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Li EW, Jones E, Bryant C, King T, Talaulikar D, Ng JY, Bryant A, Ridha Z, Doo NW, Menzies A, Ling S, Ho SJ, Abadir E, Vanguru V, Joshua D, Ho PJ. A single-day polychemotherapy regimen with proteasome inhibitor combinations for relapsed/refractory myeloma in the era of novel therapies. Eur J Haematol 2024. [PMID: 38956924 DOI: 10.1111/ejh.14266] [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: 04/22/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
PCAB (prednisone, cyclophosphamide, doxorubicin, carmustine) is a single-day regimen previously used for induction and now in relapsed/refractory multiple myeloma (RRMM). We retrospectively analysed the outcomes of 85 patients from five Australian centres. These included 30 patients (35.3%) who received PCAB with one additional agent (bortezomib most frequently). Median age of the patients was 65 years (37-80), with a median of four (1-8) prior lines of therapy. ORR was 37% (CR 4.9%). Median progression free survival and overall survival were 4.4 months (95% CI 3.5-6.7) and 7.4 months (95% CI 6.4-10.2), respectively. Extramedullary disease (EMD) was associated with shorter survival. Grade 3 or 4 cytopenia and febrile neutropenia occurred in 76.2% and 39.1%, respectively, with six (7.1%) treatment-related mortalities. Median inpatient stay was 3.3 days/28-day cycle (IQR 0.6-13), and for patients who died, a median of 20.2% of days alive were spent inpatient (IQR 6.4-39.1%). Three patients were successfully bridged to CAR T-cell therapy using PCAB, despite being penta-exposed and having EMD. PCAB may be considered as a useful salvage therapy amongst other polychemotherapy regimens in late relapse. Further studies is warranted to investigate and define its role as a bridging therapy to novel therapeutics.
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Affiliation(s)
- Eric Wenlong Li
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Esther Jones
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christian Bryant
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Tracy King
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Dipti Talaulikar
- Department of Haematology, ACT Pathology, Canberra Health Services, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Jun Yen Ng
- Department of Haematology, ACT Pathology, Canberra Health Services, Canberra, Australia
| | - Adam Bryant
- Department of Haematology, Liverpool Hospital, Sydney, Australia
| | - Zainab Ridha
- Department of Haematology, Liverpool Hospital, Sydney, Australia
| | - Nicole Wong Doo
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Department of Haematology, Concord Repatriation General Hospital, Sydney, Australia
| | - Anna Menzies
- Department of Haematology, St George Hospital, Sydney, Australia
| | - Silvia Ling
- Department of Haematology, Liverpool Hospital, Sydney, Australia
- School of Clinical Medicine, The University of New South Wales, Kensington, Australia
| | - Shir Jing Ho
- Department of Haematology, St George Hospital, Sydney, Australia
| | - Edward Abadir
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Vinay Vanguru
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Douglas Joshua
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - P Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Zafar A, Huang CY, Lo M, Arora S, Chung A, Wong SW, Wolf J, Martin T, Shah N, Banerjee R. Intensity of cyclophosphamide-based bridging therapy before CAR-T therapy in myeloma. Transplant Cell Ther 2023:S2666-6367(23)01299-X. [PMID: 37244643 DOI: 10.1016/j.jtct.2023.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/04/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Patients receiving autologous chimeric antigen receptor T-cell (CAR-T) therapies for multiple myeloma (MM) may require bridging therapy (BT) before CAR-T infusion to maintain some level of disease control. Alkylators such as cyclophosphamide (Cy) are often used as parts of BT regimens, either in high-intensity regimens such as modified hyperCVAD or once-weekly regimens such as KCd. However, there is no consensus around the optimal BT alkylator dose intensity in MM. METHODS We performed a single-center analysis of all instances of BT before planned autologous CAR-T for MM during a 5-year period ending April 2022. We classified bridging regimens into three cohorts: (1) hyperfractionated Cy (HyperCy) with inpatient Cy every 12-24 hours or as continuous intravenous infusions, (2) less intensive Cy dosing (WeeklyCy) such as KPd or KCd, and (3) NonCy, where no alkylators were used in BT. Demographic, disease-related, and treatment-related characteristics were collected for all patients. The three BT cohorts were compared using Fisher's exact tests, Kruskal-Wallis tests, and log-rank tests where appropriate. RESULTS We identified 70 discrete BT instances among 64 unique patients: 29 (41%) with HyperCy, 23 (33%) with WeeklyCy, and 18 (26%) with NonCy. Median total levels of Cy dosing during BT were 2100 mg/m2, 615 mg/m2, and 0 mg/m2 respectively. Age, number of prior lines, triple-class refractory status, presence of high-risk cytogenetics, extramedullary disease, bone marrow plasma cell burden, involved free light chain (iFLC) kinetics before collection, and other measures of disease aggressiveness were comparable between cohorts. iFLC levels rose ≥25% and ≥100 mg/L during BT (approximating progressive disease) in comparable proportions (p=0.25) between cohorts: 52% HyperCy, 39% WeeklyCy, and 28% NonCy. All BT instances without subsequent CAR-T were due to manufacturing failures. Among 61 instances of bridging followed by CAR-T, vein-to-vein times were slightly longer (p = 0.03) with HyperCy (45 days) vs WeeklyCy (39 days) and NonCy (46.5 days). Neutrophil recovery timeframes were similar between cohorts, but platelet recovery took longer with HyperCy (64 days) vs WeeklyCy (42 days) and NonCy (12 days). PFS was comparable between cohorts, but median OS was not: 15.3 months with HyperCy versus 30.0 months with WeeklyCy and not reached with NonCy. DISCUSSION In our retrospective analysis of BT before CAR-T therapy in MM, HyperCy did not result in superior disease control than WeeklyCy despite a threefold higher dose of Cy. In contrast, HyperCy was associated with longer post-CAR-T platelet recovery and worsened OS despite comparable measurements of disease aggressiveness and tumor burden. Study limitations include our small sample size as well as confounding from gestalt markers of MM aggressiveness that might have led both to poorer outcomes as well as physicians' decisions to prescribe HyperCy. Given the rarity of objective disease responses to chemotherapy in relapsed/refractory MM, our analysis suggests that hyperfractionated Cy regimens do not outperform once-weekly Cy regimens for most patients who require BT before CAR-T therapy.
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Affiliation(s)
- Aneeqa Zafar
- Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, UCSF San Francisco, CA
| | - Mimi Lo
- Division of Hematology and Oncology, Department of Pharmacy, UCSF, San Francisco, CA
| | - Shagun Arora
- Division of Hematology and Oncology, Department of Medicine, UCSF, San Francisco, CA
| | - Alfred Chung
- Division of Hematology and Oncology, Department of Medicine, UCSF, San Francisco, CA
| | - Sandy W Wong
- Division of Hematology and Oncology, Department of Medicine, UCSF, San Francisco, CA
| | - Jeffrey Wolf
- Division of Hematology and Oncology, Department of Medicine, UCSF, San Francisco, CA
| | - Thomas Martin
- Division of Hematology and Oncology, Department of Medicine, UCSF, San Francisco, CA
| | - Nina Shah
- Division of Hematology and Oncology, Department of Medicine, UCSF, San Francisco, CA
| | - Rahul Banerjee
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA.
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Mouhieddine TH, Moshier E, Thibaud S, Puliafito B, Rattu M, Jakubowski R, Sanchez L, Rossi A, Rodriguez C, Richard S, Cho HJ, Parekh S, Chari A, Steinberg A, Richter J. Bridging advanced myeloma patients to subsequent treatments and clinical trials with classical chemotherapy and stem cell support. Bone Marrow Transplant 2023; 58:80-86. [PMID: 36261708 DOI: 10.1038/s41409-022-01848-7] [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: 06/12/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 01/12/2023]
Abstract
Rapidly progressing relapsed/refractory multiple myeloma (RRMM) patients with compromised marrow have limited treatment options. Thus, non-myeloablative chemotherapy with a stem cell boost (SCB) may provide disease control and hematopoietic improvement as bridge to subsequent therapies. We identified 96 patients who received a SCB between January 2011 and December 2019 at the Mount Sinai Hospital. Patients had a median age of 64 years, received a median of 7 prior lines of therapy and 68 and 42% were triple-class and penta-drug refractory, respectively. Chemotherapy included melphalan (MEL) (n = 16), melphalan + carmustine (BCNU/MEL) (n = 52) or a variant of DCEP (dexamethasone, cyclophosphamide, etoposide, cisplatin) (n = 28). Median time to neutrophil recovery was 10 days and was significantly lower with DCEP (8 days) compared to MEL and BCNU/MEL (10-11 days) (p = 0.0047). Time to progression, progression-free survival and overall survival were 3.19, 2.7 and 8.38 months, respectively. The BCNU/MEL group had the highest response rate of 85% (p = 0.05), clinical benefit rate of 94% (p = 0.0014), progression-free survival of 3.3 months (p = 0.4) and overall survival of 8.7 months (p = 0.5). Sixty-six patients (69%) were bridged to new lines of therapy, including clinical trials. Non-myeloablative chemotherapy with SCB provides rapid disease control and marrow recovery with potential to receive further therapy.
