1
|
Fan H, Wang W, Zhang Y, Wang J, Cheng T, Qiu L, Wang X, Xia Z, An G. Current treatment paradigm and survival outcomes among patients with newly diagnosed multiple myeloma in China: a retrospective multicenter study. Cancer Biol Med 2023; 20:j.issn.2095-3941.2022.0612. [PMID: 36647781 PMCID: PMC9843447 DOI: 10.20892/j.issn.2095-3941.2022.0612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Evidence on the prognostic value of autologous stem cell transplantation (ASCT) and minimal residual disease (MRD) dynamics of patients with newly diagnosed multiple myeloma (NDMM) in China is limited. Our objective in the current study was to understand the current care paradigm and outcomes of these patients. METHODS This longitudinal cohort study used historical data from three top-tier hematologic disease care hospitals that contributed to the National Longitudinal Cohort of Hematological Diseases-Multiple Myeloma. Treatment regimens [proteasome inhibitor (PI)-, immunomodulatory drug (IMiD)-, PI+IMiD-based, and conventional], post-induction response, ASCT and MRD status, and survival outcomes [progression-free survival (PFS) and overall survival (OS)] were evaluated. RESULTS In total, 454 patients with NDMM were included (median age, 57 years; 59.0% males) with a median follow-up of 58.7 months. The overall response rate was 91.0%, 83.9%, 90.6%, and 60.9% for PI-, IMiD-, PI+IMiD-based, and conventional regimens, respectively. Patients with ASCT during first-line therapy (26.2%) had a longer PFS and OS than patients who did not receive ASCT [median PFS, 42.9 vs. 21.2 months, P < 0.001; median OS, not reached (NR) vs. 65.8 months, P < 0.001]. The median OS was NR, 71.5, and 56.6 months among patients with sustained MRD negativity, loss of MRD negativity, and persistent MRD, respectively (P < 0.001). Multivariate analysis revealed that the lactic dehydrogenase level, International Staging System stage, extra-medullary disease, and upfront ASCT were independent factors in predicting OS among NDMM patients. CONCLUSIONS Our study showed that novel agent-based regimens, first-line ASCT, and sustained MRD negativity were associated with a superior outcome for patients with NDMM in China (Identifier: NCT04645199).
Collapse
Affiliation(s)
- Huishou Fan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Weida Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Ya Zhang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Tao Cheng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
- Correspondence to: Gang An, Zhongjun Xia and Xin Wang E-mail: , and
| | - Zhongjun Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
- Correspondence to: Gang An, Zhongjun Xia and Xin Wang E-mail: , and
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
- Correspondence to: Gang An, Zhongjun Xia and Xin Wang E-mail: , and
| |
Collapse
|
2
|
Garrido DI, Bove V, Matosas V, Riva E. Comparative survival analysis using the International Stratification Score (ISS) in newly-diagnosed multiple myeloma in the Uruguayan population. Med Pharm Rep 2021; 94:48-52. [PMID: 33629048 PMCID: PMC7880064 DOI: 10.15386/mpr-1750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background and aims Multiple myeloma is a frequent hematologic malignancy, in which the International Stratification Score (ISS) is widely used to estimate the overall survival. However, there are no studies in Latin America evaluating its performance. This study aims to describe the ISS performance in the overall survival estimation for newly diagnosed multiple myeloma patients in Uruguay. Methods This is a retrospective registry-based survival analysis through the Grupo Uruguayo de Mieloma Múltiple (GUMMA) database, including newly diagnosed multiple myeloma patients from January 2001 until May 2019. Results 249 patients were included, 51.81% males and an average age of 63.49 years. According to ISS and Durie-Salmon score (DSS), 47.79% and 82.3% were ISS III and DSS III, respectively. Also, 32.3% were DSS B. Auto hematopoietic stem cell transplantation was performed in 31.73% of patients, and bortezomib was used in 44.18% as frontline therapy. The overall survival was 80% for ISS1, 64.9% ISS2, and 48.6% ISS3 (Log-Rank; p <0.01). The average overall survival was 116.5 months for ISS 1, 77.6 months for ISS 2, and 57.8 months for ISS 3. The hazard ratio between ISS II and ISS I was 2.42 (95% CI 1.10–5.33; p<0.05), and 3.94 (95% CI 1.88–8.26; p<0.05) between ISS III and ISS II. Conclusion The ISS staging system allows an adequate stratification of patients according to overall survival in the real-practice setting. However, considering the relevance of the new cytogenetic advances, it is necessary to increase the availability and quality of iFISH in Latin America.
