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Rajkumar SV. Multiple myeloma: 2024 update on diagnosis, risk-stratification, and management. Am J Hematol 2024; 99:1802-1824. [PMID: 38943315 DOI: 10.1002/ajh.27422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 07/01/2024]
Abstract
DISEASE OVERVIEW Multiple myeloma accounts for approximately 10% of hematologic malignancies. DIAGNOSIS The diagnosis requires ≥10% clonal bone marrow plasma cells or a biopsy proven plasmacytoma plus evidence of one or more multiple myeloma defining events (MDE): CRAB (hypercalcemia, renal failure, anemia, or lytic bone lesions) attributable to the plasma cell disorder, bone marrow clonal plasmacytosis ≥60%, serum involved/uninvolved free light chain (FLC) ratio ≥100 (provided involved FLC is ≥100 mg/L and urine monoclonal protein is ≥200 mg/24 h), or >1 focal lesion on magnetic resonance imaging. RISK STRATIFICATION The presence of del(17p), t(4;14), t(14;16), t(14;20), gain 1q, del 1p, or p53 mutation is considered high-risk multiple myeloma. Presence of any two high risk factors is considered double-hit myeloma; three or more high risk factors is triple-hit myeloma. RISK-ADAPTED INITIAL THERAPY In patients who are candidates for autologous stem cell transplantation, induction therapy consists of anti-CD38 monoclonal antibody plus bortezomib, lenalidomide, dexamethasone (VRd) followed by autologous stem cell transplantation (ASCT). Selected standard risk patients can delay transplant until first relapse. Frail patients who not candidates for transplant are treated with VRd for approximately 8-12 cycles followed by maintenance or alternatively with daratumumab, lenalidomide, dexamethasone (DRd) until progression. MAINTENANCE THERAPY Standard risk patients need lenalidomide maintenance, while bortezomib plus lenalidomide maintenance is needed for high-risk myeloma. MANAGEMENT OF RELAPSED DISEASE A triplet regimen is usually needed at relapse, with the choice of regimen varying with each successive relapse. Chimeric antigen receptor T (CAR-T) cell therapy and bispecific antibodies are additional options.
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Huh CY, Park SS, Lee JY, Min CK. Comparative efficacy of VMP vs. Rd in newly diagnosed, autologous stem cell transplant-ineligible multiple myeloma patients: a prematurely terminated randomized controlled study, CAREMM-2002 study. Blood Res 2024; 59:24. [PMID: 39017764 PMCID: PMC11254880 DOI: 10.1007/s44313-024-00025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024] Open
Affiliation(s)
- Cheong Yoon Huh
- Department of Hematology, College of Medicine, Catholic Hematology Hospital, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Soo Park
- Department of Hematology, College of Medicine, Catholic Hematology Hospital, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Yeon Lee
- Department of Hematology, College of Medicine, Catholic Hematology Hospital, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Ki Min
- Department of Hematology, College of Medicine, Catholic Hematology Hospital, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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O'Meara KT, Fansiwala K, Kathuria-Prakash N, El-Masry M, Oh S. Acute hypoxic respiratory failure due to Lenalidomide-induced interstitial pneumonitis in a patient with multiple myeloma. BMC Pulm Med 2024; 24:321. [PMID: 38965516 PMCID: PMC11225133 DOI: 10.1186/s12890-024-03129-z] [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: 05/10/2023] [Accepted: 06/24/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Patients with multiple myeloma are immunosuppressed due to both the disease itself and immunosuppressive therapies. Thus, when presenting with respiratory failure and pulmonary opacities, pneumonia must be considered. However, while rare, immunomodulating medications used in the treatment of multiple myeloma can also cause potentially life-threatening respiratory failure, a distinction which has important treatment implications. CASE PRESENTATION An 80-year-old male with recently diagnosed multiple myeloma undergoing treatment with lenalidomide and daratumumab presented with acute, rapidly progressive hypoxic respiratory failure ultimately requiring intubation and mechanical ventilatory support. Imaging revealed bilateral pulmonary opacities, however infectious workup was negative, and he was ultimately diagnosed with lenalidomide-induced interstitial pneumonitis, a rare but serious adverse effect of this medication. He was treated with drug discontinuation and methylprednisolone, and quickly recovered. CONCLUSION Lenalidomide is an immunomodulating medication used in the treatment of multiple myeloma, and is associated with rare but serious cases of drug-induced interstitial pneumonitis. Thus, if a patient receiving lenalidomide develops shortness of breath and/or hypoxia, drug-induced pneumonitis must be on the differential. Permanent drug discontinuation with or without corticosteroids is the mainstay of treatment, and patients are often able to fully recover, underscoring the need for early recognition of this condition.
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Affiliation(s)
| | | | | | | | - Scott Oh
- University of California, Los Angeles, Los Angeles, USA
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Dew A, Lin J, Darmon S, Roswarski J, Shriver C, Zhu K, Chiu A. Survival Among Patients With Multiple Myeloma in the United States Military Health System Compared to the Surveillance, Epidemiology, and End Results (SEER) Program. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00243-X. [PMID: 39034205 DOI: 10.1016/j.clml.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/20/2024] [Accepted: 06/28/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Access to health care is an important factor affecting survival of patients with multiple myeloma (MM) in the U.S. general population. The U.S. Military Health System (MHS) provides universal health care to beneficiaries and has been associated with improved survival across multiple malignancies. In this study, we compared survival of MHS beneficiaries with MM with MM patients from the U.S. general population. MATERIALS AND METHODS The Department of Defense's Automated Central Tumor Registry (ACTUR) and the Surveillance, Epidemiology and End Results (SEER) databases were used to extract data for MM patients from MHS and the U.S. general population, respectively. Patients had histologically confirmed MM between 1987 and 2013 and were followed through 2015 for overall survival. Two SEER patients were matched to each ACTUR patient by age group, sex, race, and diagnosis year group. Five and 10-year survival was compared between ACTUR and SEER patients to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) with adjustment for potential confounders. RESULTS Median survival of the ACTUR patients was 47.1 months (95% CI: 43.9-50.4) compared to 33.0 months (95% CI, 32.0-35.0) of the SEER patients. Five and 10-year death rates were significantly lower for ACTUR patients than the SEER patients with an adjusted HR of 0.74 (95% CI, 0.68-0.81) and 0.79 (95% CI, 0.74-0.85), respectively. The survival advantage of ACTUR patients was preserved when stratified by age, sex, race, and diagnosis year. CONCLUSION MHS beneficiaries with MM had improved overall survival compared to MM patients from the U.S. general population.
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Affiliation(s)
- Alexander Dew
- Hematology/Oncology Service, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jie Lin
- Department of Surgery, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sarah Darmon
- Department of Surgery, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Joe Roswarski
- Division of Hematology and Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Craig Shriver
- Hematology/Oncology Service, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Kangmin Zhu
- Department of Surgery, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Alden Chiu
- Hematology/Oncology Service, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD.
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Lipof JJ, Abdallah N, Lipe B. Personalized Treatment of Multiple Myeloma in Frail Patients. Curr Oncol Rep 2024; 26:744-753. [PMID: 38761302 DOI: 10.1007/s11912-024-01545-2] [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] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE OF REVIEW As the treatment landscape for multiple myeloma (MM) continues to expand at a rapid pace, management of older adults and frail patients becomes increasingly challenging. As these patients have traditionally been underrepresented on clinical trials, there is limited guidance on the optimal approach to frail patients with newly diagnosed multiple myeloma (NDMM) or relapsed and refractory multiple myeloma (RRMM). RECENT FINDINGS Frailty is an independent predictor of tolerability and response to antineoplastic treatment. Stringent eligibility criteria have often excluded these patients, but recently some large trials have included frailty sub-analyses to help guide management. In general, triplet regimens are preferred to doublet regimens in this population and enrollment on a clinical trial should be prioritized when possible. In this review, we summarize the MM frailty scoring tools that have been developed to identify and assess this vulnerable population. We present the clinical trials over the past decade that have enrolled frail patients and/or have included subgroup analyses to help elucidate the response and tolerability of different regimens in this underrepresented group. We provide practical advice regarding assessment and management of frail patients NDMM and RRMM.
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Affiliation(s)
- Jodi J Lipof
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA
| | - Nadine Abdallah
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brea Lipe
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA.
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Kastritis E, Ntanasis-Stathopoulos I, Theodorakakou F, Migkou M, Roussou M, Malandrakis P, Kanellias N, Eleutherakis-Papaiakovou E, Fotiou D, Spiliopoulou V, Gavriatopoulou M, Patel S, Majer I, Boukis C, Fetani A, Dimopoulos MA, Terpos E. Characteristics and Outcomes of Patients With Relapsed/Refractory Multiple Myeloma After Exposure to Lenalidomide in First Line of Therapy: A Single Center Database Review in Greece. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:468-477. [PMID: 38616479 DOI: 10.1016/j.clml.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The increasing use of lenalidomide (Len) in first-line (1L) therapy of multiple myeloma (MM) has led to a significant proportion of patients becoming Len-refractory following 1L treatment. However, there are limited real-world data on treatment strategies and outcomes of patients who become Len-refractory following 1L therapy. PATIENTS AND METHODS This real-world retrospective cohort study analyzed Len-refractory and non-Len-refractory patients who received 1L Len and initiated second-line (2L) therapy at a Greek MM center. The Len-exposed cohort (n = 249) included 55.4% Len-refractory patients after 1L. RESULTS Compared to non-Len-refractory patients, Len-refractory patients more frequently had high-risk cytogenetics and Revised-International Staging System-3 disease stage at diagnosis, and had shorter progression-free survival (PFS) following 1L therapy. Len-refractory versus non-Len-refractory patients more frequently received triplets (59% vs. 40%), anti-CD38 agents (20% vs. 9%) and pomalidomide (22% vs. 13%). The overall response rate was 53% for Len-refractory patients and 64% for non-Len-refractory patients in 2L therapy; median PFS was 10.7 vs. 18.3 months, respectively. Median overall survival (OS) was shorter for Len-refractory patients vs non-Len-refractory patients (23.8 vs. 53.6 months). Len refractoriness was an independent prognostic factor for both PFS and OS in Len-exposed patients. CONCLUSION In this real-world Len-exposed cohort, Len-refractory patients receiving 1L Len experienced poorer survival outcomes than non-Len-refractory patients, highlighting the unmet need in this patient population which has driven the development of novel therapies.
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Affiliation(s)
- Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece.
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Foteini Theodorakakou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Magdalini Migkou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Maria Roussou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Panagiotis Malandrakis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Nikolaos Kanellias
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | - Despina Fotiou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Vassiliki Spiliopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | | | | | | | | | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
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7
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Malard F, Neri P, Bahlis NJ, Terpos E, Moukalled N, Hungria VTM, Manier S, Mohty M. Multiple myeloma. Nat Rev Dis Primers 2024; 10:45. [PMID: 38937492 DOI: 10.1038/s41572-024-00529-7] [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] [Accepted: 05/16/2024] [Indexed: 06/29/2024]
Abstract
Multiple myeloma (MM) is a haematological lymphoid malignancy involving tumoural plasma cells and is usually characterized by the presence of a monoclonal immunoglobulin protein. MM is the second most common haematological malignancy, with an increasing global incidence. It remains incurable because most patients relapse or become refractory to treatments. MM is a genetically complex disease with high heterogeneity that develops as a multistep process, involving acquisition of genetic alterations in the tumour cells and changes in the bone marrow microenvironment. Symptomatic MM is diagnosed using the International Myeloma Working Group criteria as a bone marrow infiltration of ≥10% clonal plasma cells, and the presence of at least one myeloma-defining event, either standard CRAB features (hypercalcaemia, renal failure, anaemia and/or lytic bone lesions) or biomarkers of imminent organ damage. Younger and fit patients are considered eligible for transplant. They receive an induction, followed by consolidation with high-dose melphalan and autologous haematopoietic cell transplantation, and maintenance therapy. In older adults (ineligible for transplant), the combination of daratumumab, lenalidomide and dexamethasone is the preferred option. If relapse occurs and requires further therapy, the choice of therapy will be based on previous treatment and response and now includes immunotherapies, such as bi-specific monoclonal antibodies and chimeric antigen receptor T cell therapy.
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Affiliation(s)
- Florent Malard
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
| | - Paola Neri
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada
| | - Nizar J Bahlis
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada
| | - Evangelos Terpos
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nour Moukalled
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Salomon Manier
- Department of Hematology, Lille University Hospital and INSERM UMR-S1277 and CNRS UMR9020, Lille, France
| | - Mohamad Mohty
- Sorbonne Université, Centre de Recherche Saint-Antoine INSERM UMRs938, Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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8
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Van Oekelen O, Amatangelo M, Guo M, Upadhyaya B, Cribbs AP, Kelly G, Patel M, Kim-Schulze S, Flynt E, Lagana A, Gooding S, Merad M, Jagganath S, Pierceall WE, Oppermann U, Thakurta A, Parekh S. Iberdomide increases innate and adaptive immune cell subsets in the bone marrow of patients with relapsed/refractory multiple myeloma. Cell Rep Med 2024; 5:101584. [PMID: 38776911 PMCID: PMC11228551 DOI: 10.1016/j.xcrm.2024.101584] [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: 08/24/2023] [Revised: 02/11/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
Iberdomide is a potent cereblon E3 ligase modulator (CELMoD agent) with promising efficacy and safety as a monotherapy or in combination with other therapies in patients with relapsed/refractory multiple myeloma (RRMM). Using a custom mass cytometry panel designed for large-scale immunophenotyping of the bone marrow tumor microenvironment (TME), we demonstrate significant increases of effector T and natural killer (NK) cells in a cohort of 93 patients with multiple myeloma (MM) treated with iberdomide, correlating findings to disease characteristics, prior therapy, and a peripheral blood immune phenotype. Notably, changes are dose dependent, associated with objective response, and independent of prior refractoriness to MM therapies. This suggests that iberdomide broadly induces innate and adaptive immune activation in the TME, contributing to its antitumor efficacy. Our approach establishes a strategy to study treatment-induced changes in the TME of patients with MM and, more broadly, patients with cancer and establishes rational combination strategies for iberdomide with immune-enhancing therapies to treat MM.
