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Li P, Xu B, Xu J, Wang Y, Yang Y, Wang W, Maihemaiti A, Li J, Xu T, Ren L, Lan T, Zhou C, Wang P, Liu P. Thrombosis events in Chinese patients with newly diagnosed multiple myeloma. Clin Exp Med 2023; 23:3809-3820. [PMID: 37103654 DOI: 10.1007/s10238-023-01080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
A high risk of thrombosis is seen in patients with newly diagnosed multiple myeloma (NDMM), particularly those treated with immunomodulatory drugs (IMiDs). Large cohorts addressing the thrombosis issue of NDMM patients in Asia are lacking. We retrospectively analyzed the clinical information of NDMM patients diagnosed in Zhongshan Hospital Fudan University, a national medical center, from January 2013 to June 2021. Death and thrombotic events (TEs) were the endpoints. To investigate risk factors for TEs, the Fine and Gray competing risk regression models were created, in which unrelated deaths were labeled as competing risk events. A total of 931 NDMM patients were recruited in our study. The median follow-up was 23 months [interquartile range (IQR): 9-43 months]. Forty-two patients (4.51%) developed TEs, including 40 cases (4.30%) of venous thrombosis and 2 cases (0.21%) of arterial thrombosis. The median time from taking first-line treatment to TEs occurrence was 2.03 months (IQR: 0.52-5.70 months). The cumulative incidence of TEs was higher in patients treated with IMiDs than in those without IMiDs (8.25 vs. 4.32%, p = 0.038). There was no difference in the incidence of TEs between lenalidomide-based and thalidomide-based groups (7.80 vs. 8.84%, p = 0.886). Besides, TEs occurrence did not adversely affect OS (p = 0.150) or PFS (p = 0.210) in MM patients. Chinese NDMM patients have a lower incidence of thrombosis than those in western countries. The risk of thrombosis was particularly increased in patients treated with IMiDs. TEs were not associated with inferior progression-free survival or overall survival.
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Affiliation(s)
- Panpan Li
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bei Xu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiadai Xu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yawen Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Yang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenjing Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Aiziguli Maihemaiti
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Li
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianhong Xu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang Ren
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianwei Lan
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chi Zhou
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pu Wang
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China.
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
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Li X, Tan TTY, Lin Q, Lim CC, Goh R, Otake KI, Kitagawa S, Loh XJ, Lim JYC. MOF-Thermogel Composites for Differentiated and Sustained Dual Drug Delivery. ACS Biomater Sci Eng 2023; 9:5724-5736. [PMID: 37729089 DOI: 10.1021/acsbiomaterials.3c01103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
In recent years, multidrug therapy has gained increasing popularity due to the possibility of achieving synergistic drug action and sequential delivery of different medical payloads for enhanced treatment efficacy. While a number of composite material release platforms have been developed, few combine the bottom-up design versatility of metal-organic frameworks (MOFs) to tailor drug release behavior, with the convenience of temperature-responsive hydrogels (or thermogels) in their unique ease of administration and formulation. Yet, despite their potential, MOF-thermogel composites have been largely overlooked for simultaneous multidrug delivery. Herein, we report the first systematic study of common MOFs (UiO-66, MIL-53(Al), MIL-100(Fe), and MOF-808) with different pore sizes, geometries, and hydrophobicities for their ability to achieve simultaneous dual drug release when embedded within PEG-containing thermogel matrices. After establishing that MOFs exert small influences on the rheological properties of the thermogels despite the penetration of polymers into the MOF pores in solution, the release profiles of ibuprofen and caffeine as model hydrophobic and hydrophilic drugs, respectively, from MOF-thermogel composites were investigated. Through these studies, we elucidated the important role of hydrophobic matching between MOF pores and loaded drugs in order for the MOF component to distinctly influence drug release kinetics. These findings enabled us to identify a viable MOF-thermogel composite containing UiO-66 that showed vastly different release kinetics between ibuprofen and caffeine, enabling temporally differentiated yet sustained simultaneous drug release to be achieved. Finally, the MOF-thermogel composites were shown to be noncytotoxic in vitro, paving the way for these underexploited composite materials to find possible clinical applications for multidrug therapy.
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Affiliation(s)
- Xin Li
- Laboratory for Green Porous Materials, Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Tristan T Y Tan
- Laboratory for Green Porous Materials, Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Qianyu Lin
- Laboratory for Green Porous Materials, Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Chen Chuan Lim
- Institute of Sustainability for Chemicals, Energy and Environment (ISCE2), Agency for Science, Technology and Research (A*STAR), 1 Pesek Road Jurong Island, Singapore 627833, Republic of Singapore
| | - Rubayn Goh
- Laboratory for Green Porous Materials, Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Ken-Ichi Otake
- Laboratory for Green Porous Materials, Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
- Institute for Integrated Cell-Material Sciences, Kyoto University Institute for Advanced Study, Kyoto University, Yoshida Ushinomiya-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Susumu Kitagawa
- Laboratory for Green Porous Materials, Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
- Institute for Integrated Cell-Material Sciences, Kyoto University Institute for Advanced Study, Kyoto University, Yoshida Ushinomiya-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Xian Jun Loh
- Laboratory for Green Porous Materials, Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
- Institute of Sustainability for Chemicals, Energy and Environment (ISCE2), Agency for Science, Technology and Research (A*STAR), 1 Pesek Road Jurong Island, Singapore 627833, Republic of Singapore
- Department of Materials Science and Engineering, National University of Singapore (NUS), 9 Engineering Drive, Singapore 117576, Republic of Singapore
| | - Jason Y C Lim
- Laboratory for Green Porous Materials, Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
- Department of Materials Science and Engineering, National University of Singapore (NUS), 9 Engineering Drive, Singapore 117576, Republic of Singapore
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Franz J, Myrus E, Sanchez L, Richter J. No needles needed: All-oral therapy options for relapsed and refractory multiple myeloma. Blood Rev 2023; 57:100993. [PMID: 36137842 DOI: 10.1016/j.blre.2022.100993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 01/28/2023]
Abstract
Immense progress has been made for the treatment of multiple myeloma over the past two decades, with patient outcomes improving dramatically as a result. Patient quality of life, however, is constantly challenged by complications of the disease, side effects of therapy and the overall burden receiving continuous treatment. Compared to parenteral agents, all-oral regimens can provide logistically favorable alternatives and are associated with improved quality of life. Here, we review the currently available and investigational oral therapies for relapsed and refractory multiple myeloma and provide a practical clinical reference tool. We explore the factors that dictate the selection of therapy, such as prior drug refractoriness, disease biology and patient-specific considerations. Regimens with their respective supporting clinical data are organized by the degree of prior treatment, from lenalidomide-sensitive to heavily pretreated patients. We explore common challenges such as renal insufficiency and cytopenias. Lastly, we review investigational oral agents.
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Affiliation(s)
- Joseph Franz
- UPMC Hillman Cancer, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Elizabeth Myrus
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Larysa Sanchez
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joshua Richter
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12122954. [PMID: 36552961 PMCID: PMC9777086 DOI: 10.3390/diagnostics12122954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/06/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: Venous thromboembolism (VTE) is a life-threatening complication that may exacerbate cancer prognosis. Whilst some studies indicate an increased risk of VTE in cancer patients undergoing chemotherapy, the prevalence estimates on the pooled prevalence of VTE in cancer patients undergoing chemotherapy are not known. This study aims to calculate the pooled prevalence of VTE in chemotherapy-treated cancer patients. Methods: Studies on VTE occurrence in cancer patients undergoing chemotherapy were retrieved after database search. The terms used included “cancer”, “chemotherapy”, and “venous thromboembolism”. A random-effects meta-analysis was conducted to obtain a pooled estimate of VTE prevalence in cancer patients undergoing chemotherapy. Results: A total of 102 eligible studies involving 30,671 patients (1773 with VTE, 28,898 without) were included in the meta-analysis. The pooled estimate of VTE prevalence was found to be 6%, ranging from 6% to 7% (ES 6%; 95% CI 6−7%; z = 18.53; p < 0.001). Conclusions: The estimated pooled prevalence rate of VTEs was 6% in cancer patients undergoing CRT, which was higher than the overall crude prevalence rate (5.78%). Comprehensive cancer care should consider stratified VTE risk assessment based on cancer phenotype, given that certain phenotypes of cancer such as bladder, gastric and ovarian posing particularly high risks of VTE.
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Minařík J, Ševčíková S. Immunomodulatory Agents for Multiple Myeloma. Cancers (Basel) 2022; 14:cancers14235759. [PMID: 36497241 PMCID: PMC9739922 DOI: 10.3390/cancers14235759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
The treatment of multiple myeloma (MM) has undergone a significant paradigm shift in the last 20 years, from conventional chemotherapy to more tumor-specific treatments, based on the interference with pathogenesis of the malignant clone as well as the bone microenvironment [...].
