1
|
Ho PJ, Spencer A, Mollee P, Bryant CE, Enjeti AK, Horvath N, Butcher BE, Trotman J, Gibbs S, Joshua DE. Serum Free Light Chain Kinetics Is Predictive of Renal Response in Myeloma Patients With Renal Impairment-An ALLG Trial of Carfilzomib-Dexamethasone Therapy in Frontline and Relapse. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:543-552.e1. [PMID: 38702217 DOI: 10.1016/j.clml.2024.04.001] [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: 01/06/2024] [Revised: 03/22/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND PURPOSE Renal impairment (RI) confers adverse prognosis in myeloma; its reversal and avoidance of dialysis are crucial. We investigated whether serum free light chain (SFLC) measurements can predict renal outcome, to enable change in therapy to optimize prognosis and avoid dialysis. PATIENTS AND METHODS We investigated 36 myeloma patients (17 newly diagnosed [ND]; 19 relapsed refractory [RR]; with median of 5 prior lines) with eGFR 15-40 ml/min treated with carfilzomib (Cfz)-dexamethasone to determine whether SFLC kinetics can predict renal outcomes, and assess efficacy and tolerability. RESULTS The change in involved SFLC at Cycle 2 Day 1 was significantly correlated with renal function; for every one log10 reduction in involved SFLC, eGFR increased by 9.0-15.0 mL/min at cycles 2-4, with SFLC reduction of 54%-78%. At a median follow-up of 30.6 months, renal outcomes were favorable-CRrenal 25%, MRrenal 36%. Disease responses (ND 100%, RR 75%), progression-free survival (ND 32.2 months, RR 11.1 months) and overall survival (ND not reached, RR 42.0 months) were comparable to patients without RI. There was significant toxicity, including Cfz-related cardiac impairment of 20% within a cohort with high co-morbidity, and a high incidence of infections. CONCLUSION We propose that one log10 reduction in involved SFLC at Cycle 2 Day 1 is an appropriate target for reducing the risk of dialysis in myeloma patients with RI; below this threshold patients may benefit from a change in therapy. While Cfz-dexamethasone achieved favorable renal and disease outcomes, toxicity can be significant in this vulnerable cohort.
Collapse
Affiliation(s)
- P Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia.
| | - Andrew Spencer
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter Mollee
- Haematology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Christian E Bryant
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
| | - Anoop K Enjeti
- Department of Haematology, Calvary Mater Newcastle Hospital, Waratah, New South Wales, Australia; NSW Health Pathology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; Precision Medicine Program, Hunter Medical Research Institute and University of Newcastle, New South Wales, Australia
| | | | - Belinda E Butcher
- Biostatistics, WriteSource Medical, Lane Cove, New South Wales, Australia; School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Judith Trotman
- University of Sydney, Sydney, New South Wales, Australia; Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Simon Gibbs
- Box Hill Hospital, Melbourne, Victoria, Australia
| | - Douglas E Joshua
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Mori Y, Takizawa J, Katsuoka Y, Takezako N, Nagafuji K, Handa H, Kuroda J, Sunami K, Kamimura T, Ogawa R, Kikushige Y, Harada M, Akashi K, Miyamoto T. Autologous HSCT with novel agent-based induction and consolidation followed by lenalidomide maintenance for untreated multiple myeloma. Cancer Sci 2024; 115:2002-2011. [PMID: 38498976 PMCID: PMC11145111 DOI: 10.1111/cas.16158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024] Open
Abstract
Triplet regimen comprising proteasome inhibitors, immunomodulatory drugs, and dexamethasone (DEX) is a recommended induction/consolidation therapy for multiple myeloma (MM) patients eligible for transplant. In this Japanese phase II study conducted from 2017 to 2019, newly diagnosed MM patients aged 20-65 received four induction cycles with bortezomib (Bor), lenalidomide (Len), and DEX (VRD), followed by Bor and high-dose melphalan with autologous stem cell rescue. Subsequently, they underwent four consolidation cycles with carfilzomib, Len, and DEX (KRD), followed by Len maintenance until disease progression. A total of 141 patients were analyzed. In an intent-to-treat population, the complete or better response post induction was 19.9%, rising to 39.7%, 58.9%, and 62.4% after transplant, consolidation, and 1-year maintenance, respectively. With a median follow-up of 38 months, the 3-year progression-free survival (PFS) rate was 83.5% and the 3-year overall survival rate was 92.5%. Severe adverse events (≥grade 3) occurred in ~30% of patients; however, there was no treatment-related mortality. These findings clearly showed the tolerability and effectiveness of this protocol. Nevertheless, patients with high-risk cytogenetics showed a trend toward lower 3-year PFS than those without (77.8% vs. 89.4%, p = 0.051), and ultra-high-risk cytogenetics (≥2 high-risk cytogenetics) had an even worse prognosis, with 61.2% 3-year PFS. To overcome this situation, a more potent treatment strategy incorporating novel agents such as the CD38-antibody should be assessed in future studies.
Collapse
Affiliation(s)
- Yasuo Mori
- Department of Medicine and Biosystemic SciencesKyushu University Graduate School of MedicineFukuokaJapan
| | - Jun Takizawa
- Division of Hematology, Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
| | - Yuna Katsuoka
- Department of HematologyNational Hospital Organization Sendai Medical CenterSendaiJapan
| | - Naoki Takezako
- Department of HematologyNational Hospital Organization Disaster Medical CenterTokyoJapan
- Division of Hematology, Japan Association for Development of Community MedicineNerima Hikarigaoka HospitalTokyoJapan
| | - Koji Nagafuji
- Division of Hematology and Oncology, Department of MedicineKurume University School of MedicineKurumeJapan
| | - Hiroshi Handa
- Department of HematologyGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Kazutaka Sunami
- Department of HematologyNational Hospital Organization Okayama Medical CenterOkayamaJapan
| | | | - Ryosuke Ogawa
- Department of Hematology and OncologyJCHO Kyushu HospitalFukuokaJapan
| | - Yoshikane Kikushige
- Department of Medicine and Biosystemic SciencesKyushu University Graduate School of MedicineFukuokaJapan
| | - Mine Harada
- Karatsu Higashimatsuura Medical CenterKaratsuJapan
| | - Koichi Akashi
- Department of Medicine and Biosystemic SciencesKyushu University Graduate School of MedicineFukuokaJapan
| | - Toshihiro Miyamoto
- Department of Medicine and Biosystemic SciencesKyushu University Graduate School of MedicineFukuokaJapan
- Department of Hematology, Faculty of Medicine, Institute of Medical Pharmaceutical and Health SciencesKanazawa UniversityKanazawaIshikawaJapan
| | | |
Collapse
|
3
|
Perrot A, Roussel M, Lauwers-Cances V, Hulin C, Leleu X, Touzeau C, Facon T, Mariette C, Schiano JM, Gay J, Montes L, Ranta D, Huguet A, Wuillème S, Dejoie T, Devlamynck L, Corre J, Avet-Loiseau H, Moreau P, Attal M. Twice-weekly induction with ixazomib-lenalidomide-dexamethasone (IRd) combination followed by extended IRd consolidation and lenalidomide maintenance in transplant-eligible patients with newly diagnosed multiple myeloma: Results of the phase 2 study IFM2014-03. Br J Haematol 2024. [PMID: 38811169 DOI: 10.1111/bjh.19570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024]
Abstract
Therapeutic strategies for patients with newly diagnosed multiple myeloma (NDMM) have considerably improved during the last 10 years. The IFM2014-03 trial proposed an all-oral triplet induction/consolidation regimen in transplant-eligible NDMM patients, followed by lenalidomide maintenance. Induction consisted of three 21-day cycles of ixazomib, lenalidomide and dexamethasone (IRd), before high-dose Melphalan with transplant followed by eight 28-day cycles of IRd consolidation before 13 cycles of lenalidomide maintenance. Forty-six patients were enrolled and received at least one dose of therapy, and 39 entered the maintenance phase. The primary end-point was stringent complete response after consolidation, and was achieved in nine patients (20.9%, 90% CI 11.4-33.7; p = 0.998). Ten patients (24.4%) had an undetectable minimal residual disease. The overall response rate was 95.7%. The 3-year progression-free survival was 66.3%. No unexpected toxicities were recorded, and only eight patients suspended from any study drug. Of note, 21 (45.7%) patients reported peripheral neuropathy (PN) (grades 1-2 with no serious adverse events). IRd induction and consolidation with transplant before lenalidomide maintenance shows lower response rates compared to other triplet therapies. It could be an alternative for patients who require an all-oral regimen and/or with pre-existent PN, especially if quadruplet regimens including anti-CD38 antibody are not available.
