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Li H, Zheng Y, Gao K, Tian C. Tandem autologous hematopoietic stem cell transplantation for patients with multiple myeloma: a systematic review and meta-analysis. Hematology 2024; 29:2343164. [PMID: 38651865 DOI: 10.1080/16078454.2024.2343164] [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: 01/07/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
To evaluate whether patients with multiple myeloma (MM) could benefit from tandem autologous hematopoietic stem cell transplantation (auto-HSCT), PubMed, Embase, Web of Science and Cochrane Library databases were systematically searched, and 10 eligible studies were included after data extraction and quality evaluation. Meta-analysis showed that compared to single autologous hematopoietic stem cell transplantation, tandem auto-HSCT does not improve OS, EFS or efficacy in MM patients, and may even lead to higher treatment-related mortality (TRM). MM patients who received autologous tandem allogeneic HSCT did not achieve better response compared to tandem autologous HSCT. In summary, compared to single autologous hematopoietic stem cell transplantation, tandem autologous hematopoietic stem cell transplantation cannot provide survival advantages for MM patients, and MM patients cannot benefit from autologous tandem allogeneic hematopoietic stem cell transplantation.
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Affiliation(s)
- Hongtao Li
- Department of Spinal Orthopedics, Weifang Yidu Central Hospital, Shandong, People's Republic of China
| | - Yaxin Zheng
- 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, People's Republic of China
| | - Kehai Gao
- Department of Spinal Orthopedics, Weifang Yidu Central Hospital, Shandong, People's Republic of China
| | - Chen Tian
- 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, People's Republic of China
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2
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Wei M, Xie C, Huang J, Liu Q, Lai Y. Autologous followed by allogeneic versus tandem-autologous transplantation in high-risk, newly diagnosed multiple myeloma: a systematic review and meta-analysis. Hematology 2023; 28:2269509. [PMID: 37850613 DOI: 10.1080/16078454.2023.2269509] [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: 07/07/2023] [Accepted: 10/07/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES High-risk multiple myeloma (HRMM) is associated with poor survival, despite many advances in antimyeloma strategies. Autologous followed by allogeneic stem cell transplantation (auto-allo-SCT) has yielded controversial results compared to tandem autologous stem cell transplantation (auto-SCT) in patients with HRMM. We conducted this meta-analysis to compare the efficacy and safety of auto-allo-SCT and tandem-auto-SCT in patients with HRMM. METHODS Embase, Cochrane Library, and PubMed databases were searched until March 2023. Prospective or retrospective studies comparing the effects of auto-allo-SCT and tandem-auto-SCT were included. Hazard ratios (HRs) and 95% confidence intervals (CIs) for time-to-event outcomes, and odds ratios (ORs) and 95%CIs for dichotomous outcomes were pooled using random-effects models. RESULTS Three studies involving 491 patients were included. Despite auto-allo-SCT seemed to be associated with improvements in progression-free survival (PFS) (HR [95%CI], 0.71 [0.51-1.00]) and complete response (CR) (OR [95%CI], 3.16 [1.67-5.99]), and reduced relapse/progression rates (47% vs. 55%) in comparison with tandem-auto-SCT, no marked improvement in overall survival (OS). In comparison to tandem-auto-SCT, patients assigned to auto-allo-SCT exhibited a higher risk of transplant-related mortality (TRM) (11.9% vs. 4.1%) and non-relapse mortality (NRM) (12.3% vs. 3.1%). CONCLUSION Auto-allo-SCT seemed to be associated with improvements in PFS and CR when compared to tandem-auto-SCT in patients with HRMM, but it did not lead to a significant improvement in OS. Furthermore, patients in the auto-allo-SCT group were at a higher risk of developing TRM and NRM. Auto-allo-SCT transplantation should not be routinely incorporated into HRMM therapy but rather should be considered investigational.
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Affiliation(s)
- Min Wei
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
- Department of Hematology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, People's Republic of China
| | - Chunhong Xie
- Department of Hematology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, People's Republic of China
| | - Jinxiong Huang
- Department of Hematology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, People's Republic of China
| | - Qin Liu
- Department of Hematology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, People's Republic of China
| | - Yongrong Lai
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
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3
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Kawamura K. Maintenance therapy after allogeneic hematopoietic stem cell transplantation for patients with multiple myeloma. Int J Hematol 2023:10.1007/s12185-023-03602-1. [PMID: 37060508 DOI: 10.1007/s12185-023-03602-1] [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: 03/11/2023] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/16/2023]
Abstract
In the last two decades, proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), and monoclonal antibodies have greatly improved the overall survival of patients with multiple myeloma. However, multiple myeloma remains incurable, and high-risk patients have poor long-term survival. Although allogeneic hematopoietic stem cell transplantation (allo-HCT) is not considered standard therapy because of relatively high transplant-related mortality and relapse rates, the graft-versus-myeloma (GVM) effect makes it a potentially curative therapy. Therefore, allo-HCT remains a treatment option for younger patients and those with high-risk myeloma. Maintenance therapy with novel agents has recently been attempted to reduce relapse in patients undergoing allo-HCT, but its effectiveness remains unclear. This review focuses on the role of maintenance therapy after allo-HCT in patients with myeloma. Maintenance therapy using IMiDs and/or PIs after allo-HCT may be effective in reducing relapse or improving response because it may prevent early progression before achievement of the GVM effect or enhance the GVM effect. However, care must be taken to avoid complications, such as graft-versus-host disease. Further studies are necessary to determine the optimal maintenance drugs, drug combinations, dosing, start timing, and number of cycles.
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Affiliation(s)
- Koji Kawamura
- Division of Clinical Laboratory Medicine, Department of Multidisciplinary Internal Medicine, Tottori University, 86, Nishi-Cho, Yonago-City, Tottori, 683-8503, Japan.
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Maiolino A, Crusoé EDQ, Martinez GA, Braga WMT, de Farias DLC, Bittencourt RI, Neto JVP, Ribeiro GN, Bernardo WM, Tristão L, Magalhaes RJP, Hungria VTDM. Guidelines on the diagnosis and management of multiple myeloma treatment: Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular Project guidelines: Associação Médica Brasileira – 2022. Part I. Hematol Transfus Cell Ther 2022; 44:410-418. [PMID: 35970751 PMCID: PMC9477772 DOI: 10.1016/j.htct.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Angelo Maiolino
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Instituto Americas de Ensino e Pesquisa, Rio de Janeiro, RJ, Brazil.
| | - Edvan de Queiroz Crusoé
- Hospital Professor Edgar Santos da Universidade Federal da Bahia (HUPES-UFBA), Salvador, BA, Brazil
| | - Gracia Aparecida Martinez
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | | | | | | | | | | | - Luca Tristão
- Associação Médica Brasileira (AMB), São Paulo, SP, Brazil
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5
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Dhakal B, Shah N, Kansagra A, Kumar A, Lonial S, Garfall A, Cowan A, Poudyal BS, Costello C, Gay F, Cook G, Quach H, Einsele H, Schriber J, Hou J, Costa L, Aljurf M, Chaudhry M, Beksac M, Prince M, Mohty M, Janakiram M, Callander N, Biran N, Malhotra P, Otero PR, Moreau P, Abonour R, Iftikhar R, Silberman R, Mailankody S, Gregory T, Lin Y, Carpenter P, Hamadani M, Usmani S, Kumar S. ASTCT Clinical Practice Recommendations for Transplantation and Cellular Therapies in Multiple Myeloma. Transplant Cell Ther 2022; 28:284-293. [PMID: 35306217 DOI: 10.1016/j.jtct.2022.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Over the past decade, therapeutic options in multiple myeloma (MM) have changed dramatically. Given the unprecedented efficacy of novel agents, the role of hematopoietic cell transplantation (HCT) in MM remains under scrutiny. Rapid advances in myeloma immunotherapy including the recent approval of chimeric antigen receptor (CAR) T-cell therapy will impact the MM therapeutic landscape. The American Society for Transplantation and Cellular Therapy convened an expert panel to formulate clinical practice recommendations for role, timing, and sequencing of autologous (auto-HCT), allogeneic (allo-HCT) and CAR T-cell therapy for patients with newly diagnosed (NDMM) and relapsed/refractory MM (RRMM). The RAND-modified Delphi method was used to generate consensus statements. Twenty consensus statements were generated. The panel endorsed continued use of auto-HCT consolidation for patients with NDMM as a standard-of-care option, whereas in the front line allo-HCT and CAR-T were not recommended outside the setting of clinical trial. For patients not undergoing auto-HCT upfront, the panel recommended its use in first relapse. Lenalidomide as a single agent was recommended for maintenance especially for standard risk patients. In the RRMM setting, the panel recommended the use of CAR-T in patients with 4 or more prior lines of therapy. The panel encouraged allo-HCT in RRMM setting only in the context of clinical trial. The panel found RAND-modified Delphi methodology effective in providing a formal framework for developing consensus recommendations for the timing and sequence of cellular therapies for MM.