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Affiliation(s)
- Oliver Van Oekelen
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Manman Guo
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Bhaskar Upadhyaya
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam P Cribbs
- MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Geoffrey Kelly
- Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manishkumar Patel
- Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Seunghee Kim-Schulze
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin Flynt
- Translational Medicine, Bristol Myers Squibb, Summit, NJ, USA
| | - Alessandro Lagana
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Gooding
- MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Miriam Merad
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sundar Jagganath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Udo Oppermann
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK; Oxford Translational Myeloma Centre (OTMC), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Anjan Thakurta
- Translational Medicine, Bristol Myers Squibb, Summit, NJ, USA; Oxford Translational Myeloma Centre (OTMC), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Samir Parekh
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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9
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Facon T, Dimopoulos MA, Leleu XP, Beksac M, Pour L, Hájek R, Liu Z, Minarik J, Moreau P, Romejko-Jarosinska J, Spicka I, Vorobyev VI, Besemer B, Ishida T, Janowski W, Kalayoglu-Besisik S, Parmar G, Robak P, Zamagni E, Goldschmidt H, Martin TG, Manier S, Mohty M, Oprea C, Brégeault MF, Macé S, Berthou C, Bregman D, Klippel Z, Orlowski RZ. Isatuximab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple Myeloma. N Engl J Med 2024. [PMID: 38832972 DOI: 10.1056/nejmoa2400712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND Bortezomib, lenalidomide, and dexamethasone (VRd) is a preferred first-line treatment option for patients with newly diagnosed multiple myeloma. Whether the addition of the anti-CD38 monoclonal antibody isatuximab to the VRd regimen would reduce the risk of disease progression or death among patients ineligible to undergo transplantation is unclear. METHODS In an international, open-label, phase 3 trial, we randomly assigned, in a 3:2 ratio, patients 18 to 80 years of age with newly diagnosed multiple myeloma who were ineligible to undergo transplantation to receive either isatuximab plus VRd or VRd alone. The primary efficacy end point was progression-free survival. Key secondary end points included a complete response or better and minimal residual disease (MRD)-negative status in patients with a complete response. RESULTS A total of 446 patients underwent randomization. At a median follow-up of 59.7 months, the estimated progression-free survival at 60 months was 63.2% in the isatuximab-VRd group, as compared with 45.2% in the VRd group (hazard ratio for disease progression or death, 0.60; 98.5% confidence interval, 0.41 to 0.88; P<0.001). The percentage of patients with a complete response or better was significantly higher in the isatuximab-VRd group than in the VRd group (74.7% vs. 64.1%, P = 0.01), as was the percentage of patients with MRD-negative status and a complete response (55.5% vs. 40.9%, P = 0.003). No new safety signals were observed with the isatuximab-VRd regimen. The incidence of serious adverse events during treatment and the incidence of adverse events leading to discontinuation were similar in the two groups. CONCLUSIONS Isatuximab-VRd was more effective than VRd as initial therapy in patients 18 to 80 years of age with newly diagnosed multiple myeloma who were ineligible to undergo transplantation. (Funded by Sanofi and a Cancer Center Support Grant; IMROZ ClinicalTrials.gov number, NCT03319667.).
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Affiliation(s)
- Thierry Facon
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Meletios-Athanasios Dimopoulos
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Xavier P Leleu
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Meral Beksac
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Ludek Pour
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Roman Hájek
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Zhuogang Liu
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Jiri Minarik
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Philippe Moreau
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Joanna Romejko-Jarosinska
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Ivan Spicka
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Vladimir I Vorobyev
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Britta Besemer
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Tadao Ishida
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Wojciech Janowski
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Sevgi Kalayoglu-Besisik
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Gurdeep Parmar
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Pawel Robak
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Elena Zamagni
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Hartmut Goldschmidt
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Thomas G Martin
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Salomon Manier
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Mohamad Mohty
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Corina Oprea
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Marie-France Brégeault
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Sandrine Macé
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Christelle Berthou
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - David Bregman
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Zandra Klippel
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
| | - Robert Z Orlowski
- From the Department of Hematology, Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Lille (T.F., S. Manier), the French National Academy of Medicine (T.F.), and the Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM (M.M.), Paris, Service d'Hématologie et Thérapie Cellulaire, CHU and Centre d'Investigation Clinique INSERM Unité 1402, Poitiers (X.P.L.), the Department of Hematology, University Hospital Hôtel-Dieu, Nantes (P.M.), and Sanofi, Research and Development, Vitry-sur-Seine (C.O., M.-F.B., S. Macé, C.B.) - all in France; the Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens (M.-A.D.); the Department of Hematology, Ankara University, and the Istinye University Ankara Liv Hospital, Ankara (M.B.), and the Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul (S.K.-B.) - all in Turkey; the Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno (L.P.), the Department of Hemato-Oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (R.H.), the Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc (J.M.), and the Charles University and General Hospital in Prague, Prague (I.S.) - all in the Czech Republic; Shengjing Hospital of China Medical University, Shenyang, China (Z.L.); the Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.R.-J.), and the Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Center and Traumatology, Łódź (P.R.) - both in Poland; the S.P. Botkin Moscow City Clinical Hospital, Moscow (V.I.V.); the Department of Hematology, Oncology, Immunology, and Rheumatology, University Hospital of Tübingen, Tübingen (B.B.), and the Department of Internal Medicine V, University of Heidelberg, Heidelberg (H.G.) - both in Germany; the Japanese Red Cross Medical Center, Tokyo (T.I.); Calvary Mater Newcastle, Newcastle, NSW (W.J.), and the Illawarra Cancer Care Centre, Wollongong, NSW (G.P.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," and Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy (E.Z.); the Division of Hematology-Oncology, University of California, San Francisco, San Francisco (T.G.M.); Sanofi, Patient Safety and Pharmacovigilance, Bridgewater, NJ (D.B.); Sanofi, Cambridge, MA (Z.K.); and the Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston (R.Z.O.)
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10
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Kaedbey R, Reece D, Venner CP, McCurdy A, Su J, Chu M, Louzada M, Jimenez‐Zepeda VH, Mian H, Song K, Sebag M, Stakiw J, White D, Reiman A, Aslam M, Kotb R, Bergstrom D, Gul E, LeBlanc R. Long-term follow-up of outcomes including progression-free survival 2 in patients with transplant-ineligible multiple myeloma in the real-world practice: A multi-institutional report from the Canadian Myeloma Research Group (CMRG) database. EJHAEM 2024; 5:474-484. [PMID: 38895063 PMCID: PMC11182392 DOI: 10.1002/jha2.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/22/2024] [Accepted: 03/29/2024] [Indexed: 06/21/2024]
Abstract
Multiple myeloma remains an incurable cancer mostly affecting older adults and is characterized by a series of remission inductions and relapses. This study aims to evaluate the outcomes in newly diagnosed transplant-ineligible patients using bortezomib/lenalidomide-based regimens in the Canadian real world as well as their outcomes in the second line. The Canadian Myeloma Research Group Database (CMRG-DB) is a national database with input from multiple Canadian Centres with now up to 8000 patients entered. A total of 1980 transplant ineligible patients were identified in the CMRG-DB between the years of 2007-2021. The four most commonly used induction regimens are bortezomib/melphalan/prednisone (VMP) (23%), cyclophosphamide/bortezomib/dexamethasone (CyBorD) (47%), lenalidomide/dexamethasone (Rd) (24%), and bortezomib/lenalidomide/dexamethasone (VRd) (6%). After a median follow-up of 30.46 months (0.89-168.42), the median progression-free survival (mPFS) and median overall survival (mOS) of each cohort are 23.5, 22.9, 34.0 months, and not reached (NR) and 64.1, 51.1, 61.5 months, and NR respectively. At the time of data cut-off, 1128 patients had gone on to second-line therapy. The mPFS2 based on first-line therapy, VMP, CyBorD, Rd, and VRd is 53.3, 48.4, 62.7 months, and NR respectively. The most common second-line regimens are Rd (47.4%), DRd (12.9%), CyBorD (10.3%), and RVd (8.9%) with a mPFS and a mOS of 17.0, 31.1, 15.4, and 14.0 months and 34.7, NR, 47.6, 33.4 months, respectively. This study represents the real-world outcomes in newly diagnosed transplant-ineligible myeloma patients in Canada. The spectra of therapy presented here reflect the regimens still widely used around the world. While this is sure to change with anti-CD38 monoclonal antibodies now reflecting a new standard of care in frontline therapy, this cohort is reflective of the type of multiple myeloma patient currently experiencing relapse in the real-world setting.
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Affiliation(s)
- Rayan Kaedbey
- Division of Hematology, Department of MedicineJewish General HospitalMontrealCanada
| | - Donna Reece
- Department of Medical Oncology and HematologyPrincess Margaret Cancer CentreTorontoCanada
- Canadian Myeloma Research GroupVaughanCanada
| | - Christopher P. Venner
- Department of HematologyLymphoma and Myeloma Program, BC Cancer, Vancouver CentreVancouverCanada
| | | | - Jiandong Su
- Canadian Myeloma Research GroupVaughanCanada
| | - Michael Chu
- Department of MedicineCross Cancer InstituteEdmontonCanada
| | - Martha Louzada
- Department of MedicineLondon Regional Cancer CenterLondonCanada
| | - Victor H Jimenez‐Zepeda
- Department of MedicineArnie Charbonneau Cancer Institute, University of CalgaryCalgaryCanada
| | - Hira Mian
- Department of MedicineJuravinski Cancer CenterHamiltonCanada
| | - Kevin Song
- Department of MedicineBC Cancer Agency, Vancouver General HospitalVancouverCanada
| | - Michael Sebag
- Department of MedicineMcGill UniversityMontrealCanada
| | - Julie Stakiw
- Department of MedicineSaskatoon Cancer Centre, University of SaskatchewanSaskatoonCanada
| | - Darrell White
- Division of HematologyQueen Elizabeth II Health Sciences Centre. Dalhousie UniversityHalifaxCanada
| | - Anthony Reiman
- Department of MedicineSaint John Regional HospitalSaint JohnCanada
| | - Muhammad Aslam
- Department of Medical OncologyAllan Blair Cancer CentreReginaCanada
| | - Rami Kotb
- Department of Medical Oncology & HematologyCancer Care ManitobaWinnipegCanada
| | - Debra Bergstrom
- Division of HematologyMemorial University of NewfoundlandSt John'sCanada
| | - Engin Gul
- Canadian Myeloma Research GroupVaughanCanada
| | - Richard LeBlanc
- Department of Medical OncologyMaisonneuve‐Rosemont Hospital Research Centre, University of MontrealMontrealCanada
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11
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Shibayama H, Itagaki M, Handa H, Yokoyama A, Saito A, Kosugi S, Ota S, Yoshimitsu M, Tanaka Y, Kurahashi S, Fuchida SI, Iino M, Shimizu T, Moriuchi Y, Toyama K, Mitani K, Tsukune Y, Kada A, Tamura H, Abe M, Iwasaki H, Kuroda J, Takamatsu H, Sunami K, Kizaki M, Ishida T, Saito T, Matsumura I, Akashi K, Iida S. Primary analysis of a prospective cohort study of Japanese patients with plasma cell neoplasms in the novel drug era (2016-2021). Int J Hematol 2024; 119:707-721. [PMID: 38548963 PMCID: PMC11136844 DOI: 10.1007/s12185-024-03754-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 05/31/2024]
Abstract
The emergence of novel drugs has significantly improved outcomes of patients with plasma cell neoplasms (PCN). The Japanese Society of Hematology conducted a prospective observational study in newly diagnosed PCN patients between 2016 and 2021. The analysis focused on 1385 patients diagnosed with symptomatic PCN between 2016 and 2018. The primary endpoint was the 3-year overall survival (OS) rate among patients requiring treatment (n = 1284), which was 70.0% (95%CI 67.4-72.6%). Approximately 94% of these patients received novel drugs as frontline therapy. The 3-year OS rate was 90.3% (95%CI 86.6-93.1%) in the 25% of patients who received upfront autologous stem cell transplantation (ASCT), versus just 61.4% (95%CI 58.0-64.6%) in those who did not receive upfront ASCT. The only unfavorable prognostic factor that affected OS in ASCT recipients was an age of 65 or higher. For patients who did not receive ASCT, independent unfavorable prognostic factors included frontline treatment with conventional chemotherapies, international staging system score of 2/3, extramedullary tumors, and Freiberg comorbidity index of 2/3. This study unequivocally demonstrates that use of novel drugs improved OS in Japanese myeloma patients, and underscores the continued importance of upfront ASCT as the standard of care in the era of novel drugs.
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Affiliation(s)
- Hirohiko Shibayama
- Department of Hematology, NHO Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku, Osaka City, Osaka, 540-0006, Japan.
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Mitsuhiro Itagaki
- Department of Hematology, Hiroshima Red Cross Hospital, Hiroshima, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University, Gunma, Japan
| | - Akihiro Yokoyama
- Department of Hematology, NHO Tokyo Medical Center, Tokyo, Japan
| | - Akio Saito
- Department of Hematology, NHO Shibukawa Medical Center, Gunma, Japan
| | - Satoru Kosugi
- Department of Hematology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Hokkaido, Japan
| | - Makoto Yoshimitsu
- Department of Hematology and Rheumatology, Kagoshima University, Kagoshima, Japan
| | | | - Shingo Kurahashi
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Aichi, Japan
| | - Shin-Ichi Fuchida
- Department of Hematology, JCHO Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Masaki Iino
- Department of Hematology, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | - Takayuki Shimizu
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Kohtaro Toyama
- Department of Hematology, Fujioka General Hospital, Gunma, Japan
| | - Kinuko Mitani
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Yutaka Tsukune
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akiko Kada
- Clinical Research Center, NHO Nagoya Medical Center, Aichi, Japan
| | - Hideto Tamura
- Division of Diabetes, Endocrinology and Hematology, Department of Internal Medicine, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Masahiro Abe
- Department of Hematology, Kawashima Hospital, Tokushima, Japan
| | - Hiromi Iwasaki
- Department of Hematology, NHO Kyushu Medical Center, Fukuoka, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefecture University of Medicine, Kyoto, Japan
| | | | - Kazutaka Sunami
- Department of Hematology, NHO Okayama Medical Center, Okayama, Japan
| | - Masahiro Kizaki
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tadao Ishida
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Toshiki Saito
- Clinical Research Center, NHO Nagoya Medical Center, Aichi, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Kindai University, Osaka, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University, Fukuoka, Japan
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Institute of Medical and Pharmaceutical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-ku, Nagoya City, Aichi, 467-8601, Japan.
