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Martinez-Cordero H, Fuentes-Lacouture C, von Glasenapp A, Peña C. The 5T's of health disparities in multiple myeloma in Latin America. Curr Opin Oncol 2024; 36:610-614. [PMID: 39246175 DOI: 10.1097/cco.0000000000001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
PURPOSE OF REVIEW Health disparities or inequities, which are defined as differences in the quality of medical and healthcare between populations among racial, ethnic, and socioeconomic groups, have been validated in numerous studies as determinants of survival and quality of life in different diseases, including cancer.Compared to the improvement in overall survival in developed countries in relation to better diagnostic opportunity and novel therapeutic approaches, low and middle-income countries still have significant barriers in accessing these therapies.The potential impact of overcoming these barriers is immense and offers hope for better outcomes. RECENT FINDINGS There is great heterogeneity in the diagnostic and therapeutic approach to multiple myeloma among different latitudes. Latin America has been characterized by important limitations in using the best technologies currently available in developed countries. SUMMARY Overcoming health disparities in multiple myeloma in LMICs could help improve survival and quality of life outcomes. Likewise, it is necessary to increase the representation of the Latin population in clinical studies, primarily in our region.
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Affiliation(s)
- Humberto Martinez-Cordero
- Hospital Militar Central
- Universidad Militar Nueva Granada
- Instituto Nacional de Cancerología, Bogotá, Colombia
- Grupo de Estudio Latinoamericano en Mieloma Múltiple, GELAMM
- Latin-American Myeloma Network, International Myeloma Foundation
| | - Cynthia Fuentes-Lacouture
- Hospital Militar Central
- Universidad Militar Nueva Granada
- Grupo de Estudio Latinoamericano en Mieloma Múltiple, GELAMM
| | - Alana von Glasenapp
- Hospital Central Instituto de Previsión Social, Asunción, Paraguay
- Grupo de Estudio Latinoamericano en Mieloma Múltiple, GELAMM
- Latin-American Myeloma Network, International Myeloma Foundation
| | - Camila Peña
- Hospital Del Salvador, Santiago, Chile
- Grupo de Estudio Latinoamericano en Mieloma Múltiple, GELAMM
- Latin-American Myeloma Network, International Myeloma Foundation
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Bahlis NJ, Samaras C, Reece D, Sebag M, Matous J, Berdeja JG, Shustik J, Schiller GJ, Ganguly S, Song K, Seet CS, Acosta-Rivera M, Bar M, Quick D, Fonseca G, Liu H, Gentili C, Singh P, Siegel D. Pomalidomide/Daratumumab/Dexamethasone in Relapsed or Refractory Multiple Myeloma: Final Overall Survival From MM-014. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00285-4. [PMID: 39237427 DOI: 10.1016/j.clml.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/17/2024] [Accepted: 07/26/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Patients with relapsed or refractory multiple myeloma (RRMM) who have exhausted lenalidomide benefits require improved therapies. The 3-cohort phase 2 MM-014 trial (NCT01946477) explored pomalidomide in early lines of treatment for lenalidomide-exposed RRMM. In cohort B, pomalidomide plus daratumumab and dexamethasone (DPd) showed promising efficacy (median follow-up 28.4 months), as previously reported. Here, we report final overall survival (OS) in cohort B. METHODS Patients aged ≥ 18 years were treated in 28-day cycles: pomalidomide 4 mg orally daily from days 1 to 21; daratumumab 16 mg/kg intravenously on days 1, 8, 15, and 22 (cycles 1-2), days 1 and 15 (cycles 3-6), and day 1 (cycle ≥ 7); and dexamethasone 40 mg (age ≤ 75 years) or 20 mg (age > 75 years) orally on days 1, 8, 15, and 22. The primary endpoint was ORR. OS and safety were secondary endpoints. RESULTS Among 112 patients enrolled, 85 (75.9%) had lenalidomide-refractory disease and 27 (24.1%) had lenalidomide-relapsed disease. At a median follow-up of 41.9 months (range, 0.4-73.1), median OS was 56.7 months (95% confidence interval, 46.5-not reached). Treatment-emergent adverse events related to, and leading to discontinuation of, pomalidomide, dexamethasone, or daratumumab occurred in 7 (6.3%), 9 (8.0%), and 6 (5.4%) patients, respectively. CONCLUSION With long-term follow-up, our results show favorable OS with DPd. The safety profile was consistent with previous reports, with no new safety signals identified. IMiD agent-based therapy can still be considered in patients with RRMM who experience progressive disease on or after lenalidomide.
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Affiliation(s)
| | | | - Donna Reece
- Princess Margaret Hospital, Toronto, ON, Canada
| | - Michael Sebag
- McGill University Health Centre, Montreal, QC, Canada
| | - Jeffrey Matous
- Colorado Blood Cancer Institute, Sarah Cannon Research Institute, Denver, CO
| | | | | | | | | | - Kevin Song
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | | | | | - Donald Quick
- Joe Arrington Cancer Research and Treatment Center, Lubbock, TX
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Manier S, Dimopoulos M, Hulin C, Leleu X, Delforge M, Weisel K, Mouro J, Costa B, Sturniolo M, Facon T. Predictors of Lenalidomide Refractory Relapse Timing With Newly Diagnosed Multiple Myeloma: A FIRST Trial Subanalysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e297-e306.e1. [PMID: 37393121 DOI: 10.1016/j.clml.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION/BACKGROUND Multiple myeloma (MM) is considered an incurable cancer. Patients with newly diagnosed MM (NDMM) are at risk for relapse within 1 year of frontline therapy. The immunomodulatory agent lenalidomide combined with dexamethasone (Rd) may be used as treatment for NDMM or relapsed MM, including in patients ineligible for autologous stem cell transplant. PATIENTS This subanalysis of the phase III FIRST trial characterized patients with transplant-ineligible NDMM who experienced relapse while receiving Rd therapy by relapse timing (early [<12 months] versus late [≥12 months]) and type (CRAB vs. non-CRAB). METHODS The Kaplan-Meier product limit method was used to estimate time-to-event endpoints, including progression-free survival (PFS) and overall survival (OS). Factors associated with the odds of late relapse were identified by logistic regression with univariate and multivariate analyses using a binary outcome (relapse at <12 vs. ≥12 months) in patient-, disease-, and treatment-specific baseline variables. RESULTS Patients with early refractory relapse had functionally high-risk disease and inferior outcomes. In patients with early relapse versus those with late relapse, median OS (95% CI) was 26.8 months (21.9-32.8) versus 63.9 months (57.0-78.0), median OS from disease progression to death was 19.9 months (16.0-25.5) versus 36.4 months (27.9-47.0), and median PFS from randomization to second progression was 19.1 months (17.3-22.5) versus 42.1 months (37.4-44.9). Lactate dehydrogenase, baseline β2 microglobulin, and myeloma subtype were shown to predict time to relapse. CONCLUSIONS Clinicians could use these factors to consider more aggressive treatment regimens for those at highest risk of early relapse.
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Affiliation(s)
- Salomon Manier
- Department of Hematology, Université de Lille, CHU Lille, Lille, France.
| | - Meletios Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Cyrille Hulin
- Department of Hematology, Hôpital Haut Lévêque, University Hospital, Pessac, France
| | - Xavier Leleu
- Department of Hematology and Cellular Therapy, CIC U1402 CHU de Poitiers, Poitiers, France
| | | | - Katja Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Department of Pneumonology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jorge Mouro
- Worldwide Medical Affairs, Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Bruno Costa
- Worldwide Medical Affairs, Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Michael Sturniolo
- Worldwide Medical Affairs, Celgene, a Bristol-Myers Squibb Company, Princeton, NJ
| | - Thierry Facon
- Department of Hematology, Université de Lille, CHU Lille, Lille, France
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Tanveer N, Hussein S, Pingili S, Makkena VK, Jaramillo AP, Awosusi BL, Ayyub J, Dabhi KN, Gohil NV, Hamid P. Multiple Myeloma and the Role of Bisphosphonates in Its Management. Cureus 2023; 15:e45270. [PMID: 37846237 PMCID: PMC10576843 DOI: 10.7759/cureus.45270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
An aberrant growth of plasma cells in the bone marrow characterizes the hematological neoplasm known as multiple myeloma, which is typically accompanied by increased bone pain and skeletal-related events such as pathological fractures and/or spinal cord compression. Changes in the bone marrow microenvironment brought on by increased osteoclastic activity and/or decreased osteoblastic activity as a result of myeloma bone disease have a detrimental effect on quality of life. Bone-modifying medications such as bisphosphonates or denosumab are used to treat myeloma bone disease. These substances can lessen bone pain and the chance of pathological fracture, but they do not stimulate the growth of new bone or heal already damaged bone. In order to conduct this study, we searched the PubMed, Google Scholar, and Cochrane databases for complete free papers published in English and studied people over the previous five years, starting in 2018. The search covered randomized clinical trials (RCT), observational studies, meta-analyses, systemic reviews, and conventional reviews. Twenty-five publications are picked after using quality evaluation techniques to determine the type of study. These papers' full-text articles are investigated, examined, and tallied. We spoke about the various treatments for bone damage in multiple myeloma. It was discovered that bisphosphonates lessen the frequency and severity of bone problems. However, we are unsure of their contribution to survival. Although these medicines enhance life quality, it is unknown if they also increase overall survival. The focus of this study is on several kinds of bone-modifying drugs, their processes of action, the point at which therapy is started, how long it lasts, and any possible mortality advantages.
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Affiliation(s)
- Nida Tanveer
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sally Hussein
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shravya Pingili
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine, Kakatiya Medical College, Hyderabad, IND
| | - Vijaya Krishna Makkena
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- MBBS, Osmania Medical College, Hyderabad, IND
| | - Arturo P Jaramillo
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Babatope L Awosusi
- Pathology and Laboratory Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Javaria Ayyub
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Karan Nareshbhai Dabhi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Namra V Gohil
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Medical College Baroda, Vadodara, IND
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Mangiacavalli S, Cartia CS, Galli M, Pezzatti S, Belotti A, Fazio F, Mina R, Marcatti M, Cafro A, Zambello R, Paris L, Barilà G, Olivares C, Pompa A, Mazza R, Farina F, Soldarini M, Benvenuti P, Pagani G, Palumbo M, Masoni V, Ferretti VV, Klersy C, Arcaini L, Petrucci MT. Lenalidomide-based triplet regimens in first relapsed multiple myeloma patients: real-world evidence from a propensity score matched analysis. Haematologica 2023; 108:833-842. [PMID: 36200419 PMCID: PMC9973473 DOI: 10.3324/haematol.2022.281342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Indexed: 11/09/2022] Open
Abstract
Lenalidomide and dexamethasone (Rd)-based triplets, in particular carfilzomib-Rd (KRd) and daratumumab-Rd (DaraRd), represent a standard of care in lenalidomide-sensitive multiple myeloma (MM) patients in first relapse. Meta-analysis of randomized clinical trials (RCT), suggested better outcome with DaraRd. Trying to address this issue in clinical practice, we collected data of 430 consecutive MM patients addressed to Rd-based triplets in first relapse between January 2017 and March 2021. Overall, the most common used regimen was DaraRd, chosen in almost half of the cases (54.4%), followed by KRd (34.6%). Different triplets were used much less commonly. In an attempt to limit the imbalance of a retrospective analysis, we conducted a propensity score matching (PSM) comparison between DaraRd and KRd. After PSM, efficacy of DaraRd versus KRd was similar in terms of overall-response rate (ORR) (OR: 0.9, P=0.685) as well as of very good partial response (VGPR) or better (OR: 0.9, P=0.582). The median progression-free survival (PFS) was significantly longer for DaraRd (29.8 vs. 22.5 months; P=0.028). DaraRd was tolerated better, registering a lower rate of grade 3-4 non-hematological toxicity (OR: 0.4, P<0.001). With the limitations of any retrospective analysis, our real-life PSM comparison between DaraRd and KRd, in first-relapse MM patients, showed better tolerability and prolonged PFS of DaraRd, although with some gaps of performance, in particular of DaraRd, with respect to RCT. Carfilzomib-containing regimens, like KRd, still remain a valid second-line option in the emerging scenario of first-line daratumumab-based therapy.