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Affiliation(s)
- Jiří Minařík
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
- Correspondence:
| | - Sabina Ševčíková
- Babak Myeloma Group, Department of Pathological Physiology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
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Vasquez J, Ruiz R, Aliaga K, Valencia F, Villena M, Quintana S, Vidaurre T, Casanova L. Cyclophosphamide, Thalidomide, and Dexamethasone as Initial Therapy for Patients With Newly Diagnosed Multiple Myeloma in a Middle-Income Country: 7-Year Follow-Up. JCO Glob Oncol 2021; 7:1199-1205. [PMID: 34297605 PMCID: PMC8457778 DOI: 10.1200/go.20.00665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Major progress has occurred in multiple myeloma (MM) treatment in recent years, but this is not seen in low- and middle-income countries. MATERIALS AND METHODS We retrospectively assessed the efficacy and safety of cyclophosphamide, thalidomide, and dexamethasone (cyclophosphamide 400 mg/m2 for 5 days, thalidomide 100 mg once daily, if tolerated, and dexamethasone 40 mg once weekly; in 28-day cycles) in patients with newly diagnosed MM treated at our institution between April 2008 and December 2012. Survival outcomes were estimated by the Kaplan-Meier method. RESULTS Fifty-nine patients were found to meet the selection criteria. Median age was 56 years (27-78). Fifty-nine percent (n = 35) were male. International Staging System three was found in 24%. The median number of treatment cycles was 11 (range 4-12). After a median of 81-month follow-up (range 5-138 months), the overall response rate was 69.5%. The complete response and very good partial response were 5% and 32%, respectively. Median progression-free survival (PFS) was 35 months (95% CI, 18 to 41). The 3-year PFS was 47.4% (95% CI, 34.5 to 59.6) and 5-year PFS was 24.9% (95% CI, 14.4 to 36.9). The median of overall survival (OS) was 81 months (95% CI, 33 to not reached). The 3-year OS was 63.4% (95% CI, 49.2 to 74.6), and 5-year OS was 57.5% (95% CI, 43.2 to 69.4). The most common adverse event was neutropenia (grade 3 and 4, 30.5%). Out of 23 patients eligible for stem-cell transplantation, 10 (43.5%) proceeded with autologous transplantation. Treatment-related deaths occurred in four patients (6.7%). CONCLUSION Cyclophosphamide, thalidomide, and dexamethasone achieves good response rates with tolerable toxicity, especially in patients age 65 years or younger representing a feasible approach for patients with MM in low-income health care settings.
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Affiliation(s)
- Jule Vasquez
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Rossana Ruiz
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Karina Aliaga
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | - Marco Villena
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
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Jackson GH, Davies FE, Pawlyn C, Cairns DA, Striha A, Collett C, Waterhouse A, Jones JR, Kishore B, Garg M, Williams CD, Karunanithi K, Lindsay J, Allotey D, Shafeek S, Jenner MW, Cook G, Russell NH, Kaiser MF, Drayson MT, Owen RG, Gregory WM, Morgan GJ. Lenalidomide before and after autologous stem cell transplantation for transplant-eligible patients of all ages in the randomized, phase III, Myeloma XI trial. Haematologica 2021; 106:1957-1967. [PMID: 32499244 PMCID: PMC8252959 DOI: 10.3324/haematol.2020.247130] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/28/2020] [Indexed: 01/28/2023] Open
Abstract
The optimal way to use immunomodulatory drugs as components of induction and maintenance therapy for multiple myeloma is unresolved. We addressed this question in a large phase III randomized trial, Myeloma XI. Patients with newly diagnosed multiple myeloma (n = 2042) were randomized to induction therapy with cyclophosphamide, thalidomide, and dexamethasone (CTD) or cyclophosphamide, lenalidomide, and dexamethasone (CRD). Additional intensification therapy with cyclophosphamide, bortezomib and dexamethasone (CVD) was administered before ASCT to patients with a suboptimal response to induction therapy using a response-adapted approach. After receiving high-dose melphalan with autologous stem cell transplantation (ASCT), eligible patients were further randomized to receive either lenalidomide alone or observation alone. Co-primary endpoints were progression-free survival (PFS) and overall survival (OS). The CRD regimen was associated with significantly longer PFS (median: 36 vs. 33 months; hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.75-0.96; P = 0.0116) and OS (3-year OS: 82.9% vs. 77.0%; HR, 0.77; 95% CI, 0.63-0.93; P = 0.0072) compared with CTD. The PFS and OS results favored CRD over CTD across all subgroups, including patients with International Staging System stage III disease (HR for PFS, 0.73; 95% CI, 0.58-0.93; HR for OS, 0.78; 95% CI, 0.56-1.09), high-risk cytogenetics (HR for PFS, 0.60; 95% CI, 0.43-0.84; HR for OS, 0.70; 95% CI, 0.42-1.15) and ultra high-risk cytogenetics (HR for PFS, 0.67; 95% CI, 0.41-1.11; HR for OS, 0.65; 95% CI, 0.34-1.25). Among patients randomized to lenalidomide maintenance (n = 451) or observation (n = 377), maintenance therapy improved PFS (median: 50 vs. 28 months; HR, 0.47; 95% CI, 0.37-0.60; P < 0.0001). Optimal results for PFS and OS were achieved in the patients who received CRD induction and lenalidomide maintenance. The trial was registered with the EU Clinical Trials Register (EudraCT 2009-010956-93) and ISRCTN49407852.
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Affiliation(s)
- Graham H. Jackson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Faith E. Davies
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Charlotte Pawlyn
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - David A. Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alina Striha
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Corinne Collett
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Anna Waterhouse
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - John R. Jones
- King’s College Hospital NHS Foundation Trust, London, UK
| | | | - Mamta Garg
- Leicester Royal Infirmary, Leicester, UK
| | - Cathy D. Williams
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | | | | | - David Allotey
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Salim Shafeek
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Matthew W. Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gordon Cook
- Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Nigel H. Russell
- Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK
| | - Martin F. Kaiser
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Mark T. Drayson
- Clinical Immunology, School of Immunity and Infection, University of Birmingham, Birmingham, UK
| | - Roger G. Owen
- St James's University Hospital, Haematological Malignancy Diagnostic Service (HMDS), Leeds, UK
| | - Walter M. Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Neurotoxicity of antineoplastic drugs: Mechanisms, susceptibility, and neuroprotective strategies. Adv Med Sci 2020; 65:265-285. [PMID: 32361484 DOI: 10.1016/j.advms.2020.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 12/22/2019] [Accepted: 04/13/2020] [Indexed: 02/06/2023]
Abstract
This review summarizes the adverse effects on the central and/or peripheral nervous systems that may occur in response to antineoplastic drugs. In particular, we describe the neurotoxic side effects of the most commonly used drugs, such as platinum compounds, doxorubicin, ifosfamide, 5-fluorouracil, vinca alkaloids, taxanes, methotrexate, bortezomib and thalidomide. Neurotoxicity may result from direct action of compounds on the nervous system or from metabolic alterations produced indirectly by these drugs, and either the central nervous system or the peripheral nervous system, or both, may be affected. The incidence and severity of neurotoxicity are principally related to the dose, to the duration of treatment, and to the dose intensity, though other factors, such as age, concurrent pathologies, and genetic predisposition may enhance the occurrence of side effects. To avoid or reduce the onset and severity of these neurotoxic effects, the use of neuroprotective compounds and/or strategies may be helpful, thereby enhancing the therapeutic effectiveness of antineoplastic drug.
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Domingo S, Solé C, Moliné T, Ferrer B, Ordi-Ros J, Cortés-Hernández J. Efficacy of Thalidomide in Discoid Lupus Erythematosus: Insights into the Molecular Mechanisms. Dermatology 2020; 236:467-476. [PMID: 32659758 DOI: 10.1159/000508672] [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: 02/03/2020] [Accepted: 05/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thalidomide has been used successfully in a variety of chronic refractory inflammatory dermatological conditions with underlying autoimmune or infectious pathogenesis. It was first used for refractory discoid lupus erythematosus (DLE) in 1983 and has steadily grown since then. METHOD In this review, we describe the therapeutic benefits of thalidomide for DLE treatment and its biological properties. We explain how new discoveries in DLE pathogenesis are relevant to understand thalidomide's mechanism of action and the need to find an alternative safe drug with similar therapeutic effects. SUMMARY Thalidomide's efficacy in DLE patients is significant, with 80-90% reaching clinical remission according to different studies. However, thalidomide's use is still limited by serious adverse effects such as teratogenicity, neurotoxicity, and thrombosis. In addition, there is a frequent rate of relapse and many patients require a long-term low dose of thalidomide as maintenance. The achievement of clinical response within weeks is key to avoid irreversible DLE fibrotic sequelae, making it critical to introduce thalidomide earlier in the DLE treatment algorithm. Recently, microarray and miRNA screenings demonstrated a significant CD4+ T enrichment and T-helper 1 response predom-inance with a dysregulation of regulatory T cell (Treg) expression in DLE lesions that induced high levels of proinflammatory, chemotaxis, and apoptotic proteins that induce the chronic inflammation response. Thalidomide's anti-inflammatory, antiangiogenic, and T-cell co-stimulatory effects may be beneficial for DLE since it promotes cytokine inhibition, inhibits macrophage activation, regulates Treg responses, inhibits angiogenesis, modulates T cells, and promotes NK cell-mediated cytotoxicity.
