1
|
Dimopoulos MA, Merlini G, Bridoux F, Leung N, Mikhael J, Harrison SJ, Kastritis E, Garderet L, Gozzetti A, van de Donk NWCJ, Weisel KC, Badros AZ, Beksac M, Hillengass J, Mohty M, Ho PJ, Ntanasis-Stathopoulos I, Mateos MV, Richardson P, Blade J, Moreau P, San-Miguel J, Munshi N, Rajkumar SV, Durie BGM, Ludwig H, Terpos E. Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group. Lancet Oncol 2023; 24:e293-e311. [PMID: 37414019 DOI: 10.1016/s1470-2045(23)00223-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 07/08/2023]
Abstract
Here, the International Myeloma Working Group (IMWG) updates its clinical practice recommendations for the management of multiple myeloma-related renal impairment on the basis of data published until Dec 31, 2022. All patients with multiple myeloma and renal impairment should have serum creatinine, estimated glomerular filtration rate, and free light chains (FLCs) measurements together with 24-h urine total protein, electrophoresis, and immunofixation. If non-selective proteinuria (mainly albuminuria) or involved serum FLCs value less than 500 mg/L is detected, then a renal biopsy is needed. The IMWG criteria for the definition of renal response should be used. Supportive care and high-dose dexamethasone are required for all patients with myeloma-induced renal impairment. Mechanical approaches do not increase overall survival. Bortezomib-based regimens are the cornerstone of the management of patients with multiple myeloma and renal impairment at diagnosis. New quadruplet and triplet combinations, including proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies, improve renal and survival outcomes in both newly diagnosed patients and those with relapsed or refractory disease. Conjugated antibodies, chimeric antigen receptor T-cells, and T-cell engagers are well tolerated and effective in patients with moderate renal impairment.
Collapse
Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Frank Bridoux
- Department of Nephrology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Nelson Leung
- Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
| | - Simon J Harrison
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Alessandro Gozzetti
- Department of Hematology, University of Siena, Policlinico S Maria alle Scotte, Siena, Italy
| | - Niels W C J van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Katja C Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ashraf Z Badros
- Department of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Meral Beksac
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | | | - Mohamad Mohty
- Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM UMRs 938, Paris, France
| | - P Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Paul Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Joan Blade
- Department of Hematology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Philippe Moreau
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Jesus San-Miguel
- Cancer Center Clinica Universidad de Navarra, CCUN, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Spain
| | - Nikhil Munshi
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Brian G M Durie
- Department of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, First Department of Medicine, Clinic Ottakring, Vienna, Austria
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece.
| |
Collapse
|
2
|
Autologous stem cell transplantation for multiple myeloma patients with chronic kidney disease: a safe and effective option. Bone Marrow Transplant 2022; 57:959-965. [PMID: 35413986 PMCID: PMC9200631 DOI: 10.1038/s41409-022-01657-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/10/2022] [Accepted: 03/22/2022] [Indexed: 11/20/2022]
Abstract
Chronic Kidney Disease (CKD) is a frequent complication in patients with multiple myeloma (MM) and is associated with adverse outcomes. The use of autologous stem cell transplantation (ASCT) has improved disease outcomes, however, the safety and efficacy of ASCT in patients with CKD has been the subject of debate. To investigate this, we conducted a retrospective analysis of 370 MM patients who underwent their first ASCT, including those with mild, moderate and severe CKD as well as normal renal function at the time of transplant. No significant difference in ASCT-related mortality, Progression-Free or Overall Survival was noted between the different renal function groups. A decline in estimated glomerular filtration rate (eGFR) at 1-year of >8.79% was associated with poorer overall survival (p < 0.001). The results of this study show that ASCT is a safe and effective option for myeloma patients with CKD, including those on dialysis. Patients who demonstrate renal deterioration at 1-year post-transplant should be closely monitored as this is a predictor for poor survival.
Collapse
|
3
|
Dimopoulos MA, Mikhael J, Terpos E, Leleu X, Moreau P, Bladé J, Kim JS, Stockerl-Goldstein K, Richardson PG. An overview of treatment options for patients with relapsed/refractory multiple myeloma and renal impairment. Ther Adv Hematol 2022; 13:20406207221088458. [PMID: 35392438 PMCID: PMC8980434 DOI: 10.1177/20406207221088458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Renal impairment (RI) is a relatively common complication of multiple myeloma, which increases in frequency as disease becomes more advanced and recovery of renal function becomes less likely as patients progress through lines of therapy. Clinical trials in the relapsed/refractory multiple myeloma (RRMM) setting have not uniformly included patients with RI or robustly reported their outcomes. Here, we review existing data among patients with RI and RRMM across drug classes (including immunomodulatory agents, proteasome inhibitors, monoclonal antibodies, antibody-drug conjugates, chimeric antigen receptor T-cell therapies, and exportin-1 inhibitor) to provide an improved understanding of available treatment options for this important population. We highlight data from pivotal clinical trials, including data relating to renal response (as defined by the International Myeloma Working Group) and discuss real-world experiences in patients with RI, where applicable. Despite substantial advances in RRMM treatment, the presence of RI remains associated with reduced overall survival. Consistent inclusion of patients with RI, and uniform reporting of their outcomes, should be encouraged in future prospective trials of treatments for RRMM.
Collapse
Affiliation(s)
- Meletios A. Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Joseph Mikhael
- Applied Cancer Research and Drug Discovery Division at the Translational Genomics Research Institute (TGen), City of Hope Cancer Center, Phoenix, AZ, USA
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Xavier Leleu
- Service d’Hématologie et Thérapie Cellulaire, CHU and CIC Inserm 1402, Poitiers Cedex, France
| | | | - Joan Bladé
- Hospital Clínic de Barcelona/IDIBAPS, Barcelona, Spain
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Keith Stockerl-Goldstein
- Division of Oncology, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Paul G. Richardson
- Dana Farber Cancer Institute, 450 Brookline Avenue, 44 Binney St., Boston, MA 02115, USA
| |
Collapse
|
4
|
Management of Adverse Events and Supportive Therapy in Relapsed/Refractory Multiple Myeloma. Cancers (Basel) 2021; 13:cancers13194978. [PMID: 34638462 PMCID: PMC8508369 DOI: 10.3390/cancers13194978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Multiple myeloma (MM) patients with relapsing and/or refractory (RR) disease are exposed for a prolonged time to multiple drugs, which increase the risk of toxicity. In addition to tumor response, preserving the quality of life represents an important goal for this patient population. Therefore, supportive therapy plays a pivotal role in their treatment by limiting disease- and drug-related complications. The aim of this review is to outline current standards and future strategies to prevent and treat renal insufficiency, anemia, bone disease, and infection, including COVID-19, in RRMM patients. In addition, the incidence and treatment of side effects of novel anti-MM agents will be discussed. Abstract Relapsed/refractory (RR) multiple myeloma (MM) patients are a fragile population because of prolonged drug exposure and advanced age. Preserving a good quality of life is of high priority for these patients and the treatment of disease- and treatment-related complications plays a key role in their management. By preventing and limiting MM-induced complications, supportive care improves patients’ outcome. Erythropoietin-stimulating agents and bisphosphonates are well-established supportive strategies, yet novel agents are under investigation, such as anabolic bone agents and activin receptor-like kinase (ALK) inhibitors. The recent dramatic changes in the treatment landscape of MM pose an additional challenge for the routine care of RRMM patients. Multidrug combinations in first and later lines increase the risk for long-lasting toxicities, including adverse cardiovascular and neurological events. Moreover, recently approved first-in-class drugs have unique side-effect profiles, such as ocular toxicity of belantamab mafodotin or gastrointestinal toxicity of selinexor. This review discusses current standards in supportive treatment of RRMM patients, including recommendations in light of the recent SARS-CoV-19 pandemic, and critically looks at the incidence and management of side effects of standard as well as next generation anti-MM agents.
