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Mele G, Derudas D, Conticello C, Barilà G, Gentile M, Rocco S, Palmieri S, Palazzo G, Germano C, Reddiconto G, Sgherza N, De Novellis D, Galeone C, Castiglioni SA, Deiana L, Pascarella A, Martino EA, Foggetti I, Blasi I, Spina A, Di Renzo N, Maggi A, Tarantini G, Di Raimondo F, Specchia G, Musto P, Pastore D. Daratumumab-based regimens for patients with multiple myeloma plus extramedullary plasmacytomas or paraskeletal plasmacytomas: initial follow-up of an Italian multicenter observational clinical experience. Ann Hematol 2024:10.1007/s00277-024-05811-y. [PMID: 38805036 DOI: 10.1007/s00277-024-05811-y] [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: 12/26/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
Myeloma with extramedullary plasmacytomas not adjacent to bone (EMP) is associated with an extremely poor outcome compared with paraosseous plasmacytomas (PP) as current therapeutic approaches are unsatisfactory. The role of new molecules and in particular of monoclonal antibodies is under investigation. To determine whether daratumumab-based regimens are effective for myeloma with EMP, we report herein an initial multicenter observational analysis of 102 myeloma patients with EMP (n = 10) and PP (n = 25) at diagnosis and EMP (n = 28) and PP (n = 39) at relapse, treated with daratumumab-based regimens at 11 Haematological Centers in Italy.EMP and PP at diagnosis were associated with higher biochemical (90% vs. 96%, respectively) and instrumental ORR (86% vs. 83.3%, respectively), while at relapse, biochemical (74% vs. 73%) and instrumental (53% vs. 59%) ORR were lower. Median OS was inferior in EMP patients compared with patients with PP both at diagnosis (21.0 months vs. NR) (p = 0.005) and at relapse (32.0 vs. 40.0 months) (p = 0.428), although, during relapse, there was no statistically significant difference between the two groups. Surprisingly, at diagnosis, median TTP and median TTNT were not reached either in EMP patients or PP patients and during relapse there were no statistically significant differences in terms of median TTP (20 months for two groups), and median TTNT (24 months for PP patients vs. 22 months for EMP patients) between the two groups. Median TTR was 1 month in all populations.These promising results were documented even in the absence of local radiotherapy and in transplant-ineligible patients.
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Affiliation(s)
| | - Daniele Derudas
- Haematology, Ospedale Oncologico A. Businco, Cagliari, Italy
| | - Concetta Conticello
- Haematology, AOU Policlinico G. Rodolico-San Marco, Università degli Studi di Catania, Catania, Italy
| | - Gregorio Barilà
- Haematology, Ospedale San Bortolo, Vicenza, Italy
- Haematology, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | | | | | | | | | - Candida Germano
- Haematology, Ospedale Monsignor R. Dimiccoli, Barletta, BA, Italy
| | | | - Nicola Sgherza
- Haematology, AOU Consorziale Policlinico, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Danilo De Novellis
- Haematology, Ospedale Universitario San Giovanni di Dio e Ruggi D'Aragona, Università degli Studi di Salerno, Salerno, Italy
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Sara Agavni' Castiglioni
- Department of Statistical Sciences, Università degli Studi di Padova, National Cancer Institute of the National Institutes of Health (U24CA180996), Padova, Italy
| | - Luca Deiana
- Haematology, Ospedale Oncologico A. Businco, Cagliari, Italy
| | | | | | | | - Ilenia Blasi
- Haematology, Ospedale A. Perrino, Brindisi, Italy
| | | | | | | | | | - Francesco Di Raimondo
- Haematology, AOU Policlinico G. Rodolico-San Marco, Università degli Studi di Catania, Catania, Italy
| | - Giorgina Specchia
- Haematology, AOU Consorziale Policlinico, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Pellegrino Musto
- Haematology, AOU Consorziale Policlinico, Università degli Studi di Bari "Aldo Moro", Bari, Italy
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Ríos-Tamayo R, Soler JA, García-Sánchez R, Pérez Persona E, Arnao M, García-Guiñón A, Domingo A, González-Pardo M, de la Rubia J, Mateos MV. A glimpse into relapsed refractory multiple myeloma treatment in real-world practice in Spain: the GeminiS study. Hematology 2023; 28:2178997. [PMID: 36803194 DOI: 10.1080/16078454.2023.2178997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES To describe the incorporation of monoclonal antibodies (mAb) in real-world (RW) practice for the treatment of patients with relapsed refractory multiple myeloma (RRMM) in a setting with other treatment alternatives. METHODS This was an observational, multicenter, ambispective study of RRMM treated with or without a mAb. RESULTS A total of 171 patients were included. For the group treated without mAb, the median (95% CI) progression-free survival (PFS) to relapse was 22.4 (17.8-27.0) months; partial response or better (≥PR) and complete response or better (≥CR) was observed in 74.1% and 24.1% of patients, respectively; and median time to first response in first relapse was 2.0 months and in second relapse was 2.5 months. For the group of patients treated with mAb in first or second relapse, the median PFS was 20.9 (95% CI, could not be evaluated) months; the ≥ PR and ≥ CR rates were 76,2% and 28.6%, respectively; and the median time to first response in first relapse was 1.2 month and in second relapse was 1.0 months. The safety profiles for the combinations were consistent with those expected. CONCLUSIONS The incorporation of mAb in RW practice for the treatment of RRMM has shown good quality and speed of response with a similar safety profile shown in randomized clinical trials.