Collapse
Affiliation(s)
- Aurore Perrot
- Service Hématologie, Toulouse University Hospital, Toulouse, France
| | - Murielle Roussel
- Service Hématologie, Limoges University Hospital, Limoges, France
| | | | - Cyrille Hulin
- Service Maladies du Sang, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Leleu
- Service Hématologie, Poitiers University Hospital, Poitiers, France
| | - Cyrille Touzeau
- Service Hématologie, Nantes University Hospital, Nantes, France
| | - Thierry Facon
- Service Maladies du Sang, Lille University Hospital, Lille, France
| | - Clara Mariette
- Service Hématologie, Grenoble University Hospital, Grenoble, France
| | - Jean-Marc Schiano
- Service Hématologie, Marseille Paoli-Calmettes Institute, Marseille, France
| | - Julie Gay
- Service Hématologie, Bayonne Cote Basque Hospital, Bayonne, France
| | - Lydia Montes
- Service Hématologie, Amiens University Hospital, Amiens, France
| | - Dana Ranta
- Service Hématologie, Nancy University Hospital, Nancy, France
| | - Amandine Huguet
- Département Recherche Clinique, Toulouse University Hospital, Toulouse, France
| | - Soraya Wuillème
- Laboratoire d'Hematologie, Nantes University Hospital, Nantes, France
| | - Thomas Dejoie
- Laboratoire de Biochimie, Nantes University Hospital, Nantes, France
| | | | - Jill Corre
- Toulouse Myeloma Genomic Unit, Toulouse, France
| | | | - Philippe Moreau
- Service Hématologie, Nantes University Hospital, Nantes, France
| | - Michel Attal
- Service Hématologie, Toulouse University Hospital, Toulouse, France
| |
Collapse
|
4
|
Kumar AD, Chari A. Role of Consolidation and Maintenance. Hematol Oncol Clin North Am 2024; 38:421-440. [PMID: 38262780 DOI: 10.1016/j.hoc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Consolidation therapy consists of short-term therapy after stem cell transplant in multiple myeloma. Key consolidation trials have shown mixed results on whether consolidation should be included after transplant, leading to varied clinical practice. Maintenance therapy consists of long-term, typically fixed-duration or indefinite, therapy. Standard-risk patients typically receive single-agent therapy, whereas high-risk may benefit from doublet therapy and beyond. Adverse events and quality of life concerns should be considered, as optimal duration of maintenance therapy continues to be studied.
Collapse
Affiliation(s)
- Anupama D Kumar
- University of California, San Francisco, 400 Parnassus Avenue, ACC Building, 4th Floor, San Francisco, CA 94143, USA.
| | - Ajai Chari
- University of California, San Francisco, 400 Parnassus Avenue, ACC Building, 4th Floor, San Francisco, CA 94143, USA
| |
Collapse
|
5
|
Partanen A, Waage A, Peceliunas V, Schjesvold F, Anttila P, Säily M, Uttervall K, Putkonen M, Carlson K, Haukas E, Sankelo M, Szatkowski D, Hansson M, Marttila A, Svensson R, Axelsson P, Lauri B, Mikkola M, Karlsson C, Abelsson J, Ahlstrand E, Sikiö A, Klimkowska M, Matuzeviciene R, Fenstad MH, Ilveskero S, Pelliniemi TT, Nahi H, Silvennoinen R. Ixazomib, Lenalidomide, and Dexamethasone (IRD) Treatment with Cytogenetic Risk-Based Maintenance in Transplant-Eligible Myeloma: A Phase 2 Multicenter Study by the Nordic Myeloma Study Group. Cancers (Basel) 2024; 16:1024. [PMID: 38473382 DOI: 10.3390/cancers16051024] [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: 01/27/2024] [Revised: 02/17/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Scarce data exist on double maintenance in transplant-eligible high-risk (HR) newly diagnosed multiple myeloma (NDMM) patients. This prospective phase 2 study enrolled 120 transplant-eligible NDMM patients. The treatment consisted of four cycles of ixazomib-lenalidomide-dexamethasone (IRD) induction plus autologous stem cell transplantation followed by IRD consolidation and cytogenetic risk-based maintenance therapy with lenalidomide + ixazomib (IR) for HR patients and lenalidomide (R) alone for NHR patients. The main endpoint of the study was undetectable minimal residual disease (MRD) with sensitivity of <10-5 by flow cytometry at any time, and other endpoints were progression-free survival (PFS) and overall survival (OS). We present the preplanned analysis after the last patient has been two years on maintenance. At any time during protocol treatment, 28% (34/120) had MRD < 10-5 at least once. At two years on maintenance, 66% of the patients in the HR group and 76% in the NHR group were progression-free (p = 0.395) and 36% (43/120) were CR or better, of which 42% (18/43) had undetectable flow MRD <10-5. Altogether 95% of the patients with sustained MRD <10-5, 82% of the patients who turned MRD-positive, and 61% of those with positive MRD had no disease progression at two years on maintenance (p < 0.001). To conclude, prolonged maintenance with all-oral ixazomib plus lenalidomide might improve PFS in HR patients.
