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Abonour R, Lee HC, Rifkin R, Ailawadhi S, Omel J, Hardin JW, Narang M, Toomey K, Gasparetto C, Wagner LI, Terebelo H, Mouro J, Dhanasiri S, Liu L, Yu E, Jagannath S. The Effect of Age and Other Patient Characteristics on Outcomes Among Nontransplanted Patients Who Were Treated With First-Line Lenalidomide, Bortezomib, and Dexamethasone: Results From the Connect Ⓡ MM Registry. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00225-8. [PMID: 39033038 DOI: 10.1016/j.clml.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/03/2024] [Accepted: 05/29/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Lenalidomide (R), bortezomib (V), and dexamethasone (d) is a standard-of-care regimen in newly diagnosed multiple myeloma (NDMM); however, characteristics and outcomes for nontransplanted patients receiving frontline RVd are not well understood. PATIENTS The ConnectⓇ MM Registry is a large, US, multicenter, prospective observational cohort study of NDMM patients. METHODS This analysis investigated characteristics and outcomes of patients who received RVd alone or followed by Rd or R (RVd ± Rd/R) who did not undergo frontline autologous stem cell transplantation. RESULTS As of August 2021, 314 of 1979 nontransplanted patients received RVd ± Rd/R as initial therapy. Of these, 135 were aged ≤ 65 years and 179 were > 65 years. 108 patients had time to relapse (TTR) of ≤ 12 months and 182 had TTR > 12 months. Baseline characteristics were comparable regardless of TTR and age group except renal function, which was more commonly impaired in older patients. Among patients aged ≤ 65 and > 65 years, median duration of first-line treatment was 6.3 and 9.0 months, median time to next line for those who received second-line therapy was 15.5 and 15.2 months, median progression-free survival (PFS) was 19.3 and 23.0 months, and median overall survival was 60.0 and 59.1 months, respectively. High-risk disease (per IMWG criteria) and high serum calcium were associated with higher hazard of progression or death; the adjusted PFS hazard ratio with respect to age (≤ 65 vs. > 65 years) based on multivariable analysis was 1.18 (0.89-1.57; P = .25). CONCLUSION These results indicate RVd is active across age groups and provide a better understanding of outcomes with RVd in NDMM.
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Affiliation(s)
- Rafat Abonour
- Department of Medicine, Division of Hematology/Oncology, Indiana University, Indianapolis, IN.
| | - Hans C Lee
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert Rifkin
- Rocky Mountain Cancer Centers US Oncology, Denver, CO
| | | | - James Omel
- Myeloma Research Advocate/Advisor, Grand Island, NE
| | - James W Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Mohit Narang
- Maryland Oncology Hematology, US Oncology Research, Columbia, MD
| | | | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC
| | - Lynne I Wagner
- Department of Health Policy and Management, UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jorge Mouro
- Celgene International Sàrl, a Bristol Myers Squibb Company, Boudry, Switzerland
| | - Sujith Dhanasiri
- Celgene International Sàrl, a Bristol Myers Squibb Company, Boudry, Switzerland
| | | | | | - Sundar Jagannath
- Department of Medicine, Hematology and Medical Oncology, Mount Sinai Hospital, New York, NY
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Petrakis I, Kontogiorgis C, Nena E, Delimpasi S, Loutsidi NE, Spanoudakis E, Intzes S, Misidou C, Symeonidou M, Giannakoulas N, Constantinidis TC, Terpos E. Does the Simultaneous Introduction of Several Pharmaceuticals in the Post-Lenalidomide Era Translate to Better Outcomes in Relapse Refractory Multiple Myeloma? Findings from the Real-World Innovation in Multiple Myeloma (REAL IMM) Study. Cancers (Basel) 2023; 15:5846. [PMID: 38136391 PMCID: PMC10741914 DOI: 10.3390/cancers15245846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Newer methodologies are needed to assess the real-world comparative effectiveness of a "generation" of pharmaceutical innovation versus the prior standard of care. This chart review study aimed to first evaluate the cumulative clinical benefits of pharmaceutical innovation in everyday relapse/refractory multiple myeloma before analyzing findings in the context of respective real-world outcomes from the bortezomib/lenalidomide era. Study endpoints included the 52-week PFS rate in second and third line of therapy (LOT), mPFS-2 across the first and second LOT, the ORR, reasons for discontinuation, and the treatment duration per therapeutic algorithm. Data from 107 patients were collected. The median follow-up was 2.0 years. Of the subjects who met the selection criteria for the second LOT, 72.2% maintained the PFS at 52 weeks. In the third-line setting, the PFS rate at 52 weeks was 63.5%. The mPFS across the first and second, the second, and the third LOTs were 26, 17, and 15 months, respectively. The ORR was 76.1% in the second and 69.7% in the third LOT. After non-response or progression, the main reason for drug discontinuation was treatment intolerability. The second-line ORR and the 52-week PFS rate were similar to previous real-world findings from the bortezomib/lenalidomide era. The cumulative mPFS across the second and third LOTs was higher than the respective mPFS across the first and second LOTs. Despite its limitations, the methodology and findings from this study may be used in future clinical and economic evaluations across all hematological malignancies.
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Affiliation(s)
- Ioannis Petrakis
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.K.); (T.C.C.)
| | - Christos Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.K.); (T.C.C.)