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Affiliation(s)
| | | | - Monica Galli
- Division of Hematology, ASST Papa Giovanni XXIII, Bergamo
| | | | | | - Francesca Fazio
- Division of Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome
| | - Roberto Mina
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino
| | - Magda Marcatti
- Division of Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan
| | - Anna Cafro
- Hematology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Renato Zambello
- Hematology and Clinical Immunology, Department of Medicine, Azienda Ospedaliera di Padova, Padova
| | - Laura Paris
- Division of Hematology, ASST Papa Giovanni XXIII, Bergamo
| | - Gregorio Barilà
- University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padova
| | - Cecilia Olivares
- Division of Hematology, Ospedale di Circolo and Fondazione Macchi, University of Insubria, Varese
| | - Alessandra Pompa
- Division of Hematology and Stem Cell Transplantation, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan
| | - Rita Mazza
- Humanitas Clinical and Research Center, IRCCS, Milan
| | - Francesca Farina
- Division of Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan
| | | | - Pietro Benvenuti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | - Michele Palumbo
- Department of Molecular Medicine, University of Pavia, Pavia
| | - Valeria Masoni
- Department of Molecular Medicine, University of Pavia, Pavia
| | | | - Catherine Klersy
- Clinical Epidemiology and Biostatistics Service, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia
| | - Maria Teresa Petrucci
- Division of Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome
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Leleu X, Katodritou E, Kuehr T, Terpos E, Caers J, Zambello R, Brescianini A, Liang T, Wetten S, Badelita SN. Real-world use of carfilzomib combined with lenalidomide and dexamethasone in patients with multiple myeloma in Europe and Israel. EJHAEM 2023; 4:174-183. [PMID: 36819146 PMCID: PMC9928790 DOI: 10.1002/jha2.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022]
Abstract
Clinical trials have demonstrated the efficacy and safety of carfilzomib in patients with relapsed/refractory multiple myeloma (RRMM); however, prospective real-world data are limited. This real-world, prospective, observational study evaluated carfilzomib use, effectiveness and safety in adults with RRMM. Data are presented for a subset of patients (n = 383) who received carfilzomib in combination with lenalidomide and dexamethasone (KRd). The overall response rate (ORR) was 83.6% among 360 evaluable patients. Treatment responses were better when KRd was administered at earlier therapy lines than at later lines of therapy (ORR: second line, 85.3%; third line or later, 81.0%). In patients with the anti-CD38 antibody-refractory disease, ORR was higher when KRd was administered earlier than at later therapy lines (second line/third line, 75.0%; fourth line or later, 60.0%). An ORR of 68.1% and 82.0% was achieved in the lenalidomide-refractory and not lenalidomide-refractory subgroups, respectively. KRd was consistently administered per the European label (twice weekly dose of 27 mg/m2) and the median time to discontinuation was 14.6 months. The safety profile of KRd was consistent with previous studies. These real-world data highlight the effectiveness of KRd as a treatment for patients with RRMM, including those with disease refractory to lenalidomide or anti-CD38 antibodies.
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Affiliation(s)
- Xavier Leleu
- Department of HaematologyUniversity Hospital Centre La Miletrie and InsermPoitiersFrance
| | - Eirini Katodritou
- Department of HaematologyTheagenio Cancer HospitalThessalonikiGreece
| | - Thomas Kuehr
- Department of Internal Medicine IVAcademic Teaching Hospital Wels‐GrieskirchenWelsAustria
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of MedicineNational and Kapodistrian University of AthensAthensGreece
| | - Jo Caers
- Department of HaematologyLiège University Hospital CentreLiègeBelgium
| | - Renato Zambello
- Department of MedicineHaematology and Clinical Immunology Branch, University of PaduaPaduaItaly
| | | | - Tony Liang
- Department of BiostatisticsParexel InternationalTaipeiTaiwan
| | - Sally Wetten
- Center for Observational ResearchAmgen LtdUxbridgeUK
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7
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Pomalidomide, dexamethasone, and daratumumab in Japanese patients with relapsed or refractory multiple myeloma after lenalidomide-based treatment. Int J Hematol 2022; 116:122-130. [DOI: 10.1007/s12185-022-03338-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 11/25/2022]
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8
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Bahlis NJ, Siegel DS, Schiller GJ, Samaras C, Sebag M, Berdeja J, Ganguly S, Matous J, Song K, Seet CS, Acosta-Rivera M, Bar M, Quick D, Anz B, Fonseca G, Chung W, Lee K, Mouro J, Agarwal A, Reece D. Pomalidomide, dexamethasone, and daratumumab immediately after lenalidomide-based treatment in patients with multiple myeloma: updated efficacy, safety, and health-related quality of life results from the phase 2 MM-014 trial. Leuk Lymphoma 2022; 63:1407-1417. [PMID: 35133221 DOI: 10.1080/10428194.2022.2030477] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with relapsed/refractory multiple myeloma (RRMM) need proven subsequent therapies after early-line lenalidomide treatment failure. The phase 2 MM-014 trial (NCT01946477) investigated pomalidomide, dexamethasone, and daratumumab after 1 to 2 prior treatment lines (62.5%, 1 prior line) in patients with RRMM and prior lenalidomide (75.0%, lenalidomide refractory). With a median follow-up of 28.4 months, overall response rate was 77.7% (52.7% achieved very good partial response or better) and median progression-free survival was 30.8 months. For patients with lenalidomide-refractory disease, these outcomes were 76.2%, 47.6%, and 23.7 months, respectively. No new safety signals were observed; 64.3% experienced grade 3/4 neutropenia. Health-related quality of life was preserved or trended toward improvement through 12 treatment cycles. Pomalidomide, dexamethasone, and daratumumab given immediately after early-line lenalidomide-based treatment continues to demonstrate safety and efficacy, supporting pomalidomide-dexamethasone as a foundation of combination therapy in RRMM and providing evidence that the immunomodulatory agent class delivers benefit after lenalidomide treatment failure.
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Affiliation(s)
| | - David S Siegel
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Gary J Schiller
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Michael Sebag
- McGill University Health Centre, Montreal, QC, Canada
| | | | | | | | - Kevin Song
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Christopher S Seet
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | | | - Donald Quick
- Joe Arrington Cancer Research and Treatment Center, Lubbock, TX, USA
| | | | | | | | - Kim Lee
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Jorge Mouro
- Celgene International Sàrl, A Bristol-Myers Squibb Company, Boudry, Switzerland
| | | | - Donna Reece
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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9
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Kelly KR, Ailawadhi S, Siegel DS, Heffner LT, Somlo G, Jagannath S, Zimmerman TM, Munshi NC, Madan S, Chanan-Khan A, Lonial S, Chandwani S, Minasyan A, Ruehle M, Barmaki-Rad F, Abdolzade-Bavil A, Rharbaoui F, Herrmann-Keiner E, Haeder T, Wartenberg-Demand A, Anderson KC. Indatuximab ravtansine plus dexamethasone with lenalidomide or pomalidomide in relapsed or refractory multiple myeloma: a multicentre, phase 1/2a study. LANCET HAEMATOLOGY 2021; 8:e794-e807. [PMID: 34529955 DOI: 10.1016/s2352-3026(21)00208-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Indatuximab ravtansine (BT062) is an antibody-drug conjugate that binds to CD138 and synergistically enhances the antitumor activity of lenalidomide in preclinical models of multiple myeloma. This phase 1/2a study was done to determine the safety, activity, and pharmacokinetics of indatuximab ravtansine in combination with immunomodulatory drugs in patients with relapsed or refractory multiple myeloma. METHODS This open-label, phase 1/2a study took place at nine hospital sites in the USA. Eligible patients were aged 18 years or older, had relapsed or refractory multiple myeloma, and ECOG performance status or Zubrod score of 2 or below. Patients who received indatuximab ravtansine with lenalidomide and dexamethasone (indatuximab ravtansine plus lenalidomide) had failure of at least one previous therapy. Patients treated with indatuximab ravtansine with pomalidomide and dexamethasone (indatuximab ravtansine plus pomalidomide) had failure of at least two previous therapies (including lenalidomide and bortezomib) and had progressive disease on or within 60 days of completion of their last treatment. In phase 1, patients received indatuximab ravtansine intravenously on days 1, 8, and 15 of each 28-day cycle in escalating dose levels of 80 mg/m2, 100 mg/m2, and 120 mg/m2, with lenalidomide (25 mg; days 1 to 21 every 28 days orally) and dexamethasone (20-40 mg; days 1, 8, 15, and 22 every 28 days). In phase 2, the recommended phase 2 dose of indatuximab ravtansine was given to an expanded cohort of patients in combination with lenalidomide and dexamethasone. The protocol was amended to allow additional patients to be treated with indatuximab ravtansine plus pomalidomide (4 mg; days 1 to 21 every 28 days orally) and dexamethasone, in a more heavily pretreated patient population than in the indatuximab ravtansine plus lenalidomide group. The phase 1 primary endpoint was to determine the dose-limiting toxicities and the maximum tolerated dose (recommended phase 2 dose) of indatuximab ravtansine, and the phase 2 primary endpoint was to describe the objective response rate (ORR; partial response or better) and clinical benefit response (ORR plus minor response). All patients were analysed for safety and all patients with post-treatment response assessments were analysed for activity. This study is registered with ClinicalTrials.gov, number NCT01638936, and is complete. FINDINGS 64 (86%) of 74 screened patients were enrolled between July 3, 2012, and June 30, 2015. 47 (73%) patients received indatuximab ravtansine plus lenalidomide (median follow-up 24·2 months [IQR 19·9-45·4]) and 17 (27%) received indatuximab ravtansine plus pomalidomide (24·1 months [17·7-36·7]). The maximum tolerated dose of indatuximab ravtansine plus lenalidomide was 100 mg/m2, and defined as the recommended phase 2 dose for indatuximab ravtansine plus pomalidomide. An objective response for indatuximab ravtansine plus lenalidomide was observed in 33 (71·7%) of 46 patients and in 12 (70·6%) of 17 patients in the indatuximab ravtansine plus pomalidomide group. The clinical benefit response for indatuximab ravtansine plus lenalidomide was 85% (39 of 46 patients) and for indatuximab ravtansine plus pomalidomide it was 88% (15 of 17 patients). The most common grade 3-4 adverse events in both groups were neutropenia (14 [22%] of 64 patients), anaemia (10 [16%]), and thrombocytopenia (seven [11%]). Treatment-emergent adverse events (TEAEs) that led to discontinuation occurred in 35 (55%) of the 64 patients. Five (8%) patients with a TEAE had a fatal outcome; none was reported as related to indatuximab ravtansine. INTERPRETATION Indatuximab ravtansine in combination with immunomodulatory drugs shows preliminary antitumor activity, is tolerated, and could be further evaluated in patients with relapsed or refractory multiple myeloma. FUNDING Biotest AG.
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Affiliation(s)
- Kevin R Kelly
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | | | - David S Siegel
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Leonard T Heffner
- Department of Hematology and Medical Oncology, Emory University - Winship Cancer Institute, Atlanta, GA, USA
| | - George Somlo
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | | | | | - Nikhil C Munshi
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Sumit Madan
- Banner MD Anderson Cancer Center, Phoenix, AZ, USA
| | | | - Sagar Lonial
- Department of Hematology and Medical Oncology, Emory University - Winship Cancer Institute, Atlanta, GA, USA
| | - Suraj Chandwani
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashot Minasyan
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | - Kenneth C Anderson
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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10
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Zherebtsova VA, Vorobyev VI, Gemdzhian EG, Ulyanova MA, Chernikov MV, Ivanova VL, Vinogradova OY, Ptushkin VV. Carfilzomib, lenalidomide and dexamethasone in relapsed/refractory multiple myeloma patients: the real-life experience. TERAPEVT ARKH 2021; 93:785-792. [DOI: 10.26442/00403660.2021.07.200956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022]
Abstract
Background. Carfilzomib, lenalidomide, and dexamethasone (KRd) have been approved for the treatment of relapsed and refractory multiple myeloma (RRMM) based on ASPIRE clinical trial.
Aim. Analysis of efficacy and safety of KRd in routine clinical practice.