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Affiliation(s)
- Binod Dhakal
- Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nina Shah
- Division of Hematology-Oncology, University of California, San Francisco, California
| | - Ankit Kansagra
- Department of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ambuj Kumar
- Program for Comparative Effectiveness Research, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Alfred Garfall
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew Cowan
- University of Washington, Seattle WA, and Fred Hutch, Seattle, Washington
| | - Bishesh Sharma Poudyal
- Department of Clinical Hematology and Bone Marrow Transplant, Civil Service Hospital, Kathmandu, Nepal
| | - Caitlin Costello
- UCSD/Sharp Healthcare Transplant Program, Blood & Marrow Transplant Services, Moore's Cancer Center, San-Diego, California
| | - Francesca Gay
- Division of Hematology 1 Clinical Trial Unit, AOU CIttà della salute e della Scienza, University of Torino, Turin, Italy
| | - Gordon Cook
- Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trial Research, University of Leeds, Leeds, United Kingdom
| | - Hang Quach
- University of Melbourne, St. Vincent's Hospital, Melbourne, Australia
| | - Herman Einsele
- Universitätsklinikum Würzburg, Department of Internal Medicine II, Würzburg, Germany
| | - Jeff Schriber
- Cancer Treatment Centers of America, Phoenix, Arizona
| | - Jian Hou
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Luciano Costa
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Maria Chaudhry
- Department of hematology/Oncology, George Washington University and Cancer Center, Washington, District of Columbia
| | - Meral Beksac
- Department of Hematology, Ankara University, Ankara, Turkey
| | - Miles Prince
- Epworth Healthcare and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France
| | - Murali Janakiram
- Division of Myeloma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, California
| | | | - Noa Biran
- Hackensack Meridian Health, John Theurer Cancer Center, Multiple Myeloma Division, Hackensack, New Jersey
| | - Pankaj Malhotra
- Department of Clinical Hematology & Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| | - Rafat Abonour
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | - Rebecca Silberman
- Department of Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New, York, New York
| | - Tara Gregory
- Colorado Blood Cancer Institute, Sarah Cannon Cancer Network, Denver, Colorado
| | - Yi Lin
- Mayo Clinic, Rochester, Minnesota
| | - Paul Carpenter
- Division of Clinical Research, Fred Hutchinson Cancer Research Center and Department of Pediatrics, University of Washington, Seattle, Washington
| | - Mehdi Hamadani
- Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Saad Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New, York, New York
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6
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LeBlanc R, Ahmad I, Terra R, Boudreault JS, Ogez D, Lamore K, Delisle JS, Bambace N, Bernard L, Cohen S, Kiss T, Lachance S, Landais S, Lemieux-Blanchard É, Sauvageau G, Sebag M, Roy DC, Roy J. Outcomes in newly diagnosed young or high-risk myeloma patients receiving tandem autologous/allogeneic transplant followed by bortezomib maintenance: a phase II study. Bone Marrow Transplant 2021; 57:252-260. [PMID: 34845367 DOI: 10.1038/s41409-021-01532-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 01/14/2023]
Abstract
Despite novel drugs and autologous HCT, MM remains incurable, with short survival in patients with poor biological characteristics. Allo HCT may be curative in some patients but is hampered by high rates of toxicity and relapse. We hypothesized that bortezomib (BTZ), with its anti-myeloma and immunologic properties, could improve PFS and cGVHD after allo HCT in newly diagnosed MM patients. In this prospective phase II study, we included 39 young (≤50 years) and high-risk patients who received a tandem auto-allo HCT followed by BTZ. Patients had prospective minimal residual disease (MRD) evaluations using Next-Generation Flow cytometry prior to allo HCT, prior BTZ and every 3 months for 2 years. With a median follow-up of 48 months, we report PFS and OS at 5 years of 41% and 80%, with a non-relapse mortality of 12%. Incidences of grade II-IV aGVHD at 12 months and moderate/severe cGVHD at 2 years were 26% and 57%. In a multivariate analysis model including cytogenetics, ISS and MRD status, MRD positivity prior to allo HCT (HR 3.75, p = 0.037), prior BTZ (HR 11.3, p = 0.018) and 3 months post-BTZ initiation (HR 9.7, p = 0.001) was highly predictive of progression. Peritransplant MRD assessment thus strongly predicts disease progression.
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Affiliation(s)
- Richard LeBlanc
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada.
| | - Imran Ahmad
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Rafik Terra
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Jean-Samuel Boudreault
- Division of Hematology and Oncology, Hôpital du Sacré-Coeur, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - David Ogez
- Chronic Pain Clinic, Hôpital Maisonneuve-Rosemont, Department of Anesthesiology and Pain Medicine/Université de Montréal, Montreal, QC, Canada
| | - Kristopher Lamore
- Laboratoire de psychopathologie et processus de santé, Université de Paris, Paris, Boulogne-Billancourt, France
| | - Jean-Sébastien Delisle
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Nadia Bambace
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Léa Bernard
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Sandra Cohen
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Thomas Kiss
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Silvy Lachance
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Séverine Landais
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - Émilie Lemieux-Blanchard
- Division of Hematology and Oncology, Centre Hospitalier de l'Université de Montréal, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Guy Sauvageau
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Michael Sebag
- Division of Hematology, McGill University Health Center, Department of Medicine/McGill University, Montreal, QC, Canada
| | - Denis Claude Roy
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
| | - Jean Roy
- Division of Hematology, Oncology and Transplantation, Hôpital Maisonneuve-Rosemont, Department of Medicine/Université de Montréal, Montreal, QC, Canada
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7
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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.
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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
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8
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Liu Y, Rao J, Li J, Wen Q, Wang S, Lou S, Yang T, Li B, Gao L, Zhang C, Kong P, Gao L, Wang M, Zhu L, Xiang X, Zhou S, Liu X, Peng X, Zhong J, Zhang X. Tandem autologous hematopoietic stem cell transplantation for treatment of adult T-cell lymphoblastic lymphoma: a multiple center prospective study in China. Haematologica 2021; 106:163-172. [PMID: 31780634 PMCID: PMC7776263 DOI: 10.3324/haematol.2019.226985] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/26/2019] [Indexed: 11/27/2022] Open
Abstract
T-cell lymphoblastic lymphoma (T-LBL) is a highly aggressive form of lymphoma with poor clinical outcomes and no standard treatment regimen. In this study, we assessed the safety and efficacy of tandem autologous hematopoietic stem cell transplantation (auto-HSCT) for adult T-LBL and evaluated prognostic factors affecting survival. A total of 181 newly-diagnosed adult T-LBL patients were enrolled: 89 patients were treated with chemotherapy alone, 46 were allocated to the single auto-HSCT group, 46 were treated with tandem auto-HSCT. Median follow-up time was 37 months; the 3-year progression/relapse rate of the tandem auto- HSCT group was significantly lower than that of the single auto-HSCT and chemotherapy groups (26.5% vs. 53.1% and 54.8%). The 3-year progression- free survival (PFS) and overall survival (OS) rates of the tandem auto- HSCT group (73.5% and 76.3%) were significantly higher than those of the single auto-HSCT group (46.9% and 58.3%) and the chemotherapy group (45.1% and 57.1%). In the tandem auto-HSCT group, age and disease status after the first transplant impacted OS and PFS. Multivariate analysis identified that disease status after the first transplant was the only independent prognostic factor for patients treated with tandem-HSCT. In addition, diagnostic models of the initial CD8+CD28+/CD8+CD28– T-cell ratio in predicting the disease status were found to be significant. Taken together, tandem auto- HSCT can be considered an optimal strategy for adult T-LBL patients. (Study registered at: ChiCTR-ONN-16008480).
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Affiliation(s)
- Yao Liu
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jun Rao
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing
| | - Jiali Li
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Qin Wen
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Sanbin Wang
- Dept. Hematology, General Hospital of Kunming Military Region of People Liberation Army, Kunming
| | - Shifeng Lou
- Department of Hematology, Second Affiliated Hospital of Chongqing Medical University,Chongqing,China
| | - Tonghua Yang
- Department of Hematology, Yunan Provincial People Hospital, Kunming, China
| | - Bin Li
- Department of Hematology, Second Yunnan Provincial People Hospital, Yunnan, China
| | - Lei Gao
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Cheng Zhang
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Peiyan Kong
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing
| | - Li Gao
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Maihong Wang
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lidan Zhu
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xixi Xiang
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Sha Zhou
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xue Liu
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiangui Peng
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jiangfan Zhong
- Department of Pathology, University of Southern California, Keck School of Medicine
| | - Xi Zhang
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
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9
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Goldsmith SR, Ghobadi A, DiPersio JF. Hematopoeitic Cell Transplantation and CAR T-Cell Therapy: Complements or Competitors? Front Oncol 2020; 10:608916. [PMID: 33415078 PMCID: PMC7783412 DOI: 10.3389/fonc.2020.608916] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/18/2020] [Indexed: 01/13/2023] Open
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) and chimeric antigen receptor T cell (CAR T) therapy are the main modalities of adoptive cellular immunotherapy that have widely permeated the clinical space. The advent of both technologies revolutionized treatment of many hematologic malignancies, both offering the chance at sustained remissions for patients who would otherwise invariably succumb to their diseases. The understanding and exploitation of the nonspecific alloreactivity of allo-HCT and the graft-versus-tumor effect is contrasted by the genetically engineered precision of CAR T therapy. Historically, those with relapsed and refractory hematologic malignancies have often been considered for allo-HCT, although outcomes vary dramatically and are associated with potential acute and chronic toxicities. Such patients, mainly with B-lymphoid malignancies, may now be offered CAR T therapy. Yet, a lack of prospective data to guide decisions thereafter requires individualized approaches on whether to proceed to allo-HCT or observe. The continued innovations to make CAR T therapy more effective and accessible will continue to alter such approaches, but similar innovations in allo-HCT will likely result in similarly improved clinical outcomes. In this review, we describe the history of the two platforms, dissect the clinical indications emphasizing their intertwining and competitive roles described in trials and practice guidelines, and highlight innovations in which they complement or inform one another.