Collapse
|
5
|
Okazuka K, Ishida T. Proteasome inhibitors for multiple myeloma. Jpn J Clin Oncol 2018; 48:785-793. [PMID: 30102324 DOI: 10.1093/jjco/hyy108] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/10/2018] [Indexed: 02/06/2023] Open
Abstract
Therapeutic strategies for multiple myeloma have dramatically changed in the last two decades, especially after the introduction of proteasome inhibitors. The first-in-class proteasome inhibitor, bortezomib, was approved by the US Food and Drug Administration in 2003. Since then, it has been a backbone therapy for not only relapsed or refractory myeloma patients but also newly diagnosed multiple myeloma patients. Second-generation proteasome inhibitors, such as carfilzomib and ixazomib, have been approved, and three proteasome inhibitors were incorporated into several regimens with other cytotoxic agents, such as alkylating agents, immunomodulatory drugs and monoclonal antibodies. Because each proteasome inhibitor shows different properties with respect to adverse events, understanding and managing each adverse event of proteasome inhibitors are necessary for the continuation of therapy with minimal interruption of treatment. This review summarizes the recent advances in proteasome inhibitors used in the treatment of multiple myeloma.
Collapse
Affiliation(s)
- Kiyoshi Okazuka
- Department of Hematology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| | - Tadao Ishida
- Department of Hematology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| |
Collapse
|
6
|
Premuzic V, Batinic J, Roncevic P, Basic-Jukic N, Nemet D, Jelakovic B. Role of Plasmapheresis in the Management of Acute Kidney Injury in Patients With Multiple Myeloma: Should We Abandon It? Ther Apher Dial 2017; 22:79-86. [DOI: 10.1111/1744-9987.12606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/23/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Vedran Premuzic
- Department of Nephrology, Hypertension, Dialysis and Transplantation; University Hospital Centre Zagreb; Zagreb Croatia
| | - Josip Batinic
- Department of Haematology; University Hospital Centre Zagreb; Zagreb Croatia
| | - Pavle Roncevic
- Department of Haematology; University Hospital Centre Zagreb; Zagreb Croatia
| | - Nikolina Basic-Jukic
- Department of Nephrology, Hypertension, Dialysis and Transplantation; University Hospital Centre Zagreb; Zagreb Croatia
| | - Damir Nemet
- Department of Haematology; University Hospital Centre Zagreb; Zagreb Croatia
| | - Bojan Jelakovic
- Department of Nephrology, Hypertension, Dialysis and Transplantation; University Hospital Centre Zagreb; Zagreb Croatia
| |
Collapse
|
7
|
Rekhtina IG, Mendeleeva LP. [Current approaches to treating of patients with multiple myeloma with renal failure: Questions and proofs]. TERAPEVT ARKH 2017; 89:112-117. [PMID: 28766550 DOI: 10.17116/terarkh2017897112-117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Renal failure (RF) is detected in 20-30% of patients at the onset of multiple myeloma (MM), in 50% of patients during its progression. The advent of new, highly effective agents has considerably expanded the possibilities of treatment in MM patients. Unfortunately, patients with RF, especially those with severe RF, were not included in the majority of investigations. The available data are based on the results of treatment in small groups of patients generally without the morphological identification of nephropathies, with varying severity of RF, which explains significant differences in renal response rates. This review analyzes the results of the most important studies and gives recommendations for treatment in accordance with national and international standards.
Collapse
Affiliation(s)
- I G Rekhtina
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - L P Mendeleeva
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
8
|
Orlowski RZ, Nagler A, Sonneveld P, Bladé J, Hajek R, Spencer A, Robak T, Dmoszynska A, Horvath N, Spicka I, Sutherland HJ, Suvorov AN, Xiu L, Cakana A, Parekh T, San-Miguel JF. Final overall survival results of a randomized trial comparing bortezomib plus pegylated liposomal doxorubicin with bortezomib alone in patients with relapsed or refractory multiple myeloma. Cancer 2016; 122:2050-6. [PMID: 27191689 PMCID: PMC5701574 DOI: 10.1002/cncr.30026] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/07/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previous results from an interim analysis of an open-label, randomized, phase 3 study demonstrated that bortezomib combined with pegylated liposomal doxorubicin (PLD) was superior to bortezomib monotherapy in patients with relapsed/refractory multiple myeloma who had previously received one or more lines of therapy. Protocol-defined final survival data from that study are provided here. METHODS Patients were randomized (1:1) to receive either bortezomib alone (1.3 mg/m(2) intravenously on days 1, 4, 8, and 11 of every 21-day cycle) or bortezomib-PLD (bortezomib plus PLD 30 mg/m(2) intravenously on day 4). The primary endpoint was the time to progression. Secondary efficacy endpoints included overall survival (OS), progression-free survival, and the overall response rate. RESULTS In total, 646 patients (bortezomib-PLD, n = 324; bortezomib alone, n = 322) were randomized between December, 2004, and March, 2006. On the clinical cutoff date (May 16, 2014) for the final survival analysis, at a median follow-up of 103 months, 79% of patients had died (bortezomib-PLD group: 253 of 324 patients; 78%; bortezomib alone group: 257 of 322 patients; 80%). The median OS in the bortezomib-PLD group was 33 months (95% confidence interval [CI], 28.9-37.1) versus 30.8 months (95% CI, 25.2-36.5) in the bortezomib alone group (hazard ratio, 1.047; 95% CI, 0.879-1.246; P = .6068). Salvage therapies included conventional and novel drugs, which were well balanced between the two treatment groups. CONCLUSIONS Despite inducing a superior time to progression, long-term follow-up revealed that PLD-bortezomib did not improve OS compared with bortezomib alone in patients with relapsed/refractory multiple myeloma. The inability to sustain the early observed survival advantage may have been caused by the effects of subsequent lines of therapy, and underscores the need for long-term follow-up of phase 3 trials while recognizing the challenge of having adequate power to detect long-term differences in OS. Cancer 2016;122:2050-6. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Robert Z. Orlowski
- Department of Lymphoma/Myeloma, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Arnon Nagler
- Division of Hematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Pieter Sonneveld
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Joan Bladé
- Department of Clinical Hematology, August Pi I Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Roman Hajek
- Department of Hemato-Oncology, University Hospital and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Andrew Spencer
- Malignant Hematology and Stem Cell Transplantation Service, The Alfred Hospital, Melbourne, Australia
| | - Tadeusz Robak
- Department of Hematology, Medical University of Łødź, Łødź, Poland
| | - Anna Dmoszynska
- Hematology and Bone Marrow Transplant Department, Medical University of Lublin, Lublin, Poland
| | - Noemi Horvath
- Department of Hematology, Royal Adelaide Hospital, West Australia, Australia
| | - Ivan Spicka
- Department of Internal Medicine, Charles University General Faculty Hospital, Prague, Czech Republic
| | - Heather J. Sutherland
- Division of Hematology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander N. Suvorov
- Department of Hematology, First Republican Clinical Hospital of the Ministry of Healthcare of the Udmurt Republic, Izhevsk, Russia
| | - Liang Xiu
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - Andrew Cakana
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - Trilok Parekh
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - Jesús F. San-Miguel
- Center for Applied Medical Research, August Pi I Sunyer Biomedical Research Institute, University of Navarra, Pamplona, Spain
| |
Collapse
|
9
|
Dimopoulos MA, Sonneveld P, Leung N, Merlini G, Ludwig H, Kastritis E, Goldschmidt H, Joshua D, Orlowski RZ, Powles R, Vesole DH, Garderet L, Einsele H, Palumbo A, Cavo M, Richardson PG, Moreau P, San Miguel J, Rajkumar SV, Durie BG, Terpos E. International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment. J Clin Oncol 2016; 34:1544-57. [DOI: 10.1200/jco.2015.65.0044] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The aim of the International Myeloma Working Group was to develop practical recommendations for the diagnosis and management of multiple myeloma–related renal impairment (RI). Methods Recommendations were based on published data through December 2015, and were developed using the system developed by the Grading of Recommendation, Assessment, Development, and Evaluation Working Group. Recommendations All patients with myeloma at diagnosis and at disease assessment should have serum creatinine, estimated glomerular filtration rate, and electrolytes measurements as well as free light chain, if available, and urine electrophoresis of a sample from a 24-hour urine collection (grade A). The Chronic Kidney Disease Epidemiology Collaboration, preferably, or the Modification of Diet in Renal Disease formula should be used for the evaluation of estimated glomerular filtration rate in patients with stabilized serum creatinine (grade A). International Myeloma Working Group criteria for renal reversibility should be used (grade B). For the management of RI in patients with multiple myeloma, high fluid intake is indicated along with antimyeloma therapy (grade B). The use of high-cutoff hemodialysis membranes in combination with antimyeloma therapy can be considered (grade B). Bortezomib-based regimens remain the cornerstone of the management of myeloma-related RI (grade A). High-dose dexamethasone should be administered at least for the first month of therapy (grade B). Thalidomide is effective in patients with myeloma with RI, and no dose modifications are needed (grade B). Lenalidomide is effective and safe, mainly in patients with mild to moderate RI (grade B); for patients with severe RI or on dialysis, lenalidomide should be given with close monitoring for hematologic toxicity (grade B) with dose reduction as needed. High-dose therapy with autologous stem cell transplantation (with melphalan 100 mg/m2 to 140 mg/m2) is feasible in patients with RI (grade C). Carfilzomib can be safely administered to patients with creatinine clearance > 15 mL/min, whereas ixazomib in combination with lenalidomide and dexamethasone can be safely administered to patients with creatinine clearance > 30 mL/min (grade A).