Collapse
Affiliation(s)
- David Israel Garrido
- Department of Hematology, Universidad de la República (UDELAR), Montevideo, Uruguay
| | - Virginia Bove
- Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - Victoria Matosas
- Department of Hematology, Universidad de la República (UDELAR), Montevideo, Uruguay
| | - Eloisa Riva
- Department of Hematology, Universidad de la República (UDELAR), Montevideo, Uruguay
| |
Collapse
|
3
|
Loke C, Mollee P, McPherson I, Walpole E, Yue M, Mutsando H, Wong P, Weston H, Tomlinson R, Hollingworth S. Bortezomib use and outcomes for the treatment of multiple myeloma. Intern Med J 2020; 50:1059-1066. [DOI: 10.1111/imj.14886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Crystal Loke
- School of Pharmacy The University of Queensland Brisbane Queensland Australia
| | - Peter Mollee
- Department of Cancer Services Princess Alexandra Hospital Brisbane Queensland Australia
| | - Ian McPherson
- Department of Cancer Services Princess Alexandra Hospital Brisbane Queensland Australia
| | - Euan Walpole
- Department of Cancer Services Princess Alexandra Hospital Brisbane Queensland Australia
| | - Mimi Yue
- Department of Cancer Services Princess Alexandra Hospital Brisbane Queensland Australia
| | - Howard Mutsando
- Toowoomba Hospital Darling Downs Hospital and Health Services Toowoomba Queensland Australia
| | - Phillip Wong
- Toowoomba Hospital Darling Downs Hospital and Health Services Toowoomba Queensland Australia
| | - Helen Weston
- Regional Cancer Care, Cancer Care Services Sunshine Coast University Hospital Sunshine Coast Queensland Australia
| | - Ross Tomlinson
- Regional Cancer Care, Cancer Care Services Sunshine Coast University Hospital Sunshine Coast Queensland Australia
| | | |
Collapse
|
4
|
Lu J, Chen W. Cost-effectiveness of lenalidomide plus low-dose dexamethasone for newly diagnosed multiple myeloma patients ineligible for stem cell transplantation in China. J Comp Eff Res 2019; 8:979-992. [PMID: 31232089 DOI: 10.2217/cer-2019-0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess the cost-effectiveness of lenalidomide plus low dose dexamethasone (Rd) relative to bortezomib-contained therapy (BCT) for newly diagnosed multiple myeloma patients ineligible for stem cell transplantation (ndMM) in China. Materials & methods: A literature review was conducted to identify appropriate evidence for developing a cost-effectiveness model comparing Rd with BCT for lifetime health outcomes and direct medical costs in Chinese ndMM patients. Results: The estimated incremental cost-effectiveness ratio per gained quality-adjusted life years for Rd versus BCT was ¥49,793. The chance for Rd to be cost effective, under the cost-effectiveness thresholds of three-times the 2018 Chinese gross domestic goods per capita, was 90.8%. Conclusion: The cost-effectiveness of Rd relative to BCT for ndMM in Chinese patients is highly attractive.
Collapse
Affiliation(s)
- Jin Lu
- Department of Hematology, Peking University People's Hospital, Beijing 100032, China
| | - Wendong Chen
- Toronto Health Economics & Technology Assessment Collaborative, University of Toronto, ON M5G 2C4, Canada
| |
Collapse
|
5
|
De Santis E, Masi S, Cordone I, Pisani F, Zuppi C, Mattei F, Conti L, Cigliana G. Follow-up of IgD-κ multiple myeloma by monitoring free light chains and total heavy chain IgD: A case report. Oncol Lett 2016; 12:1884-1888. [PMID: 27588135 PMCID: PMC4998028 DOI: 10.3892/ol.2016.4869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 06/27/2016] [Indexed: 11/05/2022] Open
Abstract
Immunoglobulin (Ig)D-κ multiple myeloma (MM) is a rare neoplastic disease characterized by an aggressive and rapidly progressing course, which constitutes only a very small proportion of all MM cases. In the present report, the clinical case of a 51-year-old Caucasian woman diagnosed with IgD-κ MM is described. The patient underwent different chemotherapeutic treatments subsequently to a single autologous stem cell transplantation. Despite the inherent difficulty of monitoring IgD levels and performing serum immunofixation electrophoresis, the clinical outcome of the patient was almost uniquely monitored by measuring the levels of κ and λ free light chains (FLCs) and total heavy chain IgD. The data suggest the non-invasive potential and usefulness of FLCs evaluation for early detection of stringent complete remission, follow-up and early detection of disease relapse. In addition, this diagnostic procedure has successfully been employed for the therapeutic monitoring of the present patient, and may represent a very helpful, non-invasive tool for the follow-up of IgD myeloma patients without the requirement of serial bone marrow aspirate.