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12
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Ko H, Han S, Park SS, Choi S, Byun JM, Min CK. Risk of Secondary Malignancies After Multiple Myeloma: A Nationwide Case-Control Cohort Study. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00199-X. [PMID: 38849282 DOI: 10.1016/j.clml.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/03/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION In light of improved survival rates among multiple myeloma (MM) survivors, we sought to assess their risk of secondary malignancies compared to the general population. MATERIALS AND METHODS This nationwide population-based case-control cohort study utilized the Korea National Health Insurance Service (KNHIS) database incorporating data from 2009 to 2020. We analyzed a total of 7348 patients diagnosed with MM in the case cohort. We selected a control group of 29,351 individuals from the general population without MM, employing a 1:4 propensity score matching approach. Matching criteria included age, sex, and comorbidities to ensure a balanced and reliable comparison. RESULTS The cumulative incidence of any secondary malignancy was significantly higher in the case cohort than the control cohort (Hazard ratio [HR] 1.576, 95% confidence interval [CI], [1.381-1.798]). Hematologic malignancy risk was notably higher in the case cohort (HR 8.026, 95% CI, [5.402-11.924]), especially therapy-related myeloid neoplasms (t-MN) (HR 12.063, 95% CI, [6.839-21.278]). No significant difference was shown in nonhematologic malignancy incidence. In subgroup analysis, transplant-eligible MM patients had a significantly higher incidence of any secondary malignancy (HR 1.104, 95% CI, [1.003-1.214]) than transplant-ineligible patients. The incidence of secondary malignancy in MM patients in the lenalidomide-available era was not significantly increased compared to the prelenalidomide era. CONCLUSION While hematologic malignancies, particularly t-MN, are significantly elevated in MM patients compared to general population, nonhematologic malignancies do not appear to be significantly elevated.
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Affiliation(s)
- Heejoo Ko
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea.
| | - Seunghoon Han
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea.
| | - Sung-Soo Park
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Suein Choi
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Jongro-gu, Seoul, Republic of Korea
| | - Chang-Ki Min
- Department of Hematology, Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
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13
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Hasanali ZS, Garfall AL, Burzenski L, Shultz LD, Tang Y, Kadu S, Sheppard NC, Liu W, Dopkin D, Vogl DT, Cohen AD, Waxman AJ, Susanibar-Adaniya SP, Carroll M, Stadtmauer EA, Allman D. Human IL-6 fosters long-term engraftment of patient-derived disease-driving myeloma cells in immunodeficient mice. JCI Insight 2024; 9:e177300. [PMID: 38713510 PMCID: PMC11141932 DOI: 10.1172/jci.insight.177300] [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: 11/03/2023] [Accepted: 04/17/2024] [Indexed: 05/09/2024] Open
Abstract
Multiple myeloma is a largely incurable and life-threatening malignancy of antibody-secreting plasma cells. An effective and widely available animal model that recapitulates human myeloma and related plasma cell disorders is lacking. We show that busulfan-conditioned human IL-6-transgenic (hIL-6-transgenic) NSG (NSG+hIL6) mice reliably support the engraftment of malignant and premalignant human plasma cells, including from patients diagnosed with monoclonal gammopathy of undetermined significance, pre- and postrelapse myeloma, plasma cell leukemia, and amyloid light chain amyloidosis. Consistent with human disease, NSG+hIL6 mice engrafted with patient-derived myeloma cells developed serum M spikes, and a majority developed anemia, hypercalcemia, and/or bone lesions. Single-cell RNA sequencing showed nonmalignant and malignant cell engraftment, the latter expressing a wide array of mRNAs associated with myeloma cell survival and proliferation. Myeloma-engrafted mice given CAR T cells targeting plasma cells or bortezomib experienced reduced tumor burden. Our results establish NSG+hIL6 mice as an effective patient-derived xenograft model for study and preclinical drug development of multiple myeloma and related plasma cell disorders.
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Affiliation(s)
- Zainul S. Hasanali
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alfred L. Garfall
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Yan Tang
- Center for Cellular Immunotherapies
| | | | - Neil C. Sheppard
- Center for Cellular Immunotherapies
- Department of Pathology and Laboratory Medicine, and
| | - Wei Liu
- Center for Cellular Immunotherapies
| | - Derek Dopkin
- Stem Cell and Xenograft Core Facility, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dan T. Vogl
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam D. Cohen
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam J. Waxman
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Martin Carroll
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Stem Cell and Xenograft Core Facility, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward A. Stadtmauer
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Allman
- Department of Pathology and Laboratory Medicine, and
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14
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Ludwig H, Melchardt T, Sormann S, Schreder M, Andel J, Hartmann B, Tinchon C, Zojer N, Gunsilius E, Podar K, Egle A, Willenbacher W, Wöll E, Ruckser R, Bozic B, Krauth MT, Petzer A, Schmitt C, Machherndl-Spandl S, Agis H, Fillitz M, Wang SY, Zabernigg A, Knop S, Paiva B, Greil R. Randomized comparison between KTd and KRd induction therapy followed by maintenance therapy with K or observation in transplant-ineligible patients with newly diagnosed multiple myeloma. Am J Hematol 2024; 99:1008-1011. [PMID: 38425185 DOI: 10.1002/ajh.27280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/16/2024] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
Randomized comparison between KTd and KRd induction followed by second randomization to carfilzomib in transplant-ineligable patients with newly diagnosed multiple myeloma.
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Affiliation(s)
- Heinz Ludwig
- Department of Medicine I, Clinic Ottakring, Wilhelminen Cancer Research Institute, Vienna, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Cancer Cluster Salzburg, Salzburg, Austria
| | - Siegfried Sormann
- Department of Hematology, University Clinic for Internal Medicine, Graz, Austria
| | | | - Johannes Andel
- Department of Internal Medicine II, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Austria
| | - Bernd Hartmann
- Department of Internal Medicine II, LKH Rankweil, Rankweil, Austria
| | - Christoph Tinchon
- Department for Hematology, Oncology and Palliative Care, LKH Hochsteiermark, Standort Leoben, Standort Leoben, Austria
| | - Niklas Zojer
- Department of Medicine I, Clinic Ottakring, Vienna, Austria
| | - Eberhard Gunsilius
- Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Podar
- Department of Internal Medicine II, University Hospital Krems, Krems an der Donau, Austria
- Molecular Oncology and Hematology Unit, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Cancer Cluster Salzburg, Salzburg, Austria
| | - Wolfgang Willenbacher
- Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
- syndena GmbH, Connect to Cure, Innsbruck, Austria
| | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Krankenhaus Zams, Zams, Austria
| | | | - Boris Bozic
- Department of Medicine II, Clinic Donaustadt, Vienna, Austria
| | - Maria-Theresa Krauth
- University Clinic for Internal Medicine I, AKH, Medical University of Vienna, Vienna, Austria
| | - Andreas Petzer
- Department of Internal Medicine I, BHS Linz, Linz, Austria
| | - Clemens Schmitt
- Clinic for Internal Medicine 3, Kepler University Clinic Linz, Linz, Austria
| | | | - Hermine Agis
- Department of Internal Medicine I, Division of Oncology, Medical University Vienna, Vienna, Austria
| | - Michael Fillitz
- Department of Internal Medicine, Hanusch Krankenhaus, Vienna, Austria
| | - Song-Yau Wang
- Medical Clinic and Policlinic I, University Clinic Leipzig, Leipzig, Germany
| | - August Zabernigg
- Department of Internal Medicine, Kufstein County Hospital, Kufstein, Austria
| | - Stefan Knop
- Klinik für Innere Medizin 5, Schwerpunkt Onkologie/Hämatologie, Klinikum Nürnberg Nord, Nürnberg, Germany
| | - Bruno Paiva
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), CCUN, IDISNA, Pamplona, Spain
| | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), Paracelsus Medical University, Cancer Cluster Salzburg, Salzburg, Austria
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15
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Haider I, Pond GR, Cameron R, Aljama M, Kouroukis TC, Wong K, Fiala MA, Wildes TM, Mian H. A structured oral chemotherapy teaching tool to improve adherence in adults with multiple myeloma: A pilot randomized controlled trial. J Geriatr Oncol 2024; 15:101735. [PMID: 38460399 DOI: 10.1016/j.jgo.2024.101735] [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: 10/21/2023] [Revised: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Many of the newer treatments for adults with newly-diagnosed and relapsed multiple myeloma (MM) are orally administered. Adherence is a challenge, and little is known about strategies to optimize adherence. MATERIALS AND METHODS Forty-seven patients initiating orally-administered anti-myeloma therapy were enrolled and randomized in a pilot study to receive either standard of care teaching or the Multinational Association of Supportive Care in Cancer Oral agent Teaching Tool (MOATT), a structured teaching tool. Adherence was measured electronically with a Medication Event Monitoring System (MEMS) cap. Optimal adherence was defined as an adherence rate of ≥90% over the six months study duration. Patients completed surveys regarding cancer therapy satisfaction and self-efficacy for medication management at one month and six months following the initiation of treatment in both arms. RESULTS The mean adherence of patients over six months was 86.9%; 43.9% of the cohort were classified as non-adherent using the 90% threshold of adherence. Mean adherence was similar among standard of care teaching (87.9%) versus the MOATT intervention tool (85.6%) as was cancer therapy satisfaction and self-efficacy for medication management. DISCUSSION In our pilot, the MOATT tool was not found to be feasible or acceptable. There were no preliminary differences noted between standard of care teaching versus the structured MOATT teaching tool with regards to overall adherence rates, cancer therapy satisfaction, or self-efficacy in medication management. Overall adherence rates were suboptimal in our study. Future research should work to identify aspects of educational interventions which are effective, and investigate different strategies which can be used to supplement patient education and potentially optimize medication adherence in patients with MM.
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Affiliation(s)
- Imran Haider
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Ruthanne Cameron
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Mohammed Aljama
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Tom C Kouroukis
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Kirk Wong
- Cancer Centre Pharmacy, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Mark A Fiala
- Division of Oncology, Washington University School of Medicine, St Louis, USA
| | - Tanya M Wildes
- Department of Medicine, University of Nebraska Medical Center/ Nebraska Medicine, USA
| | - Hira Mian
- Department of Oncology, McMaster University, Hamilton, ON, Canada.
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16
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Devasia AJ, Lancman GS, Stewart AK. Management of Newly Diagnosed Multiple Myeloma Today, and in the Future. Hematol Oncol Clin North Am 2024; 38:441-459. [PMID: 38171937 DOI: 10.1016/j.hoc.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Treatment options have expanded rapidly and widely in the past two decades for patients with multiple myeloma. Triplet novel agent-based induction regimens have been accepted as the standard practice wordwide over the last decade both for transplant-eligible and non-eligible patients. The addition of anti-CD38 monoclonal antibodies as part of quadruplet regimens has led to even deeper and longer-lasting responses. The impressive results shown by the quadruplets havebeen practice-changing where accessible in recent years. Chimeric antigen receptor T cell therapy and bispecific antibodies are being tested in the upfront setting and have the potential to once again shift the paradigm of treatment of newly diagnosed MM.
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Affiliation(s)
- Anup Joseph Devasia
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, Ontario, M5G 1X6 Canada
| | - Guido Sebastian Lancman
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, Ontario, M5G 1X6 Canada
| | - Alexander Keith Stewart
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, Ontario, M5G 1X6 Canada.
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17
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Giles HV, Karunanithi K. Performance Characteristics and Limitations of the Available Assays for the Detection and Quantitation of Monoclonal Free Light Chains and New Emerging Methodologies. Antibodies (Basel) 2024; 13:19. [PMID: 38534209 DOI: 10.3390/antib13010019] [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: 02/01/2024] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
Light chain measurements form an essential component of the testing strategy for the detection and monitoring of patients with suspected and/or proven plasma cell disorders. Urine-based electrophoretic assays remain at the centre of the international guidelines for response assessment but the supplementary role of serum-free light chain (FLC) assays in response assessment and the detection of disease progression due to their increased sensitivity has been increasingly recognised since their introduction in 2001. Serum FLC assays have also been shown to be prognostic across the spectrum of plasma cell disorders and are now incorporated into risk stratification scores for patients with monoclonal gammopathy of undetermined significance (MGUS), smouldering multiple myeloma, and light chain amyloidosis (AL amyloidosis), as well as being incorporated into the criteria for defining symptomatic multiple myeloma. There are now multiple different commercially available serum FLC assays available with differing performance characteristics, which are discussed in this review, along with the implications of these for patient monitoring. Finally, newer methodologies for the identification and characterisation of monoclonal FLC, including modifications to electrophoretic techniques, mass spectrometry-based assays and Amylite, are also described along with the relevant published data available regarding the performance of each assay.
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Affiliation(s)
- Hannah V Giles
- Department of Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2SY, UK
- Instute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - Kamaraj Karunanithi
- Department of Clinical Haematology, University Hospitals North Midlands NHS Trust, Royal Stoke Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG, UK
- School of Medicine, Keele University, Keele, Newcastle-under-Lyme ST5 5BG, UK
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18
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Setia N, Almuqdadi HTA, Abid M. Journey of Von Hippel-Lindau (VHL) E3 ligase in PROTACs design: From VHL ligands to VHL-based degraders. Eur J Med Chem 2024; 265:116041. [PMID: 38199162 DOI: 10.1016/j.ejmech.2023.116041] [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: 10/02/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
The scientific community has shown considerable interest in proteolysis-targeting chimeras (PROTACs) in the last decade, indicating their remarkable potential as a means of achieving targeted protein degradation (TPD). Not only are PROTACs seen as valuable tools in molecular biology but their emergence as a modality for drug discovery has also garnered significant attention. PROTACs bind to E3 ligases and target proteins through respective ligands connected via a linker to induce proteasome-mediated protein degradation. The discovery of small molecule ligands for E3 ligases has led to the prevalent use of various E3 ligases in PROTAC design. Furthermore, the incorporation of different types of linkers has proven beneficial in enhancing the efficacy of PROTACs. By far more than 3300 PROTACs have been reported in the literature. Notably, Von Hippel-Lindau (VHL)-based PROTACs have surfaced as a propitious strategy for targeting proteins, even encompassing those that were previously considered non-druggable. VHL is extensively utilized as an E3 ligase in the advancement of PROTACs owing to its widespread expression in various tissues and well-documented binders. Here, we review the discovery of VHL ligands, the types of linkers employed to develop VHL-based PROTACs, and their subsequent modulation to design advanced non-conventional degraders to target various disease-causing proteins. Furthermore, we provide an overview of other E3 ligases recruited in the field of PROTAC technology.