Collapse
Affiliation(s)
- Meletios A. Dimopoulos
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Pieter Sonneveld
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Nelson Leung
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Giampaolo Merlini
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Heinz Ludwig
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Efstathios Kastritis
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Hartmut Goldschmidt
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Douglas Joshua
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Robert Z. Orlowski
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Raymond Powles
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - David H. Vesole
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Laurent Garderet
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Hermann Einsele
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Antonio Palumbo
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Michele Cavo
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Paul G. Richardson
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Philippe Moreau
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Jesús San Miguel
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - S. Vincent Rajkumar
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Brian G.M. Durie
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| | - Evangelos Terpos
- Meletios A. Dimopoulos, Efstathios Kastritis, and Evangelos Terpos, National and Kapodistrian University of Athens, Athens, Greece; Pieter Sonneveld, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nelson Leung and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Robert Z. Orlowski, The University of Texas MD Anderson Cancer Center, Houston, TX; David H. Vesole, Hackensack University Medical Center, Hackensack, NJ; Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
10
|
Yadav P, Cook M, Cockwell P. Current Trends of Renal Impairment in Multiple Myeloma. KIDNEY DISEASES 2016; 1:241-57. [PMID: 27536684 DOI: 10.1159/000442511] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/18/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Renal impairment (RI) is a common complication of multiple myeloma (MM). Around 50% of patients with MM have RI at presentation, and up to 5% require dialysis treatment. Severe acute kidney injury (AKI) as a cause of RI is a particular challenge as historically the survival of patients who sustain this complication and require dialysis is very poor. However, in this current period, survival is improving and the focus is on optimum use of novel chemotherapies and the evaluation of extra-corporeal therapies for removal of serum immunoglobulin light chains. SUMMARY RI in patients with MM is commonly associated with excess monoclonal free light chain (FLC) production; myeloma cast nephropathy is the predominant renal pathology in patients presenting with severe RI secondary to AKI. The majority of patients have mild to moderate RI and recover renal function. However, patients with more severe RI, in particular those with a requirement for dialysis, are less likely to recover renal function. Rapid diagnosis and prompt institution of anti-myeloma therapy is an important determinant of renal function recovery, through targeting early and sustained reduction of involved monoclonal FLC. Novel agents are associated with excellent disease response, and bortezomib is now widely used as a first-line agent in the management of MM in patients with severe RI. Extended haemodialysis using high cut-off dialysers is more effective for extracorporeal removal of FLC than plasma exchange, and clinical trials are in process. High-dose chemotherapy with autologous stem cell transplantation does have a role in patients with severe RI but requires careful patient selection. KEY MESSAGES RI is very common in patients with MM, and renal function recovery is associated with improved clinical outcomes. We summarise the epidemiology of MM in the UK, present the impact of RI and renal function recovery on patient outcome, and describe the current management of MM in western countries. FACTS FROM EAST AND WEST (1) A serum creatinine level >2 mg/dl has been reported in 16, 21, 24, and 33% of patients with MM in cohort studies from Japan, Europe, China, and Korea, respectively. A creatinine clearance rate <30 ml/min was observed in 30 and 15% of patients in Chinese and Western MM cohorts, respectively. The commonest cause of severe RI in patients with MM is myeloma cast nephropathy. (2) The efficacy of novel treatments (bortezomib, carfilzomib, thalidomide, and lenalidomide) has predominantly been assessed in Western patients. Bortezomib and dexamethasone are the current standard of care for MM and severe RI in the West. Severe RI is not a contraindication to autologous stem cell transplantation (ASCT). Most of the data are from the West; there are case reports from China describing good outcomes with ASCT. The removal of FLC by high-cut-off hemodialysis is under evaluation in randomized controlled trials (RCTs) in the West. Studies in this area are not yet conducted in China. In China, new treatments, such as bortezomib, are more widely used than before, and favorable results are being reported; however, RCT studies are still needed in this area to confirm the efficacy and safety of this and other novel treatments.
Collapse
Affiliation(s)
- Punit Yadav
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK; School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Institute of Translational Medicine, Birmingham, UK
| | - Mark Cook
- Birmingham Institute of Translational Medicine, Birmingham, UK; Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK; School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Birmingham Institute of Translational Medicine, Birmingham, UK
| |
Collapse
|
11
|
Moreau P, Pylypenko H, Grosicki S, Karamanesht I, Leleu X, Rekhtman G, Masliak Z, Robak P, Esseltine DL, Feng H, Deraedt W, van de Velde H, Arnulf B. Subcutaneous versus intravenous bortezomib in patients with relapsed multiple myeloma: subanalysis of patients with renal impairment in the phase III MMY-3021 study. Haematologica 2015; 100:e207-10. [PMID: 25596270 DOI: 10.3324/haematol.2014.118182] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Zvenyslava Masliak
- SI Institute of Blood Pathology and Transfusion Medicine UAMS, Lviv, Ukraine
| | | | - Dixie-Lee Esseltine
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Huaibao Feng
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - William Deraedt
- Janssen Research & Development, Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Helgi van de Velde
- Janssen Research & Development, Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Bertrand Arnulf
- Immuno-hématologie Department, Hôpital Saint-Louis, Paris, France
| |
Collapse
|
12
|
Visani G, Loscocco F, Isidori A. Nanomedicine strategies for hematological malignancies: what is next? Nanomedicine (Lond) 2014; 9:2415-28. [DOI: 10.2217/nnm.14.128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The major obstacle in treating cancer depends on the low therapeutic index of most anticancer drugs. The lack of specificity, coupled with the large volumes of distribution, translates into a nonpreferential distribution of anticancer drugs to the tumor. Accordingly, the dose of the anticancer drug that is achievable within tumor is limited, resulting in suboptimal treatment and unwanted toxicity. Nanoparticles applied as drug-delivery systems are submicron-sized (3–200 nm) particles, that can enhance the selectivity of the active drug to cancer cells through a change of its pharmacokinetic profile, while avoiding toxicity in normal cells. This review will discuss the current uses of nanodrugs in hematology, with a focus on the most promising nanoparticles in development for the treatment of hematologic tumors.