Materials and methods. The prospective analysis included patients with MM who received at least one line of previous therapy. The inclusion criteria were relapse/progression; refractoriness; lack of very good partial response (VGPR) and more after the first line of therapy. Since February 2016, we used KRd like in ASPIRE trial, since October 2019, carfilzomib has been used at a dose of 56 mg/m2 on days 1, 8 and 15. Autologous hematopoietic stem cell transplantation (autoHSCT), consolidation (KRd) and maintenance therapy (Rd) were regarded as one line of therapy.
Results and discussion. We evaluated 77 patients with median age at the time of diagnosis is 55 (3072) years. For 56% (n=43) of patients KRd was applied as the second line (group 1), for 44% (n=34) as the third and more (group 2). In 23/43 patients from group 1, an early change in therapy was made due to insufficient effectiveness (after 24 courses of VCD or PAD). KRd served as a "bridge" to autoHSCT in 25 (32%) patients (21 of 25 in group 1). Another 7 patients underwent collection of autoHSC (all from group 1).
The overall response rate (ORR) was 80.5%, with 33.8% complete response (CR) and 26% VGPR. ORR in group 1 was 98% versus 65.6% in group 2; 24-month overall survival (OS) was 70%, progression free survival (PFS) 49.8%. In group 1, 24-month OS was 85.6% versus 50.0% in group 2, 24-month PFS was 67.8% versus 25.5% (p=0.01).
Conclusion. Our analysis confirmed the high efficiency of KRd in the treatment of RRMM in real-life practice. Early correction of therapy with insufficient effectiveness of the first line made it possible to implement the strategy of high-dose consolidation and autoHSCT in a larger percentage of patients with MM.
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11
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Quach H, Nooka A, Samoylova O, Venner CP, Kim K, Facon T, Spencer A, Usmani SZ, Grosicki S, Suzuki K, Delimpasi S, Weisel K, Obreja M, Zahlten-Kumeli A, Mateos MV. Carfilzomib, dexamethasone and daratumumab in relapsed or refractory multiple myeloma: results of the phase III study CANDOR by prior lines of therapy. Br J Haematol 2021; 194:784-788. [PMID: 34046887 DOI: 10.1111/bjh.17541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Hang Quach
- St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Ajay Nooka
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Olga Samoylova
- Nizhniy Novgorod Region Clinical Hospital, Nizniy Novgorod, Russia
| | | | - Kihyun Kim
- Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | | | | | | | | | | | | | - Katja Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Up-front ixazomib in older patients with myeloma. Blood 2021; 137:3584-3586. [PMID: 34196682 DOI: 10.1182/blood.2021011262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Richard S, Jagannath S, Cho HJ, Parekh S, Madduri D, Richter J, Chari A. A comprehensive overview of daratumumab and carfilzomib and the recently approved daratumumab, carfilzomib and dexamethasone regimen in relapsed/refractory multiple myeloma. Expert Rev Hematol 2020; 14:31-45. [PMID: 33331794 DOI: 10.1080/17474086.2021.1858790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Novel, effective regimens are needed in patients with relapsed and refractory myeloma (RRMM) who inevitably relapse after PI and IMID containing treatment. Areas covered: Pre-clinical data, early clinical and pivotal trials relevant to the development of the two backbone drugs of carfilzomib and daratumumab, and the two important recent trials, EQUULEUS and CANDOR leading to the FDA approval of the combination regimen of daratumumab, carfilzomib, and dexamethasone (DKd) for RRMM are detailed in this review. Expert opinion: EQUULEUS and CANDOR have established the efficacy of the DKd regimen in the landscape of bortezomib and lenalidomide refractory patients. The split dosing schedule of the first dose of daratumumab was approved by the FDA based on EQUULEUS, significantly improving patient convenience. Subcutaneous daratumumab is being evaluated in this combination to further improve tolerance and convenience. Further studies are needed to evaluate and optimally sequence the many effective and potent drugs available in RRMM.
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Affiliation(s)
- Shambavi Richard
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sundar Jagannath
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hearn Jay Cho
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samir Parekh
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deepu Madduri
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Richter
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ajai Chari
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Siegel DS, Schiller GJ, Samaras C, Sebag M, Berdeja J, Ganguly S, Matous J, Song K, Seet CS, Talamo G, Acosta-Rivera M, Bar M, Quick D, Anz B, Fonseca G, Reece D, Pierceall WE, Chung W, Zafar F, Agarwal A, Bahlis NJ. Pomalidomide, dexamethasone, and daratumumab in relapsed refractory multiple myeloma after lenalidomide treatment. Leukemia 2020; 34:3286-3297. [PMID: 32376855 PMCID: PMC7685974 DOI: 10.1038/s41375-020-0813-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/06/2020] [Accepted: 03/20/2020] [Indexed: 12/16/2022]
Abstract
Patients with multiple myeloma who have relapsed after or become refractory to lenalidomide in early treatment lines represent a clinically important population in need of effective therapies. The safety and efficacy of pomalidomide, low-dose dexamethasone, and daratumumab was evaluated in lenalidomide-pretreated patients with relapsed or refractory multiple myeloma (RRMM) after one to two prior treatment lines in the phase 2 MM-014 study. Patients received pomalidomide 4 mg daily from days 1-21 and dexamethasone 40 mg weekly (28-day cycles). Daratumumab 16 mg/kg was administered per label. Primary endpoint was overall response rate (ORR); secondary endpoints included progression-free survival (PFS) and safety. Per protocol, all patients (N = 112) had received lenalidomide in their most recent prior regimen (75.0% lenalidomide refractory). ORR was 77.7% (76.2% in lenalidomide-refractory patients); median follow-up was 17.2 months. Median PFS was not reached (1-year PFS rate 75.1%). The most common hematologic grade 3/4 treatment-emergent adverse event was neutropenia (62.5%). Grade 3/4 infections were reported in 31.3% of patients, including 13.4% with grade 3/4 pneumonia. These results demonstrate the safety and efficacy of pomalidomide-based therapy as early as second line in patients with RRMM, even immediately after lenalidomide failure, indicating that switching from the immunomodulatory agent class is not necessary.
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Affiliation(s)
- David S Siegel
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA.
| | - Gary J Schiller
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | | | - Michael Sebag
- McGill University Health Centre, Montreal, QC, Canada
| | | | | | | | - Kevin Song
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Christopher S Seet
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | | | | | | | - Donald Quick
- Joe Arrington Cancer Research and Treatment Center, Lubbock, TX, USA
| | | | | | - Donna Reece
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | - Nizar J Bahlis
- Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada
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15
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Wu D, Zhang P, Li F, Shen Y, Chen H, Feng Y, He A, Wang F. CD138 - multiple myeloma cells express high level of CHK1 which correlated to overall survival in MM patient. Aging (Albany NY) 2020; 12:23067-23081. [PMID: 33197893 PMCID: PMC7746343 DOI: 10.18632/aging.104066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022]
Abstract
Multiple myeloma (MM) is a disease in which abnormal plasma cells proliferate and secrete monoclonal immunoglobulin in the bone marrow. The main characteristic of plasma cells is the expression of the cell surface antigen syndecan-1 (CD138). However, the expression of CD138 is limited to terminally differentiated plasma cells during B cell development. A small subpopulation (2~5%) of human MM cells that lack CD138 expression has been shown to possess enormous proliferation potential in vitro experiment and in animal models, and they also can differentiate into CD138+ plasma cells. Thus, this small subset of MM cells was regarded as myeloma cancer stem cell (MCSC). However, its characteristics associated with the pathogenesis of MM remain unclear. In this study, we analyzed the gene expression data of CD138 cell lines downloaded from Gene Expression Omnibus (GEO) database. Limma package in RStudio was used to identify differentially expressed genes (DEGs). Genes enrichment and protein-protein interaction (PPI) network analysis were performed on DAVID and STRING databases. Furthermore, overall survival (OS) analysis in MM patient was utilized to screen out the hub-genes closely associate with the MM pathogenesis process. Hub-genes expression validation and receiver operating characteristic curve (ROC) analysis was performed in different stages of plasma cell disorder diseases. Finally, we verified these findings in MM patient samples. Through integrated bioinformatics analysis of MM CD138- and CD138+ cell lines, we found that CDC7, CDK1, and CHK1 are highly expressed in CD138- MM cells. These genes are crucial in the G2/M phase of the cell cycle pathway, which is closely related to the malignant proliferation in various tumor cells. Of note, we found that patients with high expression of CDC7, CDK1, and CHK1 had shorter overall survival time. The expression of CHK1 was significantly increased in MM cells compared with normal plasma cell (NPC) and MGUS. More importantly, we further clarified that the expression of CHK1 in release/refraction MM (R/R MM) has obviously increased compared with new diagnosed MM (ND MM).
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Affiliation(s)
- Dong Wu
- Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Peihua Zhang
- Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Fangmei Li
- Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ying Shen
- Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hongli Chen
- Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuandong Feng
- Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Aili He
- Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Fangxia Wang
- Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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16
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Anti-tumor activities of the new oral pan-RAF inhibitor, TAK-580, used as monotherapy or in combination with novel agents in multiple myeloma. Oncotarget 2020; 11:3984-3997. [PMID: 33216827 PMCID: PMC7646837 DOI: 10.18632/oncotarget.27775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 09/29/2020] [Indexed: 12/21/2022] Open
Abstract
Many RAS pathway inhibitors, including pan-RAF inhibitors, have shown significant anti-tumor activities in both solid and hematological tumors. The pan-RAF inhibitor, TAK-580, is a representative of the novel RAF inhibitors that act by disrupting RAF homo- or heterodimerization. In this study, we examined the anti-tumor effects of TAK-580 used as monotherapy or in combination with bortezomib, lenalidomide, or other novel agents in multiple myeloma (MM) cells in vitro. TAK-580 monotherapy potently targeted proteins in the RAS-RAF-MEK-ERK signaling pathway and induced potent cytotoxicity and apoptosis in MM cell lines and myeloma cells from patients with newly diagnosed and relapsed and/or refractory MM, compared with a representative RAF inhibitor, dabrafenib. Normal donor peripheral blood B lymphocytes and cord blood CD34-positive cells were not affected. Importantly, TAK-580 significantly inhibited phospho-FOXO3 and induced upregulation of BimL and BimS in a dose-dependent manner, finally leading to apoptosis in MM cells. Moreover, TAK-580 enhanced bortezomib-induced cytotoxicity and apoptosis in MM cells via the FOXO3-Bim axis and the terminal unfolded protein response. Importantly, TAK-580 also enhanced lenalidomide-induced cytotoxicity and apoptosis in MM cells. Taken together, our results provide the rationale for TAK-580 monotherapy and/or treatment in combination with novel agents to improve outcomes in patients with MM.
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17
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Rocchi S, Tacchetti P, Pantani L, Mancuso K, Rizzello I, di Giovanni Bezzi C, Scalese M, Dozza L, Marzocchi G, Martello M, Barilà G, Antonioli E, Staderini M, Buda G, Petrini M, Cea M, Quaresima M, Furlan A, Bonalumi A, Cavo M, Zamagni E. A real-world efficacy and safety analysis of combined carfilzomib, lenalidomide, and dexamethasone (KRd) in relapsed/refractory multiple myeloma. Hematol Oncol 2020; 39:41-50. [PMID: 33085797 DOI: 10.1002/hon.2820] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 01/01/2023]
Abstract
Carfilzomib-lenalidomide-dexamethasone (KRd) has been approved for the treatment of relapsed/refractory multiple myeloma (RRMM). We conducted a retrospective analysis of 197 RRMM patients (pts) between January 2016 and March 2018 in six Italian hematologic centers, with the aim to evaluate efficacy and safety of KRd in real-life. At KRd initiation 27% carried high risk cytogenetic abnormalities (HRCA) [del17p and/or t(4;14) and/or t(14;16)], median number of prior lines of therapy was 2 (1-8), nearly all pts (96%) received prior bortezomib (18% refractory) while 45% were exposed to lenalidomide (R; 22% refractory). At the median of 12.5 months, 52% of the pts had discontinued treatment, mainly (66%) for progression. Main grade 3-4 adverse events were neutropenia (21%), infections (11%), and hypertension (6%). Overall, the response rate was 88%. The median progression-free survival (PFS) was 19.8 months and 1-year overall survival (OS) rate was 80.6%. By subgroup analysis, extended PFS and OS were observed for pts who received ≤2 prior lines of therapy (HR = 0.42, p < 0.001 and HR = 0.35, p = 0.001, respectively), not refractory to prior R (HR = 0.37, p < 0.001, and HR = 0.47, p = 0.024), without HRCA (HR = 0.33, p = 0.005 and HR = 0.26, p = 0.016) and achieving ≥ very good partial response (VGPR; HR = 0.17, p < 0.001 and HR = 0.18, p < 0.001). In conclusion, KRd demonstrated to be effective in RRMM pts treated in real-world setting, without new safety concerns. Better survival outcomes emerged for pts with ≤2 prior lines of therapy, achieving at least a VGPR, and without HRCA.