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Affiliation(s)
- Scott R. Goldsmith
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
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10
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Holstein SA, Suman VJ, Owzar K, Santo K, Benson DM, Shea TC, Martin T, Silverman M, Isola L, Vij R, Cheson BD, Linker C, Anderson KC, Richardson PG, McCarthy PL. Long-Term Follow-up of CALGB (Alliance) 100001: Autologous Followed by Nonmyeloablative Allogeneic Transplant for Multiple Myeloma. Biol Blood Marrow Transplant 2020; 26:1414-1424. [PMID: 32325171 DOI: 10.1016/j.bbmt.2020.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 11/18/2022]
Abstract
CALGB (Alliance) 100001 was a phase II study evaluating autologous stem cell transplant (ASCT) followed by nonmyeloablative allogeneic stem cell transplant (alloSCT) in patients with multiple myeloma who had received no more than 18 months of prior therapy and had experienced no more than 1 prior progression event. Conditioning for ASCT was with high-dose melphalan (200 mg/m2). The alloSCT reduced-intensity conditioning (RIC) regimen consisted of fludarabine (30 mg/m2/d i.v. on days -7 through -3) and cyclophosphamide (1 g/m2/d i.v. on days -4 through -3). The primary objective was to determine the 6-month post-alloSCT treatment-related mortality (TRM) rate. Additional objectives included determining the proportion of patients who could complete this tandem ASCT-alloSCT approach in a cooperative group setting, overall response rates, rates of donor chimerism, rates of graft-versus-host disease (GVHD), disease-free survival, and overall survival (OS). Sixty patients were enrolled, of whom 57 (95%) completed ASCT and 49 (82%) completed tandem ASCT-alloSCT. The TRM rate was 2% (1/49; 90% confidence interval, 0.10% to 9.3%). Moderate to severe (grades 2 to 3) acute GVHD was observed in 13 of 49 alloSCT patients (27%). One patient died due to GVHD within 9 months of alloSCT. Twenty-seven of the 49 patients (55%) who underwent alloSCT reported chronic GVHD as either limited (15/49; 31%) or extensive (12/49; 24%) in the first year post-alloSCT and prior to the start of nonprotocol therapy for progressive disease. With a median follow-up for survival of 11 years, the median OS time is 6.6 years and the median time to disease progression is 3.6 years. Similar to other studies, this study confirmed that tandem ASCT/alloSCT is associated with durable disease control in a subset of patients. This study demonstrated the feasibility of performing tandem ASCT/alloSCT in a cooperative group setting and determined that a fludarabine/cyclophosphamide RIC regimen is associated with a very low TRM rate.
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Affiliation(s)
| | - Vera J Suman
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Kouros Owzar
- Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Katelyn Santo
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Don M Benson
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Thomas C Shea
- UNC Lineberger Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Thomas Martin
- University of California at San Francisco, San Francisco, California
| | | | - Luis Isola
- Mount Sinai School of Medicine, New York, New York
| | - Ravi Vij
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Charles Linker
- University of California at San Francisco, San Francisco, California
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11
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Ikeda T, Mori K, Kawamura K, Mori T, Hagiwara S, Ueda Y, Kahata K, Uchida N, Tsukada N, Murakami S, Yamamoto M, Takahashi T, Ichinohe T, Onizuka M, Atsuta Y, Kanda Y, Okamoto S, Sunami K, Takamatsu H. Comparison between autologous and allogeneic stem cell transplantation as salvage therapy for multiple myeloma relapsing/progressing after autologous stem cell transplantation. Hematol Oncol 2019; 37:586-594. [DOI: 10.1002/hon.2688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/22/2019] [Accepted: 10/01/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Takashi Ikeda
- Division of Hematology and Stem Cell TransplantationShizuoka Cancer Center Shizuoka Japan
| | - Keita Mori
- Division of Hematology and Stem Cell TransplantationShizuoka Cancer Center Shizuoka Japan
| | - Koji Kawamura
- Division of HematologyJichi Medical University Saitama Medical Center Saitama Japan
| | - Takehiko Mori
- Division of Hematology, Department of MedicineKeio University School of Medicine Tokyo Japan
| | - Shotaro Hagiwara
- Department of HematologyTokyo Women's Medical University Tokyo Japan
| | - Yasunori Ueda
- Department of Hematology/Oncology and Transfusion and Hemapheresis CenterKurashiki Central Hospital Okayama Japan
| | - Kaoru Kahata
- Department of HematologyHokkaido University Hospital Hokkaido Japan
| | - Naoyuki Uchida
- Department of HematologyFederation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital Tokyo Japan
| | - Nobuhiro Tsukada
- Division of HematologyJapanese Red Cross Medical Center Tokyo Japan
| | - Satoshi Murakami
- Department of HematologyJapan Community Health Care Organization Kyoto Kuramaguchi Medical Center Kyoto Japan
| | - Masahide Yamamoto
- Department of HematologyTokyo Medical and Dental University Tokyo Japan
| | - Tsutomu Takahashi
- Department of Oncology/HematologyShimane University Hospital Shimane Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and MedicineHiroshima University Hiroshima Japan
| | - Makoto Onizuka
- Department of Hematology and OncologyTokai University School of Medicine Kanagawa Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation Aichi Japan
- Department of Healthcare AdministrationNagoya University Graduate School of Medicine Aichi Japan
| | - Yoshinobu Kanda
- Division of HematologyJichi Medical University Saitama Medical Center Saitama Japan
- Division of Hematology, Department of MedicineJichi Medical University Tochigi Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of MedicineKeio University School of Medicine Tokyo Japan
| | - Kazutaka Sunami
- Department of HematologyNational Hospital Organization Okayama Medical Center Okayama Japan
| | - Hiroyuki Takamatsu
- Department of Hematology/Respiratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health SciencesKanazawa University Ishikawa Japan
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12
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Caballero-Velázquez T, Calderón-Cabrera C, López-Corral L, Puig N, Marquez-Malaver F, Pérez-López E, García-Calderón C, Rosso-Fernández CM, Caballero Barrigón D, Martín J, Mateos MV, San Miguel J, Pérez-Simón JA. Efficacy of bortezomib to intensify the conditioning regimen and the graft-versus-host disease prophylaxis for high-risk myeloma patients undergoing transplantation. Bone Marrow Transplant 2019; 55:419-430. [PMID: 31551517 DOI: 10.1038/s41409-019-0670-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/15/2019] [Accepted: 07/22/2019] [Indexed: 11/09/2022]
Abstract
This multicenter phase I trial was designed to evaluate the safety and efficacy of bortezomib (Bz) as part of both the conditioning regimen and the graft-versus-host disease (GvHD) prophylaxis. Patients received fludarabine, melphalan and Bz (days -9 and -2). GVHD prophylaxis consisted of Bz (days +1, +4, and +7), sirolimus (Siro) from day -5 and tacrolimus (Tk) from -3 (except the first five patients that did not receive Tk). Twenty-five patients with poor prognostic multiple myeloma were included. Eleven out of the 19 patients had high-risk features. Out of the 21 patients evaluable at day +100, 14 were in CR (67%) and 7 (33%) in PR. Cumulative incidence (CI) of nonrelapse mortality at 1 year was 24%. CI of grades 2-4 and 3-4 acute GvHD was 35% and 10%, respectively; CI of chronic GvHD was 35% and 55% at 1 and 2 years, respectively. Overall and event free survival at 2 years were 64% and 31%, respectively. Bz as part of the conditioning regimen and in the combination with Siro/tacrolimus for GvHD prophylaxis is safe and effective allowing an optimal disease control early after transplant and reducing the risk of GvHD.
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Affiliation(s)
- T Caballero-Velázquez
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - C Calderón-Cabrera
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - L López-Corral
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - N Puig
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - F Marquez-Malaver
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - E Pérez-López
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - C García-Calderón
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - C M Rosso-Fernández
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - D Caballero Barrigón
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - J Martín
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - M V Mateos
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - J San Miguel
- Clínica Universidad de Navarra, Centro Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - J A Pérez-Simón
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain.
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13
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Mina R, Lonial S. Is there still a role for stem cell transplantation in multiple myeloma? Cancer 2019; 125:2534-2543. [PMID: 30985927 DOI: 10.1002/cncr.32060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/16/2018] [Accepted: 07/23/2018] [Indexed: 12/16/2022]
Abstract
High-dose chemotherapy and autologous stem cell transplantation (ASCT) are a standard of care for transplant-eligible patients with newly diagnosed multiple myeloma (MM). The introduction of novel agents, which range from immunomodulatory drugs and proteasome inhibitors to monoclonal antibodies and have now been integrated into both induction and salvage regimens, has dramatically revolutionized the treatment landscape of MM and challenged the role of high-dose chemotherapy and ASCT in treating MM. These advances have led to a number of provocative questions. First, what is the current role of stem cell transplantation (SCT) in comparison with standard-dose therapy incorporating novel agents? Second, should ASCT be performed upfront ("early") or later ("delayed") in the course of the disease? Third, should single or double ASCT be performed? Fourth, is allogeneic SCT still an option for patients with MM? This article provides an overview of available data and evidence-based responses regarding the role of SCT in MM.
