of a PI-based regimen in either the second or the third line of therapy. Participating physicians had ≥3 years of clinical experience in treating symptomatic MM patients and used PI according to the label. RESULTS Distinct patient profiles for each PI-based regimen emerged. Younger, fitter, transplant-eligible patients received novel PI triplets such as carfilzomib in combination with lenalidomide and dexamethasone (KRd) or IRd. Patients receiving lenalidomide in first-line therapy mostly received lenalidomide-free regimens in second-line therapy. In high-risk patients, no clear treatment patterns could be ascertained. The complete response rates were highest with KRd (13.0%), followed by carfilzomib in combination with dexamethasone (Kd) (5.7%) and bortezomib (4.8%). The very good partial response rates were highest with IRd (76.9%), followed by KRd (53.7%), Kd (25.7%), and bortezomib (20.5%). None of the KRd- or IRd-treated patients responded below a partial response. DISCUSSION/CONCLUSION Clear patient profiles for each PI type were observed. In second-line therapy, younger, fitter, transplant-eligible patients received novel-PI-based triplets, e.g., KRd or IRd. Patients treated with lenalidomide in first-line therapy mostly received lenalidomide-sparing regimens in second-line therapy. In high-risk patients no clear treatment patterns could be ascertained due to the limited sample size.
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Affiliation(s)
| | - Moushmi Singh
- Health Economics, Amgen Ltd., Uxbridge, United Kingdom
| | | | | | - Achim Rieth
- Medical Development, Amgen GmbH, Munich, Germany
| | | | - Wolfram Poenisch
- Department of Hematology and Cellular Therapy, Medical Clinic and Policlinic I, University of Leipzig, Leipzig, Germany
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Schinke M, Ihorst G, Duyster J, Wäsch R, Schumacher M, Engelhardt M. Risk of disease recurrence and survival in patients with multiple myeloma: A German Study Group analysis using a conditional survival approach with long-term follow-up of 815 patients. Cancer 2020; 126:3504-3515. [PMID: 32459378 DOI: 10.1002/cncr.32978] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Unlike the traditional method of overall survival prediction in patients with cancer, conditional survival predicts the survival of patients dynamically throughout the course of disease, identifying how a prognosis evolves over time. METHODS The authors assessed 815 consecutive patients with multiple myeloma through the German Study Group on Multiple Myeloma (Deutsche Studiengruppe Multiples Myelom; DSMM) incentive. Over 10 variables, including patient-specific and multiple myeloma-specific parameters, were analyzed at the time of initial diagnosis and repeatedly during follow-up. The probability of survival for another 5 years was calculated according to disease-related and host-related risks. Multivariate Cox models were used to determine baseline and updated prognostic factors for survival. RESULTS The median follow-up and overall survival were 10.3 years and 5.1 years, respectively. When comparing 5-year conditional survival probabilities from the data derived at the time of initial diagnosis with those updated over time, substantially differing prognoses were observed when follow-up data were used. Multivariate Cox regression models for cohorts surviving 0 to 5 years demonstrated hazard ratios (HRs) for patients aged <60 years, 60 to 69 years, and >70 years of 1, 1.68, and 3.17, respectively. These HRs for age were found to decline for patients surviving 5 years, as well as for those with advanced stages of disease (II/III) and unfavorable cytogenetics, whereas progressive disease remained an important factor in patients surviving 1 year, 3 years, and 5 years, with HRs of 1.85, 2.11, and 2.14, respectively. CONCLUSIONS To the authors' knowledge, the current study is the first analysis of conditional survival in patients with multiple myeloma using both baseline and follow-up risk parameters, demonstrating that regular risk assessment throughout the course of disease and complete follow-up provide a more reliable conditional survival estimation than baseline assessment alone.