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Affiliation(s)
- Tarek H Mouhieddine
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Santiago Thibaud
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Benjamin Puliafito
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Mohammad Rattu
- Department of Pharmacy, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Rita Jakubowski
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Larysa Sanchez
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Adriana Rossi
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Cesar Rodriguez
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Shambavi Richard
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Hearn Jay Cho
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Samir Parekh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ajai Chari
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Amir Steinberg
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Joshua Richter
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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Byun JM, Min CK, Kim K, Bang SM, Lee JJ, Kim JS, Yoon SS, Koh Y. Phase II trial of daratumumab with DCEP in relapsed/refractory multiple myeloma patients with extramedullary disease. J Hematol Oncol 2022; 15:150. [PMID: 36274163 PMCID: PMC9590218 DOI: 10.1186/s13045-022-01374-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022] Open
Abstract
Extramedullary multiple myeloma (EMD) is an aggressive subentity of multiple myeloma (MM) with poor prognosis. As more innovative therapeutic approaches are needed for the treatment of MM with EMD, we conducted this multicenter, non-randomized phase II trial of daratumumab in combination with dexamethasone, cyclophosphamide, etoposide and cisplatin (DARA-DCEP). A total of 32 patients (median age 59, range 35–73) were treated with DARA-DCEP. Based on the best response during the study, the complete remission (CR) rate was 35.5% and overall response rate (ORR) 67.7%. During the median follow-up of 11 months, the median progression-free survival (PFS) was 5 months and median overall survival (OS) 10 months. There were 7 long-term responders whose median PFS was not reached. The most common grade ≥ 3 hematologic AE was thrombocytopenia. The most common non-hematologic AE was nausea (22.6%), followed by dyspepsia, diarrhea and stomatitis (all 12.9%). Grade ≥ 3 daratumumab infusion-related reaction was noted in 9.7% of the patients. Except for the planned 30% dose adjustment in cycle 1, only 2 patients required DCEP dose reduction. This is one of the very few prospective trials focusing on EMD and we successfully laid grounds for implementing immunochemotherapy in MM treatment.
This is one of the very few prospective trials focusing on refractory multiple myeloma with extramdedullary disease (EMD). We successfully laid grounds for implementing immunochemotherapy in EMD treatment.
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Nehlsen AD, Sindhu KK, Moshier E, Richter J, Richard S, Chari A, Sanchez L, Parekh S, Cho HJ, Jagannath S, Dharmarajan K. The Safety and Efficacy of Radiation Therapy with Concurrent Dexamethasone, Cyclophosphamide, Etoposide, and Cisplatin-Based Systemic Therapy for Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:192-197. [PMID: 34736880 DOI: 10.1016/j.clml.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The concurrent delivery of radiation therapy (RT) with salvage chemotherapies in the management of relapsed and refractory multiple myeloma (MM) is an area of ongoing investigation. This study examined the safety and efficacy of palliative RT given in the setting of concurrent dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP). PATIENTS AND METHODS Fifty-five patients with MM received RT to 64 different sites within three weeks of receiving DCEP from 2010 to 2020. A median dose of 20 Gray (range 8-32.5 Gy) was delivered in a median of 5 fractions (range 1-15). Patients received a median of 1 cycle (range 1-5) of DCEP. Rates of hematologic and RT toxicity were recorded along with pain, radiographic, and laboratory responses to treatment. RESULTS RT was completed in 98% of patients. 21% of patients experienced RTOG grade 3+ hematologic toxicity before RT, which increased to 35% one-month post-RT (P = .13) before decreasing to 12% at 3 to 6 months (P = .02). The most common toxicity experienced was thrombocytopenia. Grade 1 to 2 non-hematologic RT-related toxicity was reported in 15% of patients while on treatment and fell to 6% one-month after completing RT. Pain resolved in 94% of patients with symptomatic lesions at baseline. Stable disease or better was observed in 34/39 (87%) of the targeted lesions on surveillance imaging. CONCLUSION RT administered concurrently with DCEP was well-tolerated by most of the patients in this series, with low rates of hematologic and RT-related toxicity. RT was also very effective, with the vast majority of patients demonstrating resolution of their pain and a significant response on follow-up imaging.