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Affiliation(s)
- Rafael Ríos-Tamayo
- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Juan Alfons Soler
- Department of Hematology, Hospital Universitari Parc Taulí de Sabadell, Catalonia, Spain
| | | | | | - Mario Arnao
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Antoni García-Guiñón
- Department of Hematology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Abel Domingo
- Department of Hematology, Hospital General de Granollers, Spain
| | | | - Javier de la Rubia
- Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Department, Universidad Católica "San Vicente Mártir", Valencia, Spain.,CIBERONC CB16/12/00284, Valencia, Spain
| | - María Victoria Mateos
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cancer (IBMCC-USAL, CSIC), Hospital Universitario de Salamanca, Salamanca, Spain
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- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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3
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Fazio M, Del Fabro V, Parrinello NL, Allegra A, Markovic U, Botta C, Accardi F, Vincelli ID, Leotta S, Elia F, Esposito B, Garibaldi B, Sapuppo G, Orofino A, Romano A, Palumbo GA, Di Raimondo F, Conticello C. Multiple Myeloma in 2023 Ways: From Trials to Real Life. Curr Oncol 2023; 30:9710-9733. [PMID: 37999125 PMCID: PMC10670159 DOI: 10.3390/curroncol30110705] [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: 09/30/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
Multiple myeloma is a chronic hematologic malignancy that obstinately tends to relapse. Basic research has made giant strides in better characterizing the molecular mechanisms of the disease. The results have led to the manufacturing of new, revolutionary drugs which have been widely tested in clinical trials. These drugs have been approved and are now part of the therapeutic armamentarium. As a consequence, it is essential to combine what we know from clinical trials with real-world data in order to improve therapeutic strategies. Starting with this premise, our review aims to describe the currently employed regimens in multiple myeloma and compare clinical trials with real-life experiences. We also intend to put a spotlight on promising therapies such as T-cell engagers and chimeric antigen receptor T-cells (CAR-T) which are proving to be effective in changing the course of advanced-stage disease.
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Affiliation(s)
- Manlio Fazio
- Post-Graduation School of Haematology, University of Catania, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (M.F.); (B.E.); (B.G.); (G.S.); (A.O.); (F.D.R.)
| | - Vittorio Del Fabro
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
| | - Nunziatina Laura Parrinello
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
| | - Alessandro Allegra
- Division of Haematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, 98125 Messina, Italy;
| | - Uroš Markovic
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
| | - Cirino Botta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy;
| | - Fabrizio Accardi
- Department of Hematology I, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, 90146 Palermo, Italy;
| | - Iolanda Donatella Vincelli
- Haematology Unit, Haemato-Oncology and Radiotherapy Department, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, 89124 Reggio Calabria, Italy;
| | - Salvatore Leotta
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
| | - Federica Elia
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
| | - Benedetta Esposito
- Post-Graduation School of Haematology, University of Catania, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (M.F.); (B.E.); (B.G.); (G.S.); (A.O.); (F.D.R.)
| | - Bruno Garibaldi
- Post-Graduation School of Haematology, University of Catania, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (M.F.); (B.E.); (B.G.); (G.S.); (A.O.); (F.D.R.)
| | - Gabriele Sapuppo
- Post-Graduation School of Haematology, University of Catania, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (M.F.); (B.E.); (B.G.); (G.S.); (A.O.); (F.D.R.)
| | - Alessandra Orofino
- Post-Graduation School of Haematology, University of Catania, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (M.F.); (B.E.); (B.G.); (G.S.); (A.O.); (F.D.R.)
| | - Alessandra Romano
- Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, Sezione di Ematologia, Università degli Studi di Catania, 95131 Catania, Italy;
| | - Giuseppe A. Palumbo
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate “G.F.Ingrassia”, University of Catania, 95131 Catania, Italy;
| | - Francesco Di Raimondo
- Post-Graduation School of Haematology, University of Catania, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (M.F.); (B.E.); (B.G.); (G.S.); (A.O.); (F.D.R.)
