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Gertz M, Abonour R, Gibbs SN, Finkel M, Landau H, Lentzsch S, Lin G, Mahindra A, Quock T, Rosenbaum C, Rosenzweig M, Sidana S, Tuchman SA, Witteles R, Yermilov I, Broder MS. Using a Modified Delphi Panel to Estimate Health Service Utilization for Patients with Advanced and Non-Advanced Systemic Light Chain Amyloidosis. CEOR 2023; 15:673-680. [PMID: 37719133 PMCID: PMC10503521 DOI: 10.2147/ceor.s412079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose Patients with diagnosed with systemic light chain (AL) amyloidosis at advanced Mayo stages have greater morbidity and mortality than those diagnosed at non-advanced stages. Estimating service use by severity is difficult because Mayo stage is not available in many secondary databases. We used an expert panel to estimate healthcare utilization among advanced and non-advanced AL amyloidosis patients. Patients and Methods Using the RAND/UCLA modified Delphi method, expert panelists completed 180 healthcare utilization estimates, consisting of inpatient and outpatient visits, testing, chemotherapy, and procedures by disease severity and organ involvement during two treatment phases (the 1 year after starting first line [1L] therapy and 1 year following treatment [post-1L]). Estimates were also provided for post-1L by hematologic treatment response (complete or very good partial response [CR/VGPR], partial, no response or relapse [PR/NR/R]). Areas of disagreement were discussed during a meeting, after which ratings were completed a second time. Results During 1L therapy, 55% of advanced patients had ≥1 hospitalization and 38% had ≥2 admissions. Rates of hematopoietic stem cell transplant (HSCT) in advanced patients were 5%, while pacemaker or implantable cardioverter defibrillator (ICD) placement were 15%. During post-1L therapy, rates of hospitalization in advanced patients remained high (≥1 hospitalization: 20-43%, ≥2 hospitalizations: 10-20%), and up to 10% of advanced patients had a HSCT. Ten percent of these patients underwent pacemaker/ICD placement. Conclusion Experts estimated advanced patients, who would not be good candidates for HSCT, would have high rates of hospitalization (traditionally the most expensive type of healthcare utilization) and other health service use. The development of new treatment options that can facilitate organ recovery and improve function may lead to decreased utilization.
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Affiliation(s)
- Morie Gertz
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rafat Abonour
- Department of Medicine, Indiana University School of Medicine; Director, Multiple Myeloma, Waldenstrom's Disease and Amyloidosis Program, Indianapolis, IN, USA
| | - Sarah N Gibbs
- PHAR (Partnership for Health Analytic Research), Beverly Hills, CA, USA
| | | | - Heather Landau
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Suzanne Lentzsch
- Multiple Myeloma and Amyloidosis Program, Columbia University Medical Center, New York, NY, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anuj Mahindra
- Malignant Hematology, Scripps Clinic MD Anderson Cancer Center, La Jolla, CA, USA
| | - Tiffany Quock
- Health Economics and Outcomes Research, Prothena Biosciences Ltd., South San Francisco, CA, USA
| | - Cara Rosenbaum
- Department of Medicine, Hematology/Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Michael Rosenzweig
- Division of Multiple Myeloma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Surbhi Sidana
- Division of Cardiovascular Medicine, Stanford School of Medicine, Palo Alto, CA, USA
| | - Sascha A Tuchman
- Division of Hematology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Ronald Witteles
- Division of Cardiovascular Medicine, Stanford School of Medicine, Palo Alto, CA, USA
| | - Irina Yermilov
- PHAR (Partnership for Health Analytic Research), Beverly Hills, CA, USA
| | - Michael S Broder
- PHAR (Partnership for Health Analytic Research), Beverly Hills, CA, USA
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Abstract
PURPOSE OF REVIEW Solitary plasmacytoma is a rare plasma cell dyscrasia, classified as solitary bone plasmacytoma or solitary extramedullary plasmacytoma. These entities are diagnosed by demonstrating infiltration of a monoclonal plasma cell population in a single bone lesion or presence of plasma cells involving a soft tissue mass, respectively. Both diseases represent a single localized process without significant plasma cell infiltration into the bone marrow or evidence of end organ damage. Clinically, it is important to classify plasmacytoma as having completely undetectable bone marrow involvement versus minimal marrow involvement. Here, we discuss the diagnosis, management, and prognosis of solitary plasmacytoma. RECENT FINDINGS There have been numerous therapeutic advances in the treatment of multiple myeloma over the last few years. While the treatment paradigm for solitary plasmacytoma has not changed significantly over the years, progress has been made with regard to diagnostic tools available that can risk stratify disease, offer prognostic value, and discern solitary plasmacytoma from quiescent or asymptomatic myeloma at the time of diagnosis. Despite various studies investigating the use of systemic therapy or combined modality therapy for the treatment of plasmacytoma, radiation therapy remains the mainstay of therapy. Much of the recent advancement in the management of solitary plasmacytoma has been through the development of improved diagnostic techniques.
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Affiliation(s)
- Andrew Pham
- Scripps Clinic, 10666 N Torrey Pines Road, MS312, La Jolla, CA, 92037, USA
| | - Anuj Mahindra
- Scripps Clinic, 10666 N Torrey Pines Road, MS312, La Jolla, CA, 92037, USA.