Collapse
Affiliation(s)
- Giuseppe Visani
- Hematology & Hematopoietic Stem Cell Transplant Center, AORMN Marche Nord, Via Lombroso, 1-61100 Pesaro, Italy
| | - Federica Loscocco
- Hematology & Hematopoietic Stem Cell Transplant Center, AORMN Marche Nord, Via Lombroso, 1-61100 Pesaro, Italy
| | - Alessandro Isidori
- Hematology & Hematopoietic Stem Cell Transplant Center, AORMN Marche Nord, Via Lombroso, 1-61100 Pesaro, Italy
| |
Collapse
|
13
|
Romano A, Chiarenza A, Conticello C, Cavalli M, Vetro C, Di Raimondo C, Cunsolo R, Palumbo GA, Di Raimondo F. Salvage therapy with pegylated liposomal doxorubicin, bortezomib, cyclophosphamide, and dexamethasone in relapsed/refractory myeloma patients. Eur J Haematol 2014; 93:207-13. [PMID: 24673398 DOI: 10.1111/ejh.12325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In vitro studies have shown synergistic anti-myeloma effects of bortezomib combined with alkylating agents or anthracycline. We tested safety and efficacy of the combination of bortezomib, doxorubicin cyclophosphamide, and dexamethasone (ABCD) in the treatment of relapsed/refractory myeloma. METHODS ABCD consisted of bortezomib given intravenous (IV) at dosage 1.3 mg/m(2) , dexamethasone 40 mg IV on days 1, 4, 8, and 15, pegylated liposomal doxorubicin (PLD) 20 mg IV on days 1 and 15, plus cyclophosphamide 100 mg/d per os for 15 d. Between January 2008 and February 2009, 24 patients received a median of four 28-d ABCD cycles (range 1-6). All patients had been already treated with a median of two previous lines of treatment (range 1-6): 38% were resistant to previous therapies and 62% were relapsed. RESULTS Clinical response was observed in 12 patients (50%), including 29% of very good partial remissions or better. Side effects included hematological toxicity (31% any grade), grades 3-4 thrombocytopenia (9%), grades 3-4 anemia (17%). Non-hematological toxicity affected 32% of administered cycles and included gastrointestinal disturbances (54%), peripheral neuropathy (8%), and infections (8%). After a median follow-up of 21.5 months (range 2-44 months), median of progression-free survival (PFS) was 8.7 months and median overall survival was 22.5 months. Achieving at least partial response within the second cycle was associated with a better PFS (19.5 months vs. 3.5 months), P = 0.03, HR 0.35 (CI 95% 0.13-0.90). CONCLUSION ABCD is safe and effective for relapsed/refractory MM subjects previously treated with novel agents.
Collapse
Affiliation(s)
- Alessandra Romano
- Department of Clinical and Molecular Biomedicine, Section of Haematology, University of Catania, Catania, Italy; Division of Hematology, Azienda Policlinico-OVE, Catania, Italy; Fondazione Umberto Veronesi, Rome, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Bendamustine and prednisone in combination with bortezomib (BPV) in the treatment of patients with relapsed or refractory multiple myeloma and light chain-induced renal failure. J Cancer Res Clin Oncol 2013; 139:1937-46. [DOI: 10.1007/s00432-013-1513-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/02/2013] [Indexed: 01/08/2023]
|
15
|
Dimopoulos MA, Beksac M, Benboubker L, Roddie H, Allietta N, Broer E, Couturier C, Mazier MA, Angermund R, Facon T. Phase II study of bortezomib-dexamethasone alone or with added cyclophosphamide or lenalidomide for sub-optimal response as second-line treatment for patients with multiple myeloma. Haematologica 2013; 98:1264-72. [PMID: 23716559 DOI: 10.3324/haematol.2013.084376] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This phase II study is the first prospective evaluation of bortezomib-dexamethasone as second-line therapy for relapsed/refractory multiple myeloma. A total of 163 patients were enrolled to receive four cycles of bortezomib-dexamethasone. Patients were investigator-assessed for response at cycle 5 Day 1, then treated as follows: responding patients received another four cycles of bortezomib-dexamethasone, while patients with stable disease were subsequently randomized to sequential treatment with a further four cycles of bortezomib-dexamethasone alone or with added cyclophosphamide or lenalidomide. The primary end point was response to sequential therapy; however, this could not be evaluated because investigator-assessed response rates to bortezomib-dexamethasone after four cycles were high, and an insufficient number of patients were randomized to sequential treatment per protocol. Among all 163 patients, validated best confirmed response rate was 66%, including 37% complete/very good partial responses; median response duration was 9.7 months. After a median follow up of 16.9 months, median time to progression and progression-free survival were 9.5 and 8.6 months, respectively; estimated 1-year overall survival was 81%. Median glomerular filtration rate improved from baseline during treatment. Among 58 patients with baseline glomerular filtration rate below 50 mL/min, 24 had renal responses. Grade 3/4 adverse events included: thrombocytopenia (17%), anemia (10%), constipation (6%), peripheral sensory neuropathy (5%), and polyneuropathy (5%). Overall, 57% of neuropathy events improved/resolved; median time to improvement was 2.1 months. These findings suggest bortezomib-dexamethasone represents an active, feasible second-line treatment option for patients with relapsed/refractory myeloma.
Collapse
Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Kastritis E, Terpos E, Dimopoulos MA. Current treatments for renal failure due to multiple myeloma. Expert Opin Pharmacother 2013; 14:1477-95. [DOI: 10.1517/14656566.2013.803068] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
17
|
Combined bendamustine, prednisone and bortezomib (BPV) in patients with relapsed or refractory multiple myeloma. J Cancer Res Clin Oncol 2012. [DOI: 10.1007/s00432-012-1339-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
18
|
Stringer S, Cook M, Cockwell P. Achieving an early myeloma response in patients with kidney impairment. Adv Chronic Kidney Dis 2012; 19:303-11. [PMID: 22920641 DOI: 10.1053/j.ackd.2012.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is increasing evidence, particularly in severe acute kidney injury, that treatment of multiple myeloma with regimens that include dexamethasone in combination with novel chemotherapy agents are associated with an early disease response in most patients. However, the evidence to guide the optimal chemotherapy regimen in patients with kidney impairment is limited, and treatment choices are complicated by the effect of kidney function on drug dosing. Here, we summarize the current status of this field, with a particular focus on chemotherapy regimens that are based on dexamethasone and novel agents and an outline of those areas in which further work is needed to improve the evidence base.
Collapse
|
19
|
Kastritis E, Dimopoulos MA, Bladé J. Evolving chemotherapy options for the treatment of myeloma kidney: a 40-year perspective. Adv Chronic Kidney Dis 2012; 19:312-23. [PMID: 22920642 DOI: 10.1053/j.ackd.2012.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 07/03/2012] [Accepted: 07/05/2012] [Indexed: 12/12/2022]
Abstract
Kidney impairment (KI) at the time of initial diagnosis is common in myeloma. The improvement of kidney function and the reversal of KI are of utmost importance. Recent advances have made it possible to reverse acute kidney damage due to myeloma in most patients, at least if treatment is immediately implemented. Immediate antimyeloma therapy and appropriate hydration are the most commonly used treatment modalities for the management of acute KI related to myeloma. Mechanical approaches can only temporarily reduce the free light-chain load, and without effective chemotherapy they are probably not able to significantly improve kidney function. However, the role of mechanical approaches together with effective chemotherapy is still being explored. Thalidomide, lenalidomide, and bortezomib have improved the survival of myeloma patients, but they have also improved the outcome of patients presenting with KI. Thalidomide is safe to use on patients with KI without dose adjustments. Lenalidomide needs dose modification, but it can improve kidney function in many patients. Bortezomib seems to be the agent of choice for most patients presenting with KI without dose modifications. This review focuses on the management of patients presenting with "myeloma kidney" using modern chemotherapy approaches, especially novel agents.