Collapse
Affiliation(s)
- Elena De Santis
- Clinical Pathology Unit, Italian National Cancer Institute 'Regina Elena', I-00144 Rome, Italy
| | - Serena Masi
- Clinical Pathology Unit, Italian National Cancer Institute 'Regina Elena', I-00144 Rome, Italy
| | - Iole Cordone
- Clinical Pathology Unit, Italian National Cancer Institute 'Regina Elena', I-00144 Rome, Italy
| | - Francesco Pisani
- Hematology and Stem Cell Transplantation Unit, Italian National Cancer Institute 'Regina Elena', I-00144 Rome, Italy
| | - Cecilia Zuppi
- Department of Laboratory Medicine and Diagnostics, University Hospital Agostino Gemelli, I-00168 Rome, Italy
| | - Fabrizio Mattei
- Department of Hematology, Oncology and Molecular Medicine, National Institute of Health, I-00161 Rome, Italy
| | - Laura Conti
- Clinical Pathology Unit, Italian National Cancer Institute 'Regina Elena', I-00144 Rome, Italy
| | - Giovanni Cigliana
- Clinical Pathology Unit, Italian National Cancer Institute 'Regina Elena', I-00144 Rome, Italy
| |
Collapse
|
6
|
Cardoso CC, de Moraes ACR, Del Moral JAG, Santos-Silva MC. Mature B cell neoplasms: retrospective analysis of 93 cases diagnosed between 2011 and 2014 in a University Hospital in southern Brazil. Rev Bras Hematol Hemoter 2016; 38:121-7. [PMID: 27208570 PMCID: PMC4877614 DOI: 10.1016/j.bjhh.2016.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/05/2016] [Accepted: 02/07/2016] [Indexed: 12/15/2022] Open
Abstract
Background According to the 2008 World Health Organization classification, mature B-cell neoplasms are a heterogeneous group of diseases that include B-cell lymphomas and plasma cell disorders. These neoplasms can have very different clinical behaviors, from highly aggressive to indolent, and therefore require diverse treatment strategies. Objective The aim of this study was to assess the profile of 93 patients diagnosed with mature B-cell neoplasms monitored between 2011 and 2014. Methods A review of patients’ charts was performed and laboratory results were obtained using the online system of the Universidade Federal de Santa Catarina. Results The study included 93 adult patients with mature B-cell neoplasms. The most frequent subtypes were multiple myeloma, chronic lymphocytic leukemia, diffuse large B-cell lymphoma, follicular lymphoma, and Burkitt's lymphoma. The median age at diagnosis was 58 years with a male-to-female ratio of 1.3:1. There were statistical differences in terms of age at diagnosis, lactate dehydrogenase activity and Ki-67 expression among the subtypes of B-cell lymphoma. According to the prognostic indexes, the majority of multiple myeloma patients were categorized as high risk, while the majority of chronic lymphocytic leukemia patients were classified as low risk. Conclusions This study demonstrates the profile of patients diagnosed with mature B-cell neoplasms in a south Brazilian university hospital. Of the B-cell lymphoma, Burkitt's lymphoma presented particular features regarding lactate dehydrogenase activity levels, Ki-67 expression, age at diagnosis, and human immunodeficiency virus infection.