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Affiliation(s)
- Sandra Domingo
- Rheumatology Research Group, Lupus Unit, Vall d'Hebron University Hospital, Vall d´Hebron Research Institute (VHIR), Barcelona, Spain
| | - Cristina Solé
- Rheumatology Research Group, Lupus Unit, Vall d'Hebron University Hospital, Vall d´Hebron Research Institute (VHIR), Barcelona, Spain,
| | - Teresa Moliné
- Departament of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Berta Ferrer
- Departament of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Josep Ordi-Ros
- Department of Internal Medicine, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Josefina Cortés-Hernández
- Rheumatology Research Group, Lupus Unit, Vall d'Hebron University Hospital, Vall d´Hebron Research Institute (VHIR), Barcelona, Spain
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Zanwar S, Abeykoon JP, Kapoor P. Challenges and Strategies in the Management of Multiple Myeloma in the Elderly Population. Curr Hematol Malig Rep 2020; 14:70-82. [PMID: 30820879 DOI: 10.1007/s11899-019-00500-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Approximately one half of the patient-population in multiple myeloma (MM) is > 70 years at diagnosis. Despite notable strides in the management and improved survival, MM remains incurable, with an increasing proportion of elderly patients comprising the relapsed-refractory cohort. RECENT FINDINGS The arbitrary age cutoff at 65 years to define the elderly patient-population has evolved to a more nuanced categorization, incorporating a comprehensive assessment for determining frailty prior to commencing treatment. This step is critical in determining the therapy-intensity, including transplant-eligibility, to minimize toxicity. Dose-modifications are crucial, as the merits of continuous therapy are becoming evident in this patient-population. Bortezomib, lenalidomide, and dexamethasone (VRd) combination has emerged as standard of care for newly diagnosed MM. Fixed-duration Rd followed by reduced-dosed continuous R may be considered in select frail patients with standard-risk MM. Herein, we review the unique challenges encountered in elderly MM and discuss strategies for optimal management.
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Affiliation(s)
- Saurabh Zanwar
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Prashant Kapoor
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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11
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Hanashima Y, Sano E, Sumi K, Ozawa Y, Yagi C, Tatsuoka J, Yoshimura S, Yamamuro S, Ueda T, Nakayama T, Hara H, Yoshino A. Antitumor effect of lenalidomide in malignant glioma cell lines. Oncol Rep 2020; 43:1580-1590. [PMID: 32323826 PMCID: PMC7108053 DOI: 10.3892/or.2020.7543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 01/29/2020] [Indexed: 02/05/2023] Open
Abstract
Glioblastoma is a malignant brain tumor exhibiting highly aggressive proliferation and invasion capacities. Despite treatment by aggressive surgical resection and adjuvant therapy including temozolomide and radiation therapy, patient prognosis remains poor. Lenalidomide, a derivative of thalidomide, is known to be an immunomodulatory agent that has been used to treat hematopoietic malignancies. There are numerous studies revealing an antitumor effect of lenalidomide in hematopoietic cells, but not in glioma cells. The present study aimed to demonstrate the antitumor effect of lenalidomide on malignant glioma cell lines. The growth inhibition of malignant glioma cells (A-172, AM-38, T98G, U-138MG, U-251MG, and YH-13) by lenalidomide was assessed using a Coulter counter. The mechanism of the antitumor effect of lenalidomide was examined employing a fluorescence-activated cell sorter, western blot analysis, and quantitative real-time reverse transcriptional polymerase chain reaction (RT-qPCR) in malignant glioma cell lines (A-172, AM-38). The results revealed that the number of malignant glioma cells was decreased in a concentration-dependent manner by lenalidomide. DNA flow cytometric analysis demonstrated an increase in the ratio of cells at the G0/G1 phase following lenalidomide treatment. Western blot analysis and RT-qPCR revealed that p53 activation and the expression of p21 were increased in glioma cells treated with lenalidomide. Western blot analysis revealed that cleavage of PARP did not occur; however, increased expression of Bax protein, cleavage of caspase-9 and cleavage of caspase-3 were confirmed. Analysis by FACS also supported the conclusion that little apoptosis induction occurred following lenalidomide treatment of malignant glioma cell lines. In conclusion, lenalidomide exerts an antitumor effect on glioma cells due to alterations in cell cycle distribution.
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Affiliation(s)
- Yuya Hanashima
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173‑8610, Japan
| | - Emiko Sano
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba 277‑8562, Japan
| | - Koichiro Sumi
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173‑8610, Japan
| | - Yoshinari Ozawa
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173‑8610, Japan
| | - Chihiro Yagi
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173‑8610, Japan
| | - Juri Tatsuoka
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173‑8610, Japan
| | - Sodai Yoshimura
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173‑8610, Japan
| | - Shun Yamamuro
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173‑8610, Japan
| | - Takuya Ueda
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Chiba 277‑8562, Japan
| | - Tomohiro Nakayama
- Division of Companion Diagnostics, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo 173‑8610, Japan
| | - Hiroyuki Hara
- Division of Anatomical Science, Department of Functional Morphology, Nihon University School of Medicine, Tokyo 173‑8610, Japan
| | - Atsuo Yoshino
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo 173‑8610, Japan
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12
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Paumgartten FJR. The tale of lenalidomide clinical superiority over thalidomide and regulatory and cost-effectiveness issues. CIENCIA & SAUDE COLETIVA 2020; 24:3783-3792. [PMID: 31577009 DOI: 10.1590/1413-812320182410.28522017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/12/2018] [Indexed: 11/22/2022] Open
Abstract
In April 2017, the National Sanitary Surveillance Agency (ANVISA-Brazil) approved lenalidomide (LEN) for multiple myeloma (MM) and myelodysplastic syndrome. ANVISA had rejected the first application in 2010, and denied a request for reconsideration in 2012. The reason for rejection was the lack of comparative effectiveness studies proving that LEN was more effective than thalidomide (THAL), a strictly controlled drug regulated by Federal law 10.651/2003 and dispensed to patients (at no costs) through public health system units and hospitals. ANVISA unexplained retreat on the LEN approval for marketing was an unquestionable triumph of the lobbying that ensued the denial, at the forefront of which were politicians, Congress members, patient organizations and medical societies. Two randomized (phase III) trials and three observational (case-control and population-based cohort) compared the effectiveness of THAL- versus LEN-based therapies in MM. Overall, these studies showed no difference in efficacy between LEN- and THAL-based therapies. LEN caused less neuropathy, and more severe hematologic adverse effects. It is much costlier than THAL, and substitution of THAL by LEN shall raise considerably public healthcare costs in Brazil.
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13
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Ibrahim EY, Ehrlich BE. Prevention of chemotherapy-induced peripheral neuropathy: A review of recent findings. Crit Rev Oncol Hematol 2020; 145:102831. [PMID: 31783290 PMCID: PMC6982645 DOI: 10.1016/j.critrevonc.2019.102831] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 01/12/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is an adverse effect of chemotherapy that is frequently experienced by patients receiving treatment for cancer. CIPN is caused by many of the most commonly used chemotherapeutic agents, including taxanes, vinca alkaloids, and bortezomib. Pain and sensory abnormalities may persist for months, or even years after the cessation of chemotherapy. The management of CIPN is a significant challenge, as it is not possible to predict which patients will develop symptoms, the timing for the appearance of symptoms can develop anytime during the chemotherapy course, there are no early indications that warrant a reduction in the dosage to halt CIPN progression, and there are no drugs approved to prevent or alleviate CIPN. This review focuses on the etiology of CIPN and will highlight the various approaches developed for prevention and treatment. The goal is to guide studies to identify, test, and standardize approaches for managing CIPN.
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Affiliation(s)
- Eiman Y Ibrahim
- Departments of Pharmacology and Cellular and Molecular Physiology, Yale University, New Haven, CT, 06510, USA.
| | - Barbara E Ehrlich
- Departments of Pharmacology and Cellular and Molecular Physiology, Yale University, New Haven, CT, 06510, USA.
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14
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Li A, Wu Q, Warnick G, Li S, Libby EN, Garcia DA, Lyman GH. The incidence of thromboembolism for lenalidomide versus thalidomide in older patients with newly diagnosed multiple myeloma. Ann Hematol 2019; 99:121-126. [PMID: 31773215 DOI: 10.1007/s00277-019-03860-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/19/2019] [Indexed: 01/06/2023]
Abstract
It is uncertain if different immunomodulatory drugs (IMID) pose distinct thrombotic risk in patients with newly diagnosed multiple myeloma (MM). Among 2397 MM patients from the SEER-Medicare database from 2007 to 2013, 78% received lenalidomide, and 22% received thalidomide. After inverse probability weighting to balance confounders, the 12-month incidences of venous thromboembolism (VTE 10%) and arterial thromboembolism (ATE 5%) were similarly high in both groups. Lenalidomide versus thalidomide had a subdistribution hazard ratio of 1.11 (0.59-2.02) for VTE and a subdistribution hazard ratio of 0.96 (0.45-1.98) for ATE. Overall survival was not significantly different with a hazard ratio of 0.88 (0.60-1.18) for lenalidomide versus thalidomide. Concurrent anticoagulant prophylaxis was infrequently prescribed in < 20% of both groups. Our study demonstrates that despite improvement in myeloma-directed therapy and supportive care, thrombosis remains an important consideration for all IMID-treated MM patients. Appropriate risk stratification and vigilant thromboprophylaxis remain essential to prevent this complication.