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3
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Lonial S, Jacobus S, Fonseca R, Weiss M, Kumar S, Orlowski RZ, Kaufman JL, Yacoub AM, Buadi FK, O'Brien T, Matous JV, Anderson DM, Emmons RV, Mahindra A, Wagner LI, Dhodapkar MV, Rajkumar SV. Randomized Trial of Lenalidomide Versus Observation in Smoldering Multiple Myeloma. J Clin Oncol 2019; 38:1126-1137. [PMID: 31652094 DOI: 10.1200/jco.19.01740] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Observation is the current standard of care for smoldering multiple myeloma. We hypothesized that early intervention with lenalidomide could delay progression to symptomatic multiple myeloma. METHODS We conducted a randomized trial that assessed the efficacy of single-agent lenalidomide compared with observation in patients with intermediate- or high-risk smoldering multiple myeloma. Lenalidomide was administered orally at a dose of 25 mg on days 1 to 21 of a 28-day cycle. The primary end point was progression-free survival, with disease progression requiring the development of end-organ damage attributable to multiple myeloma and biochemical progression. RESULTS One hundred eighty-two patients were randomly assigned-92 patients to the lenalidomide arm and 90 to the observation arm. Median follow-up is 35 months. Response to therapy was observed in 50% (95% CI, 39% to 61%) of patients in the lenalidomide arm, with no responses in the observation arm. Progression-free survival was significantly longer with lenalidomide compared with observation (hazard ratio, 0.28; 95% CI, 0.12 to 0.62; P = .002). One-, 2-, and 3-year progression-free survival was 98%, 93%, and 91% for the lenalidomide arm versus 89%, 76%, and 66% for the observation arm, respectively. Only six deaths have been reported, two in the lenalidomide arm versus four in the observation arm (hazard ratio for death, 0.46; 95% CI, 0.08 to 2.53). Grade 3 or 4 nonhematologic adverse events occurred in 25 patients (28%) on lenalidomide. CONCLUSION Early intervention with lenalidomide in smoldering multiple myeloma significantly delays progression to symptomatic multiple myeloma and the development of end-organ damage.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jeffrey V Matous
- Colorado Blood Cancer Institute and Sarah Cannon Research Institute, Denver, CO
| | | | | | | | - Lynne I Wagner
- Wake Forest University Health Sciences, Winston-Salem, NC
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4
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Radivoyevitch T, Dean RM, Shaw BE, Brazauskas R, Tecca HR, Molenaar RJ, Battiwalla M, Savani BN, Flowers MED, Cooke KR, Hamilton BK, Kalaycio M, Maciejewski JP, Ahmed I, Akpek G, Bajel A, Buchbinder D, Cahn JY, D’Souza A, Daly A, DeFilipp Z, Ganguly S, Hamadani M, Hayashi RJ, Hematti P, Inamoto Y, Khera N, Kindwall-Keller T, Landau H, Lazarus H, Majhail NS, Marks DI, Olsson RF, Seo S, Steinberg A, William BM, Wirk B, Yared JA, Aljurf M, Abidi MH, Allewelt H, Beitinjaneh A, Cook R, Cornell RF, Fay JW, Hale G, Chakrabarty JH, Jodele S, Kasow KA, Mahindra A, Malone AK, Popat U, Rizzo JD, Schouten HC, Warwick AB, Wood WA, Sekeres MA, Litzow MR, Gale RP, Hashmi SK. Risk of acute myeloid leukemia and myelodysplastic syndrome after autotransplants for lymphomas and plasma cell myeloma. Leuk Res 2018; 74:130-136. [PMID: 30055822 PMCID: PMC6219911 DOI: 10.1016/j.leukres.2018.07.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/26/2018] [Accepted: 07/17/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Exposures to DNA-damaging drugs and ionizing radiations increase risks of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). METHODS 9028 recipients of hematopoietic cell autotransplants (1995-2010) for Hodgkin lymphoma (HL; n = 916), non-Hodgkin lymphoma (NHL; n = 3546) and plasma cell myeloma (PCM; n = 4566), reported to the CIBMTR, were analyzed for risk of subsequent AML or MDS. RESULTS 335 MDS/AML cases were diagnosed posttransplant (3.7%). Variables associated with an increased risk for AML or MDS in multivariate analyses were: (1) conditioning with total body radiation versus chemotherapy alone for HL (HR = 4.0; 95% confidence interval [1.4, 11.6]) and NHL (HR = 2.5 [1.1, 2.5]); (2) ≥3 versus 1 line of chemotherapy for NHL (HR = 1.9 [1.3, 2.8]); and (3) subjects with NHL transplanted in 2005-2010 versus 1995-1999 (HR = 2.1 [1.5, 3.1]). Using Surveillance, Epidemiology and End Results (SEER) data, we found risks for AML/MDS in HL, NHL and PCM to be 5-10 times the background rate. In contrast, relative risks were 10-50 for AML and approximately 100 for MDS in the autotransplant cohort. CONCLUSIONS There are substantial risks of AML and MDS after autotransplants for HL, NHL and PCM.
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Affiliation(s)
- Tomas Radivoyevitch
- Dept. of Translational Hematology & Oncology Research, Cleveland Clinic Foundation, Cleveland, OH
| | - Robert M. Dean
- Dept. of Translational Hematology & Oncology Research, Cleveland Clinic Foundation, Cleveland, OH
| | - Bronwen E. Shaw
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
| | - Ruta Brazauskas
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Heather R. Tecca
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
| | - Remco J. Molenaar
- Dept. of Translational Hematology & Oncology Research, Cleveland Clinic Foundation, Cleveland, OH
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Minoo Battiwalla
- Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Bipin N. Savani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Mary E. D. Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kenneth R. Cooke
- Pediatric Blood and Marrow Transplantation Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Betty K. Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Matt Kalaycio
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | | | - Ibrahim Ahmed
- Department of Hematology Oncology and Bone Marrow Transplantation, The Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Görgün Akpek
- Stem Cell Transplantation and Cell Therapy, Rush University Medical Center, Chicago, IL
| | - Ashish Bajel
- Royal Melbourne Hospital City Campus, Melbourne, Australia
| | - David Buchbinder
- Division of Pediatrics Hematology, Children’s Hospital of Orange County, Orange, CA
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble Alpes, Grenoble, France
| | - Anita D’Souza
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
| | - Andrew Daly
- Tom Baker Cancer Center, Calgary, AB, Canada
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA
| | - Siddhartha Ganguly
- Blood and Marrow Transplantation, University of Kansas Medical Center, Kansas City, KS
| | - Mehdi Hamadani
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
| | - Robert J. Hayashi
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Peiman Hematti
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA
| | - Heather Landau
- Bone Marrow Transplant Service, Division of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hillard Lazarus
- Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | | | - David I. Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Richard F. Olsson
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Sachiko Seo
- Department of Hematology & Oncology; National Cancer Research Center East, Chiba, Japan
| | - Amir Steinberg
- Department of Hematology-Oncology, Mount Sinai Hospital, New York, NY
| | | | - Baldeep Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA
| | - Jean A. Yared
- Department of Medicine, University of Maryland, Baltimore, MD
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital,, Riyadh, Saudi Arabia
| | - Muneer H. Abidi
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | | | - Rachel Cook
- Oregon Health and Science University, Portland, OR
| | - Robert F. Cornell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Gregory Hale
- Department of Hematology/Oncology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | | | - Sonata Jodele
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Anuj Mahindra
- Scripps Blood & Marrow Transplant Program, La Jolla, CA
| | - Adriana K. Malone
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - J. Douglas Rizzo
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI
| | - Harry C. Schouten
- Department of Hematology, Academische Ziekenhuis, Maastricht, Netherlands
| | - Anne B. Warwick
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - William A. Wood
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mikkael A. Sekeres
- Dept. of Translational Hematology & Oncology Research, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Robert P. Gale
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Shahrukh K. Hashmi