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Affiliation(s)
- Roberto Mina
- Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Sagar Lonial
- Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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14
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Mikhael J, Ismaila N, Cheung MC, Costello C, Dhodapkar MV, Kumar S, Lacy M, Lipe B, Little RF, Nikonova A, Omel J, Peswani N, Prica A, Raje N, Seth R, Vesole DH, Walker I, Whitley A, Wildes TM, Wong SW, Martin T. Treatment of Multiple Myeloma: ASCO and CCO Joint Clinical Practice Guideline. J Clin Oncol 2019; 37:1228-1263. [PMID: 30932732 DOI: 10.1200/jco.18.02096] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations on the treatment of multiple myeloma to practicing physicians and others. METHODS ASCO and Cancer Care Ontario convened an Expert Panel of medical oncology, surgery, radiation oncology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and some phase II studies published from 2005 through 2018. Outcomes of interest included survival, progression-free survival, response rate, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 124 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed for patients with multiple myeloma who are transplantation eligible and those who are ineligible and for patients with relapsed or refractory disease.
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Affiliation(s)
- Joseph Mikhael
- 1 City of Hope Cancer Center, Phoenix, AZ.,2 International Myeloma Foundation, North Hollywood, CA
| | | | | | | | | | | | | | - Brea Lipe
- 8 University of Rochester Medical Center, Rochester, NY
| | | | - Anna Nikonova
- 10 Juravinski Cancer Center, Hamilton, Ontario, Canada
| | - James Omel
- 11 Education and Advocacy, Grand Island, NE
| | | | - Anca Prica
- 13 Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Noopur Raje
- 14 Massachusetts General Hospital, Boston, MA
| | - Rahul Seth
- 15 Upstate Medical University, Syracuse, NY
| | - David H Vesole
- 16 Hackensack University Medical Center, Hackensack, NJ.,17 Georgetown University, Washington, DC
| | - Irwin Walker
- 18 McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sandy W Wong
- 21 University of California San Francisco, San Francisco, CA
| | - Tom Martin
- 21 University of California San Francisco, San Francisco, CA
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15
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Kawamura K, Tsukada N, Kanda Y, Ikeda T, Yoshida A, Ueda Y, Ishida T, Suzuki K, Murakami H. The Role of Allogeneic Transplantation for Multiple Myeloma in the Era of Novel Agents: A Study from the Japanese Society of Myeloma. Biol Blood Marrow Transplant 2018; 24:1392-1398. [PMID: 29555314 DOI: 10.1016/j.bbmt.2018.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/11/2018] [Indexed: 11/29/2022]
Abstract
Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered a potentially curative therapy for patients with multiple myeloma, the role of allo-HSCT remains unclear in the novel agent era. We conducted a retrospective study of 65 patients with multiple myeloma who underwent allo-HSCT at 19 institutions from 2009 to 2016. Patients received a median of 3 (range, 1 to 7) lines of prior therapy, including at least 1 novel agent, except for autologous HSCT. The 3-year progression-free survival (PFS) and overall survival (OS) rates were 18.8% (95% confidence interval [CI], 9.6% to 30.3%) and 47.2% (95% CI, 33.9% to 59.4%), respectively. In a multivariate analysis, an age ≥50 years and less than a very good partial response (VGPR) before allo-HSCT were independent significant adverse factors for PFS (hazard ratio [HR], 2.30, P = .0063; HR, 2.86; P = .0059) and OS (HR, 2.37, P = .013; and HR, 2.74; P = .040). In contrast, the 3-year PFS and OS rates in patients <50 years of age who achieved a VGPR or better before allo-HSCT were 64.3% (95% CI, 29.8% to 85.1%) and 80.2% (95% CI, 40.3% to 94.8%), respectively. The overall response rate was 86.4% (95% CI, 75.0% to 94.0%). The proportion of VGPR or better increased from 29% before allo-HSCT to 71% after allo-HSCT. The nonrelapse mortality at 3 years was 23.4% (95% CI, 13.8% to 34.4%). Only an age ≥50 years was associated with higher nonrelapse mortality (HR, 4.71; P = .015). We showed that allo-HSCT is feasible for heavily pretreated patients with multiple myeloma, even in the novel agent era. Allo-HSCT in particular is a promising therapy for young and chemosensitive patients.
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Affiliation(s)
- Koji Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Nobuhiro Tsukada
- Division of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan.
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takashi Ikeda
- Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akiyo Yoshida
- Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Yasunori Ueda
- Department of Hematology/Oncology, Kurashiki Central Hospital, Okayama, Japan
| | - Tadao Ishida
- Division of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kenshi Suzuki
- Division of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hirokazu Murakami
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Gunma, Japan
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16
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Htut M, D'Souza A, Krishnan A, Bruno B, Zhang MJ, Fei M, Diaz MA, Copelan E, Ganguly S, Hamadani M, Kharfan-Dabaja M, Lazarus H, Lee C, Meehan K, Nishihori T, Saad A, Seo S, Ramanathan M, Usmani SZ, Gasparetto C, Mark TM, Nieto Y, Hari P. Autologous/Allogeneic Hematopoietic Cell Transplantation versus Tandem Autologous Transplantation for Multiple Myeloma: Comparison of Long-Term Postrelapse Survival. Biol Blood Marrow Transplant 2017; 24:478-485. [PMID: 29079457 DOI: 10.1016/j.bbmt.2017.10.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/12/2017] [Indexed: 12/22/2022]
Abstract
We compared postrelapse overall survival (OS) after autologous/allogeneic (auto/allo) versus tandem autologous (auto/auto) hematopoietic cell transplantation (HCT) in patients with multiple myeloma (MM). Postrelapse survival of patients receiving an auto/auto or auto/allo HCT for MM and prospectively reported to the Center for International Blood and Marrow Transplant Research between 2000 and 2010 were analyzed. Relapse occurred in 404 patients (72.4%) in the auto/auto group and in 178 patients (67.4%) in the auto/allo group after a median follow-up of 8.5 years. Relapse occurred before 6 months after a second HCT in 46% of the auto/allo patients, compared with 26% of the auto/auto patients. The 6-year postrelapse survival was better in the auto/allo group compared with the auto/auto group (44% versus 35%; P = .05). Mortality due to MM was 69% (n = 101) in the auto/allo group and 83% (n = 229) deaths in auto/auto group. In multivariate analysis, both cohorts had a similar risk of death in the first year after relapse (hazard ratio [HR], .72; P = .12); however, for time points beyond 12 months after relapse, overall survival was superior in the auto/allo cohort (HR for death in auto/auto =1.55; P = .005). Other factors associated with superior survival were enrollment in a clinical trial for HCT, male sex, and use of novel agents at induction before HCT. Our findings shown superior survival afterrelapse in auto/allo HCT recipients compared with auto/auto HCT recipients. This likely reflects a better response to salvage therapy, such as immunomodulatory drugs, potentiated by a donor-derived immunologic milieu. Further augmentation of the post-allo-HCT immune system with new immunotherapies, such as monoclonal antibodies, checkpoint inhibitors, and others, merit investigation.
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Affiliation(s)
- Myo Htut
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amrita Krishnan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mingwei Fei
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Siddhartha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohamed Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Cindy Lee
- Division of Haematology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kenneth Meehan
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sachiko Seo
- National Cancer Research Center, East Hospital Kashiwa, Chiba, Japan
| | - Muthalagu Ramanathan
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Saad Z Usmani
- Department of Hematology and Medical Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | | | - Tomer M Mark
- Division of Hematology, University of Colorado-Anschutz Medical College, Aurora, Colorado
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Parameswaran Hari
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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17
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Efficacy of host-dendritic cell vaccinations with or without minor histocompatibility antigen loading, combined with donor lymphocyte infusion in multiple myeloma patients. Bone Marrow Transplant 2016; 52:228-237. [PMID: 27841858 DOI: 10.1038/bmt.2016.250] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/05/2016] [Accepted: 08/16/2016] [Indexed: 12/29/2022]
Abstract
Donor lymphocyte infusions (DLI) can induce durable remissions in multiple myeloma (MM) patients, but this occurs rather infrequently. As the graft-versus-tumor (GvT) effect of DLI depends on the presence of host-dendritic cells (DCs), we tested in a phase I/II trial whether the efficacy of DLI could be improved by simultaneous vaccination with host-DCs. We also analyzed the possibility of further improving the GvT effect by loading the DCs with peptides of mismatched hematopoietic cell-specific minor histocompatibility antigens (mHags). Fifteen MM patients not responding to a first DLI were included. Eleven patients could be treated with a second equivalent dose DLI combined with DC vaccinations, generated from host monocytes (moDC). For four patients, the DC products did not meet the quality criteria. In four of the treated patients the DCs were loaded with host mHag peptides. Toxicity was limited and no acute GvHD occurred. Most patients developed objective anti-host T-cell responses and in one patient a distinct mHag-specific T-cell response accompanied a temporary clinical response. These findings confirm that DLI combined with host-DC vaccination, either unloaded or loaded with mHag peptides, is feasible, safe and capable of inducing host-specific T-cell responses. The limited clinical effects may be improved by developing more immunogenic DC products or by combining this therapy with immune potentiating modalities like checkpoint inhibitors.
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18
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Sanchez L, Wang Y, Siegel DS, Wang ML. Daratumumab: a first-in-class CD38 monoclonal antibody for the treatment of multiple myeloma. J Hematol Oncol 2016; 9:51. [PMID: 27363983 PMCID: PMC4929758 DOI: 10.1186/s13045-016-0283-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/24/2016] [Indexed: 11/17/2022] Open
Abstract
Daratumumab is a human monoclonal antibody that targets CD38, a cell surface protein that is overexpressed on multiple myeloma (MM) cells. Preclinical studies have shown that daratumumab induces MM cell death through several mechanisms, including complement-dependent cytotoxicity (CDC), antibody-dependent cell-mediated cytotoxicity (ADCC), antibody-dependent cellular phagocytosis (ADCP), and apoptosis. Given the encouraging efficacy and acceptable safety profile of daratumumab demonstrated in clinical trials, daratumumab has emerged as a novel treatment option for myeloma and became the first monoclonal antibody approved by the FDA for the treatment of MM.
