1
|
Ramdany H, Lofaro T, Deplano S. The Haemato-Oncology Frailty (HOF) score to assess frailty in lymphoma. Eur J Haematol 2024; 112:611-620. [PMID: 38112247 DOI: 10.1111/ejh.14152] [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: 10/23/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
Morbidity and mortality during chemotherapy in older adults with haematological malignancy can be unpredictable. The Haemato-Oncology Frailty (HOF) score was previously found to predict outcomes in a cohort of patients with plasma cell myeloma. In this study, we assess its utility in assessing frailty in patients with lymphoma, and compare its performance to that of two other frailty scores. The HOF score was able to predict progression-free survival in this population, and was also shown to have potential in assessing the dynamism of frailty during chemotherapy. It performed well when compared to the Charlson Comorbidity Index (CCI) score and the Haematopoietic Cell Transplantation-Specific Comorbidity Index (HCTCI), although the study was not powered to assess for non-inferiority. The HOF score is a new score with the potential for application in different haematological malignancies.
Collapse
Affiliation(s)
- Hena Ramdany
- Imperial College London, Isle of Wight NHS Trust, Newport, UK
| | | | | |
Collapse
|
2
|
Rana PS, Goparaju K, Driscoll JJ. Shutting off the fuel supply to target metabolic vulnerabilities in multiple myeloma. Front Oncol 2023; 13:1141851. [PMID: 37361580 PMCID: PMC10285382 DOI: 10.3389/fonc.2023.1141851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/18/2023] [Indexed: 06/28/2023] Open
Abstract
Pathways that govern cellular bioenergetics are deregulated in tumor cells and represent a hallmark of cancer. Tumor cells have the capacity to reprogram pathways that control nutrient acquisition, anabolism and catabolism to enhance their growth and survival. Tumorigenesis requires the autonomous reprogramming of key metabolic pathways that obtain, generate and produce metabolites from a nutrient-deprived tumor microenvironment to meet the increased bioenergetic demands of cancer cells. Intra- and extracellular factors also have a profound effect on gene expression to drive metabolic pathway reprogramming in not only cancer cells but also surrounding cell types that contribute to anti-tumor immunity. Despite a vast amount of genetic and histologic heterogeneity within and between cancer types, a finite set of pathways are commonly deregulated to support anabolism, catabolism and redox balance. Multiple myeloma (MM) is the second most common hematologic malignancy in adults and remains incurable in the vast majority of patients. Genetic events and the hypoxic bone marrow milieu deregulate glycolysis, glutaminolysis and fatty acid synthesis in MM cells to promote their proliferation, survival, metastasis, drug resistance and evasion of immunosurveillance. Here, we discuss mechanisms that disrupt metabolic pathways in MM cells to support the development of therapeutic resistance and thwart the effects of anti-myeloma immunity. A better understanding of the events that reprogram metabolism in myeloma and immune cells may reveal unforeseen vulnerabilities and advance the rational design of drug cocktails that improve patient survival.
Collapse
Affiliation(s)
- Priyanka S. Rana
- Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Immune Oncology Program, Case Comprehensive Cancer Center, Cleveland, OH, United States
| | - Krishna Goparaju
- Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - James J. Driscoll
- Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Immune Oncology Program, Case Comprehensive Cancer Center, Cleveland, OH, United States
- Adult Hematologic Malignancies & Stem Cell Transplant Section, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| |
Collapse
|
3
|
Huynh L, Birsen R, Mora L, Couderc AL, Mitha N, Farcet A, Chebib A, Chaibi P. Multiple Myeloma in Patients over 80: A Real World Retrospective Study of First Line Conservative Approach with Bortezomib Dexamethasone Doublet Therapy and Mini-Review of Literature. Cancers (Basel) 2022; 14:cancers14194741. [PMID: 36230662 PMCID: PMC9564122 DOI: 10.3390/cancers14194741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Data on octogenarian patients with MM are scarce, and optimal management remains controversial. We report a retrospective cohort of unselected octogenarian patients with NDMM treated with bortezomib dexamethasone (Vd). Seventy-four patients were treated with an initial doublet therapy (Vd regimen, 2−3 cycles, induction). A dose escalation with an adjunction of melphalan or cyclophosphamide was proposed for patients who had an insufficient response after induction and who could tolerate it. In responders, the treatment was continued until progression or a plateau response for 6 months (consolidation). The overall response rate was 73%. After a median follow-up of 31.4 months, median progression-free survival (PFS) and overall survival (OS) were 13.2 and 26.9 months, respectively. PFS and OS of patients with ECOG PS < 3 (25.4 and 54.9 months, respectively) were better in comparison to PFS and OS of patients with ECOG PS ≥ 3 (9.3 and 11.3 months, respectively). Thirteen patients (17.6%) died during induction. Twelve patients (16.2%) died during consolidation. In conclusion, a conservative therapeutic strategy based on Vd resulted in a good response rate. However, the survival remains poor in the population of patients with an ECOG PS ≥ 3, mainly because of early mortality not related to progressive disease.