- Department of Oncology, King Faisal Specialist Hospital,, Riyadh, Saudi Arabia
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5
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Musto P, Anderson KC, Attal M, Richardson PG, Badros A, Hou J, Comenzo R, Du J, Durie BGM, San Miguel J, Einsele H, Chen WM, Garderet L, Pietrantuono G, Hillengass J, Kyle RA, Moreau P, Lahuerta JJ, Landgren O, Ludwig H, Larocca A, Mahindra A, Cavo M, Mazumder A, McCarthy PL, Nouel A, Rajkumar SV, Reiman A, Riva E, Sezer O, Terpos E, Turesson I, Usmani S, Weiss BM, Palumbo A. Second primary malignancies in multiple myeloma: an overview and IMWG consensus. Ann Oncol 2018; 29:1074. [PMID: 28541409 DOI: 10.1093/annonc/mdx160] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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6
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Buchbinder D, Kelly DL, Duarte RF, Auletta JJ, Bhatt N, Byrne M, DeFilipp Z, Gabriel M, Mahindra A, Norkin M, Schoemans H, Shah AJ, Ahmed I, Atsuta Y, Basak GW, Beattie S, Bhella S, Bredeson C, Bunin N, Dalal J, Daly A, Gajewski J, Gale RP, Galvin J, Hamadani M, Hayashi RJ, Adekola K, Law J, Lee CJ, Liesveld J, Malone AK, Nagler A, Naik S, Nishihori T, Parsons SK, Scherwath A, Schofield HL, Soiffer R, Szer J, Twist I, Warwick AB, Wirk BM, Yi J, Battiwalla M, Flowers MDE, Savani B, Shaw BE. Neurocognitive dysfunction in hematopoietic cell transplant recipients: expert review from the late effects and Quality of Life Working Committee of the CIBMTR and complications and Quality of Life Working Party of the EBMT. Bone Marrow Transplant 2018; 53:535-555. [PMID: 29343837 DOI: 10.1038/s41409-017-0055-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/19/2017] [Accepted: 11/19/2017] [Indexed: 12/13/2022]
Abstract
Hematopoietic cell transplantation (HCT) is a potentially curative treatment for children and adults with malignant and non-malignant diseases. Despite increasing survival rates, long-term morbidity following HCT is substantial. Neurocognitive dysfunction is a serious cause of morbidity, yet little is known about neurocognitive dysfunction following HCT. To address this gap, collaborative efforts of the Center for International Blood and Marrow Transplant Research and the European Society for Blood and Marrow Transplantation undertook an expert review of neurocognitive dysfunction following HCT. In this review, we define what constitutes neurocognitive dysfunction, characterize its risk factors and sequelae, describe tools and methods to assess neurocognitive function in HCT recipients, and discuss possible interventions for HCT patients with this condition. This review aims to help clinicians understand the scope of this health-related problem, highlight its impact on well-being of survivors, and to help determine factors that may improve identification of patients at risk for declines in cognitive functioning after HCT. In particular, we review strategies for preventing and treating neurocognitive dysfunction in HCT patients. Lastly, we highlight the need for well-designed studies to develop and test interventions aimed at preventing and improving neurocognitive dysfunction and its sequelae following HCT.
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Affiliation(s)
- David Buchbinder
- Division of Pediatrics Hematology, Children's Hospital of Orange County, Orange, CA, USA.
| | | | | | - Jeffery J Auletta
- Blood and Marrow Transplant Program and Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA
| | - Neel Bhatt
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Melissa Gabriel
- The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Anuj Mahindra
- Scripps Blood & Marrow Transplant Program, La Jolla, CA, USA
| | - Maxim Norkin
- Division of Pediatrics Hematology, Children's Hospital of Orange County, Orange, CA, USA
| | | | - Ami J Shah
- Division of Stem Cell Transplantation and Regenerative Medicine, Lucille Packard Children's Hospital, Stanford School of Medicine, Palo Alto, CA, USA
| | - Ibrahim Ahmed
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA.,Division of Pediatric Hem/Onc/BMT, Children's Mercy Kansas City, Kansas City, Missouri; UMKC School of Medicine, Kansas City, MO, USA
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Sara Beattie
- Department of Psychosocial Oncology and Rehabilitation, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Sita Bhella
- Department of Medicine, School of Medicine, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Christopher Bredeson
- The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nancy Bunin
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jignesh Dalal
- Division of Pediatric Hem/Onc/BMT, Children's Mercy Kansas City, Kansas City, Missouri; UMKC School of Medicine, Kansas City, MO, USA.,Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Andrew Daly
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | | | - Robert Peter Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - John Galvin
- Division of Hematology/Oncology, Department of Medicine and Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mehdi Hamadani
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kehinde Adekola
- Division of Hematology/Oncology, Department of Medicine and Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jason Law
- Tufts University Medical Center, Boston, MA, USA
| | - Catherine J Lee
- Utah Blood and Marrow Transplant Program Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Jane Liesveld
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Adriana K Malone
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arnon Nagler
- Hematology Division and BMT, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Tel Aviv University, Tel Aviv, Israel
| | - Seema Naik
- Texas Transplant Institute, San Antonino, TX, USA
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Angela Scherwath
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Jeff Szer
- Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Ida Twist
- The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Anne B Warwick
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Jean Yi
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Minoo Battiwalla
- Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Mary D E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bronwen E Shaw
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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7
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Kelly DL, Buchbinder D, Duarte RF, Auletta JJ, Bhatt N, Byrne M, DeFilipp Z, Gabriel M, Mahindra A, Norkin M, Schoemans H, Shah AJ, Ahmed I, Atsuta Y, Basak GW, Beattie S, Bhella S, Bredeson C, Bunin N, Dalal J, Daly A, Gajewski J, Gale RP, Galvin J, Hamadani M, Hayashi RJ, Adekola K, Law J, Lee CJ, Liesveld J, Malone AK, Nagler A, Naik S, Nishihori T, Parsons SK, Scherwath A, Schofield HL, Soiffer R, Szer J, Twist I, Warwick A, Wirk BM, Yi J, Battiwalla M, Flowers ME, Savani B, Shaw BE. Neurocognitive Dysfunction in Hematopoietic Cell Transplant Recipients: Expert Review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Complications and Quality of Life Working Party of the European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2017; 24:228-241. [PMID: 28939455 DOI: 10.1016/j.bbmt.2017.09.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/04/2017] [Indexed: 12/25/2022]
Abstract
Hematopoietic cell transplantation (HCT) is a potentially curative treatment for children and adults with malignant and nonmalignant diseases. Despite increasing survival rates, long-term morbidity after HCT is substantial. Neurocognitive dysfunction is a serious cause of morbidity, yet little is known about neurocognitive dysfunction after HCT. To address this gap, collaborative efforts of the Center for International Blood and Marrow Transplant Research and the European Society for Blood and Marrow Transplantation undertook an expert review of neurocognitive dysfunction after HCT. In this review we define what constitutes neurocognitive dysfunction, characterize its risk factors and sequelae, describe tools and methods to assess neurocognitive function in HCT recipients, and discuss possible interventions for HCT patients with this condition. This review aims to help clinicians understand the scope of this health-related problem, highlight its impact on well-being of survivors, and help determine factors that may improve identification of patients at risk for declines in cognitive functioning after HCT. In particular, we review strategies for preventing and treating neurocognitive dysfunction in HCT patients. Finally, we highlight the need for well-designed studies to develop and test interventions aimed at preventing and improving neurocognitive dysfunction and its sequelae after HCT.