Collapse
|
20
|
The role of novel agents on the reversibility of renal impairment in newly diagnosed symptomatic patients with multiple myeloma. Leukemia 2012; 27:423-9. [PMID: 22763386 DOI: 10.1038/leu.2012.182] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The role of thalidomide, bortezomib and lenalidomide in multiple myeloma patients presenting with renal impairment was evaluated in 133 consecutive newly diagnosed patients who were treated with a novel agent-based regimen. A significant improvement of renal function (renalPR (renal partial response)) was observed in 77% of patients treated with bortezomib, in 55% with thalidomide and in 43% with lenalidomide (P=0.011). In multivariate analysis, bortezomib-based therapy was independently associated with a higher probability of renal response compared with thalidomide- or lenalidomide-based therapy. Other important variables included eGFR (estimated glomerular filtration rate) ≥30 ml/min, age ≤65 years and myeloma response. Patients treated with bortezomib achieved at least renalPR in a median of 1.34 months vs 2.7 months for thalidomide and >6 months for lenalidomide-treated patients (P=0.028). In multivariate analysis bortezomib-based therapy, higher doses of dexamethasone (≥160 mg during the first month of treatment), an eGFR ≥30 ml/min and age ≤65 years were independently associated with shorter time to renal response. In conclusion, bortezomib-based therapies may be more appropriate for the initial management of patients with myeloma-related renal failure; however, thalidomide and lenalidomide are also associated with significant probability of improvement of their renal function.
Collapse
|
21
|
Successful Treatment of Patients With Multiple Myeloma and Impaired Renal Function With Lenalidomide: Results of 4 German Centers. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2012; 12:191-6. [DOI: 10.1016/j.clml.2012.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/23/2011] [Accepted: 01/09/2012] [Indexed: 11/21/2022]
|
22
|
Pönisch W, Andrea M, Wagner I, Hammerschmidt D, Kreibich U, Schwarzer A, Zehrfeld T, Schwarz M, Winkelmann C, Petros S, Bachmann A, Lindner T, Niederwieser D. Successful treatment of patients with newly diagnosed/untreated multiple myeloma and advanced renal failure using bortezomib in combination with bendamustine and prednisone. J Cancer Res Clin Oncol 2012; 138:1405-12. [DOI: 10.1007/s00432-012-1212-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/21/2012] [Indexed: 12/01/2022]
|
23
|
Duggan ST, Keating GM. Pegylated liposomal doxorubicin: a review of its use in metastatic breast cancer, ovarian cancer, multiple myeloma and AIDS-related Kaposi's sarcoma. Drugs 2012; 71:2531-58. [PMID: 22141391 DOI: 10.2165/11207510-000000000-00000] [Citation(s) in RCA: 174] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pegylated liposomal doxorubicin (Caelyx™, Doxil®) represents an improved formulation of conventional doxorubicin, with reduced cardiotoxicity and an improved pharmacokinetic profile. This article reviews the efficacy and tolerability of pegylated liposomal doxorubicin in metastatic breast cancer, progressive ovarian cancer, relapsed or refractory multiple myeloma and AIDS-related Kaposi's sarcoma, as well as summarizing its pharmacological properties. In three randomized, open-label, multicentre trials, monotherapy with pegylated liposomal doxorubicin was as effective as doxorubicin or capecitabine in the first-line treatment of metastatic breast cancer, and as effective as vinorelbine or combination mitomycin plus vinblastine in taxane-refractory metastatic breast cancer. Pegylated liposomal doxorubicin alone was as effective as topotecan or gemcitabine alone in patients with progressive ovarian cancer resistant or refractory to platinum- or paclitaxel-based therapy, according to the results of three randomized multicentre trials. In addition, in patients with progressive ovarian cancer who had received prior platinum-based therapy, progression-free survival was significantly longer with pegylated liposomal doxorubicin plus carboplatin than with paclitaxel plus carboplatin, according to the results of a randomized, open-label multicentre trial. Combination therapy with pegylated liposomal doxorubicin plus bortezomib was more effective than bortezomib alone in patients with relapsed or refractory multiple myeloma, according to the results of a randomized, open-label, multinational trial. Randomized multinational trials also demonstrated the efficacy of pegylated liposomal doxorubicin in patients with advanced AIDS-related Kaposi's sarcoma. Pegylated liposomal doxorubicin exhibited a relatively favourable safety profile compared with conventional doxorubicin and other available chemotherapy agents. The most common treatment-related adverse events included myelosuppression, palmar-plantar erythrodysesthesia and stomatitis, although these are manageable with appropriate supportive measures. To conclude, pegylated liposomal doxorubicin is a useful option in the treatment of various malignancies, including metastatic breast cancer, ovarian cancer, multiple myeloma and AIDS-related Kaposi's sarcoma.
Collapse
Affiliation(s)
- Sean T Duggan
- Adis, a Wolters Kluwer Business, Auckland, New Zealand.
| | | |
Collapse
|
24
|
Kiyota M, Kobayashi T, Fuchida S, Yamamoto-Sugitani M, Ohshiro M, Shimura Y, Mizutani S, Nagoshi H, Sasaki N, Nakayama R, Chinen Y, Sakamoto N, Uchiyama H, Matsumoto Y, Horiike S, Shimazaki C, Kuroda J, Taniwaki M. Monosomy 13 in metaphase spreads is a predictor of poor long-term outcome after bortezomib plus dexamethasone treatment for relapsed/refractory multiple myeloma. Int J Hematol 2012; 95:516-26. [PMID: 22426624 DOI: 10.1007/s12185-012-1035-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/18/2012] [Accepted: 02/23/2012] [Indexed: 12/01/2022]
Abstract
We retrospectively investigated the prognostic impact of high-risk cytogenetic abnormalities (CAs) on the outcome of treatment with bortezomib plus dexamethasone (BD) in 43 relapsed/refractory (Rel/Ref) multiple myeloma patients. Fluorescence in situ hybridization (FISH) analysis identified del(13q) in 25 patients, t(4;14) in 14, t(14;16) in 4, 1q21 abnormality in 12 and del(17p) in 2, while G-banding also detected chromosome 13 monosomy (-13) in metaphase spreads from 7 patients. Eighteen of 25 patients with FISH-detected chromosome 13 abnormalities also exhibited other abnormalities. Median observation period was 510 days, and median overall survival (OS) and progression-free survival (PFS) were 912 days and 162 days, respectively. Detection of del(13q), t(4;14), t(14;16) or 1q21 abnormalities by FISH and co-occurrence of chromosome 13 abnormality with other abnormalities were not associated with poorer outcomes. In contrast, detection of -13 by G-banding in metaphase spreads showed significant association with shorter OS, although the overall response rate and PFS were not inferior to those for patients without -13 detected by G-banding. BD therapy may be a potent weapon for overcoming most classical high-risk CAs, while the detection of -13 in metaphase spreads may serve as a predictor of highly progressive disease, even when treated with BD.
Collapse
Affiliation(s)
- Miki Kiyota
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Faiman BM, Mangan P, Spong J, Tariman JD. Renal complications in multiple myeloma and related disorders: survivorship care plan of the International Myeloma Foundation Nurse Leadership Board. Clin J Oncol Nurs 2012; 15 Suppl:66-76. [PMID: 21816711 DOI: 10.1188/11.cjon.s1.66-76] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Kidney dysfunction is a common clinical feature of symptomatic multiple myeloma. Some degree of renal insufficiency or renal failure is present at diagnosis or will occur during the course of the disease and, if not reversed, will adversely affect overall survival and quality of life. Chronic insults to the kidneys from other illnesses, treatment, or multiple myeloma itself can further damage renal function and increase the risk for additional complications, such as anemia. Patients with multiple myeloma who have light chain (Bence Jones protein) proteinuria may experience renal failure or progress to end-stage renal disease (ESRD) and require dialysis because of light chain cast nephropathy. Kidney failure in patients with presumed multiple myeloma also may result from amyloidosis, light chain deposition disease, or acute tubular necrosis caused by nephrotoxic agents; therefore, identification of patients at risk for kidney damage is essential. The International Myeloma Foundation's Nurse Leadership Board has developed practice recommendations for screening renal function, identifying positive and negative contributing risk and environmental factors, selecting appropriate therapies and supportive care measures to decrease progression to ESRD, and enacting dialysis to reduce and manage renal complications in patients with multiple myeloma.