Collapse
Affiliation(s)
- Laurence Huynh
- Service d’Hématologie et Oncologie Gériatrique, Hôpital Charles Foix, APHP, 94200 Ivry Sur Seine, France
- Correspondence:
| | - Rudy Birsen
- Service d’Hématologie, Hôpital Cochin, APHP, Université de Paris Cité, 75014 Paris, France
| | - Lucie Mora
- Service d’Hématologie et Oncologie Gériatrique, Hôpital Charles Foix, APHP, 94200 Ivry Sur Seine, France
| | - Anne-Laure Couderc
- Service d’Hématologie et Oncologie Gériatrique, Hôpital Charles Foix, APHP, 94200 Ivry Sur Seine, France
| | - Nathalie Mitha
- Service d’Hématologie et Oncologie Gériatrique, Hôpital Charles Foix, APHP, 94200 Ivry Sur Seine, France
| | - Anaïs Farcet
- Service d’Hématologie et Oncologie Gériatrique, Hôpital Charles Foix, APHP, 94200 Ivry Sur Seine, France
| | - Amale Chebib
- Service d’Hématologie et Oncologie Gériatrique, Hôpital Charles Foix, APHP, 94200 Ivry Sur Seine, France
| | - Pascal Chaibi
- Service d’Hématologie et Oncologie Gériatrique, Hôpital Charles Foix, APHP, 94200 Ivry Sur Seine, France
| |
Collapse
|
4
|
Gavriatopoulou M, Malandrakis P, Ntanasis-Stathopoulos I, Dimopoulos MA. Non-selective proteasome inhibitors in multiple myeloma and future perspectives. Expert Opin Pharmacother 2021; 23:335-347. [PMID: 34761710 DOI: 10.1080/14656566.2021.1999411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION : The ubiquitination system is the most important cascade of protein degradation independently of lysosomal function. The proteasome system is actively involved in cell cycle regulation. Therefore, proteasome inhibition can lead to inhibition of tumor cell proliferation, and therefore it constitutes a potential therapeutic anticancer approach especially in the therapeutic algorithm of patients with multiple myeloma. AREAS COVERED Three different proteasome inhibitors are currently approved, bortezomib, carfilzomib and ixazomib, and they have been investigated in multiple myeloma and other hematological malignancies. Multiple myeloma cells are extremely sensitive to this inhibition which leads to accumulation of proteins and endoplasmic reticulum stress, leading finally to apoptosis. However, these agents lack specificity, since they target both the constitutive proteasome and the immunoproteasome. Targeting the constitutive proteasome is the main reason for side toxicity due to the effect on normal tissues. In contrary, immunoproteasome inhibition may reduce the adverse events while maintaining the therapeutic efficacy. In this review the authors present the role of the available proteasome inhibitors in myeloma therapeutics and future perspectives of both selective and non-selective proteasome inhibitors. EXPERT OPINION The available non-selective proteasome inhibitors have changed the therapeutics of multiple myeloma the last 10 years and have significantly improved the clinical outcomes of the patients. Furthermore, selective proteasome inhibitors are now under preclinical investigation and there is hope that their optimization will come with an improved safety profile with at least comparable efficacy.