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Affiliation(s)
- Maximilian Schinke
- Department of Medicine I, University of Freiburg Medical Center, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, University of Freiburg Medical Center, Freiburg, Germany
| | - Justus Duyster
- Department of Medicine I, University of Freiburg Medical Center, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralph Wäsch
- Department of Medicine I, University of Freiburg Medical Center, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Schumacher
- Center for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Monika Engelhardt
- Department of Medicine I, University of Freiburg Medical Center, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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COVID-19 in persons with haematological cancers. Leukemia 2020; 34:1637-1645. [PMID: 32332856 PMCID: PMC7180672 DOI: 10.1038/s41375-020-0836-7] [Citation(s) in RCA: 323] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023]
Abstract
Infection with SARS-CoV-2, the cause of coronavirus infectious disease–19 (COVID-19), has caused a pandemic with >850,000 cases worldwide and increasing. Several studies report outcomes of COVID-19 in predominately well persons. There are also some data on COVID-19 in persons with predominately solid cancer but controversy whether these persons have the same outcomes. We conducted a cohort study at two centres in Wuhan, China, of 128 hospitalised subjects with haematological cancers, 13 (10%) of whom developed COVID-19. We also studied 226 health care providers, 16 of whom developed COVID-19 and 11 of whom were hospitalised. Co-variates were compared with the 115 subjects with haematological cancers without COVID-19 and with 11 hospitalised health care providers with COVID-19. There were no significant differences in baseline co-variates between subjects with haematological cancers developing or not developing COVID-19. Case rates for COVID-19 in hospitalised subjects with haematological cancers was 10% (95% Confidence Interval [CI], 6, 17%) compared with 7% (4, 12%; P = 0.322) in health care providers. However, the 13 subjects with haematological cancers had more severe COVID-19 and more deaths compared with hospitalised health care providers with COVID-19. Case fatality rates were 62% (32, 85%) and 0 (0, 32%; P = 0.002). Hospitalised persons with haematological cancers have a similar case rate of COVID-19 compared with normal health care providers but have more severe disease and a higher case fatality rate. Because we were unable to identify specific risk factors for COVID-19 in hospitalised persons with haematological cancers, we suggest increased surveillance and possible protective isolation.
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Dimopoulos MA, Jakubowiak AJ, McCarthy PL, Orlowski RZ, Attal M, Bladé J, Goldschmidt H, Weisel KC, Ramasamy K, Zweegman S, Spencer A, Huang JSY, Lu J, Sunami K, Iida S, Chng WJ, Holstein SA, Rocci A, Skacel T, Labotka R, Palumbo A, Anderson KC. Developments in continuous therapy and maintenance treatment approaches for patients with newly diagnosed multiple myeloma. Blood Cancer J 2020; 10:17. [PMID: 32054831 PMCID: PMC7018731 DOI: 10.1038/s41408-020-0273-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 12/30/2022] Open
Abstract
The evolving paradigm of continuous therapy and maintenance treatment approaches in multiple myeloma (MM) offers prolonged disease control and improved outcomes compared to traditional fixed-duration approaches. Potential benefits of long-term strategies include sustained control of disease symptoms, as well as continued cytoreduction and clonal control, leading to unmeasurable residual disease and the possibility of transforming MM into a chronic or functionally curable condition. "Continuous therapy" commonly refers to administering a doublet or triplet regimen until disease progression, whereas maintenance approaches typically involve single-agent or doublet treatment following more intensive prior therapy with autologous stem cell transplant (ASCT) or doublet, triplet, or even quadruplet induction therapy. However, the requirements for agents and regimens within these contexts are similar: treatments must be tolerable for a prolonged period of time, should not be associated with cumulative or chronic toxicity, should not adversely affect patients' quality of life, should ideally be convenient with a minimal treatment burden for patients, and should not impact the feasibility or efficacy of subsequent treatment at relapse. Multiple agents have been and are being investigated as long-term options in the treatment of newly diagnosed MM (NDMM), including the immunomodulatory drugs lenalidomide and thalidomide, the proteasome inhibitors bortezomib, carfilzomib, and ixazomib, and the monoclonal antibodies daratumumab, elotuzumab, and isatuximab. Here we review the latest results with long-term therapy approaches in three different settings in NDMM: (1) maintenance treatment post ASCT; (2) continuous frontline therapy in nontransplant patients; (3) maintenance treatment post-frontline therapy in the nontransplant setting. We also discuss evidence from key phase 3 trials. Our review demonstrates how the paradigm of long-term treatment is increasingly well-established across NDMM treatment settings, potentially resulting in further improvements in patient outcomes, and highlights key clinical issues that will need to be addressed in order to provide optimal benefit.