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Affiliation(s)
| | - David Buchbinder
- Divsison of Pediatrics Hematology, Children's Hospital of Orange County, Orange, California
| | | | - Jeffrey J Auletta
- Blood and Marrow Transplant Program and Host Defense Program, Division of Hematology, Nationwide Children's Hospital, Columbus, Ohio; Blood and Marrow Transplant Program and Host Defense Program, Division of Oncology, Nationwide Children's Hospital, Columbus, Ohio; Blood and Marrow Transplant Program and Host Defense Program, Division of Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Neel Bhatt
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Byrne
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Melissa Gabriel
- The Children's Hospital at Westmead, New South Wales, Australia
| | - Anuj Mahindra
- Scripps Blood & Marrow Transplant Program, La Jolla, California
| | - Maxim Norkin
- Shands HealthCare and University of Florida, Gainesville, Florida
| | | | - Ami J Shah
- Division of Stem Cell Transplantation and Regenerative Medicine, Lucille Packard Children's Hospital, Stanford School of Medicine, Palo Alto, California
| | - Ibrahim Ahmed
- Division of Pediatric Hem/Onc/BMT, Children's Mercy Kansas City, Kansas City, Missouri; UMKC School of Medicine, Kansas City, Missouri
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Sara Beattie
- Department of Psychosocial Oncology and Rehabilitation, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Sita Bhella
- Department of Psychosocial Oncology and Rehabilitation, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Christopher Bredeson
- Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nancy Bunin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jignesh Dalal
- Case Western Reserve School of Medicine, Cleveland, Ohio; Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Andrew Daly
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | | | - Robert Peter Gale
- Division of Experimental Medicine, Department of Medicine, Imperial College London, Hematology Research Centre, London, United Kingdom
| | - John Galvin
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Kehinde Adekola
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jason Law
- Tufts University Medical Center, Boston, Massachusetts
| | - Catherine J Lee
- Utah Blood and Marrow Transplant Program Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jane Liesveld
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Adriana K Malone
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arnon Nagler
- Hematology Division and BMT, Chaim Sheba Medical Center, Tel Hashomer, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Seema Naik
- Texas Transplant Institute, San Antonino, Texas
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Angela Scherwath
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Jeff Szer
- Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, Australia
| | - Ida Twist
- The Children's Hospital at Westmead, New South Wales, Australia
| | - Anne Warwick
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - Jean Yi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Minoo Battiwalla
- Hematopoietic Transplantation Section, Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Bipin Savani
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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8
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Musto P, Anderson K, Attal M, Richardson P, Badros A, Hou J, Comenzo R, Du J, Durie B, San Miguel J, Einsele H, Chen W, Garderet L, Pietrantuono G, Hillengass J, Kyle R, Moreau P, Lahuerta J, Landgren O, Ludwig H, Larocca A, Mahindra A, Cavo M, Mazumder A, McCarthy P, Nouel A, Rajkumar S, Reiman A, Riva E, Sezer O, Terpos E, Turesson I, Usmani S, Weiss B, Palumbo A. Second primary malignancies in multiple myeloma: an overview and IMWG consensus. Ann Oncol 2017; 28:228-245. [DOI: 10.1093/annonc/mdw606] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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9
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Boyiadzis M, Bishop MR, Abonour R, Anderson KC, Ansell SM, Avigan D, Barbarotta L, Barrett AJ, Van Besien K, Bergsagel PL, Borrello I, Brody J, Brufsky J, Cairo M, Chari A, Cohen A, Cortes J, Forman SJ, Friedberg JW, Fuchs EJ, Gore SD, Jagannath S, Kahl BS, Kline J, Kochenderfer JN, Kwak LW, Levy R, de Lima M, Litzow MR, Mahindra A, Miller J, Munshi NC, Orlowski RZ, Pagel JM, Porter DL, Russell SJ, Schwartz K, Shipp MA, Siegel D, Stone RM, Tallman MS, Timmerman JM, Van Rhee F, Waller EK, Welsh A, Werner M, Wiernik PH, Dhodapkar MV. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of hematologic malignancies: multiple myeloma, lymphoma, and acute leukemia. J Immunother Cancer 2016; 4:90. [PMID: 28018601 PMCID: PMC5168808 DOI: 10.1186/s40425-016-0188-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/07/2016] [Indexed: 12/24/2022] Open
Abstract
Increasing knowledge concerning the biology of hematologic malignancies as well as the role of the immune system in the control of these diseases has led to the development and approval of immunotherapies that are resulting in impressive clinical responses. Therefore, the Society for Immunotherapy of Cancer (SITC) convened a hematologic malignancy Cancer Immunotherapy Guidelines panel consisting of physicians, nurses, patient advocates, and patients to develop consensus recommendations for the clinical application of immunotherapy for patients with multiple myeloma, lymphoma, and acute leukemia. These recommendations were developed following the previously established process based on the Institute of Medicine's clinical practice guidelines. In doing so, a systematic literature search was performed for high-impact studies from 2004 to 2014 and was supplemented with further literature as identified by the panel. The consensus panel met in December of 2014 with the goal to generate consensus recommendations for the clinical use of immunotherapy in patients with hematologic malignancies. During this meeting, consensus panel voting along with discussion were used to rate and review the strength of the supporting evidence from the literature search. These consensus recommendations focus on issues related to patient selection, toxicity management, clinical endpoints, and the sequencing or combination of therapies. Overall, immunotherapy is rapidly emerging as an effective therapeutic strategy for the management of hematologic malignances. Evidence-based consensus recommendations for its clinical application are provided and will be updated as the field evolves.