Collapse
Affiliation(s)
- Beth M Faiman
- Hematology and Medical Oncology Department, Cleveland Clinic in Ohio, USA.
| | | | | | | | | |
Collapse
|
26
|
Hutchison CA, Bladé J, Cockwell P, Cook M, Drayson M, Fermand JP, Kastritis E, Kyle R, Leung N, Pasquali S, Winearls C. Novel approaches for reducing free light chains in patients with myeloma kidney. Nat Rev Nephrol 2012; 8:234-43. [PMID: 22349488 DOI: 10.1038/nrneph.2012.14] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Myeloma kidney is a tubulointerstitial pathology that accounts for approximately 80-90% of severe acute kidney injury in patients with multiple myeloma. Unless there is rapid intervention, progressive irreversible damage from interstitial fibrosis and tubular atrophy occurs. Work over the past decade has demonstrated that an early sustained reduction in serum concentrations of pathogenic monoclonal free light chains (FLCs) leads to improved renal recovery rates. In turn, an early improvement in renal function is associated with improved patient survival. An early reduction in FLC levels should therefore become standard of care, although the optimum mechanisms to achieve this depletion of FLCs remain to be determined. To provide a coordinated, cross-disciplinary approach to research in this disease, the International Kidney and Monoclonal Gammopathy Research Group was formed. In this Review, we address the current state of knowledge in the management of myeloma kidney.
Collapse
Affiliation(s)
- Colin A Hutchison
- Renal Institute of Birmingham, University Hospital Birmingham and University of Birmingham, Birmingham, UK. c.a.hutchison@ bham.ac.uk
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Chanan-Khan AA, San Miguel JF, Jagannath S, Ludwig H, Dimopoulos MA. Novel therapeutic agents for the management of patients with multiple myeloma and renal impairment. Clin Cancer Res 2012; 18:2145-63. [PMID: 22328563 DOI: 10.1158/1078-0432.ccr-11-0498] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal impairment is a major complication of multiple myeloma. Patients presenting with severe renal impairment represent a greater therapeutic challenge and generally have poorer outcome. However, once patients with renal impairment achieve remission, their outcomes are comparable with those of patients without renal impairment. Therapies that offer substantial activity in this setting are needed. Bortezomib, thalidomide, and lenalidomide have substantially improved the survival of patients with multiple myeloma. Here we review the pharmacokinetics, activity, and safety of these agents in patients with renal impairment. Bortezomib can be administered at the full approved dose and schedule in renally impaired patients; similarly, no dose reductions are required with thalidomide. The pharmacokinetics of lenalidomide is affected by its renal route of excretion, and dose adjustments are recommended for moderate/severe impairment. Substantial evidence has emerged showing that these novel agents improve outcomes of patients with renal impairment, including impairment reversal. Bortezomib, thalidomide, and lenalidomide (at the recommended doses) are active options for patients with mild to moderate impairment, although limited data are available for thalidomide. Information on lenalidomide-based combinations is still emerging, but the available data indicate considerable activity. Substantial evidence indicates that bortezomib-high-dose dexamethasone with or without a third drug (e.g., cyclophosphamide, thalidomide, or doxorubicin) is an appropriate option for patients with any degree of renal impairment.
Collapse
Affiliation(s)
- Asher A Chanan-Khan
- Roswell Park Cancer Institute, Buffalo, and Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York, USA
| | | | | | | | | |
Collapse
|
28
|
Safety and efficacy of bortezomib-melphalan-prednisone-thalidomide followed by bortezomib-thalidomide maintenance (VMPT-VT) versus bortezomib-melphalan-prednisone (VMP) in untreated multiple myeloma patients with renal impairment. Blood 2011; 118:5759-66. [DOI: 10.1182/blood-2011-05-353995] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractWe assessed efficacy, safety, and reversal of renal impairment (RI) in untreated patients with multiple myeloma given bortezomib-melphalan-prednisone-thalidomide followed by bortezomib-thalidomide (VMPT-VT) maintenance or bortezomib-melphalan-prednisone (VMP). Exclusion criteria included serum creatinine ≥ 2.5 mg/dL. In the VMPT-VT/VMP arms, severe RI (estimated glomerular filtration rate [eGFR] ≤ 30 mL/min), moderate RI (eGFR 31-50 mL/min), and normal renal function (eGFR > 50 mL/min), were 6%/7.9%, 24.1%/24.9%, and 69.8%/67.2%, respectively. Statistically significant improvements in overall response rates and progression-free survival were observed in VMPT-VT versus VMP arms across renal cohorts, except in severe RI patients. In the VMPT group, severe RI reduced overall survival (OS). RI was reversed in 16/63 (25.4%) patients receiving VMPT-VT versus 31/77 (40.3%) receiving VMP. Multivariate analysis showed male sex (P = .022) and moderate RI (P = .003) significantly predicted RI recovery. VMP patients achieving renal response showed longer OS. In both arms, greater rates of severe hematologic adverse events were associated with RI (eGFR < 50 mL/min), however, therapy discontinuation rates were unaffected. VMPT-VT was superior to VMP for cases with normal renal function and moderate RI, whereas VMPT-VT failed to outperform VMP in patients with severe RI, although the relatively low number of cases analyzed preclude drawing definitive conclusions. VMPT-VT had no advantage in terms of RI reversal over VMP. This study is registered at http://www.clinicaltrials.gov as NCT01063179.
Collapse
|
29
|
Piro E, Molica S. A systematic review on the use of bortezomib in multiple myeloma patients with renal impairment: what is the published evidence? Acta Haematol 2011; 126:163-8. [PMID: 21778706 DOI: 10.1159/000328417] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/12/2011] [Indexed: 12/27/2022]
Abstract
This report presents the totality of evidence through a systematic review that assessed either the efficacy or safety of bortezomib-based regimens in multiple myeloma with renal impairment. A systematic and comprehensive search of the literature was performed using MEDLINE databases from 1978 to December 1, 2010, and a hand search of references. We used the following medical subject headings (MESH) to identify potential studies: 'myeloma renal failure' (1,225 hits) and 'bortezomib' (2,554 hits). An additional search performed by combining the MESH terms 'myeloma renal failure' and 'bortezomib' yielded 50 citations. Five additional case-control studies judged relevant for the purpose of study were also included. In total, 6 case reports, 9 case series and 9 case-control studies were identified that reported on myeloma, renal failure and bortezomib. In this review, only the case series and case-control studies were considered. The results of our search led to the following conclusions: (1) bortezomib is feasible and well tolerated and its efficacy and safety are not substantially modified by renal failure patients, (2) renal failure should not induce physicians to reduce doses, since the efficacy of bortezomib is attained also in dialyzed patients who may achieve dialysis independence, and (3) standard doses of bortezomib (i.e. 1.3 mg/m(2) on days 1, 4, 8, 11) associated with dexamethasone yield satisfactory tumor response, generally obtained shortly after starting therapy. Although many questions remain unanswered, our effort should be considered a relevant scientific and practical address for generating a diagnostic and therapeutic algorithm to be used in patients with renal impairment related to multiple myeloma.
Collapse
Affiliation(s)
- Eugenio Piro
- Department Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | | |
Collapse
|
30
|
|
31
|
Bladé J, Sonneveld P, Miguel JFS, Sutherland HJ, Hajek R, Nagler A, Spencer A, Robak T, Lantz KC, Zhuang SH, Harousseau JL, Orlowski RZ. Efficacy and Safety of Pegylated Liposomal Doxorubicin in Combination With Bortezomib for Multiple Myeloma: Effects of Adverse Prognostic Factors on Outcome. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:44-9. [DOI: 10.3816/clml.2011.n.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
32
|
Abstract
Abstract
Renal impairment is a common complication of multiple myeloma. Chronic renal failure is classified according to glomerular filtration rate as estimated by the MDRD (modification of diet in renal disease) formula, while RIFLE (risk, injury, failure, loss and end-stage renal disease) and AKIN (acute renal injury network) criteria may be used for the definition of the severity of acute renal injury. Novel criteria based on estimated glomerular filtration rate measurements are proposed for the definition of the reversibility of renal impairment. Renal complete response (CRrenal) is defined as sustained (i.e., lasting at least 2 months) improvement of creatinine clearance (CRCL) from under 50 mL/min at baseline to 60 mL/min or above. Renal partial response (PRrenal) is defined as sustained improvement of CRCL from under 15 mL/min at baseline to 30 to 59 mL/min. Renal minor response (MRrenal) is defined as sustained improvement of the baseline CRCL of under 15 mL/min to 15 to 29 mL/min or, if baseline CRCL was 15 to 29 mL/min, improvement to 30 to 59 mL/min. Bortezomib with high-dose dexamethasone is considered the treatment of choice for myeloma patients with renal impairment and improves renal function in most patients. Although there is limited experience with thalidomide, this agent can be administered at the standard dosage to patients with renal failure. Lenalidomide, when administered at reduced doses according to renal function, is effective and can reverse renal impairment in a subset of myeloma patients.