Collapse
Affiliation(s)
- Anu Partanen
- Department of Medicine, Kuopio University Hospital, 70210 Kuopio, Finland
| | - Anders Waage
- Department of Hematology, St. Olavs Hospital, 7030 Trondheim, Norway
| | - Valdas Peceliunas
- Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital, 08661 Vilnius, Lithuania
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, 0450 Oslo, Norway
- KG Jebsen Center for B Cell Malignancies, University of Oslo, 0316 Oslo, Norway
| | - Pekka Anttila
- Helsinki University Hospital Cancer Center Hematology, University of Helsinki, 00029 Helsinki, Finland
| | - Marjaana Säily
- Hematology-Oncology Unit, Oulu University Hospital Hematology, 90220 Oulu, Finland
| | - Katarina Uttervall
- Medical Unit Hematology, Karolinska University Hospital, 171 64 Solna, Sweden
- Department of Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Mervi Putkonen
- Department of Medicine, Turku University Hospital, 20521 Turku, Finland
| | - Kristina Carlson
- Department of Hematology, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Einar Haukas
- Stavanger University Hospital, 4011 Stavanger, Norway
| | - Marja Sankelo
- Hematology Unit, Department of Internal Medicine, Tampere University Hospital Hematology, 33520 Tampere, Finland
| | - Damian Szatkowski
- Department of Oncology, Hematology and Palliative Care, Foerde Central Hospital, 6812 Foerde, Norway
| | - Markus Hansson
- Department of Hematology, Skåne University Hospital, 222 42 Lund, Sweden
| | - Anu Marttila
- Department of Medicine, Kymenlaakso Central Hospital, 48210 Kotka, Finland
| | - Ronald Svensson
- Department of Hematology, Linköping University Hospital, 581 85 Linköping, Sweden
| | - Per Axelsson
- Department of Haematology, Helsingborg Hospital, 252 23 Helsingborg, Sweden
| | - Birgitta Lauri
- Department of Hematology, Sunderby Hospital, 971 80 Luleå, Sweden
| | - Maija Mikkola
- Department of Medicine, Päijät-Häme Central Hospital, 15850 Lahti, Finland
| | - Conny Karlsson
- Department of Haematology, Halland Hospital, 302 33 Halmstad, Sweden
| | - Johanna Abelsson
- Department of Hematology, Uddevalla Hospital, 451 53 Uddevalla, Sweden
| | - Erik Ahlstrand
- Department of Medicine, Örebro University Hospital, 701 85 Örebro, Sweden
| | - Anu Sikiö
- Department of Medicine, Central Finland Central Hospital, 40620 Jyväskylä, Finland
| | - Monika Klimkowska
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Reda Matuzeviciene
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Biomedical Sciences Institute, Vilnius University Hospital and Vilnius University Faculty of Medicine, 03101 Vilnius, Lithuania
| | - Mona Hoysaeter Fenstad
- Department of Immunology and Transfusion Medicine, St. Olavs Hospital, 7030 Trondheim, Norway
| | - Sorella Ilveskero
- Clinical Chemistry, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
| | | | - Hareth Nahi
- Hematology Centre, Karolinska University Hospital Huddinge, 141 57 Stockholm, Sweden
| | - Raija Silvennoinen
- Helsinki University Hospital Cancer Center Hematology, University of Helsinki, 00029 Helsinki, Finland
| |
Collapse
|
6
|
Zhang CW, Wang YN, Ge XL. Lenalidomide use in multiple myeloma (Review). Mol Clin Oncol 2024; 20:7. [PMID: 38125742 PMCID: PMC10729307 DOI: 10.3892/mco.2023.2705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023] Open
Abstract
Lenalidomide is a second-generation new immunomodulatory medication used to treat multiple myeloma (MM). Its mechanism of action involves affecting the expression of vascular endothelial growth factor, interleukin-6, cytochrome c, caspase-8, as well as other factors including immunological modulation and the direct killing of cells, among others, rendering it a fundamental medication, useful for the treatment of MM. Combining lenalidomide with other medications such dexamethasone, bortezomib, ixazomib, carfilzomib and daratumumab can markedly alleviate MM. When autologous-hematopoietic stem cell transplantation (ASCT) cannot be utilized to treat newly diagnosed individuals with MM (NDMM), monotherapy maintenance following lenalidomide and dexamethasone may be employed. Following ASCT, single-agent maintenance with lenalidomide can be performed as an additional treatment. The combination of bortezomib and lenalidomide has been demonstrated to be associated with favorable response rates, tolerable toxicity, and therapeutic benefits although caution is warranted to prevent the onset of peripheral neuropathy with its use. A new-generation oral drug with an excellent safety profile, ixazomib, is more practical and therapeutically applicable in relapsed refractory MM. However, the frequent occurrence of cardiovascular events, hematocrit, and infections with it require flexible adjustment in its clinical application. Carfilzomib produces a rapid and profound response in patients with NDMM eligible for transplantation, but its cardiovascular side effects need to be closely monitored. The primary aim of the present review was to examine the pharmacological properties and pharmacokinetics of lenalidomide, as well as the efficacy and safety of lenalidomide-based treatments with reference to data from clinical trials and real-world studies.
Collapse
Affiliation(s)
- Chao-Wei Zhang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Ya-Nan Wang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Xue-Ling Ge
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| |
Collapse
|
7
|
Alnasser SM, Alharbi KS, Almutairy AF, Almutairi SM, Alolayan AM. Autologous Stem Cell Transplant in Hodgkin's and Non-Hodgkin's Lymphoma, Multiple Myeloma, and AL Amyloidosis. Cells 2023; 12:2855. [PMID: 38132175 PMCID: PMC10741865 DOI: 10.3390/cells12242855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Human body cells are stem cell (SC) derivatives originating from bone marrow. Their special characteristics include their capacity to support the formation and self-repair of the cells. Cancer cells multiply uncontrollably and invade healthy tissues, making stem cell transplants a viable option for cancer patients undergoing high-dose chemotherapy (HDC). When chemotherapy is used at very high doses to eradicate all cancer cells from aggressive tumors, blood-forming cells and leukocytes are either completely or partially destroyed. Autologous stem cell transplantation (ASCT) is necessary for patients in those circumstances. The patients who undergo autologous transplants receive their own stem cells (SCs). The transplanted stem cells first come into contact with the bone marrow and then undergo engraftment, before differentiating into blood cells. ASCT is one of the most significant and innovative strategies for treating diseases. Here we focus on the treatment of Hodgkin's lymphoma, non-Hodgkin's lymphoma, multiple myeloma, and AL amyloidosis, using ASCT. This review provides a comprehensive picture of the effectiveness and the safety of ASCT as a therapeutic approach for these diseases, based on the currently available evidence.
Collapse
Affiliation(s)
- Sulaiman Mohammed Alnasser
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.F.A.)
| | - Khalid Saad Alharbi
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.F.A.)
| | - Ali F. Almutairy
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.F.A.)
| | | | | |
Collapse
|
8
|
Bar N, Firestone RS, Usmani SZ. Aiming for the cure in myeloma: Putting our best foot forward. Blood Rev 2023; 62:101116. [PMID: 37596172 DOI: 10.1016/j.blre.2023.101116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/20/2023]
Abstract
Frontline therapy for multiple myeloma (MM) is evolving to include novel combinations that can achieve unprecedented deep response rates. Several treatment strategies exist, varying in induction regimen composition, use of transplant and or consolidation and maintenance. In this sea of different treatment permutations, the overarching theme is the powerful prognostic factors of disease risk and achievement of minimal residual disease (MRD) negativity. MM has significant inter-patient variability that requires treatment to be individualized. Risk-adapted and response-adapted strategies which are increasingly being explored to define the extent and duration of therapy, and eventually aim for functional curability. In addition, with T-cell redirection therapies rapidly revolutionizing myeloma treatments, the current standard of care for myeloma will change. This review analyzes the current relevant literature in upfront therapy for fit myeloma patients and provides suggestions for treatment approach while novel clinical trials are maturing.