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Affiliation(s)
- Ang Li
- Division of Hematology, University of Washington School of Medicine, Seattle, WA, USA.
| | - Qian Wu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Greg Warnick
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Shan Li
- Hematology Oncology Clinical Pharmacy, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Edward N Libby
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - David A Garcia
- Division of Hematology, University of Washington School of Medicine, Seattle, WA, USA
| | - Gary H Lyman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA, USA
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15
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Durer C, Durer S, Lee S, Chakraborty R, Malik MN, Rafae A, Zar MA, Kamal A, Rosko N, Samaras C, Valent J, Chaulagain C, Anwer F. Treatment of relapsed multiple myeloma: Evidence-based recommendations. Blood Rev 2019; 39:100616. [PMID: 31500848 DOI: 10.1016/j.blre.2019.100616] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/14/2019] [Accepted: 08/30/2019] [Indexed: 12/01/2022]
Abstract
The practice of choosing the next best therapy for patients with relapsed and/or refractory multiple myeloma (RRMM) is becoming increasingly complex. There is no clear consensus regarding the best treatment sequence for RRMM. With the approval of novel proteasome inhibitors (ixazomib and carfilzomib), immunomodulatory agents (pomalidomide), monoclonal antibodies (daratumumab and elotuzumab), and other targeted therapies, multiple combination regimens utilizing these agents are being studied with the goal of enhancing disease control, prolonging progression-free survival, and improving overall survival. We, herein, describe a review of FDA-approved regimens for RRMM patients and offer a paradigm in selecting subsequent treatment regimens, focusing on patient specific morbidity, treatment toxicity, and disease-specific characteristics.
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Affiliation(s)
- Ceren Durer
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Seren Durer
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Sarah Lee
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Rajshekhar Chakraborty
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | | | - Abdul Rafae
- Department of Medicine, McLaren/Michigan State University, Flint, MI, USA
| | - Muhammad Abu Zar
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ahmad Kamal
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Nathaniel Rosko
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Christy Samaras
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Jason Valent
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Chakra Chaulagain
- Department of Hematology and Medical Oncology, Cleveland Clinic, Weston, FL, USA
| | - Faiz Anwer
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA.
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16
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Dempsey JL, Johns A, Rosko AE, Lazarus HM. The pharmacologic management of multiple myeloma in older adults. Expert Opin Pharmacother 2019; 20:887-902. [PMID: 30785310 PMCID: PMC6559717 DOI: 10.1080/14656566.2019.1577822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/30/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Multiple myeloma is a disease predominately affecting older adults. Pivotal to treating older adults is understanding their physiologic differences compared to younger subjects and how the complexity of therapies has an impact upon this patient population. AREAS COVERED Herein, the authors address the efficacy of chemotherapy regimens, decision-making for older adults, chemotherapy-associated toxicity and the approach to management. This review focuses on the complex treatment of older multiple myeloma patients and management of treatment-related adverse events. EXPERT OPINION Balancing efficacy and managing toxicity is a challenge for older myeloma patients. This group is more susceptible to treatment toxicities due to a higher incidence of pre-existing comorbidities and underlying diminished physiologic reserve. Intensive therapies such as autologous hematopoietic cell transplant (AHCT), however, still should be considered for all multiple myeloma patients, including older adults. The continued development of novel therapies and increased use of multi-drug regimens has changed the treatment paradigms yet understanding the complexity of the aging adult in the context of various drugs is warranted.
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Affiliation(s)
- Jessica L. Dempsey
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Andrew Johns
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ashley E. Rosko
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Hillard M. Lazarus
- Department of Medicine, Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH, USA
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17
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Luo J, Gagne JJ, Landon J, Avorn J, Kesselheim AS. Comparative effectiveness and safety of thalidomide and lenalidomide in patients with multiple myeloma in the United States of America: A population-based cohort study. Eur J Cancer 2017; 70:22-33. [DOI: 10.1016/j.ejca.2016.10.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/03/2016] [Accepted: 10/08/2016] [Indexed: 10/20/2022]
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18
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Abstract
Multiple myeloma is the second most common hematologic malignancy and predominantly affects the elderly. The introduction of novel agents such as thalidomide, lenalidomide, and bortezomib has improved progression-free survival, overall survival, and quality of life in myeloma patients. Next generation agents such as carfilzomib hold further promise for increased depth and length of remission. Autologous stem cell transplant remains a useful tool in the treatment of multiple myeloma, but not all patients are eligible for this procedure. As therapy becomes more effective, determination of the right therapy in the right patient becomes paramount. The focus of this review is a critical analysis of combinations of the novel agents in the treatment of newly diagnosed multiple myeloma in both transplant eligible and ineligible patients.
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Affiliation(s)
- Karie D Runcie
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York, NY, USA. .,Department of Medicine, New York Presbyterian Hospital-Cornell Medical Center, 525 East 68th Street, New York, NY, 10021, USA.
| | - Tomer M Mark
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medical College, New York, NY, USA. .,Weill Cornell Medical College, Center for Myeloma, 428 E. 72nd street, Suite 300, New York, NY, 10021, USA.
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19
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Canella A, Cordero Nieves H, Sborov DW, Cascione L, Radomska HS, Smith E, Stiff A, Consiglio J, Caserta E, Rizzotto L, Zanesi N, Stefano V, Kaur B, Mo X, Byrd JC, Efebera YA, Hofmeister CC, Pichiorri F. HDAC inhibitor AR-42 decreases CD44 expression and sensitizes myeloma cells to lenalidomide. Oncotarget 2016; 6:31134-50. [PMID: 26429859 PMCID: PMC4741593 DOI: 10.18632/oncotarget.5290] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/14/2015] [Indexed: 12/25/2022] Open
Abstract
Multiple myeloma (MM) is a hematological malignancy of plasma cells in the bone marrow. Despite multiple treatment options, MM is inevitably associated with drug resistance and poor outcomes. Histone deacetylase inhibitors (HDACi's) are promising novel chemotherapeutics undergoing evaluation in clinical trials for the potential treatment of patients with MM. Although in preclinical studies HDACi's have proven anti-myeloma activity, but in the clinic single-agent HDACi treatments have been limited due to low tolerability. Improved clinical outcomes were reported only when HDACi's were combined with other drugs. Here, we show that a novel pan-HDACi AR-42 downregulates CD44, a glycoprotein that has been associated with lenalidomide and dexamethasone resistance in myeloma both in vitro and in vivo. We also show that this CD44 downregulation is in part mediated by miR-9–5p, targeting insulin-like growth factor 2 mRNA binding protein 3 (IGF2BP3), which directly binds to CD44 mRNA and increases its stability. Importantly, we also demonstrate that AR-42 enhances anti-myeloma activity of lenalidomide in primary MM cells isolated from lenalidomide resistant patients and in in vivo MM mouse model. Thus, our findings shed light on potential novel combinatorial therapeutic approaches modulating CD44 expression, which may help overcome lenalidomide resistance in myeloma patients.
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Affiliation(s)
- Alessandro Canella
- Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Hector Cordero Nieves
- Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Douglas W Sborov
- Department of Internal Medicine, Oncology/Hematology Fellowship, The Ohio State University, Columbus, OH, USA
| | - Luciano Cascione
- Lymphoma & Genomics Research Program, IOR Institute of Oncology Research, Bellinzona, Switzerland
| | - Hanna S Radomska
- Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Emily Smith
- Department of Internal Medicine, Biomedical Sciences Graduate Program, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Andrew Stiff
- Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Jessica Consiglio
- Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Present Address: Sanford Burnham Prebys Medical Discovery Insitute, La Jolla, CA, USA
| | - Enrico Caserta
- Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Lara Rizzotto
- Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Nicola Zanesi
- Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Volinia Stefano
- Department of Internal Medicine, Biosystems Analysis, LTTA, Department of Morphology, Surgery and Experimental Medicine, Università degli Studi, Ferrara, Italy
| | - Balveen Kaur
- Department of Neurological Surgery, Dardinger Laboratory for Neuro-oncology and Neurosciences, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Xiaokui Mo
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - John C Byrd
- Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Yvonne A Efebera
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Craig C Hofmeister
- Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Flavia Pichiorri
- Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.,Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA
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20
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21
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García Escobar I, Antonio Rebollo M, García Adrián S, Rodríguez-Garzotto A, Muñoz Martín A. Safety and efficacy of primary thromboprophylaxis in cancer patients. Clin Transl Oncol 2016; 19:1-11. [DOI: 10.1007/s12094-016-1500-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
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22
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Efficacy and Safety of Novel Agent-Based Therapies for Multiple Myeloma: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6848902. [PMID: 26949704 PMCID: PMC4753325 DOI: 10.1155/2016/6848902] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/15/2015] [Accepted: 12/22/2015] [Indexed: 12/26/2022]
Abstract
This study aimed at comparing bortezomib, thalidomide, and lenalidomide in patients with multiple myeloma (MM) for safety and efficacy using meta-analysis. This meta-analysis identified 17 randomized controlled trials (RCTs) including 6742 patients. These RCTs were separated according to the different agent-based regimens and to autologous stem-cell transplantation (ASCT). Complete response (CR), progression-free survival (PFS), overall survival (OS), and adverse events (AE) were combined. The total weighted risk ratio (RR) of CR was 3.29 [95% confidence interval (95% CI): 2.22–4.88] (P < 0.0001) for the novel agent-based regimens. These novel agent-based regimens showed greater benefit in terms of PFS of all subgroups irrespective of whether the patient received ASCT or not. The hazard ratio (HR) for PFS was 0.64 [95% CI: 0.60–0.69] (P < 0.00001). Improvements of OS could be found only in the bortezomib- and thalidomide-based regimens without ASCT. The pooled HRs were 0.74 [95% CI: 0.65–0.86] (P < 0.0001) and 0.80 [95% CI: 0.70–0.90] (P = 0.0004), respectively. Several AEs were shown more frequently in the novel agent-based regimens compared with controls such as hematologic events (neutropenia, anemia, and thrombocytopenia), gastrointestinal infection, peripheral neuropathy, thrombosis, and embolism events. In conclusion, in spite of the AEs, novel agent-based regimens are safe and effective for the treatment of MM.