Collapse
|
33
|
Dimopoulos MA, Terpos E, Chanan-Khan A, Leung N, Ludwig H, Jagannath S, Niesvizky R, Giralt S, Fermand JP, Bladé J, Comenzo RL, Sezer O, Palumbo A, Harousseau JL, Richardson PG, Barlogie B, Anderson KC, Sonneveld P, Tosi P, Cavo M, Rajkumar SV, Durie BG, San Miguel J. Renal Impairment in Patients With Multiple Myeloma: A Consensus Statement on Behalf of the International Myeloma Working Group. J Clin Oncol 2010; 28:4976-84. [DOI: 10.1200/jco.2010.30.8791] [Citation(s) in RCA: 302] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Renal impairment is a common complication of multiple myeloma (MM). The estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula is the recommended method for the assessment of renal function in patients with MM with stabilized serum creatinine. In acute renal injury, the RIFLE (risk, injury, failure, loss and end-stage kidney disease) and Acute Renal Injury Network criteria seem to be appropriate to define the severity of renal impairment. Novel criteria based on eGFR measurements are recommended for the definition of the reversibility of renal impairment. Rapid intervention to reverse renal dysfunction is critical for the management of these patients, especially for those with light chain cast nephropathy. Bortezomib with high-dose dexamethasone is considered as the treatment of choice for such patients. There is limited experience with thalidomide in patients with myeloma with renal impairment. Thus, thalidomide can be carefully administered, mainly in the context of well-designed clinical trials, to evaluate if it can improve the rapidity and probability of response that is produced by the combination with bortezomib and high-dose dexamethasone. Lenalidomide is effective in this setting and can reverse renal insufficiency in a significant subset of patients, when it is given at reduced doses, according to renal function. The role of plasma exchange in patients with suspected light chain cast nephropathy and renal impairment is controversial. High-dose melphalan (140 mg/m2) and autologous stem-cell transplantation should be limited to younger patients with chemosensitive disease.
Collapse
Affiliation(s)
- Meletios A. Dimopoulos
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Evangelos Terpos
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Asher Chanan-Khan
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Nelson Leung
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Heinz Ludwig
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Sundar Jagannath
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Ruben Niesvizky
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Sergio Giralt
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Jean-Paul Fermand
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Joan Bladé
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Raymond L. Comenzo
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Orhan Sezer
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Antonio Palumbo
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Jean-Luc Harousseau
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Paul G. Richardson
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Bart Barlogie
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Kenneth C. Anderson
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Pieter Sonneveld
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Patrizia Tosi
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Michele Cavo
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - S. Vincent Rajkumar
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Brian G.M. Durie
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Jésus San Miguel
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| |
Collapse
|
34
|
Klein U, Neben K, Hielscher T, Heiss C, Ho AD, Goldschmidt H. Lenalidomide in combination with dexamethasone: effective regimen in patients with relapsed or refractory multiple myeloma complicated by renal impairment. Ann Hematol 2010; 90:429-39. [PMID: 20857112 DOI: 10.1007/s00277-010-1080-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 09/06/2010] [Indexed: 11/24/2022]
Abstract
Over the past decade, treatment options for patients with multiple myeloma (MM) have improved substantially, resulting in better response rates and prolonged overall survival (OS). Nevertheless, MM remains a challenging disease, especially if renal insufficiency (RI) or extensive pre-treatment aggravates the assignment of the optimal treatment schedule. In this retrospective study, we analyzed the outcome of lenalidomide plus dexamethasone in 167 patients with relapsed or refractory MM with focus on RI. The baseline creatinine clearance (CLCr) was normal in 94 patients (CLCr≥80 ml/min), while RI was observed in 73 patients, including 40 patients with mild RI (50≤CLCr<80 ml/min) and 33 patients with moderate or severe RI (CLCr<50 ml/min). Response rates declined depending on the severity of RI, being 67% among patients with normal kidney function, 60% among patients with mild RI and 49% among patients with moderate or severe RI. Time to progression (TTP) was significantly reduced in patients with severe RI and in case of >2 previous treatment lines. OS was not significantly different between patients with normal and impaired renal function. In contrast, the number of previous treatment lines (2 vs. <2) and the use of novel agents like bortezomib or thalidomide prior to lenalidomide plus dexamethasone therapy had a more adverse effect on OS. In conclusion, lenalidomide plus dexamethasone is an effective regimen for relapsed or refractory patients with MM complicated by RI with manageable toxicity.
Collapse
Affiliation(s)
- Ulrike Klein
- Department of Internal Medicine V, Hematology and Oncology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | | | | | | | | | | |
Collapse
|
35
|
Schots R, Delforge M, André M, Bries G, Caers J, Demuynck H, De Prijck B, De Samblanx H, Kentos A, Meuleman N, Offner F, Vekemans MC, Vande Broek I, Van Droogenbroeck J, Van de Vanelde A, Wu KL, Doyen C. The Belgian 2010 consensus recommendations for the treatment of multiple myeloma. Acta Clin Belg 2010; 65:252-64. [PMID: 20954465 DOI: 10.1179/acb.2010.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Since the introduction of novel therapeutic agents including thalidomide, lenalidomide and bortezomib, the prognosis of multiple myeloma (MM) has significantly improved. These agents have been incorporated into numerous treatment schedules for newly diagnosed as well as more advanced MM patients. Hence, the therapeutic options for MM have become more complex and subject to rapid changes. The multiple myeloma study group (MMSG) of the Belgian Hematological Society has established recommendations for the treatment of MM as based on an extensive review of the literature which is also summarized in this paper. The recommendations are the result of a consensus opinion between haematologists with experience in the field and representing most haematology centres in Belgium. Where applicable, reimbursement criteria are also taken into account. The consensus recommendations should be a reference for use by clinical haematologists in daily practice.
Collapse
|
36
|
Dimopoulos MA, Richardson PG, Schlag R, Khuageva NK, Shpilberg O, Kastritis E, Kropff M, Petrucci MT, Delforge M, Alexeeva J, Schots R, Masszi T, Mateos MV, Deraedt W, Liu K, Cakana A, van de Velde H, San Miguel JF. VMP (Bortezomib, Melphalan, and Prednisone) Is Active and Well Tolerated in Newly Diagnosed Patients With Multiple Myeloma With Moderately Impaired Renal Function, and Results in Reversal of Renal Impairment: Cohort Analysis of the Phase III VISTA Study. J Clin Oncol 2009; 27:6086-93. [DOI: 10.1200/jco.2009.22.2232] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo assess bortezomib plus melphalan and prednisone (VMP) and melphalan and prednisone (MP) in previously untreated patients with multiple myeloma (MM) with renal impairment enrolled on the phase III VISTA study, and to evaluate renal impairment reversibility.Patients and MethodsPatients received nine 6-week cycles of VMP (bortezomib 1.3 mg/m2, melphalan 9 mg/m2, prednisone 60 mg/m2) or MP. Patients with serum creatinine higher than 2 mg/dL were excluded.ResultsIn the VMP/MP arms, 6%/4%, 27%/30%, and 67%/66% of patients had baseline glomerular filtration rate (GFR) of ≤ 30, 31 to 50, and higher than 50 mL/min, respectively. Response rates were higher and time to progression (TTP) and overall survival (OS) longer with VMP versus MP across renal cohorts. Response rates with VMP and TTP in both arms did not appear significantly different between patients with GFR ≤ 50 or higher than 50 mL/min; OS appeared somewhat longer in patients with normal renal function in both arms. Renal impairment reversal (baseline GFR < 50 improving to > 60 mL/min) was seen in 49 (44%) of 111 patients receiving VMP versus 40 (34%) of 116 patients receiving MP. By multivariate analysis, younger age (< 75 years; P = .006) and less severe impairment (GFR ≥ 30 mL/min; P = .027) were associated with higher reversal rates. In addition, treatment with VMP approached significance (P = .07). In both arms, rates of grade 4 and 5 adverse events (AEs) and serious AEs appeared higher in patients with renal impairment; with VMP, rates of discontinuations/bortezomib dose reductions due to AEs did not appear affected.ConclusionVMP is a feasible, active, and well-tolerated treatment option for previously untreated patients with MM with moderate renal impairment, resulting in 44% renal impairment reversal.