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Affiliation(s)
- Larysa Sanchez
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Yucai Wang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David S Siegel
- Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Michael L Wang
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 429, Houston, TX, 77030, USA.
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19
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Tan Y, Xu S, Li X, Chen J. The effects of allogeneic stem cell transplantation with matched sibling donor versus autologous stem cell transplantation for newly diagnosed multiple myeloma. Hippokratia 2016. [DOI: 10.1002/14651858.cd010484.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ya Tan
- Southwest Hospital, Third Military Medical University; Center for Hematology; 38 Gao Tanyan Street Chongqing China 400038
| | - ShuangNian Xu
- Southwest Hospital, Third Military Medical University; Center for Hematology; 38 Gao Tanyan Street Chongqing China 400038
| | - Xi Li
- Southwest Hospital, Third Military Medical University; Center for Hematology; 38 Gao Tanyan Street Chongqing China 400038
| | - JiePing Chen
- Southwest Hospital, Third Military Medical University; Center for Hematology; 38 Gao Tanyan Street Chongqing China 400038
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20
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Italian consensus conference for the outpatient autologous stem cell transplantation management in multiple myeloma. Bone Marrow Transplant 2016; 51:1032-40. [PMID: 27042841 DOI: 10.1038/bmt.2016.79] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/07/2016] [Accepted: 02/19/2016] [Indexed: 01/28/2023]
Abstract
Multiple myeloma (MM) is the leading indication for autologous stem cell transplantation (ASCT) worldwide. The safety and efficacy of reducing hospital stay for MM patients undergoing ASCT have been widely explored, and different outpatient models have been proposed. However, there is no agreement on the criteria for selecting patients eligible for this strategy as well as the standards for their clinical management. On the basis of this rationale, the Italian Group for Stem Cell Transplantation (GITMO) endorsed a project to develop guidelines for the management of outpatient ASCT in MM, using evidence-based knowledge and consensus-formation techniques. An expert panel convened to discuss the currently available data on the practice of outpatient ASCT management and formulated recommendations according to the supporting evidence. Evidence gaps were filled with consensus-based statements. Three main topics were addressed: (1) the identification of criteria for selecting MM patients eligible for outpatient ASCT management; (2) the definition of standard procedures for performing outpatient ASCT (model, supportive care and monitoring during the aplastic phase); (3) the definition of the standard criteria and procedures for re-hospitalization during the aplastic phase at home. Herein, we report the summary and the results of the discussion and the consensus.
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21
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Kawamura K, Ikeda T, Hagiwara S, Mori T, Shinagawa A, Nishiwaki K, Ohashi K, Kubonishi S, Fukuda T, Ito T, Tomita N, Ichinohe T, Kato K, Morishima Y, Atsuta Y, Sunami K, Kanda Y. Tandem autologous versus autologous/allogeneic transplantation for multiple myeloma: propensity score analysis. Leuk Lymphoma 2016; 57:2077-83. [PMID: 26961137 DOI: 10.3109/10428194.2016.1154958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Autologous hematopoietic stem cell transplantation (auto-HCT) is considered a standard therapy for transplant-eligible patients with multiple myeloma, while allogeneic HCT (allo-HCT) is controversial. We retrospectively analyzed 765 patients with myeloma who underwent tandem transplantation between 1998 and 2012 using Japanese registry data. We evaluated the clinical outcomes of tandem auto-HCT (n = 676) and auto/allo-HCT (n = 89). To adjust for a selection bias, we compared overall survival (OS) between the two groups by a propensity score analysis. The probability of OS at six years was 58.5% for the tandem auto-HCT group and 54.4% for the tandem auto/allo-HCT group (p = 0.47). In a matched-pair analysis based on the propensity score, the difference in survival between the two groups was not statistically significant, although the survival curve appeared to reach a plateau beyond five years in the auto/allo group. Further strategies to reduce treatment-related mortality and enhance a graft-versus-myeloma effect are necessary to improve OS.
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Affiliation(s)
- Koji Kawamura
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Takashi Ikeda
- b Division of Hematology and Stem Cell Transplantation , Shizuoka Cancer Center , Shizuoka , Japan
| | - Shotaro Hagiwara
- c Division of Hematology, Internal Medicine , National Center for Global Health and Medicine , Tokyo , Japan
| | - Takehiko Mori
- d Department of Medicine, Division of Hematology , Keio University School of Medicine , Tokyo , Japan
| | - Atsushi Shinagawa
- e Department of Hematology , Hitachi General Hospital, Hitachi Ltd , Hitachi , Japan
| | - Kaichi Nishiwaki
- f Department of Internal Medicine, Division of Oncology and Hematology , Jikei University School of Medicine, Kashiwa Hospital , Kashiwa , Japan
| | - Kazuteru Ohashi
- g Hematology Division , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Shiro Kubonishi
- h Department of Hematology , National Hospital Organization Okayama Medical Center , Okayama , Japan
| | - Takahiro Fukuda
- i Division of Hematopoietic Stem Cell Transplantation , National Cancer Center Hospital , Tokyo , Japan
| | - Toshiro Ito
- j Second Department of Internal Medicine, Division of Hematology , Shinshu University School of Medicine , Matsumoto , Japan
| | - Naoto Tomita
- k Department of Rheumatology/Hematology/Infectious Disease , Yokohama City University Hospital , Yokohama , Japan
| | - Tatsuo Ichinohe
- l Department of Hematology and Oncology , Research Institute for Radiation Biology and Medicine, Hiroshima University , Hiroshima , Japan
| | - Koji Kato
- m Department of Hematology and Oncology , Children's Medical Center, Japanese Red Cross Nagoya First Hospital , Nagoya , Japan
| | - Yasuo Morishima
- n Department of Epidemiology and Prevention , Aichi Cancer Center Research Institute , Nagoya , Japan
| | - Yoshiko Atsuta
- o Japanese Data Center for Hematopoietic Cell Transplantation , Nagoya, Japan ;,p Department of Healthcare Administration , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kazutaka Sunami
- h Department of Hematology , National Hospital Organization Okayama Medical Center , Okayama , Japan
| | - Yoshinobu Kanda
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan ;,q Department of Medicine, Division of Hematology , Jichi Medical University , Shimotsuke , Japan
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22
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Martino M, Recchia AG, Fedele R, Neri S, Vincelli ID, Moscato T, Gentile M, Morabito F. The role of tandem stem cell transplantation for multiple myeloma patients. Expert Opin Biol Ther 2016; 16:515-34. [PMID: 26698133 DOI: 10.1517/14712598.2016.1136285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Autologous Stem Cell Transplantation (ASCT) represents the standard treatment in eligible "de-novo" multiple myeloma (MM) patients. AREAS COVERED ASCT may be single or tandem, and a single ASCT can be followed by an allogeneic (Allo)-SCT. A systematic review has been conducted to examine the current evidence for the efficacy of using a tandem transplant strategy in MM. EXPERT OPINION A tandem ASCT approach should be considered for all patients, although the benefit from the second ASCT in patients who are in complete remission or experience a very good partial response should be answered in a clinical trial. Recent results with the new induction regimens indicate that there is a role for tandem ASCT in the presence of adverse cytogenetic abnormalities. Planned AlloSCT after ASCT has not been found to be superior in the majority of studies and is not recommended outside of a clinical trial. However, single or tandem ASCT are both appropriate options and participation in prospective clinical trials should be encouraged to resolve the debate in the era of novel agents for MM.