Collapse
Affiliation(s)
- Noffar Bar
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine University, New Haven, CT, USA.
| | - Ross S Firestone
- Multiple Myeloma Service, Department of medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Saad Z Usmani
- Multiple Myeloma Service, Department of medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
9
|
Nørgaard JN, Abildgaard N, Lysén A, Tsykunova G, Vangsted AJ, João C, Remen N, Nielsen LK, Osnes L, Stokke C, Connelly JP, Revheim MER, Schjesvold F. Intensifying treatment in PET-positive multiple myeloma patients after upfront autologous stem cell transplantation. Leukemia 2023; 37:2107-2114. [PMID: 37568010 DOI: 10.1038/s41375-023-01998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
18F-Fluorodeoxyglucose positron emission tomography/computed tomography (PET) positivity after first-line treatment with autologous stem cell transplantation (ASCT) in multiple myeloma is strongly correlated with reduced progression-free and overall survival. However, PET-positive patients who achieve PET negativity after treatment seem to have comparable outcomes to patients who were PET negative at diagnosis. Hence, giving PET-positive patients additional treatment may improve their outcome. In this phase II study, we screened first-line patients with very good partial response (VGPR) or better after ASCT with PET. PET-positive patients received four 28-day cycles of carfilzomib-lenalidomide-dexamethasone (KRd). Flow cytometry-based minimal residual disease (MRD) analysis was performed before and after treatment for correlation with PET. Overall, 159 patients were screened with PET. A total of 53 patients (33%) were PET positive and 57% of PET-positive patients were MRD negative, demonstrating that these response assessments are complementary. KRd consolidation converted 33% of PET-positive patients into PET negativity. MRD-negative patients were more likely to convert than MRD-positive patients. In summary, PET after ASCT detected residual disease in a substantial proportion of patients in VGPR or better, even in patients who were MRD negative, and KRd consolidation treatment changed PET status in 33% of patients.
Collapse
Affiliation(s)
- Jakob Nordberg Nørgaard
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
- KG Jebsen Center for B cell malignancies, University of Oslo, Oslo, Norway.
| | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anna Lysén
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway
- KG Jebsen Center for B cell malignancies, University of Oslo, Oslo, Norway
| | - Galina Tsykunova
- Division of Hematology, Haukeland University Hospital, Bergen, Norway
| | | | - Cristina João
- Department of Hematology, Champalimaud Centre for the Unknown, Lisboa, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nora Remen
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - Lene Kongsgaard Nielsen
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
- Department of Hematology, Gødstrup Hospital, Herning, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Liv Osnes
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Caroline Stokke
- Division for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - James P Connelly
- Division for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Mona-Elisabeth R Revheim
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway
- KG Jebsen Center for B cell malignancies, University of Oslo, Oslo, Norway
| |
Collapse
|
10
|
Tan CR, Derkach A, Nemirovsky D, Ciardiello A, Diamond B, Hultcrantz M, Hassoun H, Mailankody S, Shah U, Maclachlan K, Patel D, Lahoud OB, Landau HJ, Chung DJ, Shah GL, Scordo M, Giralt SA, Lesokhin A, Usmani SZ, Landgren O, Korde N. Bortezomib, lenalidomide and dexamethasone (VRd) vs carfilzomib, lenalidomide and dexamethasone (KRd) as induction therapy in newly diagnosed multiple myeloma. Blood Cancer J 2023; 13:112. [PMID: 37491332 PMCID: PMC10368661 DOI: 10.1038/s41408-023-00882-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/17/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
Lenalidomide and dexamethasone with bortezomib (VRd) or carfilzomib (KRd) are commonly used induction regimens in the U.S. This single-center, retrospective study evaluated outcomes and safety of VRd and KRd. Primary endpoint was progression-free survival (PFS). Of 389 patients with newly diagnosed multiple myeloma, 198 received VRd and 191 received KRd. Median PFS was not reached (NR) in both groups; 5-year PFS was 56% (95%CI, 48-64%) for VRd and 67% (60-75%) for KRd (P = 0.027). Estimated 5-year EFS was 34% (95%CI, 27-42%) for VRd and 52% (45-60%) for KRd (P < 0.001) with corresponding 5-year OS of 80% (95%CI, 75-87%) and 90% (85-95%), respectively (P = 0.053). For standard-risk patients, 5-year PFS was 68% (95%CI, 60-78%) for VRd and 75% (65-85%) for KRd (P = 0.20) with 5-year OS of 87% (95%CI, 81-94%) and 93% (87-99%), respectively (P = 0.13). For high-risk patients, median PFS was 41 months (95%CI, 32.8-61.1) for VRd and 70.9 months (58.2-NR) for KRd (P = 0.016). Respective 5-year PFS and OS were 35% (95%CI, 24-51%) and 69% (58-82%) for VRd and 58% (47-71%) and 88% (80-97%, P = 0.044) for KRd. Overall, KRd resulted in improved PFS and EFS with a trend toward improved OS compared to VRd with associations primarily driven by improvements in outcome for high-risk patients.
Collapse
Affiliation(s)
- Carlyn Rose Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Nemirovsky
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amanda Ciardiello
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Benjamin Diamond
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Urvi Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kylee Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dhwani Patel
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oscar B Lahoud
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather J Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saad Z Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
11
|
Turner R, Quach H, Horvath N, Kerridge I, Lee E, Morris E, Kalff A, Khong T, Reynolds J, Spencer A. Response adaptive salvage with KTd and ASCT for functional high-risk multiple myeloma-The Australasian Leukemia and Lymphoma Group (ALLG) MM17 Trial. Br J Haematol 2023. [PMID: 37332079 DOI: 10.1111/bjh.18914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
We evaluated re-induction incorporating carfilzomib-thalidomide-dexamethasone (KTd) and autologous stem cell transplantation (ASCT) for newly diagnosed multiple myeloma (NDMM) refractory, or demonstrating a suboptimal response, to non-IMID bortezomib-based induction. KTd salvage consisted of thalidomide 100 mg daily and dexamethasone 20 mg orally combined with carfilzomib 56 mg/m2 days 1, 2, 8, 9, 15 and 16, of each 28-day cycle. Following four cycles, patients achieving a stringent complete response proceeded to ASCT whereas those who did not received a further two cycles then ASCT. Consolidation consisted of two cycles of KTd then Td to a total of 12 months post-ASCT therapy. Primary end-point was the overall response rate (ORR) with KTd prior to ASCT. Fifty patients were recruited. The ORR was 78% with EuroFlow MRD negativity of 34% in the intention-to-treat population and 65% in the evaluable population at 12 months post-ASCT. With follow-up >38 months median PFS and OS have not been reached with PFS and OS at 36 months of 64% and 80%, respectively. KTd was well tolerated with grade 3 and grade ≥4 adverse events rates of 32% and 10%, respectively. Response adaptive utilisation of KTd with ASCT is associated with both high-quality responses and durable disease control in functional high-risk NDMM.