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Affiliation(s)
- Nisha Setia
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi, 110025, India
| | | | - Mohammad Abid
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi, 110025, India.
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19
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Mohty M, Rajkumar SV. Considerations for the treatment of frail multiple myeloma patients. Clin Hematol Int 2024; 6:23-25. [PMID: 38817702 PMCID: PMC11086987 DOI: 10.46989/001c.92586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/21/2024] [Indexed: 06/01/2024] Open
Affiliation(s)
- Mohamad Mohty
- Sorbonne University, Service d'Hématologie Clinique Et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, INSERM UMRs938, Paris, France
| | - S Vincent Rajkumar
- Division of Hematology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
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20
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Hasanali ZS, Garfall AL, Burzenski L, Shultz LD, Tang Y, Kadu S, Sheppard NC, Dopkin D, Vogl DT, Cohen AD, Waxman AJ, Susanibar-Adaniya SP, Carroll M, Stadtmauer EA, Allman D. Human IL-6 fosters long-term engraftment of patient derived disease-driving myeloma cells in immunodeficient mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.21.576547. [PMID: 38328086 PMCID: PMC10849475 DOI: 10.1101/2024.01.21.576547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Multiple myeloma is a largely incurable and life-threatening malignancy of antibody-secreting plasma cells. An effective and widely available animal model that recapitulates human myeloma and related plasma cell disorders is lacking. We show that busulfan-conditioned hIL-6 transgenic NSG mice (NSG+hIL6) reliably support the engraftment of malignant and pre-malignant human plasma cells including from patients diagnosed with monoclonal gammopathy of undetermined significance, pre- and post-relapse myeloma, plasma cell leukemia, and AL amyloidosis. Consistent with human disease, NSG+hIL6 mice engrafted with patient-derived myeloma cells, developed serum M spikes, and a majority developed anemia, hypercalcemia, and/or bone lesions. Single cell RNA sequencing showed non-malignant and malignant cell engraftment, the latter expressing a wide array of mRNAs associated with myeloma cell survival and proliferation. Myeloma engrafted mice given CAR T-cells targeting plasma cells or bortezomib experienced reduced tumor burden. Our results establish NSG+hIL6 mice as an effective patient derived xenograft model for study and preclinical drug development of multiple myeloma and related plasma cell disorders.
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21
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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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22
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Mian H, Kaiser M, Fonseca R. Translocation t(14;16) in multiple myeloma: gangster or just part of the gang? Blood Cancer J 2024; 14:7. [PMID: 38225228 PMCID: PMC10789771 DOI: 10.1038/s41408-024-00978-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024] Open
Affiliation(s)
- Hira Mian
- Department of Oncology, McMaster University, Ontario, Canada.
| | - Martin Kaiser
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Department of Haematology, The Royal Marsden Hospital, London, UK
| | - Rafael Fonseca
- Division of Hematology and Medical Oncology, Mayo Clinic in Arizona, Phoenix, Arizona, USA
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23
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Barilà G, Quaglia FM, Furlan A, Pescosta N, Bonalumi A, Marcon C, Pascarella A, Tinelli M, De March E, Lico A, Sartori R, Clissa C, De Sabbata G, Nappi D, Porrazzo M, De Marchi R, Pavan L, Tosetto A, Gherlinzoni F, Krampera M, Bassan R, Patriarca F, Semenzato G, Zambello R. A real-life study of daratumumab-bortezomib-dexamethasone (D-VD) in lenalidomide exposed/refractory multiple myeloma patients: a report from the Triveneto Myeloma Working Group. Ann Hematol 2024; 103:125-132. [PMID: 37731147 PMCID: PMC10761376 DOI: 10.1007/s00277-023-05443-8] [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: 08/04/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
Treatment of lenalidomide refractory (Len-R) multiple myeloma (MM) patients still represents an unmet clinical need. In the last years, daratumumab-bortezomib-dexamethasone (D-VD) combination was extensively used in this setting, even though only a small fraction of Len-R patients was included in the pivotal trial. This real-life study aimed to evaluate the efficacy and safety of the D-VD regimen in a cohort that exclusively enrolled Len exposed or refractory MM patients. The study cohort included 57 patients affected by relapsed/refractory MM. All patients were previously exposed to Len, with 77.2% being refractory. The overall response rate (ORR) was 79.6% with 43% of cases obtaining at least a very good partial response (VGPR). The D-VD regimen showed a favorable safety profile, with low frequency of grade 3-4 adverse events, except for thrombocytopenia observed in 21.4% of patients. With a median follow-up of 13 months, median progression-free survival (PFS) was 17 months. No significant PFS differences were observed according to age, ISS, LDH levels, type of relapse, and high-risk FISH. Len exposed patients displayed a PFS advantage as compared to Len refractory patients (29 vs 16 months, p = 0.2876). Similarly, patients treated after Len maintenance showed a better outcome as compared to patients who had received a full-dose Len treatment (23 vs 13 months, p = 0.1728). In conclusion, our real-world data on D-VD combination showed remarkable efficacy in Len-R patients, placing this regimen as one of the standards of care to be properly taken into account in this MM setting.
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Affiliation(s)
| | | | - Anna Furlan
- Hematology Unit, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
| | - Norbert Pescosta
- Ematologia e Centro TMO, Ospedale Centrale Bolzano, Bozen, Italy
| | - Angela Bonalumi
- Hematology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Chiara Marcon
- Hematology and Transplant Center Unit, Udine University Hospital, DAME, University of Udine, Udine, Italy
| | - Anna Pascarella
- Hematology Unit, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Martina Tinelli
- Hematology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Elena De March
- Department of Medicine, Section of Hematology, Belluno Hospital, Belluno, Italy
| | - Albana Lico
- Hematology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Roberto Sartori
- Department of Clinical and Experimental Oncology, Onco-hematology Unit, Veneto Institute of Oncology, IOV-IRCCS, Castelfranco Veneto (TV), Italy
| | - Cristina Clissa
- Hematology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanni De Sabbata
- Struttura Complessa Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Davide Nappi
- Ematologia e Centro TMO, Ospedale Centrale Bolzano, Bozen, Italy
| | - Marika Porrazzo
- Struttura Complessa Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Roberta De Marchi
- Department of Clinical and Experimental Oncology, Onco-hematology Unit, Veneto Institute of Oncology, IOV-IRCCS, Castelfranco Veneto (TV), Italy
| | - Laura Pavan
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padova University School of Medicine, Via Giustiniani 2, 35128, Padua, Italy
| | | | | | - Mauro Krampera
- Hematology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Renato Bassan
- Hematology Unit, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Francesca Patriarca
- Hematology and Transplant Center Unit, Udine University Hospital, DAME, University of Udine, Udine, Italy
| | - Gianpietro Semenzato
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padova University School of Medicine, Via Giustiniani 2, 35128, Padua, Italy
| | - Renato Zambello
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padova University School of Medicine, Via Giustiniani 2, 35128, Padua, Italy.
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24
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Locher C, Laporte S, Derambure P, Chassany O, Girault C, Avakiantz A, Bahans C, Deplanque D, Fustier P, Germe AF, Kassaï B, Lacoste L, Petitpain N, Roustit M, Simon T, Train C, Cucherat M. Data Monitoring Committees and clinical trials: From scientific justification to organisation. Therapie 2024; 79:111-121. [PMID: 38103949 DOI: 10.1016/j.therap.2023.12.002] [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: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
Clinical trials often last several months or even several years. As the trial progresses, it can be tempting to find out whether the data obtained already answers the question posed at the start of the trial in order to stop inclusions or monitoring earlier. However, knowing and taking into account interim results can sometimes compromise the integrity of the results, which is counterproductive. To minimise this risk and ensure that the treatments are assessed reliably, safety and/or efficacy criteria are monitored during the study by a Data Monitoring Committee. After receiving the results confidentially, the Data Monitoring Committee assesses the benefit/risk ratio of the study treatment and recommends that the trial be continued, modified or terminated. Data Monitoring Committee members issuing these recommendations have an important responsibility: a hasty decision to end the trial may lead to inconclusive results unable to answer the initial question and, inversely, delaying the decision to end the trial may expose the subjects to potentially ineffective or even harmful interventions. The Data Monitoring Committee's task is therefore particularly complex. With this in mind, the round table discussion at the Giens workshops was a chance to review the scientific justification for creating Data Monitoring Committees and to recall the need for their members to receive comprehensive training on the complexities of multiple analyses, confidentiality requirements applying to the results and the need for them to be aware that recommendations to end a trial must be based on data that is robust enough to assess the benefit/risk ratio of the treatment studied.
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Affiliation(s)
- Clara Locher
- Inserm, UMR S 1085, service de pharmacologie clinique, Centre d'investigation clinique de Rennes (CIC1414), Institut de recherche en santé, environnement et travail (Irset), CHU de Rennes, 35000 Rennes, France.
| | - Silvy Laporte
- UMR 1059 Inserm, URC/pharmacologie clinique, université Jean-Monnet Saint-Étienne, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | | | - Olivier Chassany
- Unité de recherche clinique en économie de la santé (URC-ECO), hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Cécile Girault
- Fédération francophone de cancérologie digestive (FFCD), 21000 Dijon, France
| | | | - Claire Bahans
- Département de pédiatrie, CHU de Limoges, 87000 Limoges, France
| | - Dominique Deplanque
- Inserm, CIC 1403, Centre d'investigation clinique, University of Lille, CHU de Lille, 59000 Lille, France
| | - Pierre Fustier
- Département de recherche et développement clinique - hématologie - BeiGene, Switzerland GmbH, 4051 Basel, Switzerland
| | | | - Behrouz Kassaï
- Inserm, UMR 5558 CNRS, service de pharmacotoxicologie, Centre d'investigation clinique 1407, hospices civils de Lyon, université de Lyon, 69000 Lyon, France
| | - Louis Lacoste
- Pôle USSAR, anesthésie réanimation, CHU de Poitiers, 86021 Poitiers, France
| | - Nadine Petitpain
- Unité de vigilance des essais cliniques, DRCI CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - Matthieu Roustit
- Inserm, CIC1406, University Grenoble Alpes, CHU de Grenoble, 38000 Grenoble, France
| | - Tabassome Simon
- Service de pharmacologie clinique, plateforme de recherche de l'est parisien (URCEST-CRCEST-CRB), hôpital Saint-Antoine, Sorbonne université, Assistance publique-Hôpitaux de Paris (AP-HP), 75000 Paris, France
| | | | - Michel Cucherat
- metaEvidence.org, service de pharmacotoxicologie, hospices civils de Lyon, 69000 Lyon, France
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25
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Locher C, Laporte S, Derambure P, Chassany O, Girault C, Avakiantz A, Bahans C, Deplanque D, Fustier P, Germe AF, Kassaï B, Lacoste L, Petitpain N, Roustit M, Simon T, Train C, Cucherat M. Comité de surveillance indépendant dans les essais cliniques : de la justification scientifique à l’organisation. Therapie 2024; 79:99-110. [PMID: 37985309 DOI: 10.1016/j.therap.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Clara Locher
- Université de Rennes, CHU de Rennes, CIC 1414 (Centre d'investigation clinique de Rennes), 35000 Rennes, France.
| | - Silvy Laporte
- Université Jean Monnet Saint-Étienne, UMR 1059 Inserm, URC/Pharmacologie Clinique, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | | | - Olivier Chassany
- Unité de recherche clinique en économie de la santé (URC-ECO), hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Cécile Girault
- Fédération francophone de cancérologie digestive (FFCD), faculté de médecine, 21000 Dijon, France
| | | | - Claire Bahans
- Département de pédiatrie, CHU de Limoges, 87000 Limoges, France
| | - Dominique Deplanque
- Centre d'investigation clinique, Université Lille, Inserm, CHU de Lille, CIC 1403, 59000 Lille, France
| | - Pierre Fustier
- Département de recherche et développement clinique - Hématologie - BeiGene, Switzerland GmbH, 4051 Basel, Suisse
| | | | - Behrouz Kassaï
- Service de pharmacotoxicologie, centre d'investigation clinique 1407 Inserm - Hospices civils de Lyon, UMR 5558 CNRS université de Lyon, 69000 Lyon, France
| | - Louis Lacoste
- Pôle USSAR, anesthésie réanimation, CHU de Poitiers, 86021 Poitiers, France
| | - Nadine Petitpain
- Unité de vigilance des essais cliniques, DRCI CHRU de Nancy, 54500 Vandoeuvre lès Nancy, France
| | - Matthieu Roustit
- Université Grenoble Alpes, Inserm, CHU de Grenoble, CIC1406, 38000 Grenoble, France
| | - Tabassome Simon
- Sorbonne Université, service de pharmacologie clinique, plateforme de recherche de l'est parisien (URCEST-CRCEST-CRB), Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital St Antoine, 75000 Paris, France
| | | | - Michel Cucherat
- Service de pharmacotoxicologie Hospices civils de Lyon, metaEvidence.org, 69000 Lyon, France
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26
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Alhaj Moustafa M, Parrondo R, Abdulazeez MF, Roy V, Sher T, Alegria VR, Warsame RM, Fonseca R, Rasheed A, Gonsalves WI, Kourelis T, Kapoor P, Buadi FK, Dingli D, Hayman SR, Reeder CB, Chanan-Khan AA, Ailawadhi S. Daratumumab-lenalidomide and daratumumab-pomalidomide in relapsed lenalidomide-exposed or refractory multiple myeloma. Anticancer Drugs 2024; 35:63-69. [PMID: 37067996 DOI: 10.1097/cad.0000000000001520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Daratumumab is an anti-CD38 mAb, used frequently in combination with lenalidomide and pomalidomide. No studies compared daratumumab plus lenalidomide and dexamethasone (DRd) to daratumumab plus pomalidomide and dexamethasone (DPd) in lenalidomide-exposed multiple myeloma. We identified 504 consecutive multiple myeloma patients who received daratumumab at Mayo Clinic between January 2015 and April 2019. We excluded patients who received daratumumab in the first line, received more than four lines of therapy prior to daratumumab use, did not receive lenalidomide prior to daratumumab, or had an unknown status of lenalidomide exposure, and patients who received daratumumab combinations other than DRd or DPd. We examined the impact of using DRd compared to DPd on progression-free survival (PFS) and overall survival (OS) in patients with relapsed/refractory multiple myeloma. Out of 504 patients, 162 received DRd or DPd and were included; 67 were lenalidomide-exposed and 95 were lenalidomide-refractory. DRd was used in 76 (47%) and DPd in 86 (53%) patients. In lenalidomide-exposed multiple myeloma, there was no difference in median PFS; 34.2 months [95% confidence interval (CI), 22.8-44.6] for DRd compared to 25.2 months (95% CI, 4.9-35.3) for DPd, P = 0.2. In lenalidomide-refractory multiple myeloma, there was no difference in median PFS; 18.6 months (95% CI, 13-32) for DRd compared to 9 months (95% CI, 5.2-14.6) for DPd, P = 0.09. No difference in median OS was observed in DRd compared to DPd. Our study shows combining daratumumab with lenalidomide in patients with prior lenalidomide use is a viable and effective treatment option.