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Affiliation(s)
- Michael Boyiadzis
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, 5150 Centre Avenue, Suite 564, Pittsburg, PA 15232 USA
| | - Michael R. Bishop
- Hematopoietic Cellular Therapy Program, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637 USA
| | - Rafat Abonour
- Indiana University School of Medicine, 980 W. Walnut St., Walther Hall-R3, C400, Indianapolis, IN 46202 USA
| | | | | | - David Avigan
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Lisa Barbarotta
- Smilow Cancer Hospital at Yale New Haven, 35 Park Street, New Haven, CT 06519 USA
| | - Austin John Barrett
- National Institutes of Health, Building 10-CRC Room 3-5330, Bethesda, MD 20814 USA
| | - Koen Van Besien
- Weill Cornell Medical College, 407 E 71st St, New York, NY 10065 USA
| | | | - Ivan Borrello
- Johns Hopkins School of Medicine, 1650 Orleans St, Baltimore, MD 21231 USA
| | - Joshua Brody
- Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY 10029 USA
| | - Jill Brufsky
- University of Pittsburgh Cancer Institute, 5150 Centre Avenue, Pittsburgh, PA 15232 USA
| | - Mitchell Cairo
- New York Medical College at Maria Fareri Children’s Hospital, 100 Woods Road, Valhalla, New York 10595 USA
| | - Ajai Chari
- Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY 10029 USA
| | - Adam Cohen
- Abramson Cancer Center at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Jorge Cortes
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Stephen J. Forman
- City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010 USA
| | - Jonathan W. Friedberg
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642 USA
| | - Ephraim J. Fuchs
- Johns Hopkins University School of Medicine, 401 N. Broadway, Baltimore, MD 21231 USA
| | - Steven D. Gore
- Yale Cancer Center, 333 Cedar Street, New Haven, CT 06511 USA
| | - Sundar Jagannath
- Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, New York, NY 10029 USA
| | - Brad S. Kahl
- Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110 USA
| | - Justin Kline
- The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - James N. Kochenderfer
- National Institutes of Health, National Cancer Institute, 8500 Roseweood Drive, Bethesda, MD 20814 USA
| | - Larry W. Kwak
- City of Hope National Medical Center, 1500 E. Duarte Road, Beckman Bldg., Room 4117, Duarte, CA 91010 USA
| | - Ronald Levy
- Division of Medical Oncology, Stanford University School of Medicine, 269 Campus Drive, Stanford, CA 94305 USA
| | - Marcos de Lima
- Department of Medicine-Hematology and Oncology, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106 USA
| | - Mark R. Litzow
- Department of Hematology, Mayo Clinic Cancer Center, 200 First Street SW, Rochester, MN 55905 USA
| | - Anuj Mahindra
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, Box 0324, San Francisco, CA 94143 USA
| | - Jeffrey Miller
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455 USA
| | - Nikhil C. Munshi
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Dana B106, Boston, MA 02215 USA
| | - Robert Z. Orlowski
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 429, Houston, TX 77030 USA
| | - John M. Pagel
- Swedish Cancer Institute, 1221 Madison Street, Suite 1020, Seattle, WA 98104 USA
| | - David L. Porter
- University of Pennsylvania, 3400 Civic Center Blvd, PCAM 12 South Pavilion, Philadelphia, PA 19104 USA
| | | | - Karl Schwartz
- Patients Against Lymphoma, 3774 Buckwampum Road, Riegelsville, PA 18077 USA
| | - Margaret A. Shipp
- Dana-Farber Cancer Institute, 450 Brookline Ave, Mayer 513, Boston, MA 02215 USA
| | - David Siegel
- Hackensack University Medical Center, 92 2nd St., Hackensack, NJ 07601 USA
| | - Richard M. Stone
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 USA
| | - Martin S. Tallman
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| | - John M. Timmerman
- University of California, Los Angeles, 10833 LeConte Ave., Los Angeles, CA 90095 USA
| | - Frits Van Rhee
- University of Arkansas for Medical Sciences, Myeloma Institute, 4301 W Markham #816, Little Rock, AR 72205 USA
| | - Edmund K. Waller
- Winship Cancer Institute, Emory University, 1365B Clifton Road NE, Atlanta, GA 30322 USA
| | - Ann Welsh
- University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213 USA
| | - Michael Werner
- Patient Advocate, 33 East Bellevue Place, Chicago, IL 60611 USA
| | - Peter H. Wiernik
- Cancer Research Foundation of New York, 43 Longview Lane, Chappaqua, NY 10514 USA
| | - Madhav V. Dhodapkar
- Department of Hematology & Immunobiology, Yale University, 333 Cedar Street, Box 208021, New Haven, CT 06510 USA
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Laubach J, Garderet L, Mahindra A, Gahrton G, Caers J, Sezer O, Voorhees P, Leleu X, Johnsen HE, Streetly M, Jurczyszyn A, Ludwig H, Mellqvist UH, Chng WJ, Pilarski L, Einsele H, Hou J, Turesson I, Zamagni E, Chim CS, Mazumder A, Westin J, Lu J, Reiman T, Kristinsson S, Joshua D, Roussel M, O'Gorman P, Terpos E, McCarthy P, Dimopoulos M, Moreau P, Orlowski RZ, Miguel JS, Anderson KC, Palumbo A, Kumar S, Rajkumar V, Durie B, Richardson PG. Management of relapsed multiple myeloma: recommendations of the International Myeloma Working Group. Leukemia 2015; 30:1005-17. [DOI: 10.1038/leu.2015.356] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/11/2015] [Accepted: 09/24/2015] [Indexed: 11/09/2022]