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
- Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, Sezione di Ematologia, Università degli Studi di Catania, 95131 Catania, Italy;
| | - Concetta Conticello
- Division of Haematology and BMT, A.O.U. ‘Policlinico-San Marco’, 95123 Catania, Italy; (V.D.F.); (N.L.P.); (U.M.); (S.L.); (F.E.)
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Stork M, Spicka I, Radocha J, Minarik J, Jelinek T, Jungova A, Pavlicek P, Pospisilova L, Sedlak F, Straub J, Pika T, Knechtova Z, Fidrichova A, Boichuk I, Sevcikova S, Maisnar V, Hajek R, Pour L. Daratumumab with lenalidomide and dexamethasone in relapsed or refractory multiple myeloma patients - real world evidence analysis. Ann Hematol 2023; 102:1501-1511. [PMID: 37088816 PMCID: PMC10182121 DOI: 10.1007/s00277-023-05188-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 04/25/2023]
Abstract
We performed real world evidence (RWE) analysis of daratumumab, lenalidomide and dexamethasone (Dara-Rd) versus lenalidomide and dexamethasone (Rd) treatment in relapsed/refractory multiple myeloma patients (RRMM). In total, 240 RRMM patients were treated with Dara-Rd from 2016 to 2022 outside of clinical trials in all major Czech hematology centers. As a reference, 531 RRMM patients treated with Rd were evaluated. Patients' data were recorded in the Czech Registry of Monoclonal Gammopathies (RMG). Partial response (PR) or better response (ORR) was achieved in significantly more patients in Dara-Rd than in Rd group (91.2% vs. 69.9%; p < 0.001). The median progression free survival (PFS) was 26.9 months in the Dara-Rd and 12.8 months in the Rd group (p < 0.001). Median overall survival (OS) was not reached in the Dara-Rd compared to 27.2 months in the Rd group (p = 0.023). In patients with 1-3 previous treatment lines, there was significant PFS benefit of Dara-Rd compared to Rd (median PFS not reached vs. 13.2 months; p < 0.001). In patients with > 3 previous treatment lines, there was no significant PFS benefit of Dara-Rd treatment (7.8 months vs. 9.9 months; p = 0.874), similarly in patients refractory to PI + IMIDs (11.5 months vs. 9.2 months; p = 0.376). In RWE conditions, the median PFS in RRMM patients treated with Dara-Rd is shorter when compared to clinical trials. In heavily pretreated RRMM patients, efficacy of Dara-Rd treatment is limited; best possible outcomes of Dara-Rd are achieved in minimally pretreated patients.
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Affiliation(s)
- Martin Stork
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Ivan Spicka
- 1st Medical Department - Clinical Department of Hematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jakub Radocha
- 4th Department of Medicine - Hematology, Faculty of Medicine, Charles University Hospital, Hradec Kralove, Czech Republic
| | - Jiri Minarik
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic
| | - Tomas Jelinek
- Department of Hematooncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Alexandra Jungova
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Petr Pavlicek
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | - Frantisek Sedlak
- 1st Medical Department - Clinical Department of Hematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jan Straub
- 1st Medical Department - Clinical Department of Hematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Tomas Pika
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic
| | - Zdenka Knechtova
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Anna Fidrichova
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Ivanna Boichuk
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Sabina Sevcikova
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vladimir Maisnar
- 4th Department of Medicine - Hematology, Faculty of Medicine, Charles University Hospital, Hradec Kralove, Czech Republic
| | - Roman Hajek
- Department of Hematooncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic.