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Affiliation(s)
- Serena Rocchi
- Azienda Ospedaliero-Universitaria di Bologna, Italia - Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale - Università degli Studi, Bologna, Italy
| | - Paola Tacchetti
- Azienda Ospedaliero-Universitaria di Bologna, Italia - Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale - Università degli Studi, Bologna, Italy
| | - Lucia Pantani
- Azienda Ospedaliero-Universitaria di Bologna, Italia - Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale - Università degli Studi, Bologna, Italy
| | - Katia Mancuso
- Azienda Ospedaliero-Universitaria di Bologna, Italia - Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale - Università degli Studi, Bologna, Italy
| | - Ilaria Rizzello
- Azienda Ospedaliero-Universitaria di Bologna, Italia - Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale - Università degli Studi, Bologna, Italy
| | - Chiara di Giovanni Bezzi
- Azienda Ospedaliero-Universitaria di Bologna, Italia - Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale - Università degli Studi, Bologna, Italy
| | | | - Luca Dozza
- Azienda Ospedaliero-Universitaria di Bologna, Italia - Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale - Università degli Studi, Bologna, Italy
| | - Giulia Marzocchi
- Azienda Ospedaliero-Universitaria di Bologna, Italia - Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale - Università degli Studi, Bologna, Italy
| | - Marina Martello
- Azienda Ospedaliero-Universitaria di Bologna, Italia - Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale - Università degli Studi, Bologna, Italy
| | - Gregorio Barilà
- Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy
| | | | | | - Gabriele Buda
- Department of Clinical and Experimental Medicine, U.O. Hematology, University of Pisa, Pisa, Italy
| | - Mario Petrini
- Department of Clinical and Experimental Medicine, U.O. Hematology, University of Pisa, Pisa, Italy
| | - Michele Cea
- Hematology Unit, Department of Internal Medicine (DiMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Anna Furlan
- U.O. Hematology, Ca Foncello Hospital, Treviso, Italy
| | - Angela Bonalumi
- Hematology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michele Cavo
- Azienda Ospedaliero-Universitaria di Bologna, Italia - Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale - Università degli Studi, Bologna, Italy
| | - Elena Zamagni
- Azienda Ospedaliero-Universitaria di Bologna, Italia - Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale - Università degli Studi, Bologna, Italy
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18
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Corre J, Montes L, Martin E, Perrot A, Caillot D, Leleu X, Belhadj K, Facon T, Hulin C, Mohty M, Fontan J, Macro M, Brechignac S, Jaccard A, Stoppa AM, Orsini-Piocelle F, Adiko D, Voillat L, Keddar F, Barry M, Demarquette H, Certain MN, Plantier I, Roussel M, Hébraud B, Filleron T, Attal M, Avet-Loiseau H. Early relapse after autologous transplant for myeloma is associated with poor survival regardless of cytogenetic risk. Haematologica 2020; 105:e480-483. [PMID: 33054068 PMCID: PMC7556617 DOI: 10.3324/haematol.2019.236588] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jill Corre
- Unit for Genomics in Myeloma, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, Toulouse; Centre de Recherche en Cancérologie de Toulouse, Institut National de la Santé et de la Recherche Médicale U1037, Toulouse.
| | - Lydia Montes
- Hematology Department, University Hospital, Amiens
| | - Elodie Martin
- Biostatistics Department, Institut Claudius Regaud, IUCT-O, Toulouse
| | | | | | - Xavier Leleu
- Hematology Department, University Hospital, Poitiers
| | | | | | - Cyrille Hulin
- Hematology Department, University Hospital, Bordeaux
| | | | - Jean Fontan
- Hematology Department, University Hospital, Besancon
| | | | | | | | | | | | - Didier Adiko
- Hematology Department, Department Hospital, Libourne
| | - Laurent Voillat
- Hematology Department, Department Hospital, Chalon-sur-Saône
| | - Faiza Keddar
- Hematology Department, Department Hospital, Valenciennes
| | - Marly Barry
- Hematology Department, Department Hospital, Boulogne-Sur-Mer
| | | | | | | | - Murielle Roussel
- Hematology Department, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, Toulouse, France
| | - Benjamin Hébraud
- Hematology Department, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, Toulouse, France
| | - Thomas Filleron
- Biostatistics Department, Institut Claudius Regaud, IUCT-O, Toulouse
| | - Michel Attal
- Centre de Recherche en Cancérologie de Toulouse, Institut National de la Santé et de la Recherche Médicale U1037, Toulouse; Hematology Department, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, Toulouse, France
| | - Hervé Avet-Loiseau
- Unit for Genomics in Myeloma, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, Toulouse; Centre de Recherche en Cancérologie de Toulouse, Institut National de la Santé et de la Recherche Médicale U1037, Toulouse
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19
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Pincez T, Bruneau J, Berteloot L, Piekarski E, Thomas C, Marçais A, Trinquand A, Castelle M, Garcelon N, Plantaz D, Cheminant M, Moshous D, Molina TJ, Hermine O, Macintyre E, Fischer A, Blanche S, Suarez F, Neven B. Safety and efficacy of brentuximab vedotin as a treatment for lymphoproliferative disorders in primary immunodeficiencies. Haematologica 2020; 105:e461-464. [PMID: 33054064 PMCID: PMC7556515 DOI: 10.3324/haematol.2019.230276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Thomas Pincez
- Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris
| | - Julie Bruneau
- Pathology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris; Paris University, Paris; INSERM UMR 1163, Institut Imagine, Paris
| | | | - Eve Piekarski
- Nuclear Medicine Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris
| | - Caroline Thomas
- Pediatric Oncology-Hematology Department, Hôpital Enfant-Adolescent, CHU Nantes, Nantes
| | - Ambroise Marçais
- Paris University, Paris; INSERM UMR 1163, Institut Imagine, Paris; Department of Hematology, Hôpital Necker-Enfants Malades, AP-HP, Paris
| | - Amélie Trinquand
- Laboratory of Onco-Hematology, Hôpital Necker-Enfants Malades, AP-HP, Paris
| | - Martin Castelle
- Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris
| | - Nicolas Garcelon
- Paris University, Paris; INSERM UMR 1163, Institut Imagine, Paris
| | - Dominique Plantaz
- Pediatric Hematology-Oncology Department, Grenoble University Hospital, Grenoble
| | - Morgane Cheminant
- Paris University, Paris; INSERM UMR 1163, Institut Imagine, Paris; Department of Hematology, Hôpital Necker-Enfants Malades, AP-HP, Paris
| | - Despina Moshous
- Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris; Paris University, Paris; INSERM UMR 1163, Institut Imagine, Paris
| | - Thierry Jo Molina
- Pathology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris; Paris University, Paris
| | - Olivier Hermine
- Paris University, Paris; INSERM UMR 1163, Institut Imagine, Paris; Department of Hematology, Hôpital Necker-Enfants Malades, AP-HP, Paris
| | - Elizabeth Macintyre
- Paris University, Paris; Laboratory of Onco-Hematology, Hôpital Necker-Enfants Malades, AP-HP, Paris; INSERM UMR 1151, Institut Necker-Enfants Malades, Paris
| | - Alain Fischer
- Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris; Paris University, Paris; INSERM UMR 1163, Institut Imagine, Paris; Collège de France, Paris, France
| | - Stéphane Blanche
- Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris; Paris University, Paris; INSERM UMR 1163, Institut Imagine, Paris
| | - Felipe Suarez
- Paris University, Paris; INSERM UMR 1163, Institut Imagine, Paris; Department of Hematology, Hôpital Necker-Enfants Malades, AP-HP, Paris
| | - Bénédicte Neven
- Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, AP-HP, Paris; Paris University, Paris; INSERM UMR 1163, Institut Imagine, Paris.
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20
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Wang C, Soekojo CY, de Mel S, Ooi M, Chen Y, Goh AZK, Nagarajan C, Chng WJ. Natural History and Prognostic Factors at First Relapse in Multiple Myeloma. Cancers (Basel) 2020; 12:cancers12071759. [PMID: 32630644 PMCID: PMC7409309 DOI: 10.3390/cancers12071759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022] Open
Abstract
The prognosis of multiple myeloma has considerably improved due to the introduction of novel agents in the upfront setting. However, the great majority of patients ultimately relapse, and choosing a salvage treatment at first relapse remains challenging. The natural history of first relapsed disease in the current era is also not well described. We retrospectively studied 300 patients with first relapsed myeloma seen between 2004 and 2019 from two institutes in Singapore. The median duration from diagnosis to first relapse was 22.7 months (1.1–97.0 months). Most patients received novel agent-based induction therapy, and 41.3% underwent autologous stem cell transplant. A very good partial response (VGPR) or better was achieved in 48.6%. Regarding first relapse, 50.5% were symptomatic and 19.0% received newer agent-containing regimens. Nearly a third of patients (31.7%) had a VGPR or better response. The median progression free and overall survival from first relapse was 12.0 and 44.8 months, respectively. Based on a randomized sample splitting, we first identified non-hyperdiploid karyotype at diagnosis, clinical relapse, and treatment sequence as impacting survival independently from a testing cohort, and we then further demonstrated their significance in a validation cohort. This study provides a real-world picture of first relapsed myeloma and highlights the prognostic importance of the treatment sequence.
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Affiliation(s)
- Chen Wang
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119074, Singapore; (C.W.); (C.Y.S.); (S.d.M.); (M.O.)
| | - Cinnie Yentia Soekojo
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119074, Singapore; (C.W.); (C.Y.S.); (S.d.M.); (M.O.)
| | - Sanjay de Mel
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119074, Singapore; (C.W.); (C.Y.S.); (S.d.M.); (M.O.)
| | - Melissa Ooi
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119074, Singapore; (C.W.); (C.Y.S.); (S.d.M.); (M.O.)
| | - Yunxin Chen
- Department of Haematology, Singapore General Hospital, Singapore 169608, Singapore; (Y.C.); (A.Z.K.G.); (C.N.)
| | - Allan Zhi Kai Goh
- Department of Haematology, Singapore General Hospital, Singapore 169608, Singapore; (Y.C.); (A.Z.K.G.); (C.N.)
| | - Chandramouli Nagarajan
- Department of Haematology, Singapore General Hospital, Singapore 169608, Singapore; (Y.C.); (A.Z.K.G.); (C.N.)
| | - Wee Joo Chng
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore 119074, Singapore; (C.W.); (C.Y.S.); (S.d.M.); (M.O.)