Collapse
Affiliation(s)
- Maria Gavriatopoulou
- Plasma cell dyscrasias unit, Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Malandrakis
- Plasma cell dyscrasias unit, Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Plasma cell dyscrasias unit, Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios Athanasios Dimopoulos
- Plasma cell dyscrasias unit, Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
5
|
Metabolic Disorders in Multiple Myeloma. Int J Mol Sci 2021; 22:ijms222111430. [PMID: 34768861 PMCID: PMC8584036 DOI: 10.3390/ijms222111430] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple myeloma (MM) is the second most common hematological malignancy and is attributed to monoclonal proliferation of plasma cells in the bone marrow. Cancer cells including myeloma cells deregulate metabolic pathways to ensure proliferation, growth, survival and avoid immune surveillance, with glycolysis and glutaminolysis being the most identified procedures involved. These disorders are considered a hallmark of cancer and the alterations performed ensure that enough energy is available for rapid cell proliferation. An association between metabolic syndrome, inflammatory cytokinesand incidence of MM has been also described, while the use of metformin and statins has been identified as a positive prognostic factor for the disease course. In this review, we aim to present the metabolic disorders that occur in multiple myeloma, the potential defects on the immune system and the potential advantage of targeting the dysregulated pathways in order to enhance antitumor therapeutics.
Collapse
|
6
|
Stege CAM, Nasserinejad K, Klein SK, Timmers GJ, Hoogendoorn M, Ypma PF, Nijhof IS, Velders GA, Strobbe L, Durdu-Rayman N, Westerman M, Davidis-van Schoonhoven MA, van Kampen RJW, Beeker A, Koster A, Dijk AC, van de Donk NWCJ, van der Spek E, Leys RBL, Silbermann MH, Groen K, van der Burg-de Graauw NCHP, Sinnige HAM, van der Hem KG, Levenga H, Bilgin YM, Sonneveld P, Levin MD, Zweegman S. Improving the identification of frail elderly newly diagnosed multiple myeloma patients. Leukemia 2021; 35:2715-2719. [PMID: 33589752 DOI: 10.1038/s41375-021-01162-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/12/2021] [Accepted: 01/26/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Claudia A M Stege
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Kazem Nasserinejad
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Saskia K Klein
- Department of Internal Medicine, Meander Medical Center, Amersfoort, the Netherlands.,Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | - Gert-Jan Timmers
- Department of Internal Medicine, Amstelland Hospital, Amstelveen, the Netherlands
| | - Mels Hoogendoorn
- Department of Hematology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Paula F Ypma
- Department of Hematology, Haga Hospital, The Hague, the Netherlands
| | - Inger S Nijhof
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Gerjo A Velders
- Department of Internal Medicine, Ziekenhuis Gelderse Vallei, Ede, the Netherlands
| | - Leonie Strobbe
- Department of Internal Medicine, Gelre Hospital, Zutphen, the Netherlands
| | - Nazik Durdu-Rayman
- Department of Internal Medicine-Hematology, Franciscus Hospital location Vlietland, Schiedam, the Netherlands
| | - Matthijs Westerman
- Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | | | - Roel J W van Kampen
- Department of Internal Medicine/Hematology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - Aart Beeker
- Department of Internal Medicine, MBA Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Ad Koster
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Amanda C Dijk
- Department of Internal Medicine, St Jansdal Hospital, Harderwijk, the Netherlands
| | - Niels W C J van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Ellen van der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Rineke B L Leys
- Department of Hematology and Oncology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | | | - Kaz Groen
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Harm A M Sinnige
- Department of Internal Medicine, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, the Netherlands
| | - Klaas G van der Hem
- Department of Internal Medicine, Zaans Medical Center, Zaandam, the Netherlands
| | - Henriette Levenga
- Department of Internal Medicine, Groene Hart Hospital, Gouda, the Netherlands
| | - Yavuz M Bilgin
- Department of Internal Medicine, Admiraal de Ruijter Hospital, Goes, the Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
7
|
Malandrakis P, Ntanasis-Stathopoulos I, Gavriatopoulou M, Terpos E. Clinical Utility of Selinexor/Dexamethasone in Patients with Relapsed or Refractory Multiple Myeloma: A Review of Current Evidence and Patient Selection. Onco Targets Ther 2020; 13:6405-6416. [PMID: 32669858 PMCID: PMC7335864 DOI: 10.2147/ott.s227166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/21/2020] [Indexed: 12/11/2022] Open