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Affiliation(s)
- Meletios A Dimopoulos
- Hematology & Medical Oncology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | | | | | - Robert Z Orlowski
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michel Attal
- Hematology Department, University Hospital Purpan, Toulouse, France
| | - Joan Bladé
- Hematology Department, Hospital Clinic, Institut de Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Medical Hospital and National Center of Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Katja C Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Sonja Zweegman
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, The Netherlands
| | - Andrew Spencer
- Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, Australia
| | | | - Jin Lu
- Department of Hematology, Peking University People's Hospital and Peking University Institute of Hematology, Beijing, China
| | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Wee-Joo Chng
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, and Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Sarah A Holstein
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alberto Rocci
- Department of Haematology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, School of Medical Science, Division of Cancer Science, University of Manchester, Manchester, UK
| | - Tomas Skacel
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Richard Labotka
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Antonio Palumbo
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
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48
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Suska A, Czerniuk MR, Jurczyszyn A. Next-generation immunomodulatory drugs in multiple myeloma. POSTEP HIG MED DOSW 2019. [DOI: 10.5604/01.3001.0013.6907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Multiple myeloma (MM) is a hematological malignancy that mainly affects elderly patients, with the median age of 69 years at the time of diagnosis. Despite the recent increase in the number of drugs used in the antimyeloma therapy, the disease remains incurable, with remissions and subsequent relapses. Immunomodulatory drugs (IMIDs), known to have multiple mechanisms of actions, including direct anti-MM activity and immune-stimulatory properties, are currently the backbone in multidrug regimens. New generation IMIDs are recommended nowoby
ESMO – lenalidomide is included in frontline therapy, while pomalidomide is accepted from
the third line. Clinical trials proved lack of apparent cross-resistance between immunomodulatory
agents, confirmed their high efficacy and acceptable safety profile in individuals with
relapsed multiple myeloma (RRMM) refractory to proteasome inhibitors and lenalidomide,
even with adverse cytogenetic abnormalities. Also, triplet pomalidomide-based combinations
with bortezomib, carfilzomib, cyclophosphamide, daratumumab or elotuzumab were proved
to be effective and safe in this group of patients. The most common adverse events of the new
generation IMIDs are the following: hematological toxicity (neutropenia, thrombocytopenia,
anemia), fatigue and, while administered with dexamethasone, infections. However, peripheral
neuropathy, significantly limiting the use of first generation IMID - thalidomide, is much less
frequently observed. Due to the increased risk of venous thromboembolism, thromboprophylaxis
should be implemented in the whole course of IMID therapy. Data from real-life settings
demonstrate that new generation IMIDs are a cost-effective treatment option in relapsed/
refractory myeloma. Currently, one drug program with the new IMIDs is available in Poland.
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Affiliation(s)
- Anna Suska
- Katedra Hematologii, Uniwersytet Jagielloński Collegium Medicum, Kraków
| | | | - Artur Jurczyszyn
- Katedra Hematologii, Uniwersytet Jagielloński Collegium Medicum, Kraków
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49
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Engelhardt M, Yong K, Bringhen S, Wäsch R. Carfilzomib combination treatment as first-line therapy in multiple myeloma: where do we go from the Carthadex (KTd)-trial update? Haematologica 2019; 104:2128-2131. [PMID: 31666342 DOI: 10.3324/haematol.2019.228684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Monika Engelhardt
- Hematology and Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany .,Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
| | - Kwee Yong
- University College London, London, UK
| | - Sara Bringhen
- UNITO Dipartimento di Oncologia, University of Turin, Turin, Italy
| | - Ralph Wäsch
- Hematology and Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Center Freiburg (CCCF), Freiburg, Germany
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50
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Nishiwaki U, Yokote T, Hatooka J, Miyoshi T, Iwaki K, Masuda Y, Fujimoto M, Ueda M, Kinoshita Y, Arita Y, Shimizu M, Yamada T, Tanabe K, Akioka T, Imagawa A. Prediction of bortezomib-induced peripheral neuropathy with the R-R interval variation of the electrocardiogram in plasma cell myeloma: a retrospective study. Leuk Lymphoma 2019; 61:707-713. [PMID: 31642372 DOI: 10.1080/10428194.2019.1678152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Bortezomib-induced peripheral neuropathy (BIPN) is a key dose-limiting toxicity in patients with plasma cell myeloma (PCM). This study examined 56 patients with PCM treated with bortezomib to determine the possible predisposing factors to BIPN with the R-R interval variation (RRIV) of the electrocardiogram (ECG). Of all, 17 patients developed Clinically obvious BIPN, grades 2-4 or grade worsening from the baseline neuropathy per the National Cancer Institute's Common Terminology Criteria for Adverse Events (v5.0). In the receiver operating characteristic curve analysis, the optimal RRIV cutoff value to distinguish patients with and without risk to develop BIPN was 1.391. A lower RRIV before bortezomib treatment independently correlated with the onset of Clinically obvious BIPN (p = .002) and the time to the onset of Clinically obvious BIPN (p < 0.001). A lower RRIV of the ECG before the bortezomib treatment is a predictive factor for BIPN in PCM.
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Affiliation(s)
- Uta Nishiwaki
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Taiji Yokote
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Jun Hatooka
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Takuji Miyoshi
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Kazuki Iwaki
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Yuki Masuda
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Mayumi Fujimoto
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Mitsuya Ueda
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Yuki Kinoshita
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Yui Arita
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Masatomo Shimizu
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Tomoyuki Yamada
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Kazuki Tanabe
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Toshikazu Akioka
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
| | - Akihisa Imagawa
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki City, Japan
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