- Department of Medicine, Yong Loo Lin School of Medicine and National University of Singapore, Singapore 119228, Singapore
- Cancer Science Institute of Singapore and National University of Singapore, Singapore 117599, Singapore
- Correspondence: ; Tel.: +65-6772-4612
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21
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Early Relapse After Autologous Transplant Is Associated With Very Poor Survival and Identifies an Ultra-High-Risk Group of Patients With Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:445-452. [DOI: 10.1016/j.clml.2019.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/20/2019] [Accepted: 10/15/2019] [Indexed: 01/01/2023]
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22
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Schinke M, Ihorst G, Duyster J, Wäsch R, Schumacher M, Engelhardt M. Risk of disease recurrence and survival in patients with multiple myeloma: A German Study Group analysis using a conditional survival approach with long-term follow-up of 815 patients. Cancer 2020; 126:3504-3515. [PMID: 32459378 DOI: 10.1002/cncr.32978] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Unlike the traditional method of overall survival prediction in patients with cancer, conditional survival predicts the survival of patients dynamically throughout the course of disease, identifying how a prognosis evolves over time. METHODS The authors assessed 815 consecutive patients with multiple myeloma through the German Study Group on Multiple Myeloma (Deutsche Studiengruppe Multiples Myelom; DSMM) incentive. Over 10 variables, including patient-specific and multiple myeloma-specific parameters, were analyzed at the time of initial diagnosis and repeatedly during follow-up. The probability of survival for another 5 years was calculated according to disease-related and host-related risks. Multivariate Cox models were used to determine baseline and updated prognostic factors for survival. RESULTS The median follow-up and overall survival were 10.3 years and 5.1 years, respectively. When comparing 5-year conditional survival probabilities from the data derived at the time of initial diagnosis with those updated over time, substantially differing prognoses were observed when follow-up data were used. Multivariate Cox regression models for cohorts surviving 0 to 5 years demonstrated hazard ratios (HRs) for patients aged <60 years, 60 to 69 years, and >70 years of 1, 1.68, and 3.17, respectively. These HRs for age were found to decline for patients surviving 5 years, as well as for those with advanced stages of disease (II/III) and unfavorable cytogenetics, whereas progressive disease remained an important factor in patients surviving 1 year, 3 years, and 5 years, with HRs of 1.85, 2.11, and 2.14, respectively. CONCLUSIONS To the authors' knowledge, the current study is the first analysis of conditional survival in patients with multiple myeloma using both baseline and follow-up risk parameters, demonstrating that regular risk assessment throughout the course of disease and complete follow-up provide a more reliable conditional survival estimation than baseline assessment alone.
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Affiliation(s)
- Maximilian Schinke
- Department of Medicine I, University of Freiburg Medical Center, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, University of Freiburg Medical Center, Freiburg, Germany
| | - Justus Duyster
- Department of Medicine I, University of Freiburg Medical Center, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralph Wäsch
- Department of Medicine I, University of Freiburg Medical Center, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Schumacher
- Center for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Monika Engelhardt
- Department of Medicine I, University of Freiburg Medical Center, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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23
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Bortezomib Treatment Modulates Autophagy in Multiple Myeloma. J Clin Med 2020; 9:jcm9020552. [PMID: 32085480 PMCID: PMC7073518 DOI: 10.3390/jcm9020552] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 12/11/2022] Open
Abstract
Although the introduction of bortezomib as a therapeutic strategy has improved the overall survival of multiple myeloma (MM) patients, 15–20% of high-risk patients do not respond to bortezomib over time or become resistant to treatment. Therefore, the development of new therapeutic strategies, such as combination therapies, is urgently needed. Methods: Given that bortezomib resistance may be mediated by activation of the autophagy pathway as an alternative mechanism of protein degradation, and that an enormous amounts of misfolded protein is generated in myeloma plasma cells (PCs), we investigated the effect of the simultaneous inhibition of proteasome by bortezomib and autophagy by hydroxychloroquine (HCQ) treatment on PCs and endothelial cells (ECs) isolated from patients with monoclonal gammopathy of undetermined significance (MGUS) and MM. Results: We found that bortezomib combined with HCQ induces synergistic cytotoxicity in myeloma PCs whereas this effect is lost on ECs. Levels of microtubule-associated protein light chain beta (LC3B) and p62 are differentially modulated in PCs and ECs, with effects on cell viability and proliferation. Conclusions: Our results suggest that treatment with bortezomib and HCQ should be associated with an anti-angiogenic drug to prevent the pro-angiogenic effect of bortezomib, the proliferation of a small residual tumor PC clone, and thus the relapse.
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24
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Siegel DS, Schiller GJ, Song KW, Agajanian R, Stockerl‐Goldstein K, Kaya H, Sebag M, Samaras C, Malek E, Talamo G, Seet CS, Mouro J, Pierceall WE, Zafar F, Chung W, Srinivasan S, Agarwal A, Bahlis NJ. Pomalidomide plus low-dose dexamethasone in relapsed refractory multiple myeloma after lenalidomide treatment failure. Br J Haematol 2020; 188:501-510. [PMID: 31588567 PMCID: PMC7027539 DOI: 10.1111/bjh.16213] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/17/2019] [Indexed: 01/17/2023]
Abstract
Patients with relapsed/refractory multiple myeloma (RRMM) for whom the benefits of lenalidomide have been exhausted in early treatment lines need effective therapies. In cohort A of the phase 2 MM-014 trial, we examined the safety and efficacy of pomalidomide plus low-dose dexamethasone immediately after lenalidomide-based treatment failure in patients with RRMM and two prior lines of therapy. Pomalidomide 4 mg was given on days 1 to 21 of 28-day cycles. Dexamethasone 40 mg (20 mg for patients aged >75 years) was given on days 1, 8, 15 and 22 of 28-day cycles. The primary endpoint was overall response rate (ORR), and secondary endpoints included progression-free survival (PFS), overall survival (OS) and safety. The intention-to-treat population comprised 56 patients; all received prior lenalidomide (87·5% lenalidomide refractory) and 39 (69·6%) received prior bortezomib. ORR was 32·1% (28·2% in the prior-bortezomib subgroup). Median PFS was 12·2 months (7·9 months in the prior-bortezomib subgroup). Median OS was 41·7 months (38·6 months in the prior-bortezomib subgroup). The most common grade 3/4 treatment-emergent adverse events were anaemia (25·0%), pneumonia (14·3%) and fatigue (14·3%). These findings support earlier sequencing of pomalidomide-based therapy in lenalidomide-pretreated patients with RRMM, including those who have become refractory to lenalidomide. Trial registration: www.ClinicalTrials.gov identifier NCT01946477.
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Affiliation(s)
- David S. Siegel
- John Theurer Cancer CenterHackensack University Medical CenterHackensackNJUSA
| | | | | | | | | | | | | | | | - Ehsan Malek
- University Hospitals Case Medical CenterClevelandOHUSA
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Oriol A, Abril L, Ibarra G, Senin A. Limited treatment options in refractory multiple myeloma: promising therapeutic developments. Expert Rev Anticancer Ther 2020; 20:31-44. [PMID: 31865804 DOI: 10.1080/14737140.2020.1708721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction: Combinations of proteasome inhibitors, immunomodulators, and monoclonal antibodies are highly active against multiple myeloma. Consequently, several combinations have moved from the relapsed to the front-line setting. In the context of lenalidomide and bortezomib being used upfront, salvage options need to be evaluated.Areas covered: This manuscript reviews available data for the treatment of patients progressing on optimal frontline strategies, with a focus on the role of second-generation proteasome inhibitors and immunomodulators, monoclonal antibodies and immunotherapy.Expert opinion: Remarkable progress has been made in myeloma treatment due to the integration of immunomodulators, proteasome inhibitors and more recently monoclonal antibodies in the front-line setting. However, we work on the assumption that most individuals will eventually relapse. Optimized upfront therapy negatively selects more resistant patients among still relapsing individuals. Bortezomib and lenalidomide-exposed patients are under-represented in trials leading to currently approved combinations. Evidence needs to be reviewed taking into account how the improvement of frontline therapy has modified the characteristics of patients at the time of relapse. Second generation immunomodulatory agents and proteasome inhibitors, monoclonal antibodies and other agents have shown efficacy in this new landscape. Immunotherapeutic agents, including CAR-T cells are promising for patients failing standard combinations, despite current data are still immature.
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Affiliation(s)
- Albert Oriol
- Hematology Service and Hemato-Oncology Clinical Trial Unit, Institut Català d'Oncologia, Badalona, Barcelona, Spain.,Josep Carreras Institute and Germans Trias i Pujol Hospital, Badalona, Barcelona, Spain
| | - Laura Abril
- Hematology Service and Hemato-Oncology Clinical Trial Unit, Institut Català d'Oncologia, Badalona, Barcelona, Spain.,Josep Carreras Institute and Germans Trias i Pujol Hospital, Badalona, Barcelona, Spain
| | - Gladys Ibarra
- Hematology Service and Hemato-Oncology Clinical Trial Unit, Institut Català d'Oncologia, Badalona, Barcelona, Spain.,Josep Carreras Institute and Germans Trias i Pujol Hospital, Badalona, Barcelona, Spain
| | - Alicia Senin
- Hematology Service and Hemato-Oncology Clinical Trial Unit, Institut Català d'Oncologia, Badalona, Barcelona, Spain.,Josep Carreras Institute and Germans Trias i Pujol Hospital, Badalona, Barcelona, Spain
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26
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Jiang L, Sun Y, Wang J, He Q, Chen X, Lan X, Chen J, Dou QP, Shi X, Liu J. Proteasomal cysteine deubiquitinase inhibitor b-AP15 suppresses migration and induces apoptosis in diffuse large B cell lymphoma. J Exp Clin Cancer Res 2019; 38:453. [PMID: 31694672 PMCID: PMC6836452 DOI: 10.1186/s13046-019-1446-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/13/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The first line therapy for patients with diffuse large B cell (DLBCL) is R-CHOP. About half of DLBCL patients are either refractory to, or will relapse, after the treatment. Therefore, identifying novel drug targets and effective therapeutic agents is urgently needed for improving DLBCL patient survival. b-AP15, a selective small molecule inhibitor of proteasomal USP14 and UCHL5 deubiquitinases (DUBs), has shown selectivity and efficacy in several other types of cancer cells. This is the first study to report the effect of b-AP15 in DLBCL. METHODS Cell lines of two DLBCL subtypes, Germinal Center B Cell/ GCB (SU-DHL-4, OCI-LY-1, OCI-LY-19) and Activated B Cell/ABC (SU-DHL-2), were used in the current study. Cell viability was measured by MTS assay, proliferation by trypan blue exclusion staining assay, cellular apoptosis by Annexin V-FITC/PI staining and mitochondrial outer membrane permeability assays, the activities of 20S proteasome peptidases by cleavage of specific fluorogenic substrates, and cell migration was detected by transwell assay in these GCB- and ABC-DLBCL cell lines. Mouse xenograft models of SU-DHL-4 and SU-DHL-2 cells were used to determine in vivo effects of b-AP15 in DLBCL tumors. RESULTS b-AP15 inhibited proteasome DUB activities and activated cell death pathway, as evident by caspase activation and mitochondria apoptosis in GCB- and ABC- DLBCL cell lines. b-AP15 treatment suppressed migration of GCB- and ABC-DLBCL cells via inhibiting Wnt/β-catenin and TGFβ/Smad pathways. Additionally, b-AP15 significantly inhibited the growth of GCB- and ABC DLBCL in xenograft models. CONCLUSIONS These results indicate that b-AP15 inhibits cell migration and induces apoptosis in GCB- and ABC-DLBCL cells, and suggest that inhibition of 19S proteasomal DUB should be a novel strategy for DLBCL treatment.