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Affiliation(s)
- Massimo Martino
- a Hematology, Stem Cell Collection and Transplant Unit, Oncology and Hematology Department , Azienda Ospedaliera BMM , Reggio Calabria , Italy
| | - Anna Grazia Recchia
- b Biotechnology Research Unit , Azienda Sanitaria Provinciale di Cosenza , Aprigliano (CS) , Italy
| | - Roberta Fedele
- a Hematology, Stem Cell Collection and Transplant Unit, Oncology and Hematology Department , Azienda Ospedaliera BMM , Reggio Calabria , Italy
| | - Santo Neri
- c Hematology Unit , Azienda Ospedaliera 'Papardo' , Messina , Italy
| | | | - Tiziana Moscato
- a Hematology, Stem Cell Collection and Transplant Unit, Oncology and Hematology Department , Azienda Ospedaliera BMM , Reggio Calabria , Italy
| | - Massimo Gentile
- e Hematology Unit , Azienda Ospedaliera Cosenza , Cosenza , Italy
| | - Fortunato Morabito
- b Biotechnology Research Unit , Azienda Sanitaria Provinciale di Cosenza , Aprigliano (CS) , Italy.,e Hematology Unit , Azienda Ospedaliera Cosenza , Cosenza , Italy
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23
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Zhang XH, Wang QM, Zhang JM, Feng FE, Wang FR, Chen H, Zhang YY, Chen YH, Han W, Xu LP, Liu KY, Huang XJ. Desialylation is associated with apoptosis and phagocytosis of platelets in patients with prolonged isolated thrombocytopenia after allo-HSCT. J Hematol Oncol 2015; 8:116. [PMID: 26497387 PMCID: PMC4619537 DOI: 10.1186/s13045-015-0216-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prolonged isolated thrombocytopenia (PT) is a frequent complication in patients who undergo allogeneic hematopoietic stem cell transplantation (allo-HSCT), and it is associated with an adverse prognosis. In this study, we hypothesized that desialylation on platelet surfaces was associated with PT after allo-HSCT. The mechanisms participating in this process may include NEU1 translocation, platelet apoptosis, and phagocytosis by macrophages. METHODS PT was defined as a peripheral platelet count less than 100 × 10(9)/L without sustained anemia or leukopenia for more than 3 months after allo-HSCT. 34 patients were identified consecutively from a cohort of 255 patients who underwent allo-HSCT for hematologic malignancies between May and October 2014 at Peking University Institute of Hematology. Desialylation, enzyme expression, and phagocytosis were detected using flow cytometry, immunofluorescence, RT-PCR, Western blot, and so on. RESULTS Platelets from the PT patients had significantly fewer sialic acids (P = .001) and increased β-galactose exposure indicative of desialylation on the surface (P = .042), and serum from the PT patients showed a higher sialic acid concentration (8.400 ± 0.2209 μmol/L, P < .001). The sialidase NEU1 was over-expressed from mRNA to protein levels, and its catalytic activity was increased in platelets from the PT patients. Desialylation of GPIbα in the PT patients was correlated with changes in 14-3-3ζ distribution, which, relative to Bad activation, modulated the expression of Bcl-2 family proteins, depolarized the inner membrane of the mitochondria, and initiated the intrinsic mitochondria-dependent pathway of apoptosis. Macrophages derived from the THP-1 cell line preferred to phagocytize desialylated platelets from the PT patients in vitro. We also revealed that oseltamivir (400 μmol/L) could inhibit 50 % of the sialidase activity on platelets and could protect 20 % of platelets from phagocytosis in vitro. CONCLUSIONS Desialylation of platelets was associated with platelet apoptosis and phagocytosis, whereas oseltamivir could reduce platelet destruction in the periphery, indicating a potential novel treatment for PT after allo-HSCT.
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Affiliation(s)
- Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China.
| | - Qian-Ming Wang
- Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Jia-Min Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Fei-Er Feng
- Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Feng-Rong Wang
- Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Huan Chen
- Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Yuan-Yuan Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Yu-Hong Chen
- Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Wei Han
- Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Kai-Yan Liu
- Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China.
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24
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Chhabra S, Jain S, Wallace C, Hong F, Liu B. High expression of endoplasmic reticulum chaperone grp94 is a novel molecular hallmark of malignant plasma cells in multiple myeloma. J Hematol Oncol 2015; 8:77. [PMID: 26108343 PMCID: PMC4483199 DOI: 10.1186/s13045-015-0177-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 06/17/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Multiple myeloma (MM) is a hematologic malignancy that is characterized by the proliferation of abnormal bone marrow plasma cells (BMPC) and overproduction of immunoglobulin or light chains with evidence of end-organ damage such as bone damage, anemia, hypercalcemia, and renal dysfunction. The pathogenesis of MM is closely linked to dysregulated unfolded protein response (UPR) in the endoplasmic reticulum (ER). Constitutive activation of UPR in mice, as demonstrated by transgenic expression of a master UPR transcription factor XBP1s (a UPR-specific splice variant of X-box binding protein 1), causes myeloma. grp94 (gp96) is a key downstream chaperone in the ER that mediates the UPR as a part of the protein quality control mechanism in the secretory pathway. Our recent study has shown that the persistence of plasma cells as well as the development of myeloma in XBP1s-transgenic mice is critically dependent on grp94. However, the role of grp94 in the initiation and progression of human MM is still unknown. METHODS The expression level of grp94 in BMPCs was measured by flow cytometry, real-time RT-PCR, and Western blot analysis. We compared the expression levels of grp94 in BMPCs in a spectrum of patients including MM, monoclonal gammopathy of undetermined significance (MGUS), smoldering MM (SMM), as well as non-plasma cell disorders (NPC). RESULTS We found that grp94 was highly expressed in malignant plasma cells in patients with MM, but not in BMPCs in patients with MGUS/SMM and NPC. The expression level of grp94 correlated significantly with CD138 expression level. We also found that the grp94 expression level in BMPCs from International Staging System (ISS) stage III MM patients is higher than those in ISS stage I/II MM patients. CONCLUSIONS grp94 is highly expressed in BMPCs in MM, which correlates with the advanced stage of this disease. Our data demonstrated that grp94 is a novel diagnostic and prognostic biomarker. It also positioned grp94 as a promising therapeutic target for MM.
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Affiliation(s)
- Saurabh Chhabra
- Hollings Cancer Center, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA. .,Division of Hematology and Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Sandeep Jain
- Hollings Cancer Center, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA. .,Division of Hematology and Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Caroline Wallace
- Hollings Cancer Center, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA. .,Department of Microbiology and Immunology, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA.
| | - Feng Hong
- Hollings Cancer Center, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA. .,Department of Microbiology and Immunology, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA.
| | - Bei Liu
- Hollings Cancer Center, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA. .,Department of Microbiology and Immunology, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA.
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25
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Abstract
Utilization of allogeneic transplant in the management of multiple myeloma has been actively pursued for nearly 30 years. In this paper, the existing data for use of transplant is reviewed as primary therapy, as salvage and for genetic high-risk disease. The relative merits of using a matched-unrelated donor vs. an HLA-matched donor and what impact the introduction of the novel agents has on the decision to transplant will be covered.
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Affiliation(s)
- Morie A Gertz
- a Department of Medicine , Mayo Clinic , Rochester , MN , USA
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26
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Trends and Outcomes in Allogeneic Hematopoietic Stem Cell Transplant for Multiple Myeloma at Mayo Clinic. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:349-357.e2. [DOI: 10.1016/j.clml.2015.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/23/2015] [Accepted: 03/26/2015] [Indexed: 11/23/2022]
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27
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Festuccia M, Martino M, Ferrando F, Messina G, Moscato T, Fedele R, Boccadoro M, Giaccone L, Bruno B. Allogeneic stem cell transplantation in multiple myeloma: immunotherapy and new drugs. Expert Opin Biol Ther 2015; 15:857-72. [PMID: 25865214 DOI: 10.1517/14712598.2015.1036735] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Autologous (auto) stem cell transplantation (SCT) and the development of new drugs have improved the survival of multiple myeloma (MM) patients. By contrast, though potentially curative, the use of allogeneic (allo)-SCT is controversial. AREAS COVERED A review has been conducted to examine the current evidence for the use of allo-SCT in MM. We have examined novel cell therapies that may be exploited to induce myeloma-specific immune responses including the new promising frontier of chimeric antigen receptor (CAR)-T and -natural killer (NK) cells. EXPERT OPINION One of the major controversies facing researchers in exploring the allo approach is the remarkable recent treatment improvement observed with second- and third-generation proteasome inhibitors and immunomodulatory drugs, monoclonal antibodies and deacetylase inhibitors. Despite these great advances, the disease remains to be incurable and allo-SCT may still play a role in the cure of MM. We think that allo-SCT conserves a role in MM and its curative potential in high-risk patients should be explored in the setting of control clinical trials. Novel cell therapies such as CAR technologies may open new avenues of research toward a potential cure. Data from currently ongoing prospective studies will be helpful to clarify pending clinical questions.
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Affiliation(s)
- Moreno Festuccia
- University of Torino, Presidio Molinette, and Department of Molecular Biotechnology and Health Sciences, Division of Hematology, A.O.U. Citta' della salute e della scienza di Torino, Presidio Molinette , Torino , Italy
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28
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Shah N, Callander N, Ganguly S, Gul Z, Hamadani M, Costa L, Sengsayadeth S, Abidi M, Hari P, Mohty M, Chen YB, Koreth J, Landau H, Lazarus H, Leather H, Majhail N, Nath R, Osman K, Perales MA, Schriber J, Shaughnessy P, Vesole D, Vij R, Wingard J, Giralt S, Savani BN. Hematopoietic Stem Cell Transplantation for Multiple Myeloma: Guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2015; 21:1155-66. [PMID: 25769794 DOI: 10.1016/j.bbmt.2015.03.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 01/28/2023]
Abstract
Therapeutic strategies for multiple myeloma (MM) have changed dramatically over the past decade. Thus, the role of hematopoietic stem cell transplantation (HCT) must be considered in the context of this evolution. In this evidence-based review, we have critically analyzed the data from the most recent clinical trials to better understand how to incorporate HCT and when HCT is indicated. We have provided our recommendations based on strength of evidence with the knowledge that ongoing clinical trials make this a dynamic field. Within this document, we discuss the decision to proceed with autologous HCT, factors to consider before proceeding to HCT, the role of tandem autologous HCT, post-HCT maintenance therapy, and the role of allogeneic HCT for patients with MM.