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Affiliation(s)
- Anthony D Nehlsen
- Icahn School of Medicine at Mount Sinai, Radiation Oncology, NY, NY, USA.
| | - Kunal K Sindhu
- Icahn School of Medicine at Mount Sinai, Radiation Oncology, NY, NY, USA
| | - Erin Moshier
- Icahn School of Medicine at Mount Sinai, Biostatistics, NY, NY, USA
| | - Joshua Richter
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Shambavi Richard
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Ajai Chari
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Larysa Sanchez
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Samir Parekh
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Hearn Jay Cho
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Sundar Jagannath
- Icahn School of Medicine at Mount Sinai, Hematology and Oncology, NY, NY, USA
| | - Kavita Dharmarajan
- Icahn School of Medicine at Mount Sinai, Radiation Oncology, NY, NY, USA
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Wu L, Xia L, Chen X, Ruan M, Li L, Xia R. Long non-coding RNA LINC01003 suppresses the development of multiple myeloma by targeting miR-33a-5p/PIM1 axis. Leuk Res 2021; 106:106565. [PMID: 33865032 DOI: 10.1016/j.leukres.2021.106565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Numerous long non-coding RNAs (lncRNAs) are reported to affect the progression of multiple myeloma (MM). This study is aimed to explore the role and downstream mechanism of lncRNA LINC01003 in MM. MATERIALS AND METHODS Xenograft tumor assay was used to assess the function of LINC01003 in MM in vivo. The mRNA expression levels of LINC01003, miR-33a-5p, and PIM1 were determined by quantitative real-time polymerase chain reaction. Cell viability was examined by MTT assay. Relative protein levels of apoptosis-related factors (Bcl-2 and Bax) and proviral integration site of the Moloney leukemia virus kinase 1 (PIM1) were detected via western blot. Adhesion-related proteins were measured by Enzyme-linked immunosorbent assay was used to determine the levels of adhesion-related proteins. Besides, the target relation among LINC01003, miR-33a-5p and PIM1 was tested via dual-luciferase reporter assay. RESULTS Low expression of LINC01003 was observed in MM cell lines and peripheral blood samples of MM patients. Both LINC01003 up-regulation and miR-33a-5p down-regulation repressed cell viability and adhesion, and promoted apoptosis of MM cells. Moreover, LINC01003 suppressed the growth of xenograft tumor in mice. We then identified miR-33a-5p as a downstream target of LINC01003, and confirmed that PIM1 was a direct target gene of miR-33a-5p. Both high expression of miR-33a-5p and low expression of PIM1 reversed the suppressive effects of LINC01003 overexpression on cell adhesion and viability, and the promoting effect on apoptosis in MM cells. CONCLUSION LINC01003 functioned as a sponge of miR-33a-5p to inhibit the development MM by regulating PIM1 expression.
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Affiliation(s)
- Linlin Wu
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, No. 218, Jixi Road, Shushan District, Hefei City, Anhui Province, 230032, China
| | - Liang Xia
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, No. 218, Jixi Road, Shushan District, Hefei City, Anhui Province, 230032, China
| | - Xiaowen Chen
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, No. 218, Jixi Road, Shushan District, Hefei City, Anhui Province, 230032, China
| | - Min Ruan
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, No. 218, Jixi Road, Shushan District, Hefei City, Anhui Province, 230032, China
| | - Lingling Li
- Department of Hematology of Anhui No.2 Provincial People's Hospital, No. 1868, Dangshan Road, Hefei City, Anhui Province, 230041, China
| | - Ruixiang Xia
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, No. 218, Jixi Road, Shushan District, Hefei City, Anhui Province, 230032, China.