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23
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Ozkan MC, Tombuloglu M, Sahin F, Saydam G. Evaluation of immunomodulatory drugs in multiple myeloma: single center experience. AMERICAN JOURNAL OF BLOOD RESEARCH 2015; 5:95-100. [PMID: 27069758 PMCID: PMC4769352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/09/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Multiple myeloma (MM) comprises 1% of all cancers and 10% of hematologic malignancies and known as an incurable disease. The introduction of immunomodulatory drugs (IMiDs) has brought a major shift in therapeutic paradigm in the treatment of newly diagnosed and relapsed/refractory MM patients. The aim of this study was to evaluate the relationship between response status and hematological parameters in patients with MM treated with thalidomide or lenalidomide. METHODS Sixty-eight patients who were treated with IMiDs in Ege University, School of Medicine, Department of Hematology, between 2005 and 2012, were evaluated, retrospectively. RESULTS AND CONCLUSION We could not find any difference between the hematological parameters before and after the treatment neither with thalidomide nor lenalidomide. However, the heterogenity of our groups, the difference in treatment strategies and potential side effects would have an impact on this result. It is needed to perform prospective clinical trials to prove that whether correction of hematological parameters would reflect the response status in patients with myeloma that treated with IMiDs.
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Affiliation(s)
| | - Murat Tombuloglu
- Department of Hematology, Ege University Medical School Izmir, Turkey
| | - Fahri Sahin
- Department of Hematology, Ege University Medical School Izmir, Turkey
| | - Guray Saydam
- Department of Hematology, Ege University Medical School Izmir, Turkey
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24
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Anderson KC, Alsina M, Atanackovic D, Biermann JS, Chandler JC, Costello C, Djulbegovic B, Fung HC, Gasparetto C, Godby K, Hofmeister C, Holmberg L, Holstein S, Huff CA, Kassim A, Krishnan AY, Kumar SK, Liedtke M, Lunning M, Raje N, Singhal S, Smith C, Somlo G, Stockerl-Goldstein K, Treon SP, Weber D, Yahalom J, Shead DA, Kumar R. Multiple Myeloma, Version 2.2016: Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2015; 13:1398-435. [PMID: 26553768 PMCID: PMC4891187 DOI: 10.6004/jnccn.2015.0167] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Multiple myeloma (MM) is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. Recent statistics from the American Cancer Society indicate that the incidence of MM is increasing. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) included in this issue address management of patients with solitary plasmacytoma and newly diagnosed MM.
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25
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Guerard EJ, Tuchman SA. Monoclonal Gammopathy of Undetermined Significance and Multiple Myeloma in Older Adults. Clin Geriatr Med 2015; 32:191-205. [PMID: 26614868 DOI: 10.1016/j.cger.2015.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS) are plasma cell disorders of aging. The landscape of the diagnosis and management of MM and MGUS are rapidly changing. This article provides an updated understanding of the clinical presentation, evaluation, diagnosis, and management of older adults with MM and MGUS. Because most oncology providers are not formally trained in geriatric medicine, geriatricians play a key role in providing oncologists with a broader understanding of patient health status in the hope of improving outcomes for older adults with MM.
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Affiliation(s)
- Emily J Guerard
- Division of Hematology & Oncology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7305, Chapel Hill, NC 27599, USA
| | - Sascha A Tuchman
- Division of Cellular Therapy and Hematologic Malignancies, Duke Cancer Institute, DUMC 3961, Durham, NC 27710, USA.
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26
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Jewell S, Xiang Z, Kunthur A, Mehta P. Multiple Myeloma: Updates on Diagnosis and Management. Fed Pract 2015; 32:49S-56S. [PMID: 30766130 PMCID: PMC6375429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Two- and 3-drug treatment regimens and autologous stem cell transplants provide opportunities for longer term disease remission, though most patients will still develop relapsed multiple myeloma.
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Affiliation(s)
- Sarah Jewell
- is a hematology/oncology fellow, , , and are staff hematologist/oncologists, all in the Division of Hematology/ Oncology, Department of Internal Medicine, at the John L. McClellan Memorial Veterans Hospital in Little Rock, Arkansas. Dr. Xiang and Dr. Mehta are also faculty members at the University of Arkansas for Medical Sciences in Little Rock
| | - Zhifu Xiang
- is a hematology/oncology fellow, , , and are staff hematologist/oncologists, all in the Division of Hematology/ Oncology, Department of Internal Medicine, at the John L. McClellan Memorial Veterans Hospital in Little Rock, Arkansas. Dr. Xiang and Dr. Mehta are also faculty members at the University of Arkansas for Medical Sciences in Little Rock
| | - Anuradha Kunthur
- is a hematology/oncology fellow, , , and are staff hematologist/oncologists, all in the Division of Hematology/ Oncology, Department of Internal Medicine, at the John L. McClellan Memorial Veterans Hospital in Little Rock, Arkansas. Dr. Xiang and Dr. Mehta are also faculty members at the University of Arkansas for Medical Sciences in Little Rock
| | - Paulette Mehta
- is a hematology/oncology fellow, , , and are staff hematologist/oncologists, all in the Division of Hematology/ Oncology, Department of Internal Medicine, at the John L. McClellan Memorial Veterans Hospital in Little Rock, Arkansas. Dr. Xiang and Dr. Mehta are also faculty members at the University of Arkansas for Medical Sciences in Little Rock
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Phase I/II study of melphalan, prednisone and lenalidomide combination for patients with newly diagnosed multiple myeloma who are not candidates for stem cell transplantation. Blood Cancer J 2015; 5:e294. [PMID: 25794130 PMCID: PMC4382664 DOI: 10.1038/bcj.2015.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Bullok KF, Sippel C, Schmidt-Wolf IG. Increased effect of IMiDs by addition of cytokine-induced killer cells in multiple myeloma. Hematol Oncol 2015; 34:208-216. [DOI: 10.1002/hon.2200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 12/10/2014] [Accepted: 02/18/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Katharina F. Bullok
- Center for Integrated Oncology (CIO); Universitätsklinikum Bonn; Bonn Germany
| | - Christoph Sippel
- Center for Integrated Oncology (CIO); Universitätsklinikum Bonn; Bonn Germany
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SHEN MAN, SUN WANJUN, HUANG ZHONGXIA, ZHANG JIAJIA, AN NA, LI XIN. Partial remission of acute myeloid leukemia complicating multiple myeloma following COAP chemotherapy: A case report. Oncol Lett 2015; 9:1303-1306. [PMID: 25663902 PMCID: PMC4315064 DOI: 10.3892/ol.2015.2867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 11/06/2014] [Indexed: 11/05/2022] Open
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30
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Areethamsirikul N, Masih-Khan E, Chu CM, Jimenez-Zepeda V, Reece DE, Trudel S, Kukreti V, Tiedemann R, Chen C. CyBorD induction therapy in clinical practice. Bone Marrow Transplant 2015; 50:375-9. [PMID: 25599165 DOI: 10.1038/bmt.2014.288] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/09/2014] [Accepted: 10/15/2014] [Indexed: 11/09/2022]
Abstract
Cyclophosphamide, bortezomib and dexamethasone (CyBorD) is a highly active three-drug induction regimen for untreated transplant-eligible multiple myeloma patients. Although CyBorD has been evaluated only in the phase 2 setting in a limited number of patients, its high efficacy and ease of administration have led to its widespread use. Given that clinical trial efficacy can overestimate real-life effectiveness, we reviewed our institutional experience with 109 newly diagnosed patients who were treated with CyBorD in a non-clinical trial setting. After a median of four cycles, overall response rate (ORR) and very good partial response rate or better (⩾VGPR) were 95 and 66%, respectively, comparable to phase 2 studies of CyBorD and other three/four-drug induction regimens. All patients subsequently underwent successful stem cell collection and upgraded responses to ORR 98% and ⩾VGPR 79% post transplant. At a median follow-up of 19.8 months after diagnosis, the 2-year OS probability was 95.3% (95%CI: 89-98). The presence of concurrent plasmacytoma at diagnosis was the only prognostic factor predicting poorer survival (HR=5.56; 95%CI: 0.92-33.74; P=0.03). CyBorD was well-tolerated, with no severe peripheral neuropathy and minimal hematologic toxicity. Therefore, CyBorD is a convenient, well-tolerated, highly effective induction regimen in preparation for autologous SCT in real-life clinical practice.
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Affiliation(s)
- N Areethamsirikul
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - E Masih-Khan
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - C-M Chu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - V Jimenez-Zepeda
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - D E Reece
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - S Trudel
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - V Kukreti
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - R Tiedemann
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - C Chen
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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31
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Dimopoulos MA, Richardson PG, Moreau P, Anderson KC. Current treatment landscape for relapsed and/or refractory multiple myeloma. Nat Rev Clin Oncol 2014; 12:42-54. [PMID: 25421279 DOI: 10.1038/nrclinonc.2014.200] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Recent developments in the treatment of multiple myeloma have led to improvements in response rates and to increased survival; however, relapse is inevitable in almost all patients. Recurrence of myeloma is typically more aggressive with each relapse, leading to the development of treatment-refractory disease, which is associated with a shorter survival. Several phase II and III trials have demonstrated the efficacy of recently approved agents in the setting of relapsed and/or refractory multiple myeloma, including immunomodulatory agents, such as lenalidomide and pomalidomide, and proteasome inhibitors, such as bortezomib and carfilzomib. Currently, however, there is no standard treatment for patients with relapsed and/or refractory disease. This Review discusses the current treatment landscape for patients with relapsed and/or refractory multiple myeloma and highlights disease-related and patient-related factors--such as pre-existing comorbidities or toxicities--that are important considerations for clinicians when selecting an appropriate treatment regimen.