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Affiliation(s)
- Nina Shah
- MD Anderson Cancer Center, Houston, Texas.
| | - Natalie Callander
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Luciano Costa
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Parameswaran Hari
- Center for International Blood and Marrow Transplant Research and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohamad Mohty
- Hopital Saint-Antoine, APHP, Paris, France; Université Pierre & Marie Curie, Paris, France, INSERM, UMRs 938, Paris, France
| | - Yi-Bin Chen
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - John Koreth
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Heather Landau
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Rajneesh Nath
- University of Massachusetts, Worcester, Massachusetts
| | - Keren Osman
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jeffrey Schriber
- Cancer Transplant Institute at Scottsdale Healthcare, Scottsdale, Arizona
| | | | - David Vesole
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey
| | - Ravi Vij
- Washington University School of Medicine, St. Louis, Missouri
| | - John Wingard
- University of Florida College of Medicine, Gainesville, Florida
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennesee
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29
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Kawamura K, Takamatsu H, Ikeda T, Komatsu T, Aotsuka N, Amano I, Yamamoto G, Watanabe K, Ohno Y, Matsue K, Kouzai Y, Tsukada N, Ishiyama K, Anzai N, Kato K, Suzuki R, Sunami K, Kanda Y. Cord Blood Transplantation for Multiple Myeloma: A Study from the Multiple Myeloma Working Group of the Japan Society for Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2015; 21:1291-8. [PMID: 25708214 DOI: 10.1016/j.bbmt.2015.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/15/2015] [Indexed: 11/28/2022]
Abstract
Cord blood has been investigated as an alternative source for hematopoietic stem cell transplantation, but information about its use for multiple myeloma is limited. The purpose of this study was to evaluate the feasibility of cord blood transplantation (CBT) for patients with multiple myeloma. Eighty-six patients with multiple myeloma who underwent a first CBT between 2001 and 2011 were included in this retrospective study. Sixty-two of them had received other types of stem cell transplantation before CBT. The cumulative incidences of neutrophil engraftment at day 50, grade II to IV acute graft-versus-host disease (GVHD), and chronic GVHD were 81.4%, 39.0%, and 19.5%, respectively. The incidence of nonrelapse mortality at 2 years was 39.0%, but it was only 6.2% in patients who underwent planned tandem autologous/reduced-intensity conditioning CBT (auto/RIC-CBT). Progression-free survival (PFS) and overall survival (OS) at 6 years were 13.0% and 15.2%, respectively. Less than a partial response before CBT and lack of prior transplantation were independent significant adverse factors for PFS, whereas the presence of prior transplantation and planned tandem transplantation were associated with better OS. OS at 6 years in patients who underwent auto/RIC-CBT was 45.9%. In addition, the development of chronic GVHD was associated with superior PFS. In conclusion, we demonstrated that cord blood is feasible as an alternative graft source for myeloma patients. Although CBT provided long-term survival for a fraction of patients, optimal use of this graft requires further clinical studies.
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Affiliation(s)
- Koji Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | | | - Takashi Ikeda
- Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Nobuyuki Aotsuka
- Division of Hematology-Oncology, Japanese Red Cross Society Narita Hospital, Narita, Japan
| | - Itsuto Amano
- Department of Hematology and Respiratory, Nara Medical University Hospital, Kashihara, Japan
| | - Go Yamamoto
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Kentaro Watanabe
- Department of Hematology/Oncology/Infectious Diseases, Saiseikai Central Hospital, Tokyo, Japan
| | - Yuju Ohno
- Department of Internal Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Yasuji Kouzai
- Department of Transfusion Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Nobuhiro Tsukada
- Division of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Ken Ishiyama
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan
| | - Naoyuki Anzai
- Department of Hematology and Oncology, Takatsuki Red Cross Hospital, Takatsuki, Japan
| | - Koji Kato
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Ritsuro Suzuki
- Department of Hematopoietic Stem Cell Transplantation Data Management/Biostatistics, Nagoya University School of Medicine, Nagoya, Japan
| | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
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30
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Xiao Y, Wei X, Jiang Z, Wang X, Ye W, Liu X, Zhang M, Xu Y, Wu D, Lai L, Yao H, Liu Z, Cao S, Liu P, Xu B, Li Y, Yao Y, Pei D, Li P. Loss of Angiopoietin-like 7 diminishes the regeneration capacity of hematopoietic stem and progenitor cells. J Hematol Oncol 2015; 8:7. [PMID: 25652910 PMCID: PMC4353465 DOI: 10.1186/s13045-014-0102-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 12/29/2014] [Indexed: 12/22/2022] Open
Abstract
Successful expansion of hematopoietic stem cells (HSCs) would benefit the use of HSC transplants in the clinic. Angiopoietin-like 7 promotes the expansion of hematopoietic stem and progenitor cells (HSPC) in vitro and ex vivo. However, the impact of loss of Angptl7 on HSPCs in vivo has not been characterized. Here, we generated Angptl7-deficient mice by TALEN-mediated gene targeting and found that HSC compartments in Angptl7-null mice were compromised. In addition, wild type (WT) HSPCs failed to repopulate in the BM of Angptl7-null mice after serial transplantations while the engraftment of Angptl7-deficient HSPCs in WT mice was not impaired. These results suggest that Angptl7 is required for HSPCs repopulation in a non-cell autonomous manner.
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Affiliation(s)
- Yiren Xiao
- Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, 190 Kaiyuan Avenue, Science Park, Guangzhou, 7, Guangdong, 510530, China. .,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China.
| | - Xinru Wei
- Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, 190 Kaiyuan Avenue, Science Park, Guangzhou, 7, Guangdong, 510530, China. .,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China.
| | - Zhiwu Jiang
- Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, 190 Kaiyuan Avenue, Science Park, Guangzhou, 7, Guangdong, 510530, China. .,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China.
| | - Xiangmeng Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, China.
| | - Wei Ye
- Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, 190 Kaiyuan Avenue, Science Park, Guangzhou, 7, Guangdong, 510530, China. .,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China.
| | - Xin Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, 518055, China.
| | - Minjie Zhang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, 518055, China.
| | - Yan Xu
- Institute of Hematology, Medical College, Jinan University, Guangzhou, 510632, China. .,Key Laboratory for Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, 510632, China.
| | - Donghai Wu
- Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, 190 Kaiyuan Avenue, Science Park, Guangzhou, 7, Guangdong, 510530, China. .,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China.
| | - Liangxue Lai
- Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, 190 Kaiyuan Avenue, Science Park, Guangzhou, 7, Guangdong, 510530, China. .,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China.
| | - Huihui Yao
- Department of Outpatient, The 91th Military Hospital, 454003, Jiaozuo, China.
| | - Zixia Liu
- Division of Reproductive Endocrinology, The 91th Military Hospital, 454003, Jiaozuo, China.
| | - Su Cao
- Division of General Pediatrics, The 91th Military Hospital, 454003, Jiaozuo, China.
| | - Pentao Liu
- Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1HH, England, UK.
| | - Bing Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, China.
| | - Yangqiu Li
- Institute of Hematology, Medical College, Jinan University, Guangzhou, 510632, China. .,Key Laboratory for Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, 510632, China.
| | - Yao Yao
- Drug Discovery Pipeline, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China.
| | - Duanqing Pei
- Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, 190 Kaiyuan Avenue, Science Park, Guangzhou, 7, Guangdong, 510530, China. .,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China.
| | - Peng Li
- Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, 190 Kaiyuan Avenue, Science Park, Guangzhou, 7, Guangdong, 510530, China. .,Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China.
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31
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Byrne M, Salmasinia D, Leather H, Cogle CR, Davis A, Hsu JW, Wiggins L, Chang MN, An Q, Wingard JR, Moreb JS. Tandem Autologous Stem Cell Transplantation for Multiple Myeloma Patients Based on Response to Their First Transplant-A Prospective Phase II Study. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2014; 8:101-5. [PMID: 25232286 PMCID: PMC4159376 DOI: 10.4137/cmo.s16835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 06/18/2014] [Accepted: 06/19/2014] [Indexed: 12/22/2022]
Abstract
In this prospective phase II clinical trial, multiple myeloma (MM) patients were randomized to receive a second (tandem) autologous stem cell transplantation (ASCT) based on whether they achieved a partial response or worse (≤PR) following initial ASCT (ASCT1). Patients who achieved a very good partial response or better (≥VGPR) had salvage ASCT at relapse. Seventy-five patients received conditioning therapy and ASCT1. A total of 44 patients (59%) achieved ≥VGPR, whereas 31 patients entered ≤PR and were offered tandem ASCT. In all, 20 patients agreed to tandem ASCT. Demographic and clinical characteristics were similar between the two cohorts except for median lactate dehydrogenase (LDH) (P = 0.0141) and percentage of marrow plasma cells before ASCT1 (P = 0.0047), both lower in the ≥VGPR group. Intent to treat analysis showed that patients who achieved ≥VGPR to ASCT1 had a trend toward improved progression-free survival (PFS) (37 vs. 26 months, P = 0.078) and superior overall survival (OS) (not reached vs. 50 months, P = 0.0073). Patients with ≤PR who declined tandem transplantation had shortened PFS (20 vs. 28 months, P = 0.05) but similar OS (53 vs. 57.5 months, P = 0.29) compared to those who received it. Thus, a favorable clinical response to ASCT1 identifies a low-risk group with superior long-term prognosis despite similar PFS.