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Affiliation(s)
| | - Ricardo Parrondo
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Mays F Abdulazeez
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Vivek Roy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Taimur Sher
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Victoria R Alegria
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Rafael Fonseca
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Ahsan Rasheed
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | | | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Craig B Reeder
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Asher A Chanan-Khan
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Sikander Ailawadhi
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
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Zhang CW, Wang YN, Ge XL. Lenalidomide use in multiple myeloma (Review). Mol Clin Oncol 2024; 20:7. [PMID: 38125742 PMCID: PMC10729307 DOI: 10.3892/mco.2023.2705] [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: 09/24/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023] Open
Abstract
Lenalidomide is a second-generation new immunomodulatory medication used to treat multiple myeloma (MM). Its mechanism of action involves affecting the expression of vascular endothelial growth factor, interleukin-6, cytochrome c, caspase-8, as well as other factors including immunological modulation and the direct killing of cells, among others, rendering it a fundamental medication, useful for the treatment of MM. Combining lenalidomide with other medications such dexamethasone, bortezomib, ixazomib, carfilzomib and daratumumab can markedly alleviate MM. When autologous-hematopoietic stem cell transplantation (ASCT) cannot be utilized to treat newly diagnosed individuals with MM (NDMM), monotherapy maintenance following lenalidomide and dexamethasone may be employed. Following ASCT, single-agent maintenance with lenalidomide can be performed as an additional treatment. The combination of bortezomib and lenalidomide has been demonstrated to be associated with favorable response rates, tolerable toxicity, and therapeutic benefits although caution is warranted to prevent the onset of peripheral neuropathy with its use. A new-generation oral drug with an excellent safety profile, ixazomib, is more practical and therapeutically applicable in relapsed refractory MM. However, the frequent occurrence of cardiovascular events, hematocrit, and infections with it require flexible adjustment in its clinical application. Carfilzomib produces a rapid and profound response in patients with NDMM eligible for transplantation, but its cardiovascular side effects need to be closely monitored. The primary aim of the present review was to examine the pharmacological properties and pharmacokinetics of lenalidomide, as well as the efficacy and safety of lenalidomide-based treatments with reference to data from clinical trials and real-world studies.
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Affiliation(s)
- Chao-Wei Zhang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Ya-Nan Wang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Xue-Ling Ge
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
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Sapet M, Migala C, Daguenet E, Collet P, Boussoualim K, Thomas T, Guyotat D, Augeul-Meunier K. Advanced practice nurse management in multiple myeloma treated with oral therapy. Bull Cancer 2023; 110:1251-1259. [PMID: 37696744 DOI: 10.1016/j.bulcan.2023.07.010] [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: 06/05/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Therapeutic approaches in Multiple Myeloma (MM) have considerably changed over the last few years, with effective oral chemotherapy and continuous treatment. In this context, the objective of this study was to examine the circuitry of an advanced practitioner nurse (APN)-led intervention that provided supportive care for MM patients treated with oral chemotherapy. METHODS This population-based study was conducted at the hematology department - Institut de Cancérologie Lucien Neuwirth (ICLN, Saint-Priest-en-Jarez), from April 2017 to September 2020. A follow-up program was established with a specialized APN in oncology. RESULTS All APN interventions were recorded, representing 1240 phone calls and 162 consultations for 42 MM patients. Eighty-two calls were referred to the physician with 45 consultations triggered. Most of the calls were frequent within the few first months, with a high request for information and reassurance, especially for treatment-naive or relapsed patients. In our study, the APN was able to manage multiple side effects through care organization (i.e., hospitalizations, transfusions) and a careful coordination between the primary care team and the hospital. DISCUSSION In order to respond to the high need for care pathway and safety improvement, especially in elderly population, we have initiated an original follow-up by an APN for MM patients treated with oral chemotherapy. While the role of APN has become prominent in the oncology field in recent years, its holistic approach has to be emphasized in further studies to bring a comprehensive perspective to health care coordination in the future.
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Affiliation(s)
- Manon Sapet
- University Hospital of Saint-Étienne, Department of Rheumatology, 42055 Saint-Étienne cedex 2, France.
| | - Cécile Migala
- Cancer Institute Lucien Neuwirth, Coordination platform, Saint-Priest-en-Jarez, France
| | - Elisabeth Daguenet
- Cancer Institute Lucien Neuwirth, Hematology Department, Saint-Priest-en-Jarez, France
| | - Philippe Collet
- Cancer Institute Lucien Neuwirth, Hematology Department, Saint-Priest-en-Jarez, France
| | - Karima Boussoualim
- University Hospital of Saint-Étienne, Department of Rheumatology, 42055 Saint-Étienne cedex 2, France
| | - Thierry Thomas
- University Hospital of Saint-Étienne, Department of Rheumatology, 42055 Saint-Étienne cedex 2, France
| | - Denis Guyotat
- Cancer Institute Lucien Neuwirth, Hematology Department, Saint-Priest-en-Jarez, France
| | - Karine Augeul-Meunier
- Cancer Institute Lucien Neuwirth, Hematology Department, Saint-Priest-en-Jarez, France
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Du C, Li L, Fan H, Mao X, Liu J, Xu Y, Sui W, Deng S, Li C, Zhao J, Yi S, Hao M, Zou D, Zhao Y, Qiu L, An G. The age-dependent changes in risk weights of the prognostic factors for multiple myeloma. Hematology 2023; 28:2258686. [PMID: 37724573 DOI: 10.1080/16078454.2023.2258686] [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: 07/16/2023] [Accepted: 09/10/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE Multiple myeloma is a highly heterogenous plasma cell malignancy, commonly seen in older patients. Age is one of the important prognostic factors. However, nearly all the prognostic staging systems are based on clinical trials, where patients were relatively fit and young. It is unknown how the presence of biochemical or cytogenetic prognostic factors and their risk weights changes with older age. To further investigate this question, we retrospectively analyzed the data from a consecutive cohort of patients treated with either bortezomib or thalidomide-based therapy. METHODS This retrospective study was carried out on a cohort of 1125 newly diagnosed multiple myeloma patients, from January 2008 to December 2019. Patients received bortezomib or thalidomide-based induction and maintenance therapy. Patients accepted hematopoietic stem cell transplantation if eligible. Statistical analysis was conducted by Stata/MP 16.0 and SPSS 26.0. RESULTS With age increasing, the proportion of patients with ISS 3, performance status score ≥2, and the incidence rate of gain(1q) significantly increased. We also found that ISS became less important in older patients. However, cytogenetic abnormalities exerted a consistently adverse impact on survival, both in young and old patients. Older patients had an inferior outcome than their young counterparts. All patients in our cohort benefitted more from bortezomib than thalidomide-based induction therapy, except for patients ≥71 years old. CONCLUSIONS ISS may lose prognostic value in patients ≥71 years old. Older patients had an inferior outcome and needed more effective and less toxic treatment.Plain Language SummaryMultiple myeloma is a type of blood cancer commonly seen in older people. To treat this disease, genetic abnormality, the poor physical status of patients and the abundance of tumor cells are the main difficulties. We often draw these conclusions from clinical trials. However, clinical trials always enrolled relatively younger patients, so the presence and significance of these factors may vary from clinical trials to the real world. We conducted the study to find out the real risk in both young and old patients. We found that older patients were more likely to have anemia, poor nutritional status and renal function. We also found older patients had more risk of relapse, progression or death than young patients. Frail physical status is the key obstacle to treating older patients, and tumor burden no longer impacts the outcome of these people. Bortezomib is a powerful drug to treat this disease, but patients ≥71 years old had less benefit than younger ones. More studies should focus on older or frail patients as these patients need more effective and less toxic treatment.
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Affiliation(s)
- Chenxing Du
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Lingna Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Huishou Fan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Xuehan Mao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Jiahui Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Weiwei Sui
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Shuhui Deng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Chengwen Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Jiawei Zhao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Shuhua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Mu Hao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Yaozhong Zhao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
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Suzuki K, Yano S. IMiD-Free Interval and IMiDs Sequence: Which Strategy Is Better Suited for Lenalidomide-Refractory Myeloma? Life (Basel) 2023; 13:2229. [PMID: 38004369 PMCID: PMC10672235 DOI: 10.3390/life13112229] [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: 10/07/2023] [Revised: 11/11/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
This review discusses immunomodulatory drug (IMiDs) sequencing and IMiD-free interval strategies for lenalidomide-refractory myeloma. IMiDs and proteasome inhibitors (PIs) improve clinical outcomes in patients with myeloma; however, refractoriness to lenalidomide, a category of IMiD, predicts poor outcomes. Next-generation IMiDs, such as pomalidomide, are effective even for lenalidomide-refractory myeloma. Therefore, an IMiD-sequencing strategy from lenalidomide to pomalidomide would be desirable. PIs are an antimyeloma therapeutic agent with another mode of action that might restore cereblon, a target of IMiDs; therefore, an IMiD-free interval via class switching from lenalidomide to PIs may be a promising alternative for lenalidomide-refractory myeloma. Additionally, the anti-CD38 monoclonal antibody is a key drug for salvage therapy in anti-CD38 monoclonal antibody-naïve patients. In clinical practice, safety profiles and social convenience can play important roles in the choice of combination therapy. In the future, the selection of optimal treatments should be based on the status of the immunological environment and genetic alterations. This review aims to discuss IMiDs sequencing and IMiD-free interval strategies for lenalidomide- refractory myeloma.
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Affiliation(s)
- Kazuhito Suzuki
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan;
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31
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Booth CM, Eisenhauer EA, Gyawali B, Tannock IF. Progression-Free Survival Should Not Be Used as a Primary End Point for Registration of Anticancer Drugs. J Clin Oncol 2023; 41:4968-4972. [PMID: 37733981 DOI: 10.1200/jco.23.01423] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023] Open
Affiliation(s)
- Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
- Department of Oncology, Queen's University, Kingston, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | | | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
- Department of Oncology, Queen's University, Kingston, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Ian F Tannock
- Division of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
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Rosiñol L, Oriol A, Ríos R, Blanchard MJ, Jarque I, Bargay J, Hernández MT, Cabañas V, Carrillo-Cruz E, Sureda A, Martínez-López J, Krsnik I, González ME, Casado LF, Martí JM, Encinas C, de Arriba F, Palomera L, Sampol A, González-Montes Y, Cabezudo E, Paiva B, Puig N, Cedena MT, de la Cruz J, Mateos MV, San Miguel J, Lahuerta JJ, Bladé J. Lenalidomide and dexamethasone maintenance with or without ixazomib, tailored by residual disease status in myeloma. Blood 2023; 142:1518-1528. [PMID: 37506339 DOI: 10.1182/blood.2022019531] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
From November 2014 to May 2017, 332 patients homogeneously treated with bortezomib, lenalidomide, and dexamethasone (VRD) induction, autologous stem cell transplant, and VRD consolidation were randomly assigned to receive maintenance therapy with lenalidomide and dexamethasone (RD; 161 patients) vs RD plus ixazomib (IRD; 171 patients). RD consisted of lenalidomide 15 mg/d from days 1 to 21 plus dexamethasone 20 mg/d on days 1 to 4 and 9 to 12 at 4-week intervals, whereas in the IRD arm, oral ixazomib at a dose of 4 mg on days 1, 8, and 15 was added. Therapy for patients with negative measurable residual disease (MRD) after 24 cycles was discontinued, whereas those who tested positive for MRD remained on maintenance with RD for 36 more cycles. After a median follow-up of 69 months from the initiation of maintenance, the progression-free survival (PFS) was similar in both arms, with a 6-year PFS rate of 61.3% and 55.6% for RD and IRD, respectively (hazard ratio, 1.136; 95% confidence interval, 0.809-1.603). After 2 years of maintenance, treatment was discontinued in 163 patients with negative MRD, whereas 63 patients with positive MRD continued with RD therapy. Maintenance discontinuation in patients tested negative for MRD resulted in a low progression rate (17.2% at 4 years), even in patients with high-risk features. In summary, our results show the efficacy of RD maintenance and support the safety of maintenance therapy discontinuation in patients with negative MRD at 2 years. This trial was registered at www.clinicaltrials.gov as #NCT02406144 and at EudraCT as 2014-00055410.