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Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, University of Athens, School of Medicine, 80 Vas Sofias Avenue, 11528 Athens, Greece
| | - Paul G Richardson
- Dana-Farber Cancer Institute, 44 Binney Street, Dana 1B02, Boston, MA 02115, USA
| | - Philippe Moreau
- Haematology Department, University Hôspital Hôtel-Dieu, 44093 Nantes Cedex 01, France
| | - Kenneth C Anderson
- Dana-Farber Cancer Institute, 44 Binney Street, Dana 1B02, Boston, MA 02115, USA
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Paumgartten FJR. Thalidomide and its analogues: comparative clinical efficacy and safety, and cost-effectiveness. CAD SAUDE PUBLICA 2014; 30:684-6. [PMID: 24896044 DOI: 10.1590/0102-311xpe010414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 01/22/2014] [Indexed: 11/21/2022] Open
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Papamerkouriou YM, Kenanidis E, Gamie Z, Papavasiliou K, Kostakos T, Potoupnis M, Sarris I, Tsiridis E, Kyrkos J. Treatment of multiple myeloma bone disease: experimental and clinical data. Expert Opin Biol Ther 2014; 15:213-30. [DOI: 10.1517/14712598.2015.978853] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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34
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Amin SB, Yip WK, Minvielle S, Broyl A, Li Y, Hanlon B, Swanson D, Shah PK, Moreau P, van der Holt B, van Duin M, Magrangeas F, Sonneveld P. P, Anderson KC, Li C, Avet-Loiseau H, Munshi NC. Gene expression profile alone is inadequate in predicting complete response in multiple myeloma. Leukemia 2014; 28:2229-34. [PMID: 24732597 PMCID: PMC4198516 DOI: 10.1038/leu.2014.140] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/09/2014] [Accepted: 03/21/2014] [Indexed: 12/17/2022]
Abstract
With advent of several treatment options in multiple myeloma (MM), a selection of effective regimen has become an important issue. Use of gene expression profile (GEP) is considered an important tool in predicting outcome; however, it is unclear whether such genomic analysis alone can adequately predict therapeutic response. We evaluated the ability of GEP to predict complete response (CR) in MM. GEP from pretreatment MM cells from 136 uniformly treated MM patients with response data on an IFM, France led study were analyzed. To evaluate variability in predictive power due to microarray platform or treatment types, additional data sets from three different studies (n=511) were analyzed using same methods. We used several machine learning methods to derive a prediction model using training and test subsets of the original four data sets. Among all methods employed for GEP-based CR predictive capability, we got accuracy range of 56-78% in test data sets and no significant difference with regard to GEP platforms, treatment regimens or in newly diagnosed or relapsed patients. Importantly, permuted P-value showed no statistically significant CR predictive information in GEP data. This analysis suggests that GEP-based signature has limited power to predict CR in MM, highlighting the need to develop comprehensive predictive model using integrated genomics approach.
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Affiliation(s)
- Samirkumar B. Amin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Boston VA Healthcare System, Harvard Medical School, Boston, MA
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Wai-Ki Yip
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | - Stephane Minvielle
- Hematology Department, Hopital de Nantes, 9, Quai Moncousu, Nantes, 44093, France
- Inserm U892, University of Nantes, Nantes, 44093, France
| | - Annemiek Broyl
- Department of Hematology and HOVON Data Center, Erasmus Medical Center and University, Rotterdam, The Netherlands
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Bret Hanlon
- Department of Statistics, University of Wisconsin, Madison, WI
| | - David Swanson
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | - Parantu K. Shah
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | - Philippe Moreau
- Hematology Department, Hopital de Nantes, 9, Quai Moncousu, Nantes, 44093, France
- Inserm U892, University of Nantes, Nantes, 44093, France
| | - Bronno van der Holt
- Department of Hematology and HOVON Data Center, Erasmus Medical Center and University, Rotterdam, The Netherlands
| | - Mark van Duin
- Department of Hematology and HOVON Data Center, Erasmus Medical Center and University, Rotterdam, The Netherlands
| | - Florence Magrangeas
- Hematology Department, Hopital de Nantes, 9, Quai Moncousu, Nantes, 44093, France
- Inserm U892, University of Nantes, Nantes, 44093, France
| | - Pieter Sonneveld P.
- Hematology Department, Hopital de Nantes, 9, Quai Moncousu, Nantes, 44093, France
- Inserm U892, University of Nantes, Nantes, 44093, France
| | | | - Cheng Li
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | - Herve Avet-Loiseau
- Hematology Department, Hopital de Nantes, 9, Quai Moncousu, Nantes, 44093, France
- Inserm U892, University of Nantes, Nantes, 44093, France
| | - Nikhil C. Munshi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Boston VA Healthcare System, Harvard Medical School, Boston, MA
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Selle F, Sevin E, Ray-Coquard I, Mari V, Berton-Rigaud D, Favier L, Fabbro M, Lesoin A, Lortholary A, Pujade-Lauraine E. A phase II study of lenalidomide in platinum-sensitive recurrent ovarian carcinoma. Ann Oncol 2014; 25:2191-2196. [DOI: 10.1093/annonc/mdu392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Preeshagul IR, Van Besien K, Mark TM. Controversies in multiple myeloma: to transplant or not? Curr Hematol Malig Rep 2014; 9:360-7. [PMID: 25145553 DOI: 10.1007/s11899-014-0230-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The treatment of multiple myeloma (MM) has dramatically changed in the last decade due to the introduction of the immunomodulatory drugs (IMIDs) and proteasome inhibitors, otherwise known as the novel agents. Prior to the advent of the novel agents, the gold standard of treatment had been high-dose chemotherapy with autologous stem cell transplantation (HDT/ASCT) for eligible candidates. Given the remarkable activity of the novel agents, and the significant morbidity of HDT/ASCT, the role of stem cell transplantation has now come into question. In this review, we explore the benefits and drawbacks to HDT/ASCT in the era of the novel therapies.
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Affiliation(s)
- Isabel Ruth Preeshagul
- Department of Medicine, Division of Hematology and Oncology, Mount Sinai Beth Israel, 16th street and 1st avenue, New York, NY, 10003, USA,
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João C, Coelho I, Costa C, Esteves S, Lucio P. Efficacy and safety of lenalidomide in relapse/refractory multiple myeloma--real life experience of a tertiary cancer center. Ann Hematol 2014; 94:97-105. [PMID: 25038919 DOI: 10.1007/s00277-014-2164-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/06/2014] [Indexed: 12/11/2022]
Abstract
Lenalidomide was approved for the treatment of relapsed and refractory multiple myeloma (rrMM) based on MM009 and MM010 clinical trials. However, its effectiveness and safety profile in real clinical practice should be further assessed. We retrospectively evaluated 90 consecutive patients treated in our center with lenalidomide and dexamethasone (LenDex) between 2007 and 2012. The overall response rate to this treatment was 68 % and the median duration of response was 13.6 months. Patients treated in first relapse and those treated with LenDex longer than 1 year achieved the best responses. Cytogenetics was associated with PFS and best response to treatment was the only variable associated with longer PFS and OS in univariate and multivariate analyses. Our analysis confirmed that LenDex is effective in rrMM patient, well tolerated, and applicable to the majority of patients outside clinical trials; patients achieving a complete response, even in the context of relapse, have a longer survival; quality of response is better when lenalidomide is used in second line than later on and it is a good surrogate marker for OS. Accordingly, CR should be aimed in the rrMM setting, especially in fit patients. Previous treatment with thalidomide should not hamper the option for lenalidomide therapy.
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Affiliation(s)
- Cristina João
- Department of Hematology, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal,
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38
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Ria R, Reale A, Vacca A. Novel agents and new therapeutic approaches for treatment of multiple myeloma. World J Methodol 2014; 4:73-90. [PMID: 25332907 PMCID: PMC4202483 DOI: 10.5662/wjm.v4.i2.73] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 01/28/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
This review summarizes the therapeutic strategies and the drugs actually in development for the management of myeloma patients. Multiple myeloma is caused by the expansion of monoclonal plasma cells and secretion of M-protein (immunoglobulins, Bence Jones protein and free light chains). Multiple myeloma still remains an incurable disease with a high incidence rate in the elderly, despite the introduction of several new therapeutic agents (bortezomib, lenalidomide and thalidomide) which have changed its natural history. The high heterogeneity of this disease leads to large differences in clinical responses to treatments. Thus, the choice of the best treatment is a difficult issue. However, the introduction of new drugs has made it possible to achieve high response rates and good quality responses with long-term disease control. Interactions between tumor cells and their bone marrow microenvironment play a pivotal role in the development, maintenance, and progression of myeloma, inducing also drug resistance. These knowledges have improved treatment options, leading to the approval of new drugs which not only target the malignant cell itself, but also its microenvironment. These agents are in preclinical/early clinical evaluation and they appear to further improve disease control, but their use is still not approved outside of clinical trials.