Abstract
Multiple myeloma (MM) is one the most common hematological malignancies, and despite the survival prolongation offered by proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs) and anti-CD38 monoclonal antibodies, the need for novel agents is prominent. Selinexor is a first-in-class, oral, selective inhibitor of exportin-1 (XPO1), a vital protein for the exportation of more than 200 tumor suppressor proteins from the nucleus. Both in solid tumors and hematologic malignancies, selinexor-mediated inhibition of nucleus export seems to effectively lead to cancer cell death. Selinexor in combination with dexamethasone (Sd) received an accelerated FDA approval on July 2019 for heavily pretreated patients with relapsed/refractory MM (RRMM) based on the promising results of the Phase II STORM trial. The preliminary results of the randomized Phase III BOSTON trial have shown a 47% increase in progression-free survival among PI-sensitive, RRMM patients who received selinexor with bortezomib-dexamethasone compared with bortezomib-dexamethasone alone. Several different selinexor-containing triplet regimens are currently being tested in the RRMM setting in an umbrella trial, and the preliminary results seem promising. Furthermore, the addition of selinexor in other anti-myeloma agents seems to overcome drug-acquired resistance in preclinical studies. The main toxicities of selinexor are gastrointestinal disorders and hematologic toxicities (mainly thrombocytopenia); however, they are manageable with proper supportive measures. In conclusion, selinexor is a new anti-myeloma drug that seems to be effective in patients who have no other therapeutic options, including patients who have received novel cellular therapies such as CAR-T cells. Its potential role earlier in the therapeutic algorithm of MM is currently under clinical investigation.
Collapse
Affiliation(s)
- Panagiotis Malandrakis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
8
|
Scheepers ERM, Vondeling AM, Thielen N, van der Griend R, Stauder R, Hamaker ME. Geriatric assessment in older patients with a hematologic malignancy: a systematic review. Haematologica 2020; 105:1484-1493. [PMID: 32381581 PMCID: PMC7271571 DOI: 10.3324/haematol.2019.245803] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/02/2020] [Indexed: 12/27/2022] Open
Abstract
The aim of this systematic review is to give an update of all currently available evidence on the relevance of a geriatric assessment in the treatment of older patients with hematologic malignancies. A systematic search in MEDLINE and EMBASE was performed to find studies in which a geriatric assessment was used to detect impaired geriatric domains or to address the association between geriatric assessment and survival or clinical outcome measures. The literature search included 4,629 reports, of which 54 publications from 44 studies were included. Seventy-three percent of the studies were published in the last 5 years. The median age of the patients was 73 years (range, 58-86) and 71% had a good World Health Organization (WHO) performance status. The median prevalence of geriatric impairments varied between 17% and 68%, even in patients with a good WHO performance status. Polypharmacy, nutritional status and instrumental activities of daily living were most frequently impaired. Whereas several geriatric impairments and frailty (based on a frailty screening tool or summarized geriatric assessment score) were predictive for a shorter overall survival, WHO performance status lost its predictive value in most studies. The association between geriatric impairments and treatment-related toxicity varied, with a trend towards a higher risk of (non-)hematologic toxicity in frail patients. During the follow-up, frailty seemed to be associated with treatment non-completion, especially when patients were malnourished. Patients with a good physical capacity had a shorter stay in hospital and a lower rate of hospitalization. Geriatric assessment, even in patients with a good performance status, can detect impaired geriatric domains and these impairments may be predictive of mortality. Moreover, geriatric impairments suggest a higher risk of treatment-related toxicity, treatment non-completion and use of healthcare services. A geriatric assessment should be considered before starting treatment in older patients with hematologic malignancies.
Collapse
Affiliation(s)
- Ellen R M Scheepers
- Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Ariel M Vondeling
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Noortje Thielen
- Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - René van der Griend
- Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| |
Collapse
|