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Affiliation(s)
- Laura Rosiñol
- Hospital Clinic de Barcelona, Insitut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Albert Oriol
- Hematology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Rafael Ríos
- Hematology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Isidro Jarque
- Hematology Department, Hospital Universitari i Politècnic La Fe, Centro de Investigación Biomédica en Red de Cancer, Valencia, Spain
| | - Joan Bargay
- Hematology Department, Hospital Universitario Son Llatzer, Palma de Mallorca, Spain
| | | | - Valentín Cabañas
- Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria-Pascual Parrilla, Murcia, Spain
| | - Estrella Carrillo-Cruz
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Anna Sureda
- Hospital Duran i Reynals, Institut Català d'OncologiaI L'Hospitalet, Institut d'Investigació Biomèdica de Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Joaquín Martínez-López
- Hospital Universitario 12 de Octubre, Complutense University, Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Isabel Krsnik
- Hematology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Luis Felipe Casado
- Hematology Department, Hospital General Universitario de Toledo, Toledo, Spain
| | - Josep María Martí
- Hematology Department, Hospital Universitario Mútua de Terrassa, Terrassa, Spain
| | - Cristina Encinas
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Felipe de Arriba
- Hospital Universitario Morales Messeguer, Instituto Murciano de Investigación Biosanitaria-Pascual Parrilla, Universidad de Murcia, Murcia, Spain
| | - Luis Palomera
- Hematology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Antonia Sampol
- Hematology Department, Complejo Asistencial Son Espases, Palma de Mallorca, Spain
| | | | - Elena Cabezudo
- Hospital Althaia, Xarxa Assistencial de Manresa, Manresa, Spain
| | - Bruno Paiva
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Universidad de Navarra, Cancer Center Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red de Cancer, Pamplona, Spain
| | - Noemí Puig
- University Hospital of Salamanca, Centro de Investigación Biomédica en Red de Cancer, Center for Cancer Research-Instituto Universitario de Biología Molecular y Celular del Cáncer, Salamanca, Spain
| | | | - Javier de la Cruz
- Instituto de investigación i+12, Hospital Universitario 12 de Octubre, Red de Salud Materno Infantilal y del Desarrollo-Insituto de Salud Carlos III, Madrid, Spain
| | - María-Victoria Mateos
- University Hospital of Salamanca, Centro de Investigación Biomédica en Red de Cancer, Center for Cancer Research-Instituto Universitario de Biología Molecular y Celular del Cáncer, Salamanca, Spain
| | - Jesús San Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Universidad de Navarra, Cancer Center Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red de Cancer, Pamplona, Spain
| | - Juan José Lahuerta
- Hospital Universitario 12 de Octubre, Complutense University, Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Joan Bladé
- Hospital Clinic de Barcelona, Insitut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
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Chen MT, Huang ST, Huang HH, Chen WJ, Ko BS, Hsiao FY. Risk of thromboembolic events associated with different multiple myeloma regimens in Taiwan: a nested case-control study. J Thromb Thrombolysis 2023; 56:578-587. [PMID: 37737970 DOI: 10.1007/s11239-023-02887-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/23/2023]
Abstract
Although novel agents for multiple myeloma (MM) have a better response rate and survival in both newly diagnosed and relapsed/refractory MM patients, concerns regarding the association between MM treatments and thromboembolic events have been raised. The aim of this population-based study was to examine the association between different combinations of MM treatments and the risk of thromboembolic events. We conducted a nested case-control study using the Taiwan Cancer Registry (TCR) and National Health Insurance Research Database (NHIRD). Adult patients newly diagnosed with MM and treated with at least one of the immunomodulatory agents between 2008 and 2016 were identified. Among them, we further identified patients who developed thromboembolic events as cases and selected controls matched by age, sex and duration of MM diagnosis at a ratio of 1:5. The index date was defined as the day one year before the diagnosis date of thromboembolic events in the case group and the corresponding date in the control group. Conditional logistic regression was used to examine the association between different MM treatment regimens and the risk of thromboembolic events. A total of 4,180 newly diagnosed MM patients treated with at least one of the immunomodulatory agents were identified (mean age: 67.2 years; male: 55.7%). In this MM cohort, we further identified 388 cases and 1,940 matched controls (mean age: 71 years; male: 64.2%). The use of a thalidomide/bortezomib/steroid combination (odds ratio (OR) 2.95 [95% confidence interval (CI) 1.47-5.95]), thalidomide monotherapy (OR 3.33; 95% CI, 1.59-6.94), and a thalidomide/steroid combination (OR 4.24; 95% CI, 2.00-8.98) were associated with an increased risk of thromboembolic events. Other risk factors, particularly a history of thromboembolic events, including ischemic heart disease and pulmonary embolism, were significantly associated with increased risk of thromboembolic events. We found that the use of thalidomide alone and in specific combinations was associated with an increased risk of thromboembolic events.
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Affiliation(s)
- Mei-Tsen Chen
- Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan
| | - Huai-Hsuan Huang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Bor-Sheng Ko
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan.
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
- School of Pharmacy, National Taiwan University, Taipei, Taiwan.
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Rath C, Yoo C, Cheplowitz H, Lo M, Young R, Guglielmo J, Saunders IM, Banerjee R, Young R, Kumar A, Chung A, Rosenberg AS, Costello C, Fine J, Wilson M, Patel N, Banez MT. Predictors of lenalidomide maintenance duration after autologous stem cell transplant in patients with multiple myeloma. J Oncol Pharm Pract 2023; 29:1715-1724. [PMID: 36731514 DOI: 10.1177/10781552221150935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND For patients with multiple myeloma (MM) who have undergone autologous stem cell transplant (auto-SCT), the immunomodulatory agent lenalidomide is a first-line option for maintenance therapy. Because longer durations of lenalidomide maintenance are associated with improved survival, identifying strategies to avoid premature cessation of maintenance is an important priority in the post-transplant setting. OBJECTIVES The primary objective of this analysis was to identify specific clinical predictors of lenalidomide treatment duration that could guide optimal medication management. Key secondary objectives included predictors of intolerable toxicity, rationale for lenalidomide dose reduction/discontinuation, and characterization of dose adjustments. STUDY DESIGN This retrospective, multi-center cohort study included adults with MM who underwent auto-SCT and initiated maintenance lenalidomide between 01/01/2012 and 02/28/2021. Variables assessed as potential predictors of maintenance duration or intolerable toxicity included age, body mass index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status at time of auto-SCT, renal function, initial lenalidomide dose, use of combination maintenance therapy, and cytogenetic risk category. RESULTS Among 299 patients included, the median age at time of auto-SCT was 62 years (range 30-77). The majority of patients had standard-risk cytogenetics (64%) and an ECOG performance status of 0 or 1 (72%). In the overall population, the median duration of maintenance was 1.3 years (range 0.3-8.6 years). The median initial dose of lenalidomide was 10 mg daily (range 2.5-25 mg). During the study period, 35% of patients had a dose reduction due to toxicity, 21% stopped lenalidomide due to disease progression, and 19% stopped due to toxicity. Multivariate linear regression analyses did not identify any significant predictors of lenalidomide duration or discontinuation due to intolerable toxicity. The most frequently reported toxicities leading to discontinuation were cytopenias, rash, and fatigue. CONCLUSION This analysis did not identify any significant risk factors to predict the duration of lenalidomide maintenance or discontinuation for toxicity following auto-SCT in patients with MM. While limited by the retrospective design and relatively small sample size, our findings suggest that a priori lenalidomide dose reductions based on patient co-morbidities or performance status may not substantially affect the duration of lenalidomide maintenance.
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Affiliation(s)
- Carolyn Rath
- Department of Pharmaceutical Services, University of California, San Francisco, San Francisco, CA, USA
| | - Claude Yoo
- Department of Pharmacy Services, University of California, Davis, Sacramento, CA, USA
| | - Halle Cheplowitz
- Department of Pharmacy Services, University of California, San Diego, La Jolla, CA, USA
| | - Mimi Lo
- Department of Pharmaceutical Services, University of California, San Francisco, San Francisco, CA, USA
| | - Rebecca Young
- Department of Pharmaceutical Services, University of California, San Francisco, San Francisco, CA, USA
| | - Julie Guglielmo
- Department of Pharmacy Services, University of California, Davis, Sacramento, CA, USA
| | - Ila M Saunders
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Rahul Banerjee
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Hematology and Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Richard Young
- Division of Hematology and Oncology, University of California, Davis, Sacramento, CA, USA
| | - Anupama Kumar
- Division of Hematology and Oncology and Bone Marrow Transplantation, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Alfred Chung
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Aaron Seth Rosenberg
- Division of Hematology and Oncology, University of California, Davis, Sacramento, CA, USA
| | - Caitlin Costello
- Division of Hematology and Oncology and Bone Marrow Transplantation, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jeffrey Fine
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Machelle Wilson
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Nimish Patel
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Marisela Tan Banez
- Department of Pharmaceutical Services, University of California, San Francisco, San Francisco, CA, USA
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Manier S, Dimopoulos M, Hulin C, Leleu X, Delforge M, Weisel K, Mouro J, Costa B, Sturniolo M, Facon T. Predictors of Lenalidomide Refractory Relapse Timing With Newly Diagnosed Multiple Myeloma: A FIRST Trial Subanalysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e297-e306.e1. [PMID: 37393121 DOI: 10.1016/j.clml.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION/BACKGROUND Multiple myeloma (MM) is considered an incurable cancer. Patients with newly diagnosed MM (NDMM) are at risk for relapse within 1 year of frontline therapy. The immunomodulatory agent lenalidomide combined with dexamethasone (Rd) may be used as treatment for NDMM or relapsed MM, including in patients ineligible for autologous stem cell transplant. PATIENTS This subanalysis of the phase III FIRST trial characterized patients with transplant-ineligible NDMM who experienced relapse while receiving Rd therapy by relapse timing (early [<12 months] versus late [≥12 months]) and type (CRAB vs. non-CRAB). METHODS The Kaplan-Meier product limit method was used to estimate time-to-event endpoints, including progression-free survival (PFS) and overall survival (OS). Factors associated with the odds of late relapse were identified by logistic regression with univariate and multivariate analyses using a binary outcome (relapse at <12 vs. ≥12 months) in patient-, disease-, and treatment-specific baseline variables. RESULTS Patients with early refractory relapse had functionally high-risk disease and inferior outcomes. In patients with early relapse versus those with late relapse, median OS (95% CI) was 26.8 months (21.9-32.8) versus 63.9 months (57.0-78.0), median OS from disease progression to death was 19.9 months (16.0-25.5) versus 36.4 months (27.9-47.0), and median PFS from randomization to second progression was 19.1 months (17.3-22.5) versus 42.1 months (37.4-44.9). Lactate dehydrogenase, baseline β2 microglobulin, and myeloma subtype were shown to predict time to relapse. CONCLUSIONS Clinicians could use these factors to consider more aggressive treatment regimens for those at highest risk of early relapse.
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Affiliation(s)
- Salomon Manier
- Department of Hematology, Université de Lille, CHU Lille, Lille, France.
| | - Meletios Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Cyrille Hulin
- Department of Hematology, Hôpital Haut Lévêque, University Hospital, Pessac, France
| | - Xavier Leleu
- Department of Hematology and Cellular Therapy, CIC U1402 CHU de Poitiers, Poitiers, France
| | | | - Katja Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Department of Pneumonology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jorge Mouro
- Worldwide Medical Affairs, Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Bruno Costa
- Worldwide Medical Affairs, Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Michael Sturniolo
- Worldwide Medical Affairs, Celgene, a Bristol-Myers Squibb Company, Princeton, NJ
| | - Thierry Facon
- Department of Hematology, Université de Lille, CHU Lille, Lille, France
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Groen K, Schjesvold FH, van der Holt B, Levin MD, Seefat MR, Hansson M, Leys MB, Regelink JC, Waage A, Szatkowski D, Axelsson P, Hieu Do T, Svirskaite A, van der Spek E, Haukas E, Knut-Bojanowska D, Ypma PF, Blimark CH, Mellqvist UH, van de Donk NW, Sonneveld P, Klostergaard A, Vangsted AJ, Abildgaard N, Zweegman S. Ixazomib-Thalidomide-Dexamethasone Induction Followed by Ixazomib or Placebo Maintenance in Nontransplant Eligible Newly Diagnosed Multiple Myeloma Patients: Long-term Results of HOVON-126/NMSG 21.13. Hemasphere 2023; 7:e940. [PMID: 37663673 PMCID: PMC10470677 DOI: 10.1097/hs9.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/07/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Kazimierz Groen
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, the Netherlands
| | - Fredrik H. Schjesvold
- Department of Hematology, Oslo Myeloma Center, Oslo University Hospital, Norway
- KG Jebsen Center for B Cell Malignancies, University of Oslo, Norway
| | - Bronno van der Holt
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Maarten R. Seefat
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, the Netherlands
| | - Markus Hansson
- Department of Hematology, Skåne University Hospital Lund, Sweden
| | - Maria B.L. Leys
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Josien C. Regelink
- Department of Internal Medicine, Meander Medical Centre, Amersfoort, the Netherlands
| | - Anders Waage
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Damian Szatkowski
- Department of Oncology and Hematology, Førde Central Hospital, Norway
| | - Per Axelsson
- Department of Internal Medicine, Helsingborg Hospital, Sweden
| | - Trung Hieu Do
- Haematology Department H 60, Roskilde Sjaelland University, Denmark
| | - Asta Svirskaite
- Department of Hematology, Aalborg University Hospital, Denmark
| | - Ellen van der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Einar Haukas
- Department for Blood and Cancer Diseases, Stavanger University Hospital, Norway
| | | | - Paula F. Ypma
- Department of Hematology, Haga Hospital, The Hague, the Netherlands
| | - Cecilie H. Blimark
- Hematology Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Niels W.C.J. van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, the Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | - Niels Abildgaard
- Department of Hematology, Hematology Research Unit and Academy of Geriatric Research, Odense University Hospital and University of Southern Denmark, Denmark
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, the Netherlands
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Del Fabro V, Di Giorgio MA, Leotta V, Duminuco A, Bellofiore C, Markovic U, Romano A, Bulla A, Curto Pelle A, Elia F, Di Raimondo F, Conticello C. Lenalidomide plus Dexamethasone Combination as First-Line Oral Therapy of Multiple Myeloma Patients: A Unicentric Real-Life Study. Cancers (Basel) 2023; 15:4036. [PMID: 37627065 PMCID: PMC10452433 DOI: 10.3390/cancers15164036] [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: 06/05/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Based on the results obtained in clinical trials, the use of the combination of lenalidomide and dexamethasone (Len/Dex) has become a potential therapeutic choice for newly diagnosed multiple myeloma (NDMM) ineligible for autologous stem cell transplantation. This study evaluated 89 frail NDMM patients treated with first-line oral association. At the last follow-up, 34 out of 89 patients (38.2%) were alive, and 22 were still in treatment with Len/Dex. Among 73 evaluable patients who received at least two cycles, the overall response rate was 71% (N = 52). The disease control rate, defined as any level of clinical response to therapy, occurred in 71 patients (97%). We reported one or more adverse events of grade 3 or 4 (G3/4) in 65.2% (N = 58) of patients, with a prevalence of hematological toxicity (24 patients), leading to an overall discontinuation of treatment in two cases. In univariate analysis, high ISS, high serum β2-microglobulin, and creatinine clearance <30 mL/min negatively impact OS, while the depth of response positively impacts OS. Moreover, G3-4 anemia, ISS, frailty score, and ECOG negatively impacts PFS. In conclusion, elderly and more frail patients benefit from the Len/Dex combination also in the era of monoclonal antibodies, ensuring an increased PFS and OS in patients where the therapeutic choice is often limited and usually not very effective.
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Affiliation(s)
- Vittorio Del Fabro
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
| | - Mary Ann Di Giorgio
- Division of Hematology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, 95122 Catania, Italy; (M.A.D.G.); (V.L.); (C.B.)
| | - Valerio Leotta
- Division of Hematology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, 95122 Catania, Italy; (M.A.D.G.); (V.L.); (C.B.)
| | - Andrea Duminuco
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
| | - Claudia Bellofiore
- Division of Hematology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, 95122 Catania, Italy; (M.A.D.G.); (V.L.); (C.B.)