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39
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Tuchman SA, Shapiro GR, Ershler WB, Badros A, Cohen HJ, Dispenzieri A, Flores IQ, Kanapuru B, Jurivich D, Longo DL, Nourbakhsh A, Palumbo A, Walston J, Yates JW. Multiple myeloma in the very old: an IASIA conference report. J Natl Cancer Inst 2014; 106:dju067. [PMID: 24700806 DOI: 10.1093/jnci/dju067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Multiple myeloma (MM) in patients aged greater than 80 years poses an increasingly common challenge for oncology providers. A multidisciplinary workshop was held in which MM-focused hematologists/oncologists, geriatricians, and associated health-care team members discussed the state of research for MM therapy, as well as themes from geriatric medicine that pertain directly to this patient population. A summary statement of our discussions is presented here, in which we highlight several topics. MM disproportionately affects senior adults, and demographic trends indicate that this trend will accelerate. Complex issues impact cancer in seniors, and although factors such as social environment, comorbidities, and frailty have been well characterized in nononcological geriatric medicine, these themes have been inadequately explored in cancers such as MM, despite their clear relevance to this field. Therapeutically, novel agents have improved survival for MM patients of all ages, but less so for seniors than younger patients for a variety of reasons. Lastly, both MM- and treatment-related symptoms and toxicities require special attention in senior adults. Existing research provides limited insight into how best to manage these often complex patients, who are often not reflected in typical clinical trial populations. We hence offer suggestions for clinical trials that address knowledge gaps in how to manage very old and/or frail patients with MM, given the complicated issues that often surround this patient population.
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Affiliation(s)
- Sascha A Tuchman
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY).
| | - Gary R Shapiro
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - William B Ershler
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Ashraf Badros
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Harvey J Cohen
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Angela Dispenzieri
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Irene Q Flores
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Bindu Kanapuru
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Donald Jurivich
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Dan L Longo
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Ali Nourbakhsh
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Antonio Palumbo
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Jeremy Walston
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
| | - Jerome W Yates
- Affiliations of authors: Division of Hematologic Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC (SAT, HJC); Cancer Center of Western Wisconsin, New Richmond, WI (GRS); Institute for Advanced Studies in Aging and Geriatric Medicine, Falls Church, VA (GRS, WBE, IQF, BK, JWY); Division of Hematology and Oncology, University of Maryland, Baltimore, MD (AB); Division of Hematology, Mayo Clinic, Rochester, MN (AD); Division of Geriatric Medicine, University of Illinois College of Medicine, Chicago, IL (DJ); Division of Hematology, Harvard Medical School, Cambridge, MA (DLL); Bristol-Meyers Squibb, Plainsboro, NJ (AN); Myeloma Unit, University of Torino, Torino, Italy (AP); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (JW); Department of Social and Preventive Medicine, Roswell Park Cancer Institute, University of Buffalo, Roswell Park Cancer Institute, Buffalo, NY (JWY)
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Mark TM, Bowman IA, Rossi AC, Shah M, Rodriguez M, Quinn R, Pearse RN, Zafar F, Pekle K, Jayabalan D, Ely S, Coleman M, Chen-Kiang S, Niesvizky R. Thalidomide, clarithromycin, lenalidomide and dexamethasone therapy in newly diagnosed, symptomatic multiple myeloma. Leuk Lymphoma 2014; 55:2842-9. [PMID: 24576165 DOI: 10.3109/10428194.2014.896005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We studied T-BiRD (thalidomide [Thalomid(®)], clarithromycin [Biaxin(®)], lenalidomide [Revlimid(®)] and dexamethasone) in symptomatic, newly diagnosed multiple myeloma. In 28-day cycles, patients received dexamethasone 40 mg/day on days 1, 8, 15, 22, clarithromycin 500 mg twice daily on days 1-28; lenalidomide 25 mg/day on days 1-21; and thalidomide 100 mg/day (50 mg/day on days 1-7 of cycle 1 only) on days 1-28. Twenty-six patients received a median of 6 cycles (range 0-41). Overall response rate (ORR) was 80% for the group and 100% in 11 patients who underwent autologous stem cell transplantation as part of first-line therapy. The 4-year overall survival rate was 74.9%, and the median progression-free survival was 35.6 months. Eight patients discontinued due to regimen toxicity. Grade 3 non hematologic toxicity affected 12 patients (46.2%). T-BiRD is a highly active regimen with potential toxicity limitations. ClinicalTrials.gov identifier: NCT00538733.
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Affiliation(s)
- Tomer M Mark
- Center of Excellence for Lymphoma and Myeloma, Weill Medical College of Cornell University, New York Presbyterian Hospital , New York, NY , USA
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41
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Quach H, Prince HM, Spencer A. Managing multiple myeloma in the elderly: are we making progress? Expert Rev Hematol 2014; 4:301-15. [DOI: 10.1586/ehm.11.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Park SB, Goldstein D, Krishnan AV, Lin CSY, Friedlander ML, Cassidy J, Koltzenburg M, Kiernan MC. Chemotherapy-induced peripheral neurotoxicity: a critical analysis. CA Cancer J Clin 2013; 63:419-37. [PMID: 24590861 DOI: 10.3322/caac.21204] [Citation(s) in RCA: 477] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/14/2013] [Accepted: 08/23/2013] [Indexed: 12/11/2022] Open
Abstract
With a 3-fold increase in the number of cancer survivors noted since the 1970s, there are now over 28 million cancer survivors worldwide. Accordingly, there is a heightened awareness of long-term toxicities and the impact on quality of life following treatment in cancer survivors. This review will address the increasing importance and challenge of chemotherapy-induced neurotoxicity, with a focus on neuropathy associated with the treatment of breast cancer, colorectal cancer, testicular cancer, and hematological cancers. An overview of the diagnosis, symptomatology, and pathophysiology of chemotherapy-induced peripheral neuropathy will be provided, with a critical analysis of assessment strategies, neuroprotective approaches, and potential treatments. The review will concentrate on neuropathy associated with taxanes, platinum compounds, vinca alkaloids, thalidomide, and bortezomib, providing clinical information specific to these chemotherapies.
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Affiliation(s)
- Susanna B Park
- RG Menzies Fellow, Institute of Neurology, University College London, London, United Kingdom; Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Fernyhough LJ, Hock BD, Taylor J, Pearson J, Ganly P. Survival of myeloma patients following the introduction of thalidomide as a second-line therapy: a retrospective study at a single New Zealand centre. Intern Med J 2013; 43:130-7. [PMID: 22530659 DOI: 10.1111/j.1445-5994.2012.02819.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 03/06/2012] [Indexed: 11/29/2022]
Abstract
AIM This retrospective study compares the overall survival (OS) of multiple myeloma (MM) patients following treatment at a New Zealand hospital over a period in which novel therapies were available but restricted, almost exclusively, to thalidomide as a second-line therapy. METHODS Clinical, laboratory and OS data were collected on 361 MM patients who were treated at Christchurch Hospital during 2000-2010. Patients were subdivided according to the clinical criteria used to determine front-line treatment decisions. Older patients (age ≥66, n = 180) generally received standard-dose chemotherapy without autologous stem cell transplant (SCT) and formed one group. Younger patients were further subdivided according to whether they received autologous SCT (n = 89), allogeneic SCT (n = 24) or no SCT (n = 68). RESULTS Older patients had a significantly shorter OS (P < 0.0001) than younger patients (median OS = 25 vs 78 months) however treated. Analysis of relative survival demonstrated that the increased mortality of older patients was greater than that attributable to normal ageing. Younger patients who received no transplant had a significantly shorter OS (P < 0.0001) than those who received autologous SCT or allogeneic SCT with 5-year survivals of 38%, 70% and 72% respectively. Use of novel therapies was significantly higher in younger than older patients (60% vs 47%, P = 0.011). CONCLUSIONS The front-line treatment groupings of hospital MM patients had significantly different survivals. The OS of SCT ineligible patients remains poor despite the introduction of thalidomide.
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Affiliation(s)
- L J Fernyhough
- Department of Pathology, University of Otago at Christchurch, Christchurch, New Zealand
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Olivier-Abbal P, Teisseyre AC, Montastruc JL. Comparison of serious adverse reactions between thalidomide and lenalidomide: analysis in the French Pharmacovigilance database. Med Oncol 2013; 30:733. [DOI: 10.1007/s12032-013-0733-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/21/2013] [Indexed: 01/18/2023]
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Raja KRM, Plasil M, Rihova L, Pelcova J, Adam Z, Hajek R. Flow cytometry-based enumeration and functional characterization of CD8 T regulatory cells in patients with multiple myeloma before and after lenalidomide plus dexamethasone treatment. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 86:220-8. [PMID: 23922218 DOI: 10.1002/cyto.b.21109] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 06/01/2013] [Accepted: 06/24/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multiple myeloma (MM) is a malignancy of plasma cells frequently associated with immune abnormalities. Several studies have confirmed that in MM immune deregulation can be mediated by increased numbers of CD4 T regulatory (Treg) cells, and these cells were also associated with poor outcome. In this study, we aimed to study CD8 Treg cells before and after lenalidomide plus dexamethasone (len-dex) treatment in MM patients. METHODS Using flow cytometry, we enumerated and assessed suppressive function of CD8 Treg cells in 16 MM patients before and after len-dex treatment. RESULTS Numbers of CD8 Treg cells (CD8+CD25hi+FoxP3+) (P < 0.01) were significantly increased in MM patients (before treatment) compared to healthy donors. However, no significant changes were observed in CD4 and CD8 T cells. A significant increase in CD8 Treg cells was observed after len-dex treatment compared to pre-treatment but no significant difference was observed in CD4 and CD8 T cells. Proliferation assay data showed that CD8 Treg cells inhibited proliferation of CD4 T cells and IFN-γ secretion in a concentration dependent manner. Suppressive activity of CD8 Treg cells did not differ significantly between healthy donors, untreated and len-dex treated MM patients. A significant abnormal level of IL-10 was observed from proliferation assays of untreated and len-dex treated MM patients compared to healthy donors (P ≤ 0.03). CONCLUSIONS Using flow cytometry, we have shown that suppressive CD8 Treg cells are increased in MM patients and len-dex treatment is unable to control these suppressive CD8 Treg cells.