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11
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Mannis GN, Martin TG, Damon LE, Logan AC, Ai W, Gaensler KM, Kaplan LD, Mahindra A, Olin RL, Sayre P, Smith CC, Wolf JL, Hwang J, Andreadis C. Long-Term Outcomes of 133 Patients with Intermediate-Risk Acute Myeloid Leukemia Treated with High-Dose Chemotherapy and Autologous Stem Cell Rescue in First Complete Remission. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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O'Donnell E, Mahindra A, Yee AJ, Nardi V, Birrer N, Horick N, Borger D, Finkelstein D, Iafrate JA, Raje N. Clinical Grade "SNaPshot" Genetic Mutation Profiling in Multiple Myeloma. EBioMedicine 2014; 2:71-3. [PMID: 26137536 PMCID: PMC4485483 DOI: 10.1016/j.ebiom.2014.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 11/26/2022] Open
Abstract
Whole genome sequencing studies have identified several oncogenic mutations in multiple myeloma (MM). As MM progresses, it evolves genetically underscoring the need to have tools for rapid detection of targetable mutations to optimize individualized treatment. Massachusetts General Hospital (MGH) has developed a Clinical Laboratory Improvement Amendments (CLIA)-approved, high-throughput, genotyping platform to determine the mutation status of a panel of known oncogenes. Sequence analysis using SNaPshot on DNA extracted from bone marrow and extramedullary plasmacytomas is feasible and leads to the detection of potentially druggable mutations. Screening MM patients for somatic mutations in oncogenes may provide novel targets leading to additional therapies for this patient population. SNaPshot on deoxyribonucleic acid (DNA) extracted from bone marrow and extramedullary plasmacytomas is feasible. SNaPshot can detect potentially druggable mutations and thereby integrate rapid genomic analysis into clinical practice. SNaPshot can rapidly identify 152 mutations across 15 genes.
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Affiliation(s)
| | - Anuj Mahindra
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | - Andrew J Yee
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | - Valentina Nardi
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | - Nicole Birrer
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | - Nora Horick
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | - Darrell Borger
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | | | - John A Iafrate
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
| | - Noopur Raje
- Massachusetts General Hospital Cancer Center, Boston, MA, United States
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13
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Mannis GN, Logan AC, Leavitt AD, Yanada M, Hwang J, Olin RL, Damon LE, Andreadis C, Ai WZ, Gaensler KM, Greene CC, Gupta NK, Kaplan LD, Mahindra A, Miyazaki Y, Naoe T, Ohtake S, Sayre PH, Smith CC, Venstrom JM, Wolf JL, Caballero L, Emi N, Martin TG. Delayed hematopoietic recovery after auto-SCT in patients receiving arsenic trioxide-based therapy for acute promyelocytic leukemia: a multi-center analysis. Bone Marrow Transplant 2014; 50:40-4. [PMID: 25243620 DOI: 10.1038/bmt.2014.201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/28/2014] [Accepted: 08/07/2014] [Indexed: 11/09/2022]
Abstract
A potential link between arsenic (ATO)-based therapy and delayed hematopoietic recovery after autologous hematopoietic SCT (HSCT) for acute promyelocytic leukemia (APL) has previously been reported. We retrospectively reviewed the clinical histories of 58 patients undergoing autologous HSCT for APL at 21 institutions in the United States and Japan. Thirty-three (56%) of the patients received ATO-based therapy prior to stem cell collection. Delayed neutrophil engraftment occurred in 10 patients (17%): 9 of the 10 patients (90%) received prior ATO (representing 27% of all ATO-treated patients), compared with 1 of the 10 patients (10%) not previously treated with ATO (representing 4% of all ATO-naïve patients; P<0.001). Compared with ATO-naïve patients, ATO-treated patients experienced significantly longer times to ANC recovery (median 12 days vs 9 days, P<0.001). In multivariate analysis, the only significant independent predictor of delayed neutrophil engraftment was prior treatment with ATO (hazard ratio 4.87; P<0.001). Of the available stem cell aliquots from APL patients, the median viable post-thaw CD34+ cell recovery was significantly lower than that of cryopreserved autologous stem cell products from patients with non-APL AML. Our findings suggest that ATO exposure prior to CD34+ cell harvest has deleterious effects on hematopoietic recovery after autologous HSCT.