Collapse
|
7
|
Ríos-Tamayo R, Sánchez MJ, Puerta JM, Sáinz J, Chang DYL, Rodríguez T, López P, de Pablos JM, Navarro P, de Veas JLG, Romero A, Garrido P, Moratalla L, Alarcón-Payer C, López-Fernández E, González PA, Jiménez-Moleón JJ, Calleja-Hernández MÁ, Jurado M. Trends in survival of multiple myeloma: a thirty-year population-based study in a single institution. Cancer Epidemiol 2015; 39:693-9. [PMID: 26277330 DOI: 10.1016/j.canep.2015.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/02/2015] [Accepted: 08/06/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite the progress made in recent years, multiple myeloma is still considered an incurable disease. Most survival data come from clinical trials. Little is known about the outcome in unselected real-life patients. METHODS Overall survival was analyzed in a cohort of newly diagnosed symptomatic multiple myeloma patients, over the last three decades, in a single institution population-based study. RESULTS 582 consecutive myeloma patients were included in the study. Survival increased over time in patients younger than 65 years but did not reach statistical significance in patients with 65 years or older. The prognostic factors associated with overall survival were the International Staging System, the serum lactate dehydrogenase level, the renal impairment, the realization of autologous stem cell transplantation, and the presence of concomitant amyloidosis. Overall survival shows a steady improvement over time. INTERPRETATION The survival of myeloma is improving progressively in real-life patients, particularly after the widespread use of the novel agents. A comprehensive assessment of comorbidity can help to explain the huge heterogeneity of myeloma outcome. The optimization of current therapeutic resources as well as the incorporation of new drugs will allow further improvement of survival in the coming years.
Collapse
Affiliation(s)
- Rafael Ríos-Tamayo
- Monoclonal Gammopathies Unit, University Hospital Virgen de las Nieves, Granada, Spain; Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain; Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
| | - María José Sánchez
- Granada Cancer Registry, Andalusian School of Public Health, Granada, Spain; CIBER Epidemiology and Public Health, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - José Manuel Puerta
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Juan Sáinz
- Monoclonal Gammopathies Unit, University Hospital Virgen de las Nieves, Granada, Spain; Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain; Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Daysi-Yoe-Ling Chang
- Granada Cancer Registry, Andalusian School of Public Health, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Teresa Rodríguez
- Department of Inmunology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Pilar López
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | - José María de Pablos
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Pilar Navarro
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Antonio Romero
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Pilar Garrido
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Lucía Moratalla
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
| | | | | | | | - José Juan Jiménez-Moleón
- CIBER Epidemiology and Public Health, Granada, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Miguel Ángel Calleja-Hernández
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; Pharmacy Department, University Hospital Virgen de las Nieves, Granada, Spain
| | - Manuel Jurado
- Monoclonal Gammopathies Unit, University Hospital Virgen de las Nieves, Granada, Spain; Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain; Genomic Oncology Area, GENYO, Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| |
Collapse
|
8
|
Clinical features and treatment outcome in newly diagnosed Chinese patients with multiple myeloma: results of a multicenter analysis. Blood Cancer J 2014; 4:e239. [PMID: 25127393 PMCID: PMC4219472 DOI: 10.1038/bcj.2014.55] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 06/02/2014] [Accepted: 07/02/2014] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to understand the clinical features and treatment outcome of Chinese patients with multiple myeloma (MM). This retrospective study enrolled 940 newly diagnosed inpatients (median age, 59 years; immunoglobulin (Ig)D isotype, 6.5%) with complete follow-up data at three centers. In all, 85.8% of patients were of Durie-Salmon stage III and 48.3% were of International Staging System (ISS) stage III at diagnosis. Also, 9.6% of patients had extramedullary plasmacytoma. Compared with IgG, IgD-type patients were diagnosed at a younger age, and more patients were of ISS stage III, with hypercalcemia, elevated levels of lactate dehydrogenase, hyperuricemia, renal dysfunction and 1q21 amplification (P=0.03). The overall survival (OS) benefit was more prominent in IgG than in IgD when patients received bortezomib; however, they showed no significant difference when they received older therapies such as melphalan combined with prednisone or vincristine combined with adriamycin and dexamethasone. Fluorescence in situ hybridization (FISH) results showed that 17.6% had 17p13 deletion. Conventional cytogenetics revealed that 13.3% were hypodiploid and those cases had the worst survival, but hyperdiploid cases (9.3%) did not show any survival benefit compared with those with a normal karyotype (77.4%). Median OS and progression-free survival for all patients were 54 and 26 months, respectively. Significant factors for survival by multivariate analysis were gender, ISS stage, number of FISH abnormalities and extramedullary disease. MM in mainland China presents with different features, with patients being of younger age and having higher risk and more survival benefit in IgG patients receiving bortezomib.
Collapse
|