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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5
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Mangiacavalli S, Cartia CS, Galli M, Pezzatti S, Belotti A, Fazio F, Mina R, Marcatti M, Cafro A, Zambello R, Paris L, Barilà G, Olivares C, Pompa A, Mazza R, Farina F, Soldarini M, Benvenuti P, Pagani G, Palumbo M, Masoni V, Ferretti VV, Klersy C, Arcaini L, Petrucci MT. Lenalidomide-based triplet regimens in first relapsed multiple myeloma patients: real-world evidence from a propensity score matched analysis. Haematologica 2023; 108:833-842. [PMID: 36200419 PMCID: PMC9973473 DOI: 10.3324/haematol.2022.281342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Indexed: 11/09/2022] Open
Abstract
Lenalidomide and dexamethasone (Rd)-based triplets, in particular carfilzomib-Rd (KRd) and daratumumab-Rd (DaraRd), represent a standard of care in lenalidomide-sensitive multiple myeloma (MM) patients in first relapse. Meta-analysis of randomized clinical trials (RCT), suggested better outcome with DaraRd. Trying to address this issue in clinical practice, we collected data of 430 consecutive MM patients addressed to Rd-based triplets in first relapse between January 2017 and March 2021. Overall, the most common used regimen was DaraRd, chosen in almost half of the cases (54.4%), followed by KRd (34.6%). Different triplets were used much less commonly. In an attempt to limit the imbalance of a retrospective analysis, we conducted a propensity score matching (PSM) comparison between DaraRd and KRd. After PSM, efficacy of DaraRd versus KRd was similar in terms of overall-response rate (ORR) (OR: 0.9, P=0.685) as well as of very good partial response (VGPR) or better (OR: 0.9, P=0.582). The median progression-free survival (PFS) was significantly longer for DaraRd (29.8 vs. 22.5 months; P=0.028). DaraRd was tolerated better, registering a lower rate of grade 3-4 non-hematological toxicity (OR: 0.4, P<0.001). With the limitations of any retrospective analysis, our real-life PSM comparison between DaraRd and KRd, in first-relapse MM patients, showed better tolerability and prolonged PFS of DaraRd, although with some gaps of performance, in particular of DaraRd, with respect to RCT. Carfilzomib-containing regimens, like KRd, still remain a valid second-line option in the emerging scenario of first-line daratumumab-based therapy.
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Affiliation(s)
| | | | - Monica Galli
- Division of Hematology, ASST Papa Giovanni XXIII, Bergamo
| | | | | | - Francesca Fazio
- Division of Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome
| | - Roberto Mina
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino
| | - Magda Marcatti
- Division of Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan
| | - Anna Cafro
- Hematology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Renato Zambello
- Hematology and Clinical Immunology, Department of Medicine, Azienda Ospedaliera di Padova, Padova
| | - Laura Paris
- Division of Hematology, ASST Papa Giovanni XXIII, Bergamo
| | - Gregorio Barilà
- University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padova
| | - Cecilia Olivares
- Division of Hematology, Ospedale di Circolo and Fondazione Macchi, University of Insubria, Varese
| | - Alessandra Pompa
- Division of Hematology and Stem Cell Transplantation, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan
| | - Rita Mazza
- Humanitas Clinical and Research Center, IRCCS, Milan
| | - Francesca Farina
- Division of Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan
| | | | - Pietro Benvenuti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | - Michele Palumbo
- Department of Molecular Medicine, University of Pavia, Pavia
| | - Valeria Masoni
- Department of Molecular Medicine, University of Pavia, Pavia
| | | | - Catherine Klersy
- Clinical Epidemiology and Biostatistics Service, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia
| | - Maria Teresa Petrucci
- Division of Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome
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Wechalekar AD, Cibeira MT, Gibbs SD, Jaccard A, Kumar S, Merlini G, Palladini G, Sanchorawala V, Schönland S, Venner C, Boccadoro M, Kastritis E. Guidelines for non-transplant chemotherapy for treatment of systemic AL amyloidosis: EHA-ISA working group. Amyloid 2023; 30:3-17. [PMID: 35838162 DOI: 10.1080/13506129.2022.2093635] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND This guideline has been developed jointly by the European Society of Haematology and International Society of Amyloidosis recommending non-transplant chemotherapy treatment for patients with AL amyloidosis. METHODS A review of literature and grading of evidence as well as expert recommendations by the ESH and ISA guideline committees. RESULTS AND CONCLUSIONS The recommendations of this committee suggest that treatment follows the clinical presentation which determines treatment tolerance tempered by potential side effects to select and modify use of drugs in AL amyloidosis. All patients with AL amyloidosis should be considered for clinical trials where available. Daratumumab-VCD is recommended from most untreated patients (VCD or VMDex if daratumumab is unavailable). At relapse, the two guiding principles are the depth and duration of initial response, use of a class of agents not previously exposed as well as the limitation imposed by patients' fitness/frailty and end organ damage. Targeted agents like venetoclax need urgent prospective evaluation. Future prospective trials should include advanced stage patients to allow for evidence-based treatment decisions. Therapies targeting amyloid fibrils or those reducing the proteotoxicity of amyloidogenic light chains/oligomers are urgently needed.