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Improving outcomes for patients with relapsed multiple myeloma: Challenges and considerations of current and emerging treatment options. Blood Rev 2021; 49:100808. [PMID: 33863601 DOI: 10.1016/j.blre.2021.100808] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/22/2020] [Accepted: 01/29/2021] [Indexed: 01/23/2023]
Abstract
Despite the recent introduction of new therapies for multiple myeloma (MM), it remains an incurable disease. As MM progresses, patients experience cycles of relapse and remission, with remission periods becoming increasingly shorter as the disease becomes less treatment-sensitive. The treatment of relapsed refractory MM (RRMM) remains a significant clinical challenge. Patients with RRMM are a highly heterogeneous group and choosing the most appropriate treatment requires careful consideration. Furthermore, the number of treatment options for MM is continually growing with no definitive consensus to guide treating clinicians. The emergence of second-generation proteasome inhibitors (e.g., carfilzomib and ixazomib), immunomodulatory drugs (e.g., pomalidomide) and monoclonal antibodies (e.g., isatuximab) has expanded an already complex treatment landscape. This review provides a clear summary of the available treatments for MM and discusses how to tailor treatments to individual patients' needs. Novel treatments currently under clinical development, including venetoclax, melflufen and CAR T-cell therapies, are also discussed.
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Narayan R, Galligan D, Lazar AA, Kim S, Fong R, Tan M, Lo M, Arora S, Shah N, Wong SW, Martin T, Wolf J. Modified Hyper-CVAD With Proteasome Inhibition for Multiple Myeloma: A Single-Center Retrospective Analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e961-e985. [DOI: 10.1016/j.clml.2020.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 12/28/2022]
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9
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Ainley L, Chavda SJ, Counsell N, Cheesman S, Newrick F, Horder J, Kyriakou C, Papanikolaou X, Sive J, Lee L, Wechalekar A, Mehta A, Popat R, Rabin N, Yong K. DT-PACE/ESHAP chemotherapy regimens as salvage therapy for multiple myeloma prior to autologous stem cell transplantation. Br J Haematol 2020; 192:e73-e77. [PMID: 33236352 DOI: 10.1111/bjh.17248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Louise Ainley
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | | | | | - Simon Cheesman
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Fiona Newrick
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Jackie Horder
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Charalampia Kyriakou
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Xenofon Papanikolaou
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Jonathan Sive
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Lydia Lee
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Ashutosh Wechalekar
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Atul Mehta
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Rakesh Popat
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Neil Rabin
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK
| | - Kwee Yong
- Department of Haematology, University College London Hospitals NHS Foundation Trusts, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
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Wang Y, Lin Q, Song C, Ma R, Li X. Circ_0007841 promotes the progression of multiple myeloma through targeting miR-338-3p/BRD4 signaling cascade. Cancer Cell Int 2020; 20:383. [PMID: 32782441 PMCID: PMC7414763 DOI: 10.1186/s12935-020-01475-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/01/2020] [Indexed: 12/11/2022] Open
Abstract
Background The pathogenesis of multiple myeloma (MM) is not completely known. Uncovering the potential mechanism of MM initiation and progression is essential for identifying novel diagnostic and therapeutic targets. Herein, we explored the function and the working mechanism of circular RNA circ_0007841 in MM progression. Methods Quantitative real-time polymerase chain reaction (qRT-PCR) was employed to detect the expression of circ_0007841, microRNA-338-3p (miR-338-3p) and bromodomain containing 4 (BRD4). Cell proliferation ability was analyzed through cell counting kit-8 (CCK8) assay, colony formation assay and flow cytometry. Transwell assays were conducted to measure the migration and invasion abilities of MM cells. Cell apoptosis was also assessed by flow cytometry. The interaction between miR-338-3p and circ_0007841 or BRD4 was confirmed by dual-luciferase reporter assay and RNA-pull down assay. Results Circ_0007841 was highly expressed in bone marrow (BM)-derived plasma cells of MM patients and MM cell lines than that in healthy volunteers and normal plasma cell line nPCs. Circ_0007841 promoted the proliferation, cell cycle and metastasis and impeded the apoptosis of MM cells. miR-338-3p was a direct target of circ_0007841 in MM cells and circ_0007841 accelerated the progression of MM through targeting miR-338-3p. BRD4 could directly bind to miR-338-3p in MM cells and miR-338-3p exerted an anti-tumor role through targeting BRD4. Circ_0007841 promoted the activation of PI3K/AKT signaling via miR-338-3p/BRD4 axis. Exosomes generated from mesenchymal stromal cells (MSCs) elevated the malignant behaviors of MM cells via circ_0007841. Conclusion Circ_0007841 acted as an oncogene to promote the proliferation, cell cycle and motility and restrain the apoptosis of MM cells through sequestering miR-338-3p to up-regulate the expression of BRD4.