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Affiliation(s)
- Liling Jiang
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation State Key Laboratory of RespiratoryDisease, School of Basic Medical Science, Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Yuening Sun
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation State Key Laboratory of RespiratoryDisease, School of Basic Medical Science, Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Jinxiang Wang
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation State Key Laboratory of RespiratoryDisease, School of Basic Medical Science, Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Qingyan He
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation State Key Laboratory of RespiratoryDisease, School of Basic Medical Science, Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Xinmei Chen
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation State Key Laboratory of RespiratoryDisease, School of Basic Medical Science, Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Xiaoying Lan
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation State Key Laboratory of RespiratoryDisease, School of Basic Medical Science, Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Jinghong Chen
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation State Key Laboratory of RespiratoryDisease, School of Basic Medical Science, Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Q. Ping Dou
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation State Key Laboratory of RespiratoryDisease, School of Basic Medical Science, Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
- The Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, and Departments of Oncology, Pharmacology and Pathology, School of Medicine, Wayne State University, Detroit, MI USA
| | - Xianping Shi
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation State Key Laboratory of RespiratoryDisease, School of Basic Medical Science, Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
- Sino-French Hoffmann institute, Guangzhou Medical University, Guangzhou, China
| | - Jinbao Liu
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Protein Modification and Degradation State Key Laboratory of RespiratoryDisease, School of Basic Medical Science, Affiliated Cancer Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
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Allogeneic Hematopoietic Stem Cell Transplantation for Myeloma: Time for an Obituary or Not Just Yet! Indian J Hematol Blood Transfus 2019; 35:416-422. [PMID: 31388250 DOI: 10.1007/s12288-019-01077-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022] Open
Abstract
The management of myeloma has evolved dramatically in the last two decades. High dose melphalan and autologous hematopoietic stem cell transplantation (HSCT) marked the beginning of this journey. This was followed by an explosion of novel agents which were approved for management of myeloma. Allogeneic HSCT which was deemed as the only curative option was largely abhorred due to high transplant-related mortality (TRM) until the advent of reduced intensity conditioning (RIC). An approach of tandem autologous and RIC-allogeneic transplantations has showed the best promise for cure for this condition, particularly for those with high-risk cytogenetics. Yet, allogeneic HSCT seems to have fallen out of favor due to the projected high TRM and late relapses, even though the alternatives do not offer a cure, but merely prolong survival. Offering an allogeneic HSCT as a final resort in unlikely to yield gratifying results. At the same time, allogeneic HSCT needs to evolve in a disease-specific manner to address the relevant concerns regarding TRM and relapse. With the introduction of effective GVHD prophylaxis in the form of post-transplantation cyclophosphamide, transplantation from a haploidentical family donor has become a reality. The challenge lies in segregating graft-vs-myeloma effect from a graft-versus-host effect. We discuss the pro-survival and anti-apoptotic pathways via CD28-CD86 interactions which confer survival advantages to myeloma cells and the possibility of disruption of this pathway in the context of haploidentical transplantation through the use of CTLA4Ig without incurring T cell alloreactivity.
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28
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Terebelo HR, Abonour R, Gasparetto CJ, Toomey K, Durie BGM, Hardin JW, Jagannath S, Wagner L, Narang M, Flick ED, Srinivasan S, Yue L, Kitali A, Agarwal A, Rifkin RM. Development of a prognostic model for overall survival in multiple myeloma using the Connect ® MM Patient Registry. Br J Haematol 2019; 187:602-614. [PMID: 31382320 PMCID: PMC6899784 DOI: 10.1111/bjh.16139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/10/2019] [Indexed: 02/02/2023]
Abstract
Median overall survival (OS) has improved for patients with newly diagnosed multiple myeloma (NDMM), but prognosis varies depending on baseline patient characteristics. Current models use data from selected clinical trial populations, which prevent application to patients in an unselected community setting that reflects routine clinical practice. Using data from the Connect® MM Registry, a large, US, multicentre, prospective observational cohort study (Cohort 1: 2009-2011; Cohort 2: 2012-2016) of 3011 patients with NDMM, we identified prognostic variables for OS via the multivariable analysis of baseline patient characteristics in Cohort 1 (n = 1493) and developed a tool to examine individual outcomes. Factors associated with OS (n = 1450 treated patients; P < 0·05) were age, del(17p), triplet therapy use, EQ-5D mobility, International Staging System stage, solitary plasmacytoma, history of diabetes, platelet count, Eastern Cooperative Oncology Group performance status and serum creatinine, which were used to create survival matrices for 3- and 5-year OS. The model was internally and externally validated using Connect MM Cohort 2 (Harrell's concordance index, 0·698), MM-015 (0·649), and the phase 3 FIRST (0·647) clinical trials. This novel prognostic tool may help inform outcomes for NDMM in the era of triplet therapy use with novel agents.
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Affiliation(s)
| | | | | | | | | | | | | | - Lynne Wagner
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Lihua Yue
- Celgene Corporation, Summit, NJ, USA
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29
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Mele G, Pastore D, Di Renzo N, Fragasso A, Guarini A, Mazza P, Musto P, Pavone V, Tarantini G, Curci P, Falcone AP, Mele A, Miccolis MR, Palazzo G, Palumbo G, Quinto AM, Reddiconto G, Rizzi R, Cascavilla N, Specchia G, Capalbo SF. Real world Italian experience of pomalidomide plus low-dose dexamethasone in the relapsed and refractory myeloma setting: extended follow-up of a retrospective multicenter study by the 'Rete Ematologica Pugliese E Basilicata'. Leuk Lymphoma 2019; 60:3565-3568. [PMID: 31286780 DOI: 10.1080/10428194.2019.1636989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Giuseppe Mele
- Haematology and BMT Unit, Ospedale Antonio Perrino, Brindisi, Italy
| | - Domenico Pastore
- Haematology and BMT Unit, Ospedale Antonio Perrino, Brindisi, Italy
| | | | - Alberto Fragasso
- Haematology and BMT Unit, Ospedale Madonna delle Grazie, Matera, Italy
| | - Attilio Guarini
- Haematology and BMT Unit, Ospedale Giovanni Paolo II, Bari, Italy
| | - Patrizio Mazza
- Haematology and BMT Unit, Ospedale Giuseppe Moscati, Taranto, Italy
| | - Pellegrino Musto
- Haematology and BMT Unit, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Vincenzo Pavone
- Haematology and BMT Unit, Ospedale Cardinale Panico, Tricase, Italy
| | - Giuseppe Tarantini
- Haematology and BMT Unit, Ospedale Monsignor R. Dimiccoli, Barletta, Italy
| | - Paola Curci
- Haematology and BMT Unit, University of Bari Medical School, Policlinico, Italy
| | - Antonietta Pia Falcone
- Haematology and BMT Unit, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Anna Mele
- Haematology and BMT Unit, Ospedale Cardinale Panico, Tricase, Italy
| | | | - Giulia Palazzo
- Haematology and BMT Unit, Ospedale Giuseppe Moscati, Taranto, Italy
| | - Gaetano Palumbo
- Haematology and BMT Unit, Ospedali Riuniti-Azienda Ospedaliera Universitaria, Foggia, Italy
| | | | | | - Rita Rizzi
- Haematology and BMT Unit, University of Bari Medical School, Policlinico, Italy
| | - Nicola Cascavilla
- Haematology and BMT Unit, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giorgina Specchia
- Haematology and BMT Unit, University of Bari Medical School, Policlinico, Italy
| | - Silvana Franca Capalbo
- Haematology and BMT Unit, Ospedali Riuniti-Azienda Ospedaliera Universitaria, Foggia, Italy
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Biran N, Siegel D, Berdeja JG, Raje N, Cornell RF, Alsina M, Kovacsovics T, Fang B, Kimball AS, Landgren O. Weekly carfilzomib, lenalidomide, and dexamethasone in relapsed or refractory multiple myeloma: A phase 1b study. Am J Hematol 2019; 94:794-802. [PMID: 31021005 PMCID: PMC6593978 DOI: 10.1002/ajh.25498] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/27/2019] [Accepted: 04/22/2019] [Indexed: 01/24/2023]
Abstract
Twice-weekly carfilzomib (27 mg/m2 ) with lenalidomide-dexamethasone (KRd) is a standard-of-care in relapsed or refractory multiple myeloma (RRMM). This phase 1b study evaluated KRd with once-weekly carfilzomib in RRMM. Patients received carfilzomib (30-minute infusion; 56 or 70mg/m2 ) on days 1, 8, and 15; lenalidomide 25 mg on days 1-21; and dexamethasone 40 mg on days 1, 8, 15, and 22 (day 22 omitted for cycles 9+) of 28-day cycles. Primary objective was safety/tolerability; efficacy was a secondary objective. Fifty-six RRMM patients enrolled: 22 during dose evaluation (56-mg/m2 , n = 10; 70-mg/m2 , n = 12) and 34 during dose expansion (all initiated dosing at 70 mg/m2 ). After 2 fatal adverse events (AEs) during 70-mg/m2 dose expansion, dosage reduction to 56 mg/m2 was permitted. Results are presented for carfilzomib 56-mg/m2 (n = 10) and 70-mg/m2 groups (dose evaluation/expansion; n = 46). Median carfilzomib dose was 53.2 mg/m2 (56-mg/m2 group) and 62.4 mg/m2 (70-mg/m2 group). Grade ≥3 AE rates were 70.0% (56 mg/m2 ) and 69.6% (70 mg/m2 ). Overall response rates were 90.0% (56 mg/m2 ) and 89.1% (70 mg/m2 ); ≥very good partial response rates were 50.0% (56 mg/m2 ) and 73.9% (70 mg/m2 ). Once-weekly KRd was active with acceptable toxicity in RRMM, supporting further evaluation of this regimen.
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Affiliation(s)
- Noa Biran
- Myeloma DivisionJohn Theurer Cancer Center, Hackensack University Medical CenterHackensackNew Jersey
| | - David Siegel
- Myeloma DivisionJohn Theurer Cancer Center, Hackensack University Medical CenterHackensackNew Jersey
| | - Jesus G. Berdeja
- Department of MedicineSarah Cannon Research InstituteNashvilleTennessee
| | - Noopur Raje
- Department of Hematology and OncologyMassachusetts General Hospital Cancer CenterBostonMassachusetts
| | - Robert Frank Cornell
- Division of Hematology and OncologyVanderbilt University Medical CenterNashvilleTennessee
| | - Melissa Alsina
- Department of Blood and Marrow TransplantationMoffit Cancer CenterTampaFlorida
| | - Tibor Kovacsovics
- Division of Hematology and Hematologic Malignancies, Department of Internal MedicineHuntsman Cancer Institute, University of Utah School of MedicineSalt Lake CityUtah
| | - Belle Fang
- Global Biostatistical ScienceAmgen Inc.Thousand OaksCalifornia
| | | | - Ola Landgren
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew York CityNew York
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Betulinic Acid Induces ROS-Dependent Apoptosis and S-Phase Arrest by Inhibiting the NF- κB Pathway in Human Multiple Myeloma. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:5083158. [PMID: 31281581 PMCID: PMC6590575 DOI: 10.1155/2019/5083158] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/08/2019] [Accepted: 04/24/2019] [Indexed: 02/07/2023]
Abstract
Betulinic acid (BA), as a prospective natural compound, shows outstanding antitumor bioactivities against many solid malignancies. However, its mechanism against multiple myeloma (MM) remains elusive. Herein, for the first time, we studied the antitumor activity of BA against MM both in vivo and in vitro. We showed that BA mediated cytotoxicity in MM cells through apoptosis, S-phase arrest, mitochondrial membrane potential (MMP) collapse, and overwhelming reactive oxygen species (ROS) accumulation. Moreover, when the ROS scavenger N-acetyl cysteine (NAC) effectively abated elevated ROS, the BA-induced apoptosis was partially reversed. Our results revealed that BA-mediated ROS overproduction played a pivotal role in anticancer activity. Molecularly, we found that BA resulted in marked inhibition of the aberrantly activated NF-κB pathway in MM. As demonstrated by using the NF-κB pathway-specific activator TNF-α and the inhibitor BAY 11-7082, BA-mediated inhibition of the NF-κB pathway directly promoted the overproduction of ROS and, ultimately, cell death. Furthermore, BA also exerted enormous tumor-inhibitory effects via repressing proliferation and inhibiting the NF-κB pathway in our xenograft model. Overall, by blocking the NF-κB pathway that breaks redox homeostasis, BA, as a potent NF-κB inhibitor, is a promising therapeutic alternative for MM.