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Affiliation(s)
- Karthick Raja Muthu Raja
- Department of Pathological Physiology, Babak Myeloma Group, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
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46
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Dimopoulos MA, Terpos E, Niesvizky R. How lenalidomide is changing the treatment of patients with multiple myeloma. Crit Rev Oncol Hematol 2013; 88 Suppl 1:S23-35. [PMID: 23816163 DOI: 10.1016/j.critrevonc.2013.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 05/24/2013] [Accepted: 05/30/2013] [Indexed: 01/06/2023] Open
Abstract
Lenalidomide is a distinct second-generation immunomodulatory drug with multiple anticancer and immunomodulatory effects against hematologic malignancies, in particular multiple myeloma (MM). Dexamethasone synergistically enhances the anticancer effects of lenalidomide, and the combination of lenalidomide and dexamethasone (Len/Dex) is approved for the treatment of patients with relapsed and/or refractory MM. Results from pivotal phase III trials in this setting have demonstrated that Len/Dex extends overall survival compared with dexamethasone alone. Optimal clinical benefits are seen when Len/Dex is initiated at first relapse and continued, beyond best treatment response, until disease progression. Lenalidomide based regimens are also effective as induction therapy in patients with newly diagnosed MM. Importantly, lenalidomide has a predictable and manageable tolerability profile, with minimal neurotoxicity, allowing long-term administration. As the paradigm of myeloma disease continues to change, future studies will determine the efficacy of lenalidomide in novel combinations with potentially complimentary agents.
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Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece.
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Evidence of a role for CD44 and cell adhesion in mediating resistance to lenalidomide in multiple myeloma: therapeutic implications. Leukemia 2013; 28:373-83. [PMID: 23760401 DOI: 10.1038/leu.2013.174] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/08/2013] [Accepted: 05/24/2013] [Indexed: 12/31/2022]
Abstract
Resistance of myeloma to lenalidomide is an emerging clinical problem, and though it has been associated in part with activation of Wnt/β-catenin signaling, the mediators of this phenotype remained undefined. Lenalidomide-resistant models were found to overexpress the hyaluronan (HA)-binding protein CD44, a downstream Wnt/β-catenin transcriptional target. Consistent with a role of CD44 in cell adhesion-mediated drug resistance (CAM-DR), lenalidomide-resistant myeloma cells were more adhesive to bone marrow stroma and HA-coated plates. Blockade of CD44 with monoclonal antibodies, free HA or CD44 knockdown reduced adhesion and sensitized to lenalidomide. Wnt/β-catenin suppression by FH535 enhanced the activity of lenalidomide, as did interleukin-6 neutralization with siltuximab. Notably, all-trans retinoic acid (ATRA) downregulated total β-catenin, cell-surface and total CD44, reduced adhesion of lenalidomide-resistant myeloma cells and enhanced the activity of lenalidomide in a lenalidomide-resistant in vivo murine xenograft model. Finally, ATRA sensitized primary myeloma samples from patients that had relapsed and/or refractory disease after lenalidomide therapy to this immunomodulatory agent ex vivo. Taken together, our findings support the hypotheses that CD44 and CAM-DR contribute to lenalidomide resistance in multiple myeloma, that CD44 should be evaluated as a putative biomarker of sensitivity to lenalidomide, and that ATRA or other approaches that target CD44 may overcome clinical lenalidomide resistance.
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Redman MW, Goldman BH, LeBlanc M, Schott A, Baker LH. Modeling the relationship between progression-free survival and overall survival: the phase II/III trial. Clin Cancer Res 2013; 19:2646-56. [PMID: 23669424 PMCID: PMC4131693 DOI: 10.1158/1078-0432.ccr-12-2939] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The standard phase II trial design has changed dramatically over the past decade. Randomized phase II studies have essentially become the standard phase II design in oncology for a variety of reasons. The use of these designs is motivated by concerns about the use of historical data to determine if a new agent or regimen shows promise of activity. However, randomized phase II designs come with the cost of increased study duration and patient resources. Progression-free survival (PFS) is an important endpoint used in many phase II designs. In many clinical settings, changes in PFS with the introduction of a new treatment may represent true benefit in terms of the gold standard outcome, overall survival (OS). The phase II/III design has been proposed as an approach to shorten the time of discovery of an active regimen. In this article, design considerations for a phase II/III trial are discussed and presented in terms of a model defining the relationship between OS and PFS. The design is also evaluated using 15 phase III trials completed in the Southwest Oncology Group (SWOG) between 1990 and 2005. The model provides a framework to evaluate the validity and properties of using a phase II/III design. In the evaluation of SWOG trials, three of four positive studies would have also proceeded to the final analysis and 10 of 11 negative studies would have stopped at the phase II analysis if a phase II/III design had been used. Through careful consideration and thorough evaluation of design properties, substantial gains could occur using this approach.
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Affiliation(s)
- Mary W Redman
- Southwest Oncology Group Fred Hutchinson Cancer Research Center; Seattle, Washington 98109, USA.
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49
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Yang B, Yu RL, Chi XH, Lu XC. Lenalidomide treatment for multiple myeloma: systematic review and meta-analysis of randomized controlled trials. PLoS One 2013; 8:e64354. [PMID: 23691202 PMCID: PMC3653900 DOI: 10.1371/journal.pone.0064354] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/11/2013] [Indexed: 01/12/2023] Open
Abstract
Background In recent years, a number of randomized controlled trials (RCTs) have reported on lenalidomide as a treatment for multiple myeloma (MM). Herein, we report results of a meta-analysis of RCTs examining the efficacy and safety of lenalidomide for MM. Patients and Methods Databases were searched using the terms “lenalidomide or revlimid AND multiple myeloma.”RCTs evaluating initial or maintenance therapeutic outcomes were included. Main outcome measures were response rates, progression-free survival (PFS), overall survival, and adverse events. Results Seven trials were included (N = 192–614 participants). Lenalidomide doses and treatment regimens differed between trials. Complete response (CR) and very good partial response (VGPR) risk ratios (RR) favored lenalidomide over placebo (CR = 2.54, 95% confidence interval [CI] = 1.29–5.02; VGPR = 2.82, 95% CI = 1.30–6.09). The PFS hazard ratio favored lenalidomide over placebo (0.37, 95% CI = 0.33–0.41). For adverse events, neutropenia, deep vein thrombosis (DVT), infection, and hematologic cancer RR favored placebo over lenalidomide (neutropenia: 4.74, 95% CI = 2.96–7.57; DVT: 2.52; 95% CI: 1.60–3.98; infection: 1.98; 95% CI: 1.50–2.62; hematologic cancer: 3.20; 95% CI: 1.28–7.98). Conclusions Lenalidomide is an effective treatment for MM; however, treatment-related adverse events must be considered and appropriate adjustments and/or prophylactic treatment should be initiated where possible.
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Affiliation(s)
- Bo Yang
- Department of Geriatric Hematology, Chinese PLA General Hospital, Beijing, China
| | - Rui-li Yu
- Institute of Otorhinolaryngology, Chinese PLA General Hospital, Beijing, China
| | - Xiao-hua Chi
- Department of Pharmacy, the Second Artillery General Hospital, Beijing, China
| | - Xue-chun Lu
- Department of Geriatric Hematology, Chinese PLA General Hospital, Beijing, China
- * E-mail:
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Abstract
Although multiple myeloma (MM) remains an incurable disease, the advent of novel treatment paradigms has improved survival outcomes in the past two decades. This includes widespread use of high-dose chemotherapy with autologous stem cell transplantation (HDT-ASCT) and the development of the novel agents thalidomide, lenalidomide and bortezomib. The efficacy and tolerability of these novel agents have allowed for the exploration of continuous therapy approaches. Maintenance therapy after HDT-ASCT, for example, may help prolong progression-free survival by providing sustained control of residual disease. Trials are also under way to evaluate lenalidomide in patients with high-risk smoldering MM, with the aim of delaying progression to symptomatic MM. Other research is focusing on improving HDT-ASCT protocols and integrating novel agents, such as bortezomib, as an induction or consolidation therapy. Despite these advances, more effective strategies are needed, particularly for the management of older, less fit patients who are ineligible for HDT-ASCT. Preliminary results on the use of lenalidomide maintenance therapy in elderly patients are encouraging. Taken together, these observations indicate that in this era of novel agents, optimal treatment of MM requires a long-term perspective that focuses on providing sustained disease control while maintaining quality of life.
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