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, 27100 Pavia, Italy
| | - Uros Markovic
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
| | - Alessandra Romano
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
- Dipartimento di Chirurgia Generale e Specialità Medico Chirurgiche, University of Catania, 95123 Catania, Italy
| | - Anna Bulla
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
| | - Angelo Curto Pelle
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
| | - Federica Elia
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
| | - Francesco Di Raimondo
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
- Dipartimento di Chirurgia Generale e Specialità Medico Chirurgiche, University of Catania, 95123 Catania, Italy
| | - Concetta Conticello
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
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Milan E, Gullà A. Editorial: Proteomic and metabolic reprogramming in myeloma cells within the tumor microenvironment. Front Oncol 2023; 13:1264740. [PMID: 37609386 PMCID: PMC10441542 DOI: 10.3389/fonc.2023.1264740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/24/2023] Open
Affiliation(s)
- Enrico Milan
- Age Related Diseases Unit, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milano, Italy
- Faculty of Medicine and Surgery, University Vita-Salute San Raffaele, Milano, Italy
| | - Annamaria Gullà
- Experimental Hematology and Immunology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, United States
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39
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Solimando AG, Krebs M, Desantis V, Marziliano D, Caradonna IC, Morizio A, Argentiero A, Shahini E, Bittrich M. Breaking through Multiple Myeloma: A Paradigm for a Comprehensive Tumor Ecosystem Targeting. Biomedicines 2023; 11:2087. [PMID: 37509726 PMCID: PMC10377041 DOI: 10.3390/biomedicines11072087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/29/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Multiple myeloma (MM) is a cancerous condition characterized by the proliferation of plasma cells within the hematopoietic marrow, resulting in multiple osteolytic lesions. MM patients typically experience bone pain, kidney damage, fatigue due to anemia, and infections. Historically, MM was an incurable disease with a life expectancy of around three years after diagnosis. However, over the past two decades, the development of novel therapeutics has significantly improved patient outcomes, including response to treatment, remission duration, quality of life, and overall survival. These advancements include thalidomide and its derivatives, lenalidomide and pomalidomide, which exhibit diverse mechanisms of action against the plasma cell clone. Additionally, proteasome inhibitors such as bortezomib, ixazomib, and carfilzomib disrupt protein degradation, proving specifically toxic to cancerous plasma cells. Recent advancements also involve monoclonal antibodies targeting surface antigens, such as elotuzumab (anti-CS1) and daratumumab (anti-CD38), bispecific t-cell engagers such as teclistamab (anti-BCMA/CD3) and Chimeric antigen receptor T (CAR-T)-based strategies, with a growing focus on drugs that exhibit increasingly targeted action against neoplastic plasma cells and relevant effects on the tumor microenvironment.
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Affiliation(s)
- Antonio G Solimando
- Unit of Internal Medicine and Clinical Oncology "G. Baccelli", Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Markus Krebs
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Urology and Pediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Vanessa Desantis
- Department of Precision and Regenerative Medicine and Ionian Area, Pharmacology Section, University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Donatello Marziliano
- Unit of Internal Medicine and Clinical Oncology "G. Baccelli", Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Ingrid Catalina Caradonna
- Department of Precision and Regenerative Medicine and Ionian Area, Pharmacology Section, University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Arcangelo Morizio
- Orthopedics and Traumatology Unit ASL BA-Ospedale della Murgia "Fabio Perinei", 70022 Altamura, Italy
| | | | - Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology-IRCCS "Saverio de Bellis", 70013 Castellana Grotte, Italy
| | - Max Bittrich
- Department of Internal Medicine II, University Hospital Würzburg, 97080 Würzburg, Germany
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McCurdy A, Mian H, LeBlanc R, Jimenez-Zepeda VH, Su J, Masih-Khan E, Visram A, Louzada M, Song K, White D, Sebag M, Stakiw J, Reiman A, Aslam M, Bergstrom D, Kotb R, Kaedbey R, Gul E, Reece D, Venner CP. Redefining attrition in multiple myeloma (MM): a Canadian Myeloma Research Group (CMRG) analysis. Blood Cancer J 2023; 13:111. [PMID: 37474492 PMCID: PMC10359388 DOI: 10.1038/s41408-023-00883-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/16/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Abstract
While most patients diagnosed with multiple myeloma (MM) receive initial therapy, reported attrition rates are high. Understanding attrition rates and characteristics of patients not receiving subsequent therapy is useful for MM stakeholders. We performed an analysis of attrition rates in a large disease-specific database of patients with newly diagnosed MM who received at least one line of therapy between Jan 1/10-Dec 31/20. Attrition was defined as failure to receive a subsequent line of therapy despite progression of MM or due to death. A total of 5548 patients were identified, 3111 autologous stem cell transplant (ASCT) patients and 2437 non-ASCT. In the ASCT cohort, the attrition rate was 7% after line 1, 12% after line 2, and 23% after line 3. In non-ASCT patients, the attrition rate was 19% after line 1, 26% after line 2, and 40% after line 3. Death was the dominant contributor to attrition across all cohorts, with a minority of patients alive with progressive disease in the absence of further therapy at each line. Multivariable analysis identified older age, shorter time to progression, and inferior response as independent risk factors for attrition. Our data show that attrition rates increase with each line of therapy and are higher in non-ASCT patients but are appreciably lower than previously reported. This study supports a revision of the previous definition of attrition, demonstrating that most patients who do not receive subsequent therapy are either continuing their current therapy and/or are in remission off-treatment rather than being irreversibly lost to attrition.
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Affiliation(s)
- Arleigh McCurdy
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Hira Mian
- Juravinski Cancer Center, Hamilton, Ontario, Canada
| | - Richard LeBlanc
- Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | | | - Jiandong Su
- Canadian Myeloma Research Group, Vaughn, Ontario, Canada
| | - Esther Masih-Khan
- Canadian Myeloma Research Group, Vaughn, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Alissa Visram
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Martha Louzada
- Department of Medicine, London Regional Cancer Center, London, Ontario, Canada
| | - Kevin Song
- BC Cancer Agency, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Darrell White
- Queen Elizabeth II Health Sciences Centre. Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Sebag
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Julie Stakiw
- Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Anthony Reiman
- Department of Medicine, Saint John Regional Hospital, Saint John, NB, Canada
| | - Muhammad Aslam
- Muhammad Aslam, Department of Medical Oncology, Allan Blair Cancer Centre, Regina, Saskatchewan, Canada
| | - Debra Bergstrom
- Division of Hematology, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Rami Kotb
- Department of Medical Oncology & Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Rayan Kaedbey
- Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada
| | - Engin Gul
- Canadian Myeloma Research Group, Vaughn, Ontario, Canada
| | - Donna Reece
- Canadian Myeloma Research Group, Vaughn, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Christopher P Venner
- BC Cancer Agency, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of Medicine, Cross Cancer Institute, Edmonton, Alberta, Canada
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41
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Grant SJ, Wildes TM, Rosko AE, Silberstein J, Giri S. A real-world data analysis of predictors of early mortality after a diagnosis of multiple myeloma. Cancer 2023; 129:2023-2034. [PMID: 36989073 PMCID: PMC10330042 DOI: 10.1002/cncr.34760] [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: 11/05/2022] [Revised: 01/21/2023] [Accepted: 02/24/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Despite the increased availability and use of novel therapies for multiple myeloma, early mortality is a pervasive challenge with a significant impact on older adults. Reported rates and predictors of early mortality have varied in the literature, with most studies seldom focusing on community-treated patients. METHODS In this retrospective cohort analysis of a real-world electronic health record-derived deidentified database of 7512 patients newly diagnosed with multiple myeloma between January 1, 2011, and February 2, 2021, and treated primarily in US-based community oncology practices, factors associated with early mortality (defined as death within 6 months after the multiple myeloma diagnosis) were examined with the use of binary logistic regression. RESULTS The median age was 70 years overall. We found an overall early mortality rate of 8.3%, with 73% of early deaths occurring in those aged ≥70 years. Among the early deaths, only 49 patients (8.7%) had documented disease progression before death (median time to progression, 30 days [interquartile range, 7-53 days]). Baseline factors associated with higher odds of early mortality included an Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 2, Revised International Staging System (R-ISS) stage III, an age ≥ 70 years, receipt of proteasome inhibitor-doublet therapy, a light-chain isotype, and the presence of renal dysfunction (estimated glomerular filtration rate < 30 mL/min). Among those aged ≥70 years, ECOG PS ≥ 2 and R-ISS stage III remained the strongest predictors of early mortality. CONCLUSIONS Early mortality disproportionately affects older adults (aged ≥70 years) with multiple myeloma. Interventions to support this population are needed to reduce disparate survival outcomes. PLAIN LANGUAGE SUMMARY Factors associated with an increased risk of dying within 6 months (early mortality) of a new diagnosis of multiple myeloma (MM) among 7512 mostly community-treated patients with MM were evaluated. The early mortality rate was 8.3%; among those deaths, 49 patients (8.7%) had documented evidence of MM progression before death. The risk of early mortality was greatest for older patients (aged ≥70 years) and those with a poor performance status, poor kidney function, a higher disease stage, and light-chain MM and those receiving two-drug MM therapies. These findings highlight the need for supportive interventions geared toward older adults with MM.
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Affiliation(s)
- Shakira J. Grant
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tanya M. Wildes
- Division of Hematology/Oncology, University of Nebraska Medical Center/Nebraska Medicine, Omaha NE
| | - Ashley E. Rosko
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH
| | - Juliet Silberstein
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Smith Giri
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
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Qian X, Yang Y, Deng Y, Liu Y, Zhou Y, Han F, Xu Y, Yuan H. SETDB1 induces lenalidomide resistance in multiple myeloma cells via epithelial‑mesenchymal transition and PI3K/AKT pathway activation. Exp Ther Med 2023; 25:274. [PMID: 37206551 PMCID: PMC10189757 DOI: 10.3892/etm.2023.11973] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/22/2023] [Indexed: 05/21/2023] Open
Abstract
SET domain bifurcated histone lysine methyltransferase 1 (SETDB1) is a histone H3K9 methyltransferase that stimulates cell proliferation by methylating AKT, which contributes to drug resistance in multiple myeloma (MM). Lenalidomide is an immunomodulatory agent widely used in the treatment of MM. However, lenalidomide resistance occurs in patients with MM. Currently, the role of SETDB1 in lenalidomide resistance in MM remains unclear. Thus, the present study aimed to explore the functional association between SETDB1 and lenalidomide resistance in MM. The analysis of GEO datasets revealed that SETDB1 was upregulated in lenalidomide-resistant MM cells and that its expression was associated with poor prognosis of patients with MM. Apoptosis analysis revealed that overexpression of SETDB1 in MM cells significantly decreased apoptosis, while knockdown of SETDB1 increased apoptosis. Furthermore, the IC50 value of lenalidomide in MM cells increased following SETDB1 overexpression and decreased following SETDB1 silencing. Additionally, SETDB1 mediated epithelial-mesenchymal transition (EMT) and activated the PI3K/AKT pathway. Mechanistic analysis revealed that inhibition of PI3K/AKT signaling in MM cells increased apoptosis, sensitized the cells to lenalidomide and inhibited EMT, whereas SETDB1 overexpression inhibited the effects of PI3K/AKT cascade inhibition. In conclusion, the findings of the present study indicated that SETDB1 promoted lenalidomide resistance in MM cells by promoting EMT and the PI3K/AKT signaling pathway. Thus, SETDB1 may be a potential therapeutic target for MM.
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Affiliation(s)
- Xiaoli Qian
- Department of Hematology, The Second People's Hospital of Taizhou, Medical College of Yangzhou University, Jiangyan, Taizhou, Jiangsu 225500, P.R. China
| | - Yang Yang
- Department of Gastroenterology, The Second People's Hospital of Taizhou, Medical College of Yangzhou University, Jiangyan, Taizhou, Jiangsu 225500, P.R. China
| | - Yingfen Deng
- Department of Hematology, The Second People's Hospital of Taizhou, Medical College of Yangzhou University, Jiangyan, Taizhou, Jiangsu 225500, P.R. China
| | - Yali Liu
- Department of Hematology, The Second People's Hospital of Taizhou, Medical College of Yangzhou University, Jiangyan, Taizhou, Jiangsu 225500, P.R. China
| | - Yuwen Zhou
- Department of Hematology, The Second People's Hospital of Taizhou, Medical College of Yangzhou University, Jiangyan, Taizhou, Jiangsu 225500, P.R. China
| | - Fang Han
- Department of Gastroenterology, The Second People's Hospital of Taizhou, Medical College of Yangzhou University, Jiangyan, Taizhou, Jiangsu 225500, P.R. China
| | - Yue Xu
- Department of Hematology, The Second People's Hospital of Taizhou, Medical College of Yangzhou University, Jiangyan, Taizhou, Jiangsu 225500, P.R. China
| | - Hongjian Yuan
- Department of Hematology, The Second People's Hospital of Taizhou, Medical College of Yangzhou University, Jiangyan, Taizhou, Jiangsu 225500, P.R. China
- Correspondence to: Professor Hongjian Yuan, Department of Hematology, The Second People's Hospital of Taizhou, Medical College of Yangzhou University, 27 Jiankang Road, Jiangyan, Taizhou, Jiangsu 225500, P.R. China
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Oertel M, Schlusemann T, Shumilov E, Reinartz G, Bremer A, Rehn S, Lenz G, Khandanpour C, Eich HT. Radiotherapy in Combination with Systemic Therapy for Multiple Myeloma-A Critical Toxicity Evaluation in the Modern Treatment Era. Cancers (Basel) 2023; 15:cancers15112909. [PMID: 37296874 DOI: 10.3390/cancers15112909] [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: 04/24/2023] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Radiotherapy (RT) is an established treatment modality in the management of patients with multiple myeloma (MM), aiming at analgesia and stabilization of osteolytic lesions. As a multifocal disease, the combined use of RT, systemic chemotherapy, and targeted therapy (ST) is pivotal to achieve better disease control. However, adding RT to ST may lead to increased toxicity. The aim of this study was to evaluate the tolerability of ST given concurrently with RT. Overall, 82 patients treated at our hematological center with a median follow-up of 60 months from initial diagnosis and 46.5 months from the start of RT were evaluated retrospectively. Toxicities were recorded from 30 days before RT up to 90 days after RT. 54 patients (65.9%) developed at least one non-hematological toxicity, with 50 patients (61.0%) showing low-grade (grade I or II) and 14 patients (17.1%) revealing high-grade (grade III and IV) toxicities. Hematological toxicities were documented in 50 patients (61.0%) before RT, 60 patients (73.2%) during RT, and 67 patients (81.7%) following RT. After RT, patients who had received ST during RT showed a significant increase in high-grade hematological toxicities (p = 0.018). In summary, RT can be safely implemented into modern treatment regimens for MM, but stringent monitoring of potential toxicities even after completion of RT has to be ensured.