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Affiliation(s)
- G N Mannis
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - A C Logan
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - A D Leavitt
- Departments of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - M Yanada
- Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan
| | - J Hwang
- Department of Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - R L Olin
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - L E Damon
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - C Andreadis
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - W Z Ai
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - K M Gaensler
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - C C Greene
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - N K Gupta
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - L D Kaplan
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - A Mahindra
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Y Miyazaki
- Department of Hematology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Naoe
- Department of Hematology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Ohtake
- Department of Clinical Laboratory Science, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - P H Sayre
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - C C Smith
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - J M Venstrom
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - J L Wolf
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - L Caballero
- Departments of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - N Emi
- Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan
| | - T G Martin
- Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
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14
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Cirstea D, Santo L, Hideshima T, Eda H, Mishima Y, Nemani N, Mahindra A, Yee A, Gorgun G, Hu Y, Ohguchi H, Suzuki R, Cottini F, Guichard SM, Anderson KC, Raje N. Delineating the mTOR Kinase Pathway Using a Dual TORC1/2 Inhibitor, AZD8055, in Multiple Myeloma. Mol Cancer Ther 2014; 13:2489-500. [DOI: 10.1158/1535-7163.mct-14-0147] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Lin JJ, Mahindra A, Santo L, Amin S, Sohani AR, Raje N. MicroRNA expression patterns in medullary and extramedullary plasmacytoma. Blood Cancer J 2014; 4:e223. [PMID: 24972152 PMCID: PMC4080212 DOI: 10.1038/bcj.2014.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- J J Lin
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - A Mahindra
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - L Santo
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - S Amin
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - A R Sohani
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - N Raje
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, MA, USA
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16
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Saad A, Mahindra A, Zhang MJ, Zhong X, Costa LJ, Dispenzieri A, Drobyski WR, Freytes CO, Gale RP, Gasparetto CJ, Holmberg LA, Kamble RT, Krishnan AY, Kyle RA, Marks D, Nishihori T, Pasquini MC, Ramanathan M, Lonial S, Savani BN, Saber W, Sharma M, Sorror ML, Wirk BM, Hari PN. Hematopoietic cell transplant comorbidity index is predictive of survival after autologous hematopoietic cell transplantation in multiple myeloma. Biol Blood Marrow Transplant 2014; 20:402-408.e1. [PMID: 24342394 PMCID: PMC3961011 DOI: 10.1016/j.bbmt.2013.12.557] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/10/2013] [Indexed: 12/22/2022]
Abstract
Autologous hematopoietic stem cell transplantation (AHCT) improves survival in patients with multiple myeloma (MM) but is associated with morbidity and nonrelapse mortality (NRM). Hematopoietic cell transplant comorbidity index (HCT-CI) was shown to predict risk of NRM and survival after allogeneic transplantation. We tested the utility of HCT-CI as a predictor of NRM and survival in patients with MM undergoing AHCT. We analyzed outcomes of 1156 patients of AHCT after high-dose melphalan reported to the Center for International Blood and Marrow Transplant Research. Individual comorbidities were prospectively collected at the time of AHCT. The impact of HCT-CI and other potential prognostic factors, including Karnofsky performance score (KPS), on NRM and survival were studied in multivariate Cox regression models. HCT-CI score was 0, 1, 2, 3, and >3 in 42%, 18%, 13%, 13%, and 14% of the study cohort, respectively. Subjects were stratified into 3 risk groups: HCT-CI score of 0 (42%) versus HCT-CI score of 1 to 2 (32%) versus HCT-CI score > 2 (26%). Higher HCT-CI was associated with lower KPS < 90 (33% of subjects score of 0 versus 50% in HCT-CI score > 2). HCT-CI score > 2 was associated with melphalan dose reduction (22% versus 10% in score 0 cohort). One-year NRM was low at 2% (95% confidence interval, 1% to 4%) and did not correlate with HCT-CI score (P = .9). On multivariate analysis, overall survival was inferior in groups with HCT-CI score of 1 to 2 (relative risk, 1.37, [95% confidence interval, 1.01 to 1.87], P = .04) and HCT-CI score > 2 (relative risk, 1.5 [95% confidence interval, 1.09 to 2.08], P = .01). Overall survival was also inferior with KPS < 90 (P < .001), IgA subtype (P ≤ .001), those receiving >1 pretransplant induction regimen (P = .007), and those with resistant disease at the time of AHCT (P < .001). AHCT for MM is associated with low NRM, and death is predominantly related to disease progression. Although a higher HCT-CI score did not predict NRM, it was associated with inferior survival.
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Affiliation(s)
- Ayman Saad
- Bone Marrow Transplantation Program, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anuj Mahindra
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Xiaobo Zhong
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Luciano J Costa
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | | | - William R Drobyski
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cesar O Freytes
- Department of Medicine, University of Texas Health Care System, San Antonio, Texas
| | - Robert Peter Gale
- Visiting Professor of Hematology, Dept. of Medicine, Imperial College, London, United Kingdom
| | | | - Leona A Holmberg
- Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Rammurti T Kamble
- Department of Medicine, Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas
| | - Amrita Y Krishnan
- Division of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Robert A Kyle
- Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - David Marks
- Department of Molecular and Cellular Medicine, Bristol Children's Hospital, Bristol, United Kingdom
| | - Taiga Nishihori
- Department of Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Muthalagu Ramanathan
- Department of Medicine, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Sagar Lonial
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Bipin N Savani
- Department of Medicine, Vanderbilt University Medical Center, Brentwood, Tennessee
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Manish Sharma
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mohamed L Sorror
- Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Baldeep M Wirk
- Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Parameswaran N Hari
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Mannis GN, Damon LE, Ai W, Andreadis C, Gaensler KML, Kaplan LD, Logan AC, Mahindra A, Olin RL, Sayre P, Smith CC, Venstrom JM, Wolf JL, Martin TG. A Phase 1 Study of Targeted, Dose-Escalated Intravenous Busulfan in Combination with Etoposide As Preparative Therapy for Autologous Stem Cell Transplant in Acute Myeloid Leukemia. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Saini N, Mahindra A. Therapeutic strategies for the treatment of multiple myeloma. Discov Med 2013; 15:251-258. [PMID: 23636142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The outcome of patients with myeloma has improved significantly in the past decade with the incorporation of the immunomodulatory drugs thalidomide and lenalidomide and the proteasome inhibitor, bortezomib. Considering nearly all patients relapse, myeloma remains an active area of investigation. There are several promising classes of agents including next generation immunomodulatory agents, proteasome inhibitors, antibody and antitumor immunotherapy approaches that are being evaluated. This article provides an overview on the therapeutic strategies in the treatment of multiple myeloma.
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Affiliation(s)
- Neeraj Saini
- Department of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, Massachusetts 02114, USA
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Abstract
INTRODUCTION The treatment options for patients with multiple myeloma (MM) remain limited. Immunomodulatory agents (IMiDs), such as thalidomide and lenalidomide, have changed the landscape in the treatment of patients with MM while newer IMiDs such as pomalidomide are showing promise in early clinical trials. AREAS COVERED This review focuses on the biologic rationales of IMiDs and the clinical results supporting their use in MM. It includes data on the new IMiD, pomalidomide and also explores the possible utility of combining IMiDs with other agents. A PubMed search and abstracts from oncology scientific meetings (ASCO and ASH) of articles related to IMiDs and MM was conducted. EXPERT OPINION IMiDs have shown clinical activity as single agents and in combination. Thalidomide was the first in class drug. Lenalidomide has a better toxicity profile than thalidomide. Pomalidomide may overcome resistance to lenalidomide indicating differences in their mechanisms of action and resistance. Molecular biomarkers may allow us to identify patients who will respond to IMiDs.