Collapse
Affiliation(s)
- Meletios A. Dimopoulos
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Paul G. Richardson
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Rudolf Schlag
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Nuriet K. Khuageva
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Ofer Shpilberg
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Efstathios Kastritis
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Martin Kropff
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Maria T. Petrucci
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Michel Delforge
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Julia Alexeeva
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Rik Schots
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Tamás Masszi
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Maria-Victoria Mateos
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - William Deraedt
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Kevin Liu
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Andrew Cakana
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Helgi van de Velde
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Jesús F. San Miguel
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| |
Collapse
|
37
|
Morabito F, Gentile M, Ciolli S, Petrucci MT, Galimberti S, Mele G, Casulli AF, Mannina D, Piro E, Pinotti G, Palmieri S, Catalano L, Callea V, Offidani M, Musto P, Bringhen S, Baldini L, Tosi P, Di Raimondo F, Boccadoro M, Palumbo A, Cavo M. Safety and efficacy of bortezomib-based regimens for multiple myeloma patients with renal impairment: a retrospective study of Italian Myeloma Network GIMEMA. Eur J Haematol 2009; 84:223-8. [PMID: 19930441 DOI: 10.1111/j.1600-0609.2009.01385.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Renal impairment (RI) is a severe complication throughout the course of multiple myeloma (MM). Bortezomib has been shown to be highly active in MM patients with RI. We designed this retrospective analysis to investigate the safety and efficacy of bortezomib-based therapy in 117 MM patients with RI, 14 cases required dialysis. A total of 603 cycles of bortezomib were administered (median number, five cycles/patient). Ten patients required early discontinuation of bortezomib because of WHO grade IV toxicity. The rate of bortezomib discontinuation in cases with severe, moderate and mild RI was 11%, 5% and 0%, respectively (P = NS). Overall, 91 episodes of WHO grade III/IV toxicity were observed. At least a partial response was documented in 83/113 evaluable patients (73%), including complete response (19%) and near complete response (8%). The overall response rate was similar across RI subgroups. Reversal of RI was documented in 41% of patients after a median of 2.3 months (range 0.4-7.9). In three of 14 patients on dialysis, renal replacement therapy was discontinued after 1, 1 and 4 months. The 2-yr estimate of response duration and overall survival was 70% and 51%, respectively. In conclusion, bortezomib-based regimens are safe and effective and should be considered as appropriate treatment options for MM patients with any degree of RI.
Collapse
Affiliation(s)
- Fortunato Morabito
- Unità Operativa di Ematologia, Azienda Ospedaliera dell'Annunziata, 87100 Cosenza, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Shah JJ, Orlowski RZ. Proteasome inhibitors in the treatment of multiple myeloma. Leukemia 2009; 23:1964-79. [PMID: 19741722 PMCID: PMC4737506 DOI: 10.1038/leu.2009.173] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 06/16/2009] [Accepted: 06/29/2009] [Indexed: 01/09/2023]
Abstract
Targeting intracellular protein turnover by inhibiting the ubiquitin-proteasome pathway as a strategy for cancer therapy is a new addition to our chemotherapeutic armamentarium, and has seen its greatest successes against multiple myeloma. The first-in-class proteasome inhibitor, bortezomib, was initially approved for treatment of patients in the relapsed/refractory setting as a single agent, and was recently shown to induce even greater benefits as part of rationally designed combinations that overcome chemoresistance. Modulation of proteasome function is also a rational approach to achieve chemosensitization to other antimyeloma agents, and bortezomib has now been incorporated into the front-line setting. Bortezomib-based induction regimens are able to achieve higher overall response rates and response qualities than was the case with prior standards of care, and unlike these older approaches, maintain efficacy in patients with clinically and molecularly defined high-risk disease. Second-generation proteasome inhibitors with novel properties, such as NPI-0052 and carfilzomib, are entering the clinical arena, and showing evidence of antimyeloma activity. In this spotlight review, we provide an overview of the current state of the art use of bortezomib and other proteasome inhibitors against multiple myeloma, and highlight areas for future study that will further optimize our ability to benefit patients with this disease.
Collapse
Affiliation(s)
- Jatin J. Shah
- The University of Texas M. D. Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, TX
| | - Robert Z. Orlowski
- The University of Texas M. D. Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, TX
- The University of Texas M. D. Anderson Cancer Center, Department of Experimental Therapeutics, Division of Cancer Medicine, Houston, TX
| |
Collapse
|
39
|
Moreau P. Combination regimens using doxorubicin and pegylated liposomal doxorubicin prior to autologous transplantation in multiple myeloma. Expert Rev Anticancer Ther 2009; 9:885-90. [PMID: 19589027 DOI: 10.1586/era.09.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Doxorubicin and pegylated liposomal doxorubicin are key compounds of several induction regimens used prior to autologous stem cell transplantation in patients with de novo multiple myeloma, such as vincristine, doxorubicin, dexamethasone (VAD), vincristine, pegylated liposomal doxorubicin/Doxil, dexamethasone (DVd) or PS-341/bortezomib, doxorubicin, dexamethasone (PAD). The aim of this article is to summarize the more recent data available on the efficacy of these combinations and to discuss their role as part of initial therapy.
Collapse
Affiliation(s)
- Philippe Moreau
- Hematology Department, CHU Hôtel-Dieu, 44093 Nantes, France.
| |
Collapse
|
40
|
Yang H, Zonder JA, Dou QP. Clinical development of novel proteasome inhibitors for cancer treatment. Expert Opin Investig Drugs 2009; 18:957-71. [PMID: 19505187 PMCID: PMC3758888 DOI: 10.1517/13543780903002074] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Emerging evidence demonstrates that targeting the tumor proteasome is a promising strategy for cancer therapy. OBJECTIVE This review summarizes recent results from cancer clinical trials using specific proteasome inhibitors or some natural compounds that have proteasome-inhibitory effects. METHODS A literature search was carried out using PubMed. Results about the clinical application of specific proteasome inhibitors and natural products with proteasome-inhibitory activity for cancer prevention or therapy were reviewed. RESULTS/CONCLUSION Bortezomib, the reversible proteasome inhibitor that first entered clinical trials, has been studied extensively as a single agent and in combination with glucocorticoids, cytotoxic agents, immunomodulatory drugs and radiation as treatment for multiple myeloma and other hematological malignancies. The results in some cases have been impressive. There is less evidence of bortezomib's efficacy in solid tumors. Novel irreversible proteasome inhibitors, NPI-0052 and carfilzomib, have also been developed and clinical trials are underway. Natural products with proteasome-inhibitory effects, such as green tea polyphenol (-)-epigallocatechin-3-gallate (EGCG), soy isoflavone genistein, and the spice turmeric compound curcumin, have been studied alone and in combination with traditional chemotherapy and radiotherapy against various cancers. There is also interest in developing these natural compounds as potential chemopreventive agents.
Collapse
Affiliation(s)
- Huanjie Yang
- The Prevention Program, Barbara Ann Karmanos Cancer Institute, and the Department of Pathology, School of Medicine, Wayne State University, 540.1 HWCRC, 4100 John R. Road, Detroit, Michigan 48201, USA
| | | | | |
Collapse
|