Collapse
Affiliation(s)
- R Turner
- Alfred Health, Melbourne, Victoria, Australia
| | - H Quach
- St Vincent's Hospital, Melbourne, Victoria, Australia
- Melbourne University, Melbourne, Victoria, Australia
| | - N Horvath
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - I Kerridge
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - E Lee
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - E Morris
- Townsville Cancer Centre, Townsville, Queensland, Australia
| | - A Kalff
- Alfred Health, Melbourne, Victoria, Australia
| | - T Khong
- Alfred Health, Melbourne, Victoria, Australia
| | - J Reynolds
- Alfred Health, Melbourne, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| | - A Spencer
- Alfred Health, Melbourne, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| |
Collapse
|
12
|
Zheng Y, Huang S, Xie B, Zhang N, Liu Z, Tse G, Liu T. Cardiovascular Toxicity of Proteasome Inhibitors in Multiple Myeloma Therapy. Curr Probl Cardiol 2023; 48:101536. [PMID: 36481392 DOI: 10.1016/j.cpcardiol.2022.101536] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
The treatment for multiple myeloma has advanced significantly over the past few decades. Proteasome inhibitors have become the cornerstone of the treatment of multiple myeloma. However, proteasome inhibitors have shown cardiovascular complications such as hypertension, pulmonary hypertension, heart failure, arrhythmias, ischaemic heart disease and thromboembolism. Detection, monitoring and management of proteasome inhibitor-related cardiovascular toxicity are essential to improve clinical outcomes for patients. Proposed mechanisms of proteasome inhibitor-related cardiovascular toxicity are apoptosis, prolonged inhibition of the ubiquitin-proteasome system, accumulation of improperly folded proteins within cardiomyocytes and higher protein phosphatase 2A activity. To better understand the mechanisms underlying cardiotoxicity, further in vitro and in vivo experiments are required to investigate these hypotheses. Combined use of metformin or angiotensin II receptor blockers with the proteasome inhibitor, carfilzomib, showed an emerging role as a prophylactic therapy because they can preserve heart function in multiple myeloma patients. Metformin is expected to be an effective therapeutic intervention for the management of carfilzomib-induced cardiotoxicity. There has been evidence that three compounds, apremilast, rutin, and dexrazoxane, can reverse carfilzomib-induced cardiotoxicity in rats. The future transition from animal experiments to clinical trials is worth waiting for.
Collapse
Affiliation(s)
- Yi Zheng
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin China
| | - Shan Huang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin China
| | - Bingxin Xie
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin China
| | - Nan Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin China
| | - Zhiqiang Liu
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China; The province and ministry co-sponsored collaborative innovation center for medical epigenetics; Tianjin Key Laboratory of Cellular Homeostasis and Human Diseases; Department of Physiology and Pathophysiology, School of Basic Medical Science, Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin China; Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, UK; School of Nursing and Health Studies, Metropolitan University, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin China.
| |
Collapse
|
13
|
Tan CR, Derkach A, Nemirovsky D, Ciardiello A, Diamond B, Hultcrantz M, Hassoun H, Mailankody S, Shah U, Maclachlan K, Patel D, Lahoud O, Landau H, Chung D, Shah G, Scordo M, Giralt S, Lesokhin A, Usmani S, Landgren O, Korde N. Bortezomib, Lenalidomide and Dexamethasone (VRd) vs Carfilzomib, Lenalidomide and Dexamethasone (KRd) as Induction Therapy in Newly Diagnosed Multiple Myeloma. RESEARCH SQUARE 2023:rs.3.rs-2583053. [PMID: 36865246 PMCID: PMC9980212 DOI: 10.21203/rs.3.rs-2583053/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Lenalidomide and dexamethasone with bortezomib (VRd) or carfilzomib (KRd) are commonly used induction regimens in the U.S. This single-center, retrospective study evaluated outcomes and safety of VRd and KRd. Primary endpoint was progression-free survival (PFS). Of 389 patients with newly diagnosed multiple myeloma, 198 received VRd and 191 received KRd. Median PFS was not reached (NR) in both groups; 5-year PFS was 56% (95%CI, 48%-64%) for VRd and 67% (60%-75%) for KRd (P = 0.027). Estimated 5-year EFS was 34% (95%CI, 27%-42%) for VRd and 52% (45%-60%) for KRd (P < 0.001) with corresponding 5-year OS of 80% (95%CI, 75%-87%) and 90% (85%-95%), respectively (P = 0.053). For standard-risk patients, 5-year PFS was 68% (95%CI, 60%-78%) for VRd and 75% (65%-85%) for KRd (P = 0.20) with 5-year OS of 87% (95%CI, 81%-94%) and 93% (87%-99%), respectively (P = 0.13). For high-risk patients, median PFS was 41 months (95%CI, 32.8-61.1) for VRd and 70.9 months (58.2-NR) for KRd (P = 0.016). Respective 5-year PFS and OS were 35% (95%CI, 24%-51%) and 69% (58%-82%) for VRd and 58% (47%-71%) and 88% (80%-97%, P = 0.044) for KRd. Overall, KRd resulted in improved PFS and EFS with a trend toward improved OS compared to VRd with associations primarily driven by improvements in outcome for high-risk patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Urvi Shah
- Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | | | | | | | | | - Ola Landgren
- Sylvester Comprehensive Cancer Center, University of Miami
| | | |
Collapse
|
14
|
Tanenbaum B, Miett T, Patel SA. The emerging therapeutic landscape of relapsed/refractory multiple myeloma. Ann Hematol 2023; 102:1-11. [PMID: 36462062 PMCID: PMC10888499 DOI: 10.1007/s00277-022-05058-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/13/2022] [Indexed: 12/07/2022]
Abstract
From a historic lens, treatment for patients with relapsed/refractory multiple myeloma (R/R MM) has advanced significantly since the advent of immunomodulatory agents (IMiDs) in the 1990s, proteasome inhibitors in the 2000s, monoclonal antibodies in the 2010s, and CAR-T treatments in the 2020s. However, the availability of multiple new therapies has also created significant ambiguity regarding therapy selection and sequencing, as consensus guidelines are limited, and cross-trial comparisons of the novel agents are challenging. In this focused review, we discuss the novel Food & Drug Administration (FDA)-approved medications for R/R MM, including the recently approved first-in-class BCMA-directed bispecific antibody teclistamab. We highlight the seminal clinical trials data and discuss optimal sequencing considerations based on the goal of treatment, with an emphasis on the two novel CAR-T cell products. We consider the limited tolerability of certain agents, prospects for our aging population, and financial aspects of these therapies. Finally, we spotlight ongoing trials involving promising agents making their way through the pharmacologic pipeline including the BCMA-directed bispecific antibody elranatamab and the GPRC5D-directed bispecific antibody talquetamab. We summarize our recommendations based on the best available evidence as we enter 2023.
Collapse
Affiliation(s)
- Benjamin Tanenbaum
- Department of Medicine, UMass Chan Medical School, UMass Memorial Medical Center, 55 Lake Ave. North, Worcester, MA, 01655, USA
| | - Timothy Miett
- Department of Medicine, UMass Chan Medical School, UMass Memorial Medical Center, 55 Lake Ave. North, Worcester, MA, 01655, USA
| | - Shyam A Patel
- Department of Medicine - Division of Hematology/Oncology, UMass Chan Medical School, UMass Memorial Medical Center, 55 Lake Ave. North, Worcester, MA, 01655, USA.
- Center for Clinical and Translational Science (CCTS), UMass Chan Medical School, 55 Lake Ave. North, Worcester, MA, 01655, USA.
| |
Collapse
|
15
|
McCaughan GJ, Gandolfi S, Moore JJ, Richardson PG. Lenalidomide, bortezomib and dexamethasone induction therapy for the treatment of newly diagnosed multiple myeloma: a practical review. Br J Haematol 2022; 199:190-204. [PMID: 35796524 PMCID: PMC9796722 DOI: 10.1111/bjh.18295] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/10/2022] [Accepted: 05/20/2022] [Indexed: 01/07/2023]
Abstract
For patients with newly diagnosed multiple myeloma, survival outcomes continue to improve significantly: however, nearly all patients will relapse following induction treatment. Optimisation of induction therapy is essential to provide longer term disease control and the current standard of care for most patients incorporates an immunomodulatory agent and proteasome inhibitor, most commonly lenalidomide and bortezomib in combination with dexamethasone (RVD), with maintenance until progression. Historically there has been limited access to RVD as an induction strategy outside of the United States; fortunately, there is now increasing access worldwide. This review discusses the rationale for use of RVD as induction therapy and aims to provide guidance in prescribing this regimen in order to optimise efficacy while minimising the toxicities of treatment. We also highlight the increasing evidence for the utility of addition of a monoclonal antibody to the RVD backbone to deepen responses and potentially provide longer disease control.