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Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Tom Schlusemann
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Evgenii Shumilov
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Gabriele Reinartz
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Anne Bremer
- Department of Oncology, St. Franziskus-Hospital, Hohenzollernring 70, 48145 Muenster, Germany
| | - Stephan Rehn
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Cyrus Khandanpour
- Department of Hematology and Oncology, University Hospital of Schleswig-Holstein, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Costa BA, Mouhieddine TH, Ortiz RJ, Richter J. Revisiting the Role of Alkylating Agents in Multiple Myeloma: Up-to-Date Evidence and Future Perspectives. Crit Rev Oncol Hematol 2023; 187:104040. [PMID: 37244325 DOI: 10.1016/j.critrevonc.2023.104040] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023] Open
Abstract
From the 1960s to the early 2000s, alkylating agents (e.g., melphalan, cyclophosphamide, and bendamustine) remained a key component of standard therapy for newly-diagnosed or relapsed/refractory multiple myeloma (MM). Later on, their associated toxicities (including second primary malignancies) and the unprecedented efficacy of novel therapies have led clinicians to increasingly consider alkylator-free approaches. Meanwhile, new alkylating agents (e.g., melflufen) and new applications of old alkylators (e.g., lymphodepletion before chimeric antigen receptor T-cell [CAR-T] therapy) have emerged in recent years. Given the expanding use of antigen-directed modalities (e.g., monoclonal antibodies, bispecific antibodies, and CAR-T therapy), this review explores the current and future role of alkylating agents in different treatment settings (e.g., induction, consolidation, stem cell mobilization, pre-transplant conditioning, salvage, bridging, and lymphodepleting chemotherapy) to ellucidate the role of alkylator-based regimens in modern-day MM management.
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Affiliation(s)
- Bruno Almeida Costa
- Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tarek H Mouhieddine
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo J Ortiz
- Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Richter
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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45
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Park SS, Lee JC, Byun JM, Choi G, Kim KH, Lim S, Dingli D, Jeon YW, Yahng SA, Shin SH, Min CK, Koo J. ML-based sequential analysis to assist selection between VMP and RD for newly diagnosed multiple myeloma. NPJ Precis Oncol 2023; 7:46. [PMID: 37210456 DOI: 10.1038/s41698-023-00385-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/03/2023] [Indexed: 05/22/2023] Open
Abstract
Optimal first-line treatment that enables deeper and longer remission is crucially important for newly diagnosed multiple myeloma (NDMM). In this study, we developed the machine learning (ML) models predicting overall survival (OS) or response of the transplant-ineligible NDMM patients when treated by one of the two regimens-bortezomib plus melphalan plus prednisone (VMP) or lenalidomide plus dexamethasone (RD). Demographic and clinical characteristics obtained during diagnosis were used to train the ML models, which enabled treatment-specific risk stratification. Survival was superior when the patients were treated with the regimen to which they were low risk. The largest difference in OS was observed in the VMP-low risk & RD-high risk group, who recorded a hazard ratio of 0.15 (95% CI: 0.04-0.55) when treated with VMP vs. RD regimen. Retrospective analysis showed that the use of the ML models might have helped to improve the survival and/or response of up to 202 (39%) patients among the entire cohort (N = 514). In this manner, we believe that the ML models trained on clinical data available at diagnosis can assist the individualized selection of optimal first-line treatment for transplant-ineligible NDMM patients.
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Affiliation(s)
- Sung-Soo Park
- Catholic Research Network for Multiple Myeloma, Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Jong Cheol Lee
- Department of Otorhinolaryngology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gyucheol Choi
- ImpriMedKorea, Inc., Seoul, 08507, Republic of Korea
| | - Kwan Hyun Kim
- ImpriMedKorea, Inc., Seoul, 08507, Republic of Korea
| | - Sungwon Lim
- ImpriMedKorea, Inc., Seoul, 08507, Republic of Korea
- ImpriMed, Inc., Palo Alto, CA, 94303, USA
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Young-Woo Jeon
- Catholic Research Network for Multiple Myeloma, Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- Department of Hematology, Yeoido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 07345, Republic of Korea
| | - Seung-Ah Yahng
- Catholic Research Network for Multiple Myeloma, Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- Department of Hematology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, 22711, Republic of Korea
| | - Seung-Hwan Shin
- Catholic Research Network for Multiple Myeloma, Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- Department of Hematology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, Republic of Korea
| | - Chang-Ki Min
- Catholic Research Network for Multiple Myeloma, Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Jamin Koo
- ImpriMedKorea, Inc., Seoul, 08507, Republic of Korea.
- ImpriMed, Inc., Palo Alto, CA, 94303, USA.
- Department of Chemical Engineering, Hongik University, Seoul, 04066, Republic of Korea.
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46
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Larocca A, Cani L, Bertuglia G, Bruno B, Bringhen S. New Strategies for the Treatment of Older Myeloma Patients. Cancers (Basel) 2023; 15:2693. [PMID: 37345030 DOI: 10.3390/cancers15102693] [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: 03/29/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 06/23/2023] Open
Abstract
Multiple myeloma (MM) mostly affects older patients, who represent a highly heterogeneous population. In the last few years, the introduction of novel agents led to a significant improvement in the outcome of MM patients. Nonetheless, this positive trend is less likely to occur in all older patients due to comorbidities/disabilities and major susceptibility to toxic events. Furthermore, older patients with major comorbidities are usually excluded or underrepresented in most registrational clinical trials. In this context, physicians have called for greater caution in the management of the disease. Several scores allow for the identification of frail and unfit patients and establish the possibility of tailoring therapy, reducing toxicity. This review explores the available tools for the assessment of frailty and what has been done to improve the discriminative power of the available scores. Thereafter, it describes the main therapeutic strategies for the management of transplant-ineligible (NTE) newly diagnosed (ND) MM patients and relapsed/refractory (RR) MM patients, in order to better guide physicians in choosing treatment options and to suggest possible strategies for more frail patients.
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Affiliation(s)
- Alessandra Larocca
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Department of Oncology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Lorenzo Cani
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Department of Oncology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Giuseppe Bertuglia
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Department of Oncology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Benedetto Bruno
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy
- Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Sara Bringhen
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Department of Oncology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
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47
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Fang Y, Wang S, Han S, Zhao Y, Yu C, Liu H, Li N. Targeted protein degrader development for cancer: advances, challenges, and opportunities. Trends Pharmacol Sci 2023; 44:303-317. [PMID: 37059054 DOI: 10.1016/j.tips.2023.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 04/16/2023]
Abstract
Anticancer-targeted therapies inhibit various kinases implicated in cancer and have been used in clinical settings for decades. However, many cancer-related targets are proteins without catalytic activity and are difficult to target using traditional occupancy-driven inhibitors. Targeted protein degradation (TPD) is an emerging therapeutic modality that has expanded the druggable proteome for cancer treatment. With the entry of new-generation immunomodulatory drugs (IMiDs), selective estrogen receptor degraders (SERDs), and proteolysis-targeting chimera (PROTAC) drugs into clinical trials, the field of TPD has seen explosive growth in the past 10 years. Several challenges remain that need to be tackled to increase successful clinical translation of TPD drugs. We present an overview of the global landscape of clinical trials of TPD drugs over the past decade and summarize the clinical profiles of new-generation TPD drugs. In addition, we highlight the challenges and opportunities for the development of effective TPD drugs for future successful clinical translation.
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Affiliation(s)
- Yuan Fang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shuhang Wang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Songzhe Han
- Department of Chemistry, BeiGene (Beijing) Co. Ltd, Beijing 100020, China
| | - Yizhou Zhao
- Department of Chemistry, BeiGene (Beijing) Co. Ltd, Beijing 100020, China
| | - Cunjing Yu
- Translational Discovery, Research, and Medicine, BeiGene (Beijing) Co. Ltd, Beijing 100020, China
| | - Huaqing Liu
- Department of Chemistry, BeiGene (Beijing) Co. Ltd, Beijing 100020, China
| | - Ning Li
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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48
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Raje N, Mateos MV, Iida S, Reece D. Clinical evidence for immune-based strategies in early-line multiple myeloma: current challenges in decision-making for subsequent therapy. Blood Cancer J 2023; 13:41. [PMID: 36944635 PMCID: PMC10030780 DOI: 10.1038/s41408-023-00804-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 03/23/2023] Open
Abstract
Almost all patients with multiple myeloma (MM) will eventually develop disease that has relapsed with or become refractory to available treatments and will require additional therapy. However, data are still lacking on how best to sequence regimens in the relapsed/refractory (RR) setting after the failure of early-line lenalidomide, bortezomib, and/or daratumumab, the most commonly used agents in clinical practice today. With the treatment landscape rapidly changing in response to emerging clinical trial data and approvals of several new drugs and additional combinations, it is critically important to focus on patients with RRMM. Variability in patient baseline characteristics, such as the number of prior lines of treatment, refractoriness to prior treatments, prior stem cell transplant, and timing and dosing of prior lenalidomide, makes it difficult to select the best options for patients with RRMM for whom first-line treatments have failed. The aim of this review is to provide both an overview of current therapies and future directions within the RRMM treatment landscape, and a framework for clinicians to choose the most promising next treatment option.
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Affiliation(s)
- Noopur Raje
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
| | - María-Victoria Mateos
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Donna Reece
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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49
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Xu T, Yang Y, Li J, Xu J, Wang W, Wang Y, Maihemaiti A, Ren L, Lan T, Zhou C, Li P, Wang P, Liu P. Real world outcomes of lenalidomide or bortezomib maintenance in patients with multiple myeloma not undergoing stem cell transplantation. Ann Hematol 2023; 102:1171-1184. [PMID: 36882560 DOI: 10.1007/s00277-023-05148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/19/2022] [Indexed: 03/09/2023]
Abstract
Maintenance is one form of long-term therapies in multiple myeloma (MM). Lenalidomide and bortezomib are two commonly used options. The role of maintenance in patients not undergoing transplant remains unclear. A total of 248 newly diagnosed MM patients who received over 180 days of any standard-of-care induction therapy and did not receive autologous stem cell transplantation were included. Patients either receive lenalidomide, bortezomib or no maintenance. Patterns of usage, survival benefit, discontinuation status were analyzed. 93, 99 and 56 patients received no, lenalidomide (Len) and bortezomib (Bor) maintenance respectively. Patients receiving Bor had a higher incidence of traditional high-risk cytogenetics (14.0% (No) vs 14.1% (Len) vs 41.1% (Bor), P < 0.001). Len maintenance conferred a superior progression-free survival (PFS) and overall survival (OS) compared to no maintenance (median PFS, 60.1 vs 26.9 months, P = 0.003; median OS, NR vs 56.7 months, P = 0.046), with a near independent impact on PFS (adjusted HR 0.580, P = 0.058). The PFS and OS benefit of Len maintenance was seen in subgroups of ISS stage I/II, traditional standard-risk cytogenetics, and pre-maintenance < CR. Bor maintenance did not confer PFS or OS benefit for the entire cohort, but improved OS in patients with pre-maintenance < CR. Discontinuation due to toxicity was recorded in 11.1% and 8.9% of patients receiving Len or Bor maintenance respectively. Our study supports lenalidomide maintenance as the standard-of-care in MM patients not undergoing transplant. Further studies are warranted for bortezomib maintenance in the non-transplant setting, and better maintenance strategy is needed for patients with adverse prognostic factors.
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Affiliation(s)
- Tianhong Xu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Hematology, Shanghai Geriatric Medical Center, Shanghai, China
| | - Yang Yang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Li
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiadai Xu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenjing Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yawen Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Aziguli Maihemaiti
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang Ren
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianwei Lan
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chi Zhou
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Panpan Li
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pu Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China. .,Department of Hematology, Shanghai Geriatric Medical Center, Shanghai, China.
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50
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Bortezomib, melphalan, and prednisone with or without daratumumab in transplant-ineligible Asian patients with newly diagnosed multiple myeloma: the phase 3 OCTANS study. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2023; 23:446-455.e4. [PMID: 37024420 DOI: 10.1016/j.clml.2023.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/12/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION In the global phase 3 ALCYONE trial, daratumumab plus bortezomib/melphalan/prednisone (D-VMP) improved outcomes versus VMP in transplant-ineligible newly diagnosed multiple myeloma (NDMM) patients. Here, we report the primary analysis of the phase 3 OCTANS trial of D-VMP versus VMP in transplant-ineligible Asian NDMM patients. PATIENTS AND METHODS In total, 220 patients were randomized (2:1) to receive 9 cycles of VMP (bortezomib 1.3 mg/m2 subcutaneously twice weekly in Cycle 1 and weekly in Cycles 2 to 9; melphalan 9 mg/m2 orally; and prednisone 60 mg/m2 orally on Days 1 to 4 of each cycle) ± daratumumab 16 mg/kg intravenously weekly in Cycle 1, every 3 weeks in Cycles 2 to 9, and every 4 weeks thereafter until disease progression. RESULTS After a median follow-up of 12.3 months, very good partial response or better rates (primary endpoint) were 74.0% versus 43.2% with D-VMP versus VMP (odds ratio, 3.57; 95% confidence interval [CI], 1.99-6.43; P < .0001). Median progression-free survival (PFS) with D-VMP versus VMP was not reached versus 18.2 months (hazard ratio, .43; 95% CI, .24-.77; P = .0033); 12-month PFS rates were 84.2% versus 64.6%. The most frequent grade 3/4 treatment-emergent adverse events with D-VMP/VMP were thrombocytopenia (46.5%/45.1%), neutropenia (39.6%/50.7%), and leukopenia (31.3%/36.6%). CONCLUSION D-VMP demonstrated a favorable benefit/risk profile in transplant-ineligible Asian NDMM patients. This trial was registered at www. CLINICALTRIALS gov as #NCT03217812.
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