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Affiliation(s)
- Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - M Teresa Cibeira
- Amyloidosis and Myeloma Unit, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Simon D Gibbs
- Victorian and Tasmanian Amyloidosis Service, Eastern Health Monash University Clinical School, Box Hill, VIC, Australia
| | - Arnaud Jaccard
- Hematology Department, French Reference Center for AL Amyloidosis (Limoges-Poitiers), CHU Limoges, Limoges, France
| | - Shaji Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation "Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo" and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Foundation "Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo" and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Stefan Schönland
- Medical Department V, Amyloidosis Center, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Mario Boccadoro
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Wang MC, Chiu LJ, Kuo CY, Ma MC, Liao CK, Liu HL. Real-world evidence of daratumumab-lenalidomide-dexamethasone in relapsed/refractory multiple myeloma patients: A single-center experience in Taiwan focusing on efficacy. JOURNAL OF CANCER RESEARCH AND PRACTICE 2023. [DOI: 10.4103/ejcrp.ejcrp-d-22-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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Mele G, Cascavilla N, Di Renzo N, Guarini A, Mazza P, Melillo L, Pavone V, Tarantini G, Curci P, Falcone AP, Germano C, Mele A, Palazzo G, Palumbo G, Reddiconto G, Rossini B, Specchia G, Musto P, Pastore D. Daratumumab plus bortezomib or daratumumab plus lenalidomide as salvage therapy for patients with myeloma: initial follow-up of an Italian multicentre retrospective clinical experience by 'Rete Ematologica Pugliese'. Ann Hematol 2022; 101:1727-1739. [PMID: 35587825 DOI: 10.1007/s00277-022-04857-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/24/2022] [Indexed: 12/01/2022]
Abstract
We report herein a multicentre retrospective analysis of 192 consecutive patients with symptomatic refractory/relapsed multiple myeloma (RRMM) treated with daratumumab in combination with bortezomib or lenalidomide as salvage therapy at 9 haematological centres in Puglia. Choice of both regimens was based on previous treatment and/or physicians' preference. Considering the under-representation of older patients (very old patient ≥ 80 years) in clinical trials and the prognostic and predictive importance and value of frailty status, here, we further characterised the patient cohort by age. The overall response rate (ORR) was generally lower than what was previously reported in the CASTOR (ORR 72.6% vs 85%) and POLLUX (ORR 86.5% vs 93%) trials. The lower ORR in our analysis compared to the CASTOR and POLLUX trials could be related to a less selected population. Similarly, amongst very old patients, the ORR was encouraging: ORR to treatment with DVd (daratumumab + bortezomib + dexamethasone) was 66.7%, and ORR to treatment with DRd (daratumumab + lenalidomide + dexamethasone) was 92.3%. Median TTP (time to progression) was 10.8 months (1-year TTP: 44.7%; 2-year TTP: 25.3%) in the DVd group; median TTP was not reached in the DRd group (1-year TTP: 82.7%; 2-year TTP: 71.4%). Median OS (overall survival) was not reached either in the DRd group (1-year OS: 85.9%; 2-year OS: 73.7%) or the DVd group (1-year OS: 70.2%; 2-year OS: 58.9%).
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Affiliation(s)
- G Mele
- Haematology and BMT Unit, Ospedale A. Perrino, SS 7 per Mesagne, 72100, Brindisi, Italy.