Collapse
Affiliation(s)
- Georgia J. McCaughan
- Department of HaematologySt Vincent's HospitalSydneyAustralia
- University of New South Wales, Medicine and HealthSydneyAustralia
| | - Sara Gandolfi
- Translational Research ProgramUniversity of HelsinkiHelsinkiFinland
- Haematology Research UnitUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - John J. Moore
- Department of HaematologySt Vincent's HospitalSydneyAustralia
- University of New South Wales, Medicine and HealthSydneyAustralia
| | - Paul G. Richardson
- Dana‐Farber Cancer Institute, Jerome Lipper Multiple Myeloma Center, Department of Medical OncologyBostonMassachusettsUSA
| |
Collapse
|
16
|
Vaxman I, Gertz MA. How I approach smoldering multiple myeloma. Blood 2022; 140:828-838. [PMID: 35576526 PMCID: PMC9412010 DOI: 10.1182/blood.2021011670] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/28/2022] [Indexed: 11/30/2022] Open
Abstract
The current standard of care in smoldering multiple myeloma (SMM) is close surveillance, outside of clinical trials. Efforts are being made to understand the pathobiologic process that leads to the progression of SMM to active MM. This review provides a critical description of available data, including risk factors and risk models of progression, as well as clinical trials investigating interventions for this patient population. We describe 2 cases in which patients were seen before the concept of a myeloma-defining event was established. Today, based on the International Myeloma Working Group criteria, both patients would have been identified as experiencing myeloma-defining events, and therapy would have been initiated. These cases show that occasionally, patients can undergo observation only, even when they exceed criteria for high-risk SMM.
Collapse
Affiliation(s)
- Iuliana Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel; and
- Department of Hematology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | |
Collapse
|
17
|
Rybinski B, Rapoport AP, Badros AZ, Hardy N, Kocoglu M. Prolonged Lenalidomide Induction Does Not Significantly Impair Stem Cell Collection in Multiple Myeloma Patients Mobilized With Cyclophosphamide or Plerixafor: A Report From The Covid Era. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2022; 22:e716-e729. [PMID: 35504807 PMCID: PMC8958842 DOI: 10.1016/j.clml.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/24/2022] [Accepted: 03/25/2022] [Indexed: 11/26/2022]
Abstract
Introduction Induction therapy for multiple myeloma is traditionally capped at 6 cycles of lenalidomide due to concerns that longer treatment compromises the ability to collect sufficient stem cells for autologous stem cell transplantation (ASCT). However, during the COVID-19 pandemic, many of our patients received prolonged lenalidomide induction due to concerns about proceeding to ASCT. We investigated whether prolonged induction with lenalidomide affects the efficacy of stem cell collection among patients mobilized with cyclophosphamide and/or plerixafor. Patients and methods This single center, retrospective study included patients who were treated with lenalidomide induction regimens, received mobilization with cyclophosphamide or plerixafor, and underwent apheresis in preparation for ASCT. 94 patients were included, 40 of whom received prolonged induction with >6 cycles of lenalidomide containing regimen. Results Patients who received prolonged induction were more likely to require >1 day of apheresis (38% vs. 15%; OR 3.45; P = .0154), and there was a significant correlation between the duration of lenalidomide treatment and the apheresis time required to collect sufficient cells for transplant (R2 = 0.06423, P = .0148). However, there was no significant difference between patients who received prolonged induction and those who did not with respect to CD34+ stem cell yields at completion of apheresis (9.99 vs. 10.46 cells/Kg, P = .5513) or on the first day of collection (8.29 vs. 9.59 cells/Kg, P = .1788). Conclusion Among patients treated with >6 cycles of lenalidomide, mobilization augmented with cyclophosphamide and/or plerixafor will likely facilitate sufficient stem cell harvest to permit ASCT.
Collapse
|
18
|
Derman BA, Kansagra A, Zonder J, Stefka AT, Grinblatt DL, Anderson LD, Gurbuxani S, Narula S, Rayani S, Major A, Kin A, Jiang K, Karrison T, Jasielec J, Jakubowiak AJ. Elotuzumab and Weekly Carfilzomib, Lenalidomide, and Dexamethasone in Patients With Newly Diagnosed Multiple Myeloma Without Transplant Intent: A Phase 2 Measurable Residual Disease-Adapted Study. JAMA Oncol 2022; 8:1278-1286. [PMID: 35862034 DOI: 10.1001/jamaoncol.2022.2424] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Treatment of newly diagnosed multiple myeloma (NDMM) with a quadruplet regimen consisting of a monoclonal antibody, proteasome inhibitor, immunomodulatory imide, and corticosteroid has been associated with improved progression-free survival (PFS) compared with triplet regimens. The optimal quadruplet combination, and whether this obviates the need for frontline autologous stem cell transplant (ASCT), remains unknown. We evaluated elotuzumab and weekly carfilzomib, lenalidomide, and dexamethasone (Elo-KRd) without ASCT in NDMM. Objective To investigate the efficacy of Elo-KRd using a measurable residual disease (MRD)-adapted design in NDMM regardless of ASCT eligibility. Design, Setting, and Participants This multicenter, single-arm, phase 2 study enrolled patients between July 2017 and February 2021. Median follow-up was 29 months. Interventions Twelve to 24 cycles of Elo-KRd; consecutive MRD-negative results at 10-6 by next-generation sequencing (NGS) after cycles 8 (C8) and 12 determined the duration of Elo-KRd. This was followed by Elo-Rd (no carfilzomib) maintenance therapy until disease progression. Main Outcomes and Measures The primary end point was the rate of stringent complete response (sCR) and/or MRD-negativity (10-5) after C8 Elo-KRd. Secondary end points included safety, rate of response, MRD status, PFS, and overall survival (OS). As an exploratory analysis, MRD was assessed using liquid chromatography mass spectrometry (MS) on peripheral blood samples. Results Forty-six patients were enrolled (median age 62 years, 11 [24%] aged >70 years). Overall, 32 (70%) were White, 6 (13%) were Black, 3 (6%) were more than 1 race, and 5 (11%) were of unknown race. Thirty-three (72%) were men and 13 (28%) were women. High-risk cytogenetic abnormalities were present in 22 (48%) patients. The rate of sCR and/or MRD-negativity after C8 was 26 of 45 (58%), meeting the predefined statistical threshold for efficacy. Responses deepened over time, with the MRD-negativity (10-5) rate increasing to 70% and MS-negativity rate increasing to 65%; concordance between MRD by NGS and MS increased over time. The most common (>10%) grade 3 or 4 adverse events were lung and nonpulmonary infections (13% and 11%, respectively). There was 1 grade 5 myocardial infarction. The estimated 3-year PFS was 72% overall and 92% for patients with MRD-negativity (10-5) at C8. Conclusions and Relevance An MRD-adapted design using elotuzumab and weekly KRd without ASCT showed a high rate of sCR and/or MRD-negativity and durable responses. This approach provides support for further evaluation of MRD-guided deescalation of therapy to decrease treatment exposure while sustaining deep responses. Trial Registration ClinicalTrials.gov Identifier: NCT02969837.