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32
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Ghobrial I, Cruz CH, Garfall A, Shah N, Munshi N, Kaufman J, Boise LH, Morgan G, Adalsteinsson VA, Manier S, Pillai R, Malavasi F, Lonial S. Immunotherapy in Multiple Myeloma: Accelerating on the Path to the Patient. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:332-344. [DOI: 10.1016/j.clml.2019.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/11/2019] [Accepted: 02/11/2019] [Indexed: 11/16/2022]
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33
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Daratumumab plus carfilzomib and dexamethasone in patients with relapsed or refractory multiple myeloma. Blood 2019; 134:421-431. [PMID: 31113777 DOI: 10.1182/blood.2019000722] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/09/2019] [Indexed: 12/31/2022] Open
Abstract
Patients with relapsed or refractory multiple myeloma (RRMM) have limited treatment options and poor survival outcomes. The increasing adoption of lenalidomide-based therapy for frontline treatment of multiple myeloma has resulted in a need for effective regimens for lenalidomide-refractory patients. This phase 1b study evaluated daratumumab plus carfilzomib and dexamethasone (D-Kd) in patients with RRMM after 1 to 3 prior lines of therapy, including bortezomib and an immunomodulatory drug; lenalidomide-refractory patients were eligible. Carfilzomib- and daratumumab-naïve patients (n = 85) received carfilzomib weekly on days 1, 8, and 15 of each 28-day cycle (20 mg/m2 initial dose, escalated to 70 mg/m2 thereafter) and dexamethasone (40 mg/wk). Of these, 10 patients received the first daratumumab dose as a single infusion (16 mg/kg, day 1 cycle 1), and 75 patients received a split first dose (8 mg/kg, days 1-2 cycle 1). Subsequent dosing was per the approved schedule for daratumumab. Patients received a median of 2 (range, 1-4) prior lines of therapy; 60% were lenalidomide refractory. The most common grade 3/4 treatment-emergent adverse events were thrombocytopenia (31%), lymphopenia (24%), anemia (21%), and neutropenia (21%). Infusion-related reactions were observed in 60% and 43% of single and split first-dose patients, respectively. Overall response rate was 84% (79% in lenalidomide-refractory patients). Median progression-free survival (PFS) was not reached; 12-month PFS rates were 74% for all treated patients and 65% for lenalidomide-refractory patients. D-Kd was well tolerated with low neutropenia rates, and it demonstrated deep responses and encouraging PFS, including in patients refractory to lenalidomide. The trial was registered at www.clinicaltrials.gov as #NCT01998971.
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34
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Schumacher M, Hieke S, Ihorst G, Engelhardt M. Dynamic prediction: A challenge for biostatisticians, but greatly needed by patients, physicians and the public. Biom J 2019; 62:822-835. [PMID: 30908745 DOI: 10.1002/bimj.201800248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 12/12/2022]
Abstract
Prognosis is usually expressed in terms of the probability that a patient will or will not have experienced an event of interest t years after diagnosis of a disease. This quantity, however, is of little informative value for a patient who is still event-free after a number of years. Such a patient would be much more interested in the conditional probability of being event-free in the upcoming t years, given that he/she did not experience the event in the s years after diagnosis, called "conditional survival." It is the simplest form of a dynamic prediction and can be dealt with using straightforward extensions of standard time-to-event analyses in clinical cohort studies. For a healthy individual, a related problem with further complications is the so-called "age-conditional probability of developing cancer" in the next t years. Here, the competing risk of dying from other diseases has to be taken into account. For both situations, the hazard function provides the central dynamic concept, which can be further extended in a natural way to build dynamic prediction models that incorporate both baseline and time-dependent characteristics. Such models are able to exploit the most current information accumulating over time in order to accurately predict the further course or development of a disease. In this article, the biostatistical challenges as well as the relevance and importance of dynamic prediction are illustrated using studies of multiple myeloma, a hematologic malignancy with a formerly rather poor prognosis which has improved over the last few years.
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Affiliation(s)
- Martin Schumacher
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Stefanie Hieke
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Roche Pharma AG, Grenzach-Wyhlen, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Monika Engelhardt
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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35
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Maiese EM, Ainsworth C, Le Moine JG, Ahdesmӓki O, Bell J, Hawe E. In Reply: Network Meta-analyses Are Not About a Single Treatment But About Sets of Regimens. Clin Ther 2019; 41:188-190. [DOI: 10.1016/j.clinthera.2018.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
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36
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Uckun FM, Qazi S, Demirer T, Champlin RE. Contemporary patient-tailored treatment strategies against high risk and relapsed or refractory multiple myeloma. EBioMedicine 2019; 39:612-620. [PMID: 30545798 PMCID: PMC6354702 DOI: 10.1016/j.ebiom.2018.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 01/03/2023] Open
Abstract
Recurrence of disease due to chemotherapy drug resistance remains a major obstacle to a more successful survival outcome of multiple myeloma (MM). Overcoming drug resistance and salvaging patients with relapsed and/or refractory (R/R) MM is an urgent and unmet medical need. Several new personalized treatment strategies have been developed against molecular targets to overcome this drug resistance. There are several targeted therapeutics with anti-MM activity in clinical pipeline, including inhibitors of anti-apoptotic proteins, monoclonal antibodies, antibody-drug conjugates, bispecific antibodies, fusion proteins, and various cell therapy platforms. For example, B-cell maturation antigen (BCMA)-specific CAR-T cell platforms showed promising activity in heavily pretreated R/R MM patients. Therefore, there is renewed hope for high-risk as well as R/R MM patients in the era of personalized medicine.
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Affiliation(s)
- Fatih M Uckun
- Immuno-Oncology Program, Ares Pharmaceuticals, St. Paul, MN 55110, USA; Norris Comprehensive Cancer Center and Childrens Center for Cancer and Blood Diseases, University of Southern California Keck School of Medicine (USC KSOM), Los Angeles, CA 90027, USA.
| | - Sanjive Qazi
- Norris Comprehensive Cancer Center and Childrens Center for Cancer and Blood Diseases, University of Southern California Keck School of Medicine (USC KSOM), Los Angeles, CA 90027, USA; Bioinformatics Program, Gustavus Adolphus College, 800 W College Avenue, St. Peter, MN 56082, USA
| | - Taner Demirer
- Ankara University School of Medicine, Cebeci Hospital, Cebeci, 6590 Cankaya, Ankara, Turkey
| | - Richard E Champlin
- Department of Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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37
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Role of Proteasome Inhibitors in Relapsed and/or Refractory Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:9-22. [DOI: 10.1016/j.clml.2018.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/21/2018] [Accepted: 08/31/2018] [Indexed: 12/17/2022]
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38
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Pomalidomide, cyclophosphamide, and dexamethasone for relapsed multiple myeloma. Blood 2018; 132:2555-2563. [DOI: 10.1182/blood-2018-07-863829] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/19/2018] [Indexed: 12/28/2022] Open
Abstract
Abstract
It is important to have an effective therapy for patients with multiple myeloma (MM) at first relapse, particularly if an autologous stem cell transplant (ASCT) is considered at this stage. This multicenter, phase 2 trial evaluated the efficacy and safety of weekly oral pomalidomide-cyclophosphamide-dexamethasone (PCD) in patients with MM in first relapse after treatment with lenalidomide-bortezomib-dexamethasone (RVD). All patients had received RVD as induction and consolidation therapy, plus lenalidomide maintenance for 1 year (arm A). Half had also received an ASCT after induction (arm B). At MM relapse, all patients received 4 oral cycles of pomalidomide 4 mg (days 1-21), cyclophosphamide 300 mg (days 1, 8, 15, and 22), and dexamethasone 40 mg (days 1-4 and days 15-18 of a 28-day cycle; PCD). Responding patients in arm A underwent ASCT and received 2 additional cycles of PCD, whereas those in arm B received 5 cycles of PCD. All patients received pomalidomide-dexamethasone maintenance until disease progression. Primary end point was partial remission or better after the initial 4 cycles of PCD. Responses were obtained in 82/97 (85%) patients evaluated: complete remission (n = 1; 1%), very good partial remission (n = 32; 33%), and partial remission (n = 49; 51%). Three patients (3%) had stable disease, and 6 (6%) had disease progression (6 response failures). Forty-five (94%) of the 48 patients in arm A underwent planned ASCT. PCD was effective therapy after first relapse with RVD. After 4 cycles, the rate of partial remission or better was 85%, and 94% of planned ASCTs were performed. Toxicity was mostly hematologic and manageable. This trial was registered at www.clinicaltrials.gov as #NCT02244125.
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39
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He GL, Xu DR, Zou WY, He SZ, Li J. The VAD Scheme versus Thalidomide plus VAD for Reduction of Vascular Endothelial Growth Factor in Multiple Myeloma: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3936706. [PMID: 30534560 PMCID: PMC6252213 DOI: 10.1155/2018/3936706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 08/02/2018] [Indexed: 11/25/2022]
Abstract
The VAD (vincristine-doxorubicin-dexamethasone) regimen has been used for decades to treat multiple myeloma (MM). Based on reports that vascular endothelial growth factor- (VEGF-) mediated angiogenesis is critical for MM pathogenesis, the antiangiogenic compound thalidomide has been added to VAD (T-VAD). However, it remains unclear whether T-VAD is more efficacious than VAD for serum VEGF reduction or if the difference influences clinical outcome. Pubmed, Cochrane library, China Biomedical Literature (CBM) database, China National Knowledge Infrastructure (CNKI) database, Vip database, and Wanfang database were searched for relevant studies published up to June 2017. RevMan5.2 was used for methodological quality evaluation and data extraction. Thirteen trials (five randomized, seven nonrandomized, and one historically controlled) involving 815 cases were included. Serum VEGF was significantly higher in MM cases than non-MM controls (MD=353.01, [95%CI 187.52-518.51], P<0.01), and the overall efficacy of T-VAD was higher than that of VAD (RR=1.36, [1.21-1.53], P <0.01). Further, T-VAD reduced VEGF to a greater extent than VAD does ([MD=-49.85, [-66.28- -33.42], P<0.01). The T-VAD regimen also reduced VEGF to a greater extent in newly diagnosed MM patients than it did in recurrent patients ([MD=-120.20, [-164.60--39.80], P<0.01). There was no significant difference in VEGF between T-VAD patients (2 courses) and nontumor controls (MD=175.94, [-26.08-377.95], P=0.09). Greater serum VEGF reduction may be responsible for the superior efficacy of T-VAD compared to VAD.
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Affiliation(s)
- Gan-Lin He
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Duo-Rong Xu
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wai-Yi Zou
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sui-Zhi He
- Teaching and Research Section of Advanced Mathematics, Xinhua College of Sun Yat-sen University, Guangzhou, China
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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40
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Lu G, Weng S, Matyskiela M, Zheng X, Fang W, Wood S, Surka C, Mizukoshi R, Lu CC, Mendy D, Jang IS, Wang K, Marella M, Couto S, Cathers B, Carmichael J, Chamberlain P, Rolfe M. UBE2G1 governs the destruction of cereblon neomorphic substrates. eLife 2018; 7:40958. [PMID: 30234487 PMCID: PMC6185104 DOI: 10.7554/elife.40958] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/19/2018] [Indexed: 12/11/2022] Open
Abstract
The cereblon modulating agents (CMs) including lenalidomide, pomalidomide and CC-220 repurpose the Cul4-RBX1-DDB1-CRBN (CRL4CRBN) E3 ubiquitin ligase complex to induce the degradation of specific neomorphic substrates via polyubiquitination in conjunction with E2 ubiquitin-conjugating enzymes, which have until now remained elusive. Here we show that the ubiquitin-conjugating enzymes UBE2G1 and UBE2D3 cooperatively promote the K48-linked polyubiquitination of CRL4CRBN neomorphic substrates via a sequential ubiquitination mechanism. Blockade of UBE2G1 diminishes the ubiquitination and degradation of neomorphic substrates, and consequent antitumor activities elicited by all tested CMs. For example, UBE2G1 inactivation significantly attenuated the degradation of myeloma survival factors IKZF1 and IKZF3 induced by lenalidomide and pomalidomide, hence conferring drug resistance. UBE2G1-deficient myeloma cells, however, remained sensitive to a more potent IKZF1/3 degrader CC-220. Collectively, it will be of fundamental interest to explore if loss of UBE2G1 activity is linked to clinical resistance to drugs that hijack the CRL4CRBN to eliminate disease-driving proteins.