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Affiliation(s)
- Michael Byrne
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Donya Salmasinia
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Helen Leather
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Amy Davis
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Jack W Hsu
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Laura Wiggins
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Myron N Chang
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Qi An
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - John R Wingard
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan S Moreb
- Department of Medicine, University of Florida, Gainesville, FL, USA
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32
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Ludwig H, Sonneveld P, Davies F, Bladé J, Boccadoro M, Cavo M, Morgan G, de la Rubia J, Delforge M, Dimopoulos M, Einsele H, Facon T, Goldschmidt H, Moreau P, Nahi H, Plesner T, San-Miguel J, Hajek R, Sondergeld P, Palumbo A. European perspective on multiple myeloma treatment strategies in 2014. Oncologist 2014; 19:829-44. [PMID: 25063227 PMCID: PMC4122482 DOI: 10.1634/theoncologist.2014-0042] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
The treatment of multiple myeloma has undergone significant changes and has resulted in the achievement of molecular remissions, the prolongation of remission duration, and extended survival becoming realistic goals, with a cure being possible in a small but growing number of patients. In addition, nowadays it is possible to categorize patients more precisely into different risk groups, thus allowing the evaluation of therapies in different settings and enabling a better comparison of results across trials. Here, we review the evidence from clinical studies, which forms the basis for our recommendations for the management of patients with myeloma. Treatment approaches depend on "fitness," with chronological age still being an important discriminator for selecting therapy. In younger, fit patients, a short three drug-based induction treatment followed by autologous stem cell transplantation (ASCT) remains the preferred option. Consolidation and maintenance therapy are attractive strategies not yet approved by the European Medicines Agency, and a decision regarding post-ASCT therapy should only be made after detailed discussion of the pros and cons with the individual patient. Two- and three-drug combinations are recommended for patients not eligible for transplantation. Treatment should be administered for at least nine cycles, although different durations of initial therapy have only rarely been compared so far. Comorbidity and frailty should be thoroughly assessed in elderly patients, and treatment must be adapted to individual needs, carefully selecting appropriate drugs and doses. A substantial number of new drugs and novel drug classes in early clinical development have shown promising activity. Their introduction into clinical practice will most likely further improve treatment results.
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Affiliation(s)
- Heinz Ludwig
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Pieter Sonneveld
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Faith Davies
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Joan Bladé
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Mario Boccadoro
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Michele Cavo
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Gareth Morgan
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Javier de la Rubia
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Michel Delforge
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Meletios Dimopoulos
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Hermann Einsele
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Thierry Facon
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Hartmut Goldschmidt
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Philippe Moreau
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Hareth Nahi
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Torben Plesner
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Jesús San-Miguel
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Roman Hajek
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Pia Sondergeld
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
| | - Antonio Palumbo
- Department of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria; Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; Institute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, United Kingdom; Hematology Service, University Hospital La Fe, Valencia, Spain; Department of Hematology, University Hospital, Leuven, Belgium; Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; Service d'Hématologie, Centre Hospitalier Universitaire, Lille, France; Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; University Hospital, Nantes, France; Karolinska Institute, Stockholm, Sweden; Department of Hematology, Center Lillebaelt, University of Southern Denmark, Odense, Denmark; Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada, Pamplona, Spain; Department of Hemato-oncology, University of Ostrava, Ostrava, Czech Republic; University of Giessen, Giessen, Germany
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Abstract
Prospective trials comparing tandem autologous stem cell transplantation (ASCT) with ASCT followed by allogeneic stem cell transplantation (AlloSCT) have shown mixed results with regard to progression-free and overall survival rates. Thus, AlloSCT, although a potentially curative treatment, is not regarded as a standard treatment for multiple myeloma by most experts in the field. Strategies to improve the therapeutic index of the conditioning regimens have the potential to improve outcomes. Other approaches to modulate graft-versus-host disease while preserving or improving a graft-versus-myeloma effect could elevate AlloSCT to mainstream treatment. These approaches include vaccines, monoclonal antibodies, and adoptive immunotherapies.
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Affiliation(s)
- William Bensinger
- Division of Oncology, University of Washington, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-390, Seattle, WA 98109, USA.
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Abate-Daga D, Speiser DE, Chinnasamy N, Zheng Z, Xu H, Feldman SA, Rosenberg SA, Morgan RA. Development of a T cell receptor targeting an HLA-A*0201 restricted epitope from the cancer-testis antigen SSX2 for adoptive immunotherapy of cancer. PLoS One 2014; 9:e93321. [PMID: 24681846 PMCID: PMC3969312 DOI: 10.1371/journal.pone.0093321] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/04/2014] [Indexed: 11/18/2022] Open
Abstract
The clinical success of adoptive immunotherapy of cancer relies on the selection of target antigens that are highly expressed in tumor cells but absent in essential normal tissues. A group of genes that encode the cancer/testis or cancer germline antigens have been proposed as ideal targets for immunotherapy due to their high expression in multiple cancer types and their restricted expression in immunoprivileged normal tissues. In the present work we report the isolation and characterization of human T cell receptors (TCRs) with specificity for synovial sarcoma X breakpoint 2 (SSX2), a cancer/testis antigen expressed in melanoma, prostate cancer, lymphoma, multiple myeloma and pancreatic cancer, among other tumors. We isolated seven HLA-A2 restricted T cell receptors from natural T cell clones derived from tumor-infiltrated lymph nodes of two SSX2-seropositive melanoma patients, and selected four TCRs for cloning into retroviral vectors. Peripheral blood lymphocytes (PBL) transduced with three of four SSX2 TCRs showed SSX241-49 (KASEKIFYV) peptide specific reactivity, tumor cell recognition and tetramer binding. One of these, TCR-5, exhibited tetramer binding in both CD4 and CD8 cells and was selected for further studies. Antigen-specific and HLA-A*0201-restricted interferon-γ release, cell lysis and lymphocyte proliferation was observed following culture of TCR engineered human PBL with relevant tumor cell lines. Codon optimization was found to increase TCR-5 expression in transduced T cells, and this construct has been selected for development of clinical grade viral vector producing cells. The tumor-specific pattern of expression of SSX2, along with the potent and selective activity of TCR-5, makes this TCR an attractive candidate for potential TCR gene therapy to treat multiple cancer histologies.
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Affiliation(s)
- Daniel Abate-Daga
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| | - Daniel E. Speiser
- Department of Oncology, Ludwig Center, University of Lausanne, Lausanne, Switzerland
| | - Nachimuthu Chinnasamy
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Zhili Zheng
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Hui Xu
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Steven A. Feldman
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Steven A. Rosenberg
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Richard A. Morgan
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
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Wang ZX, Cao JX, Liu ZP, Cui YX, Li CY, Li D, Zhang XY, Liu JL, Li JL. Combination of chemotherapy and immunotherapy for colon cancer in China: A meta-analysis. World J Gastroenterol 2014; 20:1095-1106. [PMID: 24574784 PMCID: PMC3921535 DOI: 10.3748/wjg.v20.i4.1095] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 10/28/2013] [Accepted: 11/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether autologous dendritic cell (DC)-cytokine-induced killer (CIK) cell therapy is able to improve the therapeutic efficacy of chemotherapy in colon cancer.
METHODS: We conducted a systematic review of published papers from the sources of MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the Wanfang Database, the China Science and Technology Periodical Database and China Journal Net. Published data were extracted independently by two authors using predefined database templates. The quality of the data from individual papers was also assessed. The effects of chemotherapy were compared with those of chemotherapy in combination with DC-CIK immunotherapy. The pooled analysis was performed using the data from random or fixed-effect models.
RESULTS: Seven trials matched our inclusion criteria (n = 533). The overall analysis showed significant survival benefit [one-year overall survival (OS), P < 0.0001; two-year OS, P = 0.009; three-year OS, P = 0.002] in favor of DC-CIK immunotherapy combined with chemotherapy. Disease-free survival (DFS) rate was improved after the combination of DC-CIK immunotherapy and chemotherapy (one-year DFS, P < 0.0001; two-year DFS, P = 0.002; three-year DFS, P = 0.02). An improved overall response rate (P = 0.009) was also observed in patients who received DC-CIK therapy. Furthermore, the analysis of T-lymphocyte subsets in peripheral blood indicated that the number of CD4+ T cells significantly increased in the DC-CIK plus chemotherapy group (P < 0.05).
CONCLUSION: The combination of DC-CIK immunotherapy and chemotherapy was superior in prolonging the survival time and enhancing immunological responses.
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Locke FL, Nishihori T, Alsina M, Kharfan-Dabaja MA. Immunotherapy strategies for multiple myeloma: the present and the future. Immunotherapy 2013; 5:1005-20. [PMID: 23998734 PMCID: PMC4905571 DOI: 10.2217/imt.13.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Growing knowledge of the complexities of the immune system have led to a better understanding of how it can be harnessed for the purpose of anticancer therapy. Moreover, recent success with immunotherapies for solid tumors, combined with novel therapeutic strategies against myeloma, heighten excitement at the prospect of improving clinical outcomes for myeloma by improving antitumor immunity. Increased understanding of myeloma tumor-associated antigens, availability of more potent vaccines, expanded immune-modulating therapies, development of agents that block immune-suppressive pathways, increased sophistication of adoptive cell therapy techniques and capitalization upon standard autologous transplant are all important standalone or combination strategies that might ultimately improve prognosis of patients with multiple myeloma.
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Affiliation(s)
- Frederick L Locke
- Department of Blood & Marrow Transplantation, H Lee Moffitt Cancer, Center & Research Institute, 12902 Magnolia Drive, FOB-3, Tampa, FL 33612, USA
- Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Taiga Nishihori
- Department of Blood & Marrow Transplantation, H Lee Moffitt Cancer, Center & Research Institute, 12902 Magnolia Drive, FOB-3, Tampa, FL 33612, USA
- Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Melissa Alsina
- Department of Blood & Marrow Transplantation, H Lee Moffitt Cancer, Center & Research Institute, 12902 Magnolia Drive, FOB-3, Tampa, FL 33612, USA
- Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Mohamed A Kharfan-Dabaja
- Department of Blood & Marrow Transplantation, H Lee Moffitt Cancer, Center & Research Institute, 12902 Magnolia Drive, FOB-3, Tampa, FL 33612, USA
- Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, FL 33612, USA
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