Collapse
Affiliation(s)
| | - Ankit Kansagra
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Jeffrey Zonder
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | | | - Larry D Anderson
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | | | - Sunil Narula
- University of Chicago Medical Center, Chicago, Illinois
| | - Shayan Rayani
- University of Chicago Medical Center, Chicago, Illinois
| | - Ajay Major
- University of Chicago Medical Center, Chicago, Illinois
| | - Andrew Kin
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Ken Jiang
- University of Chicago Medical Center, Chicago, Illinois
| | | | | | | |
Collapse
|
19
|
Landgren O, Kazandjian D, Roussel M, Jasielec J, Dytfeld D, Anderson A, Kervin TA, Iskander K, McFadden I, Jakubowiak AJ. Efficacy and safety of carfilzomib-lenalidomide-dexamethasone in newly diagnosed multiple myeloma: pooled analysis of four single-arm studies. Leuk Lymphoma 2022; 63:2413-2421. [DOI: 10.1080/10428194.2022.2068001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ola Landgren
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
| | | | - Murielle Roussel
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Jagoda Jasielec
- Internal Medicine - Hematology, University of Chicago, Chicago, IL, USA
| | - Dominik Dytfeld
- Department of Hematology, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | | | | | | |
Collapse
|
20
|
Morè S, Corvatta L, Manieri VM, Saraceni F, Scortechini I, Mancini G, Fiorentini A, Olivieri A, Offidani M. Autologous Stem Cell Transplantation in Multiple Myeloma: Where Are We and Where Do We Want to Go? Cells 2022; 11:606. [PMID: 35203257 PMCID: PMC8870632 DOI: 10.3390/cells11040606] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/22/2022] Open
Abstract
The introduction of high-dose therapy in the 1990s as well as the development of drugs such as thalidomide, lenalidomide, and bortezomib in the 2000s led to an impressive improvement in outcome of patients with multiple myeloma (MM) eligible for autologous stem cell transplantation (ASCT). Clinical trials conducted in the first ten years of the twenty-first century established as standard therapy for these patients a therapeutic approach including induction, single or double ASCT, consolidation, and maintenance therapy. More recently, incorporating second-generation proteasome inhibitors carfilzomib and monoclonal antibody daratumumab into each phase of treatment significantly improved the efficacy of ASCT in terms of measurable residual disease (MRD) negativity, Progression Free Survival (PFS), and Overall Survival (OS). The availability of techniques such as multiparameter flow cytometry (MFC) and next-generation sequencing (NGS) for MRD assessment allowed the design of MRD-based response-adjusted trials that will define, in particular, the role of consolidation and maintenance therapies. In this review, we will provide an overview of the most recent evidence and the future prospects of ASCT in MM patients.
Collapse
Affiliation(s)
- Sonia Morè
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Torrette, Italy; (S.M.); (V.M.M.); (F.S.); (I.S.); (G.M.); (A.F.); (A.O.)
| | - Laura Corvatta
- U.O.C. Medicina, Ospedale Engles Profili, 60044 Fabriano, Italy;
| | - Valentina Maria Manieri
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Torrette, Italy; (S.M.); (V.M.M.); (F.S.); (I.S.); (G.M.); (A.F.); (A.O.)
| | - Francesco Saraceni
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Torrette, Italy; (S.M.); (V.M.M.); (F.S.); (I.S.); (G.M.); (A.F.); (A.O.)
| | - Ilaria Scortechini
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Torrette, Italy; (S.M.); (V.M.M.); (F.S.); (I.S.); (G.M.); (A.F.); (A.O.)
| | - Giorgia Mancini
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Torrette, Italy; (S.M.); (V.M.M.); (F.S.); (I.S.); (G.M.); (A.F.); (A.O.)
| | - Alessandro Fiorentini
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Torrette, Italy; (S.M.); (V.M.M.); (F.S.); (I.S.); (G.M.); (A.F.); (A.O.)
| | - Attilio Olivieri
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Torrette, Italy; (S.M.); (V.M.M.); (F.S.); (I.S.); (G.M.); (A.F.); (A.O.)
| | - Massimo Offidani
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Torrette, Italy; (S.M.); (V.M.M.); (F.S.); (I.S.); (G.M.); (A.F.); (A.O.)
| |
Collapse
|
21
|
Carfilzomib with cyclophosphamide and dexamethasone or lenalidomide and dexamethasone plus autologous transplantation or carfilzomib plus lenalidomide and dexamethasone, followed by maintenance with carfilzomib plus lenalidomide or lenalidomide alone for patients with newly diagnosed multiple myeloma (FORTE): a randomised, open-label, phase 2 trial. Lancet Oncol 2021; 22:1705-1720. [PMID: 34774221 DOI: 10.1016/s1470-2045(21)00535-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bortezomib-based induction followed by high-dose melphalan (200 mg/m2) and autologous stem-cell transplantation (MEL200-ASCT) and maintenance treatment with lenalidomide alone is the current standard of care for young and fit patients with newly diagnosed multiple myeloma. We aimed to evaluate the efficacy and safety of different carfilzomib-based induction and consolidation approaches with or without transplantation and of maintenance treatment with carfilzomib plus lenalidomide versus lenalidomide alone in newly diagnosed multiple myeloma. METHODS UNITO-MM-01/FORTE was a randomised, open-label, phase 2 trial done in 42 Italian academic and community practice centres. We enrolled transplant-eligible patients with newly diagnosed multiple myeloma aged 65 years or younger with a Karnofsky Performance Status of 60% or higher. Patients were stratified according to International Staging System stage (I vs II/III) and age (<60 years vs 60-65 years) and randomly assigned (1:1:1) to KRd plus ASCT (four 28-day induction cycles with carfilzomib plus lenalidomide plus dexamethasone [KRd], melphalan at 200 mg/m2 and autologous stem-cell transplantation [MEL200-ASCT], followed by four 28-day KRd consolidation cycles), KRd12 (12 28-day KRd cycles), or KCd plus ASCT (four 28-day induction cycles with carfilzomib plus cyclophosphamide plus dexamethasone [KCd], MEL200-ASCT, and four 28-day KCd consolidation cycles). Carfilzomib 36 mg/m2 was administered intravenously on days 1, 2, 8, 9, 15, and 16; lenalidomide 25 mg administered orally on days 1-21; cyclophosphamide 300 mg/m2 administered orally on days 1, 8, and 15; and dexamethasone 20 mg administered orally or intravenously on days 1, 2, 8, 9, 15, 16, 22, and 23. Thereafter, patients were stratified according to induction-consolidation treatment and randomly assigned (1:1) to maintenance treatment with carfilzomib plus lenalidomide or lenalidomide alone. Carfilzomib 36 mg/m2 was administered intravenously on days 1-2 and 15-16 every 28 days for up to 2 years; lenalidomide 10 mg was administered orally on days 1-21 every 28 days until progression or intolerance in both groups. The primary endpoints were the proportion of patients with at least a very good partial response after induction with KRd versus KCd and progression-free survival with carfilzomib plus lenalidomide versus lenalidomide alone as maintenance treatment, both assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02203643. Study recruitment is complete, and all patients are in the follow-up or maintenance phases. FINDINGS Between Feb 23, 2015, and April 5, 2017, 474 patients were randomly assigned to one of the induction-intensification-consolidation groups (158 to KRd plus ASCT, 157 to KRd12, and 159 to KCd plus ASCT). The median duration of follow-up was 50·9 months (IQR 45·7-55·3) from the first randomisation. 222 (70%) of 315 patients in the KRd group and 84 (53%) of 159 patients in the KCd group had at least a very good partial response after induction (OR 2·14, 95% CI 1·44-3·19, p=0·0002). 