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Affiliation(s)
- Gang Lu
- Celgene Corporation, San Diego, United States
| | | | | | - Xinde Zheng
- Celgene Corporation, San Diego, United States
| | - Wei Fang
- Celgene Corporation, San Diego, United States
| | - Scott Wood
- Celgene Corporation, San Diego, United States
| | | | | | | | - Derek Mendy
- Celgene Corporation, San Diego, United States
| | | | - Kai Wang
- Celgene Corporation, San Diego, United States
| | | | | | | | | | | | - Mark Rolfe
- Celgene Corporation, San Diego, United States
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41
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Oostvogels R, Jak M, Raymakers R, Mous R, Minnema MC. Efficacy of retreatment with immunomodulatory drugs and proteasome inhibitors following daratumumab monotherapy in relapsed and refractory multiple myeloma patients. Br J Haematol 2018; 183:60-67. [PMID: 30080247 PMCID: PMC6220946 DOI: 10.1111/bjh.15504] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/07/2018] [Indexed: 12/19/2022]
Abstract
This single‐centre retrospective observational study analysed the efficacy of retreatment with immunomodulatory agents (IMiDs) and proteasome inhibitors (PIs) after treatment with daratumumab monotherapy in patients with relapsed and/or refractory multiple myeloma (RRMM). In total 55 patients were treated with daratumumab monotherapy between 2010 and 2017. From this group 29 (53%) IMiD‐refractory patients were retreated with an IMiD after daratumumab and 6 (11%) PI‐refractory patients were retreated with a PI‐based regimen. For the IMiD‐refractory patients the overall response rate (ORR) was 52% (15/29 patients, partial response or better) upon IMiD retreatment, whereas the ORR to PI retreatment was 67% (4/6 patients) in the PI‐refractory group. The immunomodulatory effects of daratumumab may play a role in these high response rates in previously refractory patients. Due to the >6 month‐long persistence of daratumumab in the plasma the subsequent therapies can effectively be considered as combination therapy. Furthermore, the excellent tolerability of daratumumab treatment may enable patients to recover from prior lines of treatment and receive full dosing of subsequent therapies. In conclusion, a high proportion of RRMM patients benefitted from retreatment with IMiDs and PIs after daratumumab treatment. These retreatment options should therefore be explored in RRMM patients progressing on daratumumab monotherapy.
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Affiliation(s)
- Rimke Oostvogels
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Margot Jak
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Reinier Raymakers
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Rogier Mous
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Monique C Minnema
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
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42
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Abstract
Intravenous daratumumab (DARZALEX®) is a first-in-class human IgG1κ monoclonal antibody against CD38 available for use in patients with relapsed and/or refractory multiple myeloma. In phase I/II and II trials and a pooled analysis of these studies, daratumumab monotherapy induced an overall response (partial response or better) in approximately one-third of patients; responses were rapid, deep and durable. An overall survival (OS) benefit was seen with daratumumab monotherapy, including in patients with a minimal response or stable disease. In phase III trials, daratumumab in combination with either bortezomib plus dexamethasone or lenalidomide plus dexamethasone significantly prolonged progression-free survival and induced deep and durable responses compared with bortezomib plus dexamethasone or lenalidomide plus dexamethasone. An OS benefit with daratumumab triple combination therapy is yet to be demonstrated (as the OS data were not mature at the time of the last analysis). Daratumumab was generally well tolerated when used as monotherapy and had a generally manageable tolerability profile when used in combination therapy. Infusion-related reactions (IRRs) were the most common adverse events; these were predominantly grade 1 or 2 and mostly occurred during the first infusion. The most common grade 3-4 adverse events associated with daratumumab triple combination therapy were thrombocytopenia, neutropenia and anaemia. Although final OS data are awaited, current evidence indicates that daratumumab is a valuable addition to the treatment options currently available for patients with relapsed or refractory multiple myeloma.
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43
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Cost-effectiveness of Daratumumab-based Triplet Therapies in Patients With Relapsed or Refractory Multiple Myeloma. Clin Ther 2018; 40:1122-1139. [DOI: 10.1016/j.clinthera.2018.05.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/11/2018] [Accepted: 05/15/2018] [Indexed: 12/20/2022]
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44
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Wu C, Yang T, Liu Y, Lu Y, Yang Y, Liu X, Liu X, Ye L, Sun Y, Wang X, Li Q, Yang P, Yu X, Gao S, Kumar S, Jin F, Dai Y, Li W. ARNT/HIF-1β links high-risk 1q21 gain and microenvironmental hypoxia to drug resistance and poor prognosis in multiple myeloma. Cancer Med 2018; 7:3899-3911. [PMID: 29926531 PMCID: PMC6089175 DOI: 10.1002/cam4.1596] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/25/2018] [Accepted: 05/14/2018] [Indexed: 02/05/2023] Open
Abstract
1q21 gain is a common cytogenetic abnormality featuring high‐risk multiple myeloma (HRMM). However, the molecular mechanism underlying the adverse prognostic effect of 1q21 gain remains largely unclear. Here, we report that ARNT/HIF‐1β, a 1q21 gene, is highly expressed in HRMM and induced by microenvironmental hypoxia, which confers drug resistance and correlates with inferior outcome. Analysis of the gene expression profile database revealed that ARNT expression was upregulated in MM and increased with disease progression or in HRMM subtypes (particularly 1q21 gain), while correlated to shorter overall survival. In a cohort of 40 MM patients, qPCR further validated that ARNT expression was higher in MM patients than normal donors. MM cells carrying 1q21 gain or acquired drug resistance displayed a robust increase in HIF‐1β protein level. Hypoxia induced HIF‐1β expression via a NF‐κB‐dependent process. Notably, HIF‐1β overexpression impaired bortezomib sensitivity, whereas shRNA knockdown of ARNT reversed hypoxia‐mediated drug resistance. Together, these findings suggest that ARNT/HIF‐1β might represent a novel biomarker for risk stratification and prognosis of HRMM patients, as well as a potential therapeutic target for overcoming 1q21 gain‐ or microenvironment‐mediated and acquired drug resistance in MM.
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Affiliation(s)
- Chuan Wu
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, Jilin, China.,Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ting Yang
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yingmin Liu
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yicheng Lu
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yanping Yang
- Department of Hematology, Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaobo Liu
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xuelian Liu
- Department of Hematology, Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Long Ye
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yue Sun
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xue Wang
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Qingchao Li
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Peiyu Yang
- Department of Hematology, Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaoyuan Yu
- Department of Hematology, Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Sujun Gao
- Department of Hematology, Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Fengyan Jin
- Department of Hematology, Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yun Dai
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Li
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
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Plesner T, Krejcik J. Daratumumab for the Treatment of Multiple Myeloma. Front Immunol 2018; 9:1228. [PMID: 29915586 PMCID: PMC5994592 DOI: 10.3389/fimmu.2018.01228] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/16/2018] [Indexed: 11/13/2022] Open
Abstract
This mini-review will summarize the present state of development of the CD38 antibody daratumumab for the treatment of multiple myeloma.
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Affiliation(s)
- Torben Plesner
- Institute of Regional Health Science, University of Southern Denmark, Vejle Hospital, Vejle, Denmark
| | - Jakub Krejcik
- Department of Hematology, Vejle Hospital, Vejle, Denmark
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46
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Siegel DS, Dimopoulos MA, Ludwig H, Facon T, Goldschmidt H, Jakubowiak A, San-Miguel J, Obreja M, Blaedel J, Stewart AK. Improvement in Overall Survival With Carfilzomib, Lenalidomide, and Dexamethasone in Patients With Relapsed or Refractory Multiple Myeloma. J Clin Oncol 2018; 36:728-734. [DOI: 10.1200/jco.2017.76.5032] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose In the ASPIRE study of carfilzomib, lenalidomide, and dexamethasone (KRd) versus lenalidomide plus dexamethasone (Rd) in patients with relapsed or refractory multiple myeloma, progression-free survival was significantly improved in the carfilzomib group (hazard ratio, 0.69; two-sided P < .001). This prespecified analysis reports final overall survival (OS) data and updated safety results. Patients and Methods Adults with relapsed multiple myeloma (one to three prior lines of therapy) were eligible and randomly assigned at a one-to-one ratio to receive KRd or Rd in 28-day cycles until withdrawal of consent, disease progression, or occurrence of unacceptable toxicity. After 18 cycles, all patients received Rd only. Progression-free survival was the primary end point; OS was a key secondary end point. OS was compared between treatment arms using a stratified log-rank test. Results Median OS was 48.3 months (95% CI, 42.4 to 52.8 months) for KRd versus 40.4 months (95% CI, 33.6 to 44.4 months) for Rd (hazard ratio, 0.79; 95% CI, 0.67 to 0.95; one-sided P = .0045). In patients receiving one prior line of therapy, median OS was 11.4 months longer for KRd versus Rd; it was 6.5 months longer for KRd versus Rd among patients receiving ≥ two prior lines of therapy. Rates of treatment discontinuation because of adverse events (AEs) were 19.9% (KRd) and 21.5% (Rd). Grade ≥ 3 AE rates were 87.0% (KRd) and 83.3% (Rd). Selected grade ≥ 3 AEs of interest (grouped terms; KRd v Rd) included acute renal failure (3.8% v 3.3%), cardiac failure (4.3% v 2.1%), ischemic heart disease (3.8% v 2.3%), hypertension (6.4% v 2.3%), hematopoietic thrombocytopenia (20.2% v 14.9%), and peripheral neuropathy (2.8% v 3.1%). Conclusion KRd demonstrated a statistically significant and clinically meaningful reduction in the risk of death versus Rd, improving survival by 7.9 months. The KRd efficacy advantage is most pronounced at first relapse.
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Affiliation(s)
- David S. Siegel
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Meletios A. Dimopoulos
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Heinz Ludwig
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Thierry Facon
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Hartmut Goldschmidt
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Andrzej Jakubowiak
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Jesus San-Miguel
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Mihaela Obreja
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - Julie Blaedel
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
| | - A. Keith Stewart
- David S. Siegel, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ; Meletios A. Dimopoulos, National and Kapodistrian University of Athens, Athens, Greece; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria; Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France; Hartmut Goldschmidt, Heidelberg Medical University and National Center of Tumor Diseases, Heidelberg, Germany; Andrzej
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Gössi U, Jeker B, Mansouri Taleghani B, Bacher U, Novak U, Betticher D, Egger T, Zander T, Pabst T. Prolonged survival after second autologous transplantation and lenalidomide maintenance for salvage treatment of myeloma patients at first relapse after prior autograft. Hematol Oncol 2018; 36:436-444. [DOI: 10.1002/hon.2490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Ursina Gössi
- Department of Medical Oncology; Inselspital, University Hospital of Bern; Bern Switzerland
| | - Barbara Jeker
- Department of Medical Oncology; Inselspital, University Hospital of Bern; Bern Switzerland
| | | | - Ulrike Bacher
- Department of Hematology; Inselspital, University Hospital of Bern; Bern Switzerland
| | - Urban Novak
- Department of Medical Oncology; Inselspital, University Hospital of Bern; Bern Switzerland
| | - Daniel Betticher
- Department of Oncology; Kantonsspital Fribourg; Fribourg Switzerland
| | - Thomas Egger
- Department of Oncology; Kantonsspital Solothurn; Solothurn Switzerland
| | - Thilo Zander
- Department of Oncology; Kantonsspital Lucerne; Lucerne Switzerland
| | - Thomas Pabst
- Department of Medical Oncology; Inselspital, University Hospital of Bern; Bern Switzerland
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48
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Lee H, Duggan P, Chaudhry A, Neri P, Tay J, Rashid-Kolvear F, Bahlis NJ, Jimenez-Zepeda VH. Early Relapse for Multiple Myeloma Patients Undergoing Single Autologous Stem Cell Therapy: A Single-center Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e69-e75. [DOI: 10.1016/j.clml.2017.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/10/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
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49
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Sonneveld P. Management of multiple myeloma in the relapsed/refractory patient. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:508-517. [PMID: 29222299 PMCID: PMC6142583 DOI: 10.1182/asheducation-2017.1.508] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The approach to the patient with relapsed or relapsed/refractory multiple myeloma requires a careful evaluation of the results of previous treatments, the toxicities associated with it, and an assessment of prognostic factors. The majority of patients will have received prior therapy with drug combinations, including a proteasome inhibitor and an immune-modulatory agent. It is the physician's task to choose the right moment for the start of therapy and decide with the patient which goals need to be achieved. The choice of regimen is usually based on prior response, drugs already received, adverse effects, comorbidities of the patient, and expected efficacy and tolerability. Many double and triple drug combinations are available. In addition, promising new drugs such as pomalidomide, carfilzomib, and monoclonal antibodies are or will be available shortly, and other options can be explored in clinical trials. Finally, supportive care and palliative options need to be considered in later relapsed disease. Increasingly, it becomes important to consider the therapeutic options for the whole duration of the disease and integrate a systematic approach for the patient.
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Affiliation(s)
- Pieter Sonneveld
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
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