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Affiliation(s)
- Yan Wang
- Department of Hematology, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Kangfuqian Street, Zhengzhou, 450052 Henan China
| | - Quande Lin
- Department of Hematology, Henan Cancer Hospital, Zhengzhou, 450052 Henan China
| | - Chunge Song
- Department of Hematology, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Kangfuqian Street, Zhengzhou, 450052 Henan China
| | - Ruojin Ma
- Department of Hematology, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Kangfuqian Street, Zhengzhou, 450052 Henan China
| | - Xiaojie Li
- Department of Hematology, The Fifth Affiliated Hospital of Zhengzhou University, No.3 Kangfuqian Street, Zhengzhou, 450052 Henan China
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Djebbari F, De Abrew K, Salhan B, Panitsas F, Hossain MI, Eyre TA, Willan J, Ramasamy K, Basu S, Jenner M, Kothari J. DPACE‐based chemotherapy in the era of myeloma novel agents: A UK multicentre study. Eur J Haematol 2020; 105:231-233. [DOI: 10.1111/ejh.13422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Faouzi Djebbari
- Department of Clinical Haematology Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Kanchana De Abrew
- Department of Haematology University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Beena Salhan
- Department of Haematology Royal Wolverhampton NHS Trust Wolverhampton UK
| | - Fotios Panitsas
- Department of Clinical Haematology Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Md Imran Hossain
- Department of Haematology Royal Wolverhampton NHS Trust Wolverhampton UK
| | - Toby A Eyre
- Department of Clinical Haematology Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - John Willan
- Department of Clinical Haematology Oxford University Hospitals NHS Foundation Trust Oxford UK
- Department of Haematology Wexham Park Hospital Slough UK
| | - Karthik Ramasamy
- Department of Clinical Haematology Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Supratik Basu
- Department of Haematology Royal Wolverhampton NHS Trust Wolverhampton UK
- University of Wolverhampton Wolverhampton UK
| | - Matthew Jenner
- Department of Haematology University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Jaimal Kothari
- Department of Clinical Haematology Oxford University Hospitals NHS Foundation Trust Oxford UK
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DCEP and bendamustine/prednisone as salvage therapy for quad- and penta-refractory multiple myeloma. Ann Hematol 2020; 99:1041-1048. [PMID: 32130471 DOI: 10.1007/s00277-020-03970-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 02/18/2020] [Indexed: 12/18/2022]
Abstract
Multiple myeloma (MM) almost invariably progresses through novel therapies. Patients with quad-refractory MM (refractory to bortezomib, carfilzomib, lenalidomide, and pomalidomide) and penta-refractory MM (additional refractoriness to daratumumab) have few treatment options. Two chemotherapy regimens, bendamustine/prednisone (BP) and dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP), are often used in quad- and penta-refractory MM, but there are limited data on outcomes in this heavily pre-treated population. We conducted a single-center retrospective study to identify all patients who received DCEP and/or BP for quad- or penta-refractory MM. Disease response and refractoriness were defined by International Myeloma Working Group criteria. The primary endpoint was overall response rate (ORR). Secondary endpoints included overall survival (OS), progression-free survival (PFS), and duration of response (DOR). We identified 27 patients who received BP for quad- or penta-refractory MM. The median number of prior lines of therapy was 6. The ORR for BP was 26%. The median PFS for BP was 1.4 months (95% CI 1.1-1.6) and median OS was 8.7 months (95% CI 2.3-15.0). Patients treated with cyclophosphamide had less response to BP. Thirty-one patients received DCEP for quad-refractory or penta-refractory MM. The median number of prior treatment regimens was 8. The ORR to DCEP was 35%. The median PFS was 2.7 months (95% CI 1.5-3.8) and median OS was 6.2 months (95% CI 4.4-7.8). DCEP and BP retain efficacy in quad- and penta-refractory MM. Our analysis supports prospective study of these regimens, possibly in combination or in comparison with other agents in this area of unmet need.
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Deng M, Yuan H, Liu S, Hu Z, Xiao H. Exosome-transmitted LINC00461 promotes multiple myeloma cell proliferation and suppresses apoptosis by modulating microRNA/BCL-2 expression. Cytotherapy 2019; 21:96-106. [DOI: 10.1016/j.jcyt.2018.10.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/05/2018] [Accepted: 10/07/2018] [Indexed: 02/06/2023]
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