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.K.); (T.C.C.)
| | - Sosana Delimpasi
- Bone Marrow Transplantation Unit, Department of Hematology, Evangelismos Hospital, 10676 Athens, Greece; (S.D.); (N.E.L.)
| | - Natasa E. Loutsidi
- Bone Marrow Transplantation Unit, Department of Hematology, Evangelismos Hospital, 10676 Athens, Greece; (S.D.); (N.E.L.)
| | - Emmanouil Spanoudakis
- Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (S.I.); (C.M.); (M.S.)
| | - Stergios Intzes
- Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (S.I.); (C.M.); (M.S.)
| | - Christina Misidou
- Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (S.I.); (C.M.); (M.S.)
| | - Marianthi Symeonidou
- Department of Hematology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.S.); (S.I.); (C.M.); (M.S.)
| | - Nikolaos Giannakoulas
- Department of Hematology, School of Medicine, University of Thessaly, 41110 Larisa, Greece;
| | - Theodoros C. Constantinidis
- Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (C.K.); (T.C.C.)
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
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Geng C, Yang G, Zhou H, Wang H, Li Y, Leng Y, Zhang Z, Jian Y, Chen W. Characteristics and Risk Factors of Ultra-High-Risk Patients with Newly Diagnosed Multiple Myeloma. J Pers Med 2023; 13:jpm13040666. [PMID: 37109052 PMCID: PMC10146518 DOI: 10.3390/jpm13040666] [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: 03/05/2023] [Revised: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE To investigate the clinical characteristics and risk factors of ultra-high-risk (UHR) patients with newly diagnosed multiple myeloma (MM). METHODS We screened UHR patients with a survival of less than 24 months and we selected patients with a concurrent survival of more than 24 months as a control group. We retrospectively analyzed the clinical characteristics of UHR patients with newly diagnosed MM and screened related risk factors. RESULTS In total we analyzed 477 patients, which included 121 (25.4%) UHR patients and 356 (74.6%) control patients. Median overall survival (OS) and progression-free survival (PFS) of UHR patients was 10.5 months (7.5-13.5 months) and 6.3 months (5.4-7.2 months), respectively. Univariate logistic regression analysis showed that age > 65 years, hemoglobin (HGB) < 100 g/L, lactate dehydrogenase (LDH) > 250 U/L, serum creatinine (SCr) > 2 mg/dL, corrected serum calcium (CsCa) > 2.75 mmol/L, B-type natriuretic peptide (BNP) or N-terminal prohormone BNP (NT-proBNP) > 2 upper limit of normal (ULN), high-risk cytogenetics, Barthel index score, and International Staging System (ISS) stage III were associated with UHR MM. In a multivariate analysis, age > 65 years, LDH > 250 U/L, CsCa > 2.75 mmol/L, BNP or NT-proBNP > 2 ULN, high-risk cytogenetics, and Barthel index score were independent risk factors for UHR MM. Moreover, UHR patients had a worse response rate than control patients. CONCLUSION Our study highlighted the characteristics of UHR MM patients and suggested that the combination of organ insufficiency and highly malignant myeloma cells resulted in poor outcomes of patients with UHR MM.
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Affiliation(s)
- Chuanying Geng
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Guangzhong Yang
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Huixing Zhou
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Huijuan Wang
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Yanchen Li
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Yun Leng
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Zhiyao Zhang
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Yuan Jian
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Wenming Chen
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Pacelli P, Raspadori D, Bestoso E, Gozzetti A, Bocchia M. "Friends and foes" of multiple myeloma measurable/minimal residual disease evaluation by next generation flow. Front Oncol 2022; 12:1057713. [PMID: 36518304 PMCID: PMC9742464 DOI: 10.3389/fonc.2022.1057713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/14/2022] [Indexed: 09/19/2023] Open
Abstract
Next Generation Flow (NGF) represents a gold standard for the evaluation of Minimal Residual Disease (MRD) in Multiple Myeloma (MM) patients at any stage of treatment. Although the assessment of MRD is still not universally employed in clinical practice, numerous studies have demonstrated the strength of MRD as a reliable predictor of long-term outcome, and its potential to supersede the prognostic value of CR. The possibility to acquire millions of events, in combination with the use of standard reagents and a good expertise in the analysis of rare populations, led to high chance of success and a sensitivity of 10-6 that is superimposable to the one of Next Generation Sequencing molecular techniques. Some minor bias, correlated to the protocols applied, to the quality of samples and to the high heterogeneity of plasma cells phenotype, may be overcome using standard protocols and having at disposition personnel expertise for MRD analysis. With the use of NGF we can today enter a new phase of the quantification of residual disease, switching from the definition of "minimal" residual disease to "measurable" residual disease. This review takes account of the principle "friends and foes" of Myeloma "Measurable" Residual Disease evaluation by NGF, to give insights into the potentiality of this technique. The optimization of the quality of BM samples and the analytic expertise that permits to discriminate properly the rare pathologic clones, are the keys for obtaining results with a high clinical value that could be of great impact and relevance in the future.
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Affiliation(s)
- Paola Pacelli
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Elena Bestoso
- Hematology Unit, Siena University Hospital, Siena, Italy
| | - Alessandro Gozzetti
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Hematology Unit, Siena University Hospital, Siena, Italy
| | - Monica Bocchia
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Hematology Unit, Siena University Hospital, Siena, Italy
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