| | - N Cascavilla
- Haematology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - N Di Renzo
- Haematology, Ospedale V. Fazzi, Lecce, Italy
| | - A Guarini
- Haematology, Ospedale Giovanni Paolo II°, Bari, Italy
| | - P Mazza
- Haematology, Ospedale G. Moscati, Taranto, Italy
| | - L Melillo
- Haematology, Ospedali Riuniti, Foggia, Italy
| | - V Pavone
- Haematology, Ospedale Cardinale Panico, Tricase, Lecce, Italy
| | - G Tarantini
- Haematology, Ospedale Monsignor R. Dimiccoli, Barletta, Bari, Italy
| | - P Curci
- University of Bari Medical School, Policlinico, Bari, Italy
| | - A P Falcone
- Haematology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - C Germano
- Haematology, Ospedale Monsignor R. Dimiccoli, Barletta, Bari, Italy
| | - A Mele
- Haematology, Ospedale Cardinale Panico, Tricase, Lecce, Italy
| | - G Palazzo
- Haematology, Ospedale G. Moscati, Taranto, Italy
| | - G Palumbo
- Haematology, Ospedali Riuniti, Foggia, Italy
| | | | - B Rossini
- Haematology, Ospedale Giovanni Paolo II°, Bari, Italy
| | - G Specchia
- University of Bari Medical School, Policlinico, Bari, Italy
| | - P Musto
- University of Bari Medical School, Policlinico, Bari, Italy
| | - D Pastore
- Haematology and BMT Unit, Ospedale A. Perrino, SS 7 per Mesagne, 72100, Brindisi, Italy
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Fucci L, Gensini L, Coppetelli U, La Barbera EO, Gentile M, Fiori L, Perrone S, Cimino G. Daratumumab triplet therapies in patients with relapsed or refractory Multiple Myeloma: a “real world” experience. Leuk Res Rep 2022; 17:100330. [PMID: 35694449 PMCID: PMC9184873 DOI: 10.1016/j.lrr.2022.100330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/18/2022] [Accepted: 05/28/2022] [Indexed: 11/24/2022] Open
Abstract
We report our retrospective analysis on 34 relapsed/refractory multiple myeloma (RRMM) patients treated with daratumumab based triplets. Twenty patients were females and 14 males. Median age was 73.2. Daratumumab was associated to lenalidomide in and dexamethasone (DRd) in 30 (88,3%) and to bortezomib and dexamethasone (DVd) in 4 cases (11,7%). The ORR was 88%. CR occurred in 12% of cases, VGPR in 44% and PR in 32%. The 12 months PFS and OS rates were 78% and 86,5%, respectively. Present data confirm those recently reported in the literature and further reinforce the early use of daratumumab-based triplets for RRMM patients.
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Fazio F, Franceschini L, Tomarchio V, Rago A, Garzia MG, Cupelli L, Bongarzoni V, Andriani A, Gumenyuk S, Tafuri A, Siniscalchi A, Piciocchi A, De Fabritiis P, De Rosa L, Caravita di Toritto T, Annibali O, Cantonetti M, Petrucci MT. Daratumumab combined with dexamethasone and lenalidomide or bortezomib in relapsed/refractory multiple myeloma (RRMM) patients: Report from the multiple myeloma GIMEMA Lazio group. EJHAEM 2022; 3:121-128. [PMID: 35846211 PMCID: PMC9175681 DOI: 10.1002/jha2.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Francesca Fazio
- Department of Translational and Precision Medicine, Hematology Azienda Policlinico Umberto I Sapienza University of RomeSapienza Università di Roma
| | | | | | - Angela Rago
- ASL RM/A UOSD Ematologia Asl Roma 1 Rome Italy
| | - Maria Grazia Garzia
- Department of Hematology, Hematology San Camillo Forlanini Hospital Rome Italy
| | - Luca Cupelli
- Department of Hematology, Hematology Ospedale Sant'Eugenio Rome Italy
| | - Velia Bongarzoni
- Department of Hematology San Giovanni‐Addolorata Hospital Rome Italy
| | | | - Svitlana Gumenyuk
- Haematology and Stem Cell Transplant Regina Elena National Cancer Institute Rome Italy
| | | | | | - Alfonso Piciocchi
- Data Center, Italian Group for Adult Hematologic Diseases, (GIMEMA) Rome Italy
| | | | - Luca De Rosa
- Hematology and Bone Marrow Transplantation Unit Azienda Ospedaliera San Camillo‐Forlanini Rome Italy
| | | | - Ombretta Annibali
- Department of Haematology Campus Bio‐Medico University of Rome Rome Italy
| | | | - Maria Teresa Petrucci
- Department of Translational and Precision Medicine, Hematology Azienda Policlinico Umberto I Sapienza University of RomeSapienza Università di Roma
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Multiple drugs. REACTIONS WEEKLY 2021. [PMCID: PMC7862834 DOI: 10.1007/s40278-021-90689-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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