356 patients were randomly assigned to maintenance treatment with carfilzomib plus lenalidomide (n=178) or lenalidomide alone (n=178). The median duration of follow-up was 37·3 months (IQR 32·9-41·9) from the second randomisation. 3-year progression-free survival was 75% (95% CI 68-82) with carfilzomib plus lenalidomide versus 65% (58-72) with lenalidomide alone (hazard ratio [HR] 0·64 [95% CI 0·44-0·94], p=0·023). During induction and consolidation, the most common grade 3-4 adverse events were neutropenia (21 [13%] of 158 patients in the KRd plus ASCT group vs 15 [10%] of 156 in the KRd12 group vs 18 [11%] of 159 in the KCd plus ASCT group); dermatological toxicity (nine [6%] vs 12 [8%] vs one [1%]); and hepatic toxicity (13 [8%] vs 12 [8%] vs none). Treatment-related serious adverse events were reported in 18 (11%) of 158 patients in the KRd-ASCT group, 29 (19%) of 156 in the KRd12 group, and 17 (11%) of 159 in the KCd plus ASCT group; the most common serious adverse event was pneumonia, in seven (4%) of 158, four (3%) of 156, and five (3%) of 159 patients. Treatment-emergent deaths were reported in two (1%) of 158 patients in the KRd plus ASCT group, two (1%) of 156 in the KRd12 group, and three (2%) of 159 in the KCd plus ASCT group. During maintenance, the most common grade 3-4 adverse events were neutropenia (35 [20%] of 173 patients on carfilzomib plus lenalidomide vs 41 [23%] of 177 patients on lenalidomide alone); infections (eight [5%] vs 13 [7%]); and vascular events (12 [7%] vs one [1%]). Treatment-related serious adverse events were reported in 24 (14%) of 173 patients on carfilzomib plus lenalidomide versus 15 (8%) of 177 on lenalidomide alone; the most common serious adverse event was pneumonia, in six (3%) of 173 versus five (3%) of 177 patients. One patient died of a treatment-emergent adverse event in the carfilzomib plus lenalidomide group. INTERPRETATION Our data show that KRd plus ASCT showed superiority in terms of improved responses compared with the other two treatment approaches and support the prospective randomised evaluation of KRd plus ASCT versus standards of care (eg, daratumumab plus bortezomib plus thalidomide plus dexamethasone plus ASCT) in transplant-eligible patients with multiple myeloma. Carfilzomib plus lenalidomide as maintenance therapy also improved progression-free survival compared with the standard-of-care lenalidomide alone. FUNDING Amgen, Celgene/Bristol Myers Squibb. TRANSLATION For the Italian translation of the abstract see Supplementary Materials section.
Collapse
|
22
|
Li H, Liu ZL, Lu L, Buffet P, Karniadakis GE. How the spleen reshapes and retains young and old red blood cells: A computational investigation. PLoS Comput Biol 2021; 17:e1009516. [PMID: 34723962 PMCID: PMC8584971 DOI: 10.1371/journal.pcbi.1009516] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/11/2021] [Accepted: 10/01/2021] [Indexed: 11/18/2022] Open
Abstract
The spleen, the largest secondary lymphoid organ in humans, not only fulfils a broad range of immune functions, but also plays an important role in red blood cell’s (RBC) life cycle. Although much progress has been made to elucidate the critical biological processes involved in the maturation of young RBCs (reticulocytes) as well as removal of senescent RBCs in the spleen, the underlying mechanisms driving these processes are still obscure. Herein, we perform a computational study to simulate the passage of RBCs through interendothelial slits (IES) in the spleen at different stages of their lifespan and investigate the role of the spleen in facilitating the maturation of reticulocytes and in clearing the senescent RBCs. Our simulations reveal that at the beginning of the RBC life cycle, intracellular non-deformable particles in reticulocytes can be biomechanically expelled from the cell upon passage through IES, an insightful explanation of why this peculiar “pitting” process is spleen-specific. Our results also show that immature RBCs shed surface area by releasing vesicles after crossing IES and progressively acquire the biconcave shape of mature RBCs. These findings likely explain why RBCs from splenectomized patients are significantly larger than those from nonsplenectomized subjects. Finally, we show that at the end of their life span, senescent RBCs are not only retained by IES due to reduced deformability but also become susceptible to mechanical lysis under shear stress. This finding supports the recent hypothesis that transformation into a hemolyzed ghost is a prerequisite for phagocytosis of senescent RBCs. Altogether, our computational investigation illustrates critical biological processes in the spleen that cannot be observed in vivo or in vitro and offer insights into the role of the spleen in the RBC physiology. The spleen, the largest secondary lymphoid organ in humans, not only fulfils a broad range of immune functions, but also plays an important role in red blood cell (RBC) life cycle. In this study, we perform a computational study to simulate the passage of RBCs through interendothelial slits (IES) in the spleen at different stages of their lifespan, a critical biological process that cannot be observed in humans. Our simulation results illustrate a specific role of spleen in shaping young RBCs, which points to a probable missing step in current in vitro RBC culture protocols that fail to generate a majority of typical biconcave RBCs. Our results also reveal that intra-splenic mechanical constraints likely contribute to the final clearance and elimination of aged RBCs. Altogether, we demonstrate that our computational model can provide mechanistic rationales for experimental studies, offer insights into the role of the spleen in the RBC physiology and help the optimization of in vitro RBC culture techniques.
Collapse
Affiliation(s)
- He Li
- School of Engineering, Brown University, Providence, Rhode Island, United States of America
| | - Zixiang Leonardo Liu
- Division of Applied Mathematics, Brown University, Providence, Rhode Island, United States of America
| | - Lu Lu
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Pierre Buffet
- Université de Paris, Inserm, Biologie Intégrée du Globule Rouge, Paris, France
| | - George Em Karniadakis
- School of Engineering, Brown University, Providence, Rhode Island, United States of America
- Division of Applied Mathematics, Brown University, Providence, Rhode Island, United States of America
- * E-mail:
| |
Collapse
|
23
|
Derman BA, Kosuri S, Jakubowiak A. Knowing the unknowns in high risk multiple myeloma. Blood Rev 2021; 51:100887. [PMID: 34479756 DOI: 10.1016/j.blre.2021.100887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 12/28/2022]
Abstract
High risk multiple myeloma (HRMM) continues to portend worse outcomes despite the many advances in anti-myeloma therapeutics. The optimal approach to treatment is not clearly defined on account of the variable definitions of HRMM and the paucity of studies dedicated to the treatment of HRMM. In this review, we use a case-based approach to review the definitions of HRMM, and evaluate the evidence for induction, stem cell transplantation, and post-transplant therapy approaches for HRMM.
Collapse
Affiliation(s)
- Benjamin A Derman
- Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, United States of America.
| | - Satyajit Kosuri
- Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, United States of America
| | - Andrzej Jakubowiak
- Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, United States of America
| |
Collapse
|
24
|
KRd: the new KiD in the French myeloma induction class. Blood 2021; 138:105-106. [PMID: 34264276 DOI: 10.1182/blood.2021011751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/20/2022] Open
|