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Affiliation(s)
- Neeraj Saini
- North Shore Medical Center, Internal Medicine, Boston, MA, USA
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20
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Fernández de Larrea C, Kyle RA, Durie BGM, Ludwig H, Usmani S, Vesole DH, Hajek R, San Miguel JF, Sezer O, Sonneveld P, Kumar SK, Mahindra A, Comenzo R, Palumbo A, Mazumber A, Anderson KC, Richardson PG, Badros AZ, Caers J, Cavo M, LeLeu X, Dimopoulos MA, Chim CS, Schots R, Noeul A, Fantl D, Mellqvist UH, Landgren O, Chanan-Khan A, Moreau P, Fonseca R, Merlini G, Lahuerta JJ, Bladé J, Orlowski RZ, Shah JJ. Plasma cell leukemia: consensus statement on diagnostic requirements, response criteria and treatment recommendations by the International Myeloma Working Group. Leukemia 2012; 27:780-91. [PMID: 23288300 DOI: 10.1038/leu.2012.336] [Citation(s) in RCA: 229] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive variant of myeloma characterized by the presence of circulating plasma cells. It is classified as either primary PCL occurring at diagnosis or as secondary PCL in patients with relapsed/refractory myeloma. Primary PCL is a distinct clinic-pathological entity with different cytogenetic and molecular findings. The clinical course is aggressive with short remissions and survival duration. The diagnosis is based upon the percentage (≥ 20%) and absolute number (≥ 2 × 10(9)/l) of plasma cells in the peripheral blood. It is proposed that the thresholds for diagnosis be re-examined and consensus recommendations are made for diagnosis, as well as, response and progression criteria. Induction therapy needs to begin promptly and have high clinical activity leading to rapid disease control in an effort to minimize the risk of early death. Intensive chemotherapy regimens and bortezomib-based regimens are recommended followed by high-dose therapy with autologous stem cell transplantation if feasible. Allogeneic transplantation can be considered in younger patients. Prospective multicenter studies are required to provide revised definitions and better understanding of the pathogenesis of PCL.
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Affiliation(s)
- C Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain.
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21
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Mahindra A, Pozzi S, Raje N. Clinical trials of bisphosphonates in multiple myeloma. Clin Adv Hematol Oncol 2012; 10:582-587. [PMID: 23073123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
More than 80% of patients with multiple myeloma (MM) have osteolytic bone disease, which increases the risk of skeletal-related events (SREs) such as pathologic fracture, spinal cord compression, and the need for radiotherapy or surgery. Bone disease is primarily due to increased osteoclastic activity and impaired osteoblast activity. Bisphosphonates are pyrophosphate analogues with high bone affinity that can inhibit osteoclastic activity. Pamidronate and zoledronic acid are the most commonly used bisphosphonates in multiple myeloma. Other agents include ibandronate and clodronate. Bisphosphonates are associated with several adverse events, such as renal toxicity and osteonecrosis of the jaw. The optimal duration of bisphosphonate therapy has yet to be determined. Clinical trials are investigating tailored approaches to management based on treatment-related changes in levels of bone resorption markers.
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Affiliation(s)
- Anuj Mahindra
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts 02114, USA.
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22
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Mahindra A, Anderson KC. Role of Interleukin 16 in Multiple Myeloma Pathogenesis: * A Potential Novel Therapeutic Target? J Natl Cancer Inst 2012; 104:964-5. [DOI: 10.1093/jnci/djs274] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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23
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Laubach JP, Mitsiades CS, Mahindra A, Luskin MR, Rosenblatt J, Ghobrial IM, Schlossman RL, Avigan D, Raje N, Munshi NC, Anderson KC, Richardson PG. Management of relapsed and relapsed/refractory multiple myeloma. J Natl Compr Canc Netw 2012; 9:1209-16. [PMID: 21975917 DOI: 10.6004/jnccn.2011.0098] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite significant progress in the treatment of multiple myeloma (MM) over the past decade, this disease remains incurable and almost all patients ultimately experience relapse and become refractory to treatment over time. However, the outlook for patients with relapsed MM has improved markedly with the use of the immunomodulatory drugs thalidomide and lenalidomide, and the proteasome inhibitor bortezomib. Moreover, the development of new drug classes based on preclinical rationale and the introduction of next-generation agents is likely to further expand treatment options and improve outcomes for relapsed MM.
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Affiliation(s)
- Jacob P Laubach
- Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA.
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Richardson PG, Laubach JP, Schlossman RL, Ghobrial IM, Mitsiades CS, Rosenblatt J, Mahindra A, Raje N, Munshi N, Anderson KC. The Medical Research Council Myeloma IX trial: the impact on treatment paradigms. Eur J Haematol 2012; 88:1-7. [PMID: 21991938 PMCID: PMC3267050 DOI: 10.1111/j.1600-0609.2011.01721.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2011] [Indexed: 11/29/2022]
Abstract
Osteolytic bone disease is a hallmark of symptomatic multiple myeloma. Bisphosphonates have been the mainstay of treatment to preserve skeletal integrity and prevent skeletal-related events in patients with myeloma-related bone disease. Recently, the MRC Myeloma IX trial demonstrated for the first time improved survival and delayed disease progression with the use of an intravenous amino-bisphosphonate, zoledronic acid, vs. an oral agent, clodronate, with intensive and non-intensive anti-myeloma treatment regimens in patients with newly diagnosed multiple myeloma. These results validate a large body of preclinical, translational and other clinical data suggesting anti-myeloma effects of amino-bisphosphonates. In addition, this trial also provided the first head-to-head evidence for superiority of one bisphosphonate over another (zoledronic acid vs. clodronate) for reducing skeletal morbidity in patients with multiple myeloma, as well as a prospective comparison of toxicities. Despite the use of non-bortezomib containing anti-myeloma treatment regimens in the MRC Myeloma IX trial, these results are encouraging and provide an impetus to continue to evaluate current treatment guidelines for myeloma-associated bone disease.
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Affiliation(s)
- Paul G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
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25
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Mahindra A, Bolwell BJ, Rybicki L, Elder P, Kalaycio M, Dean R, Avalos B, Sobecks R, Tench S, Andresen S, Pohlman B, Sweetenham J, Devine S, Copelan E. Etoposide plus G-CSF priming compared with G-CSF alone in patients with lymphoma improves mobilization without an increased risk of secondary myelodysplasia and leukemia. Bone Marrow Transplant 2011; 47:231-5. [DOI: 10.1038/bmt.2011.73] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Multiple myeloma (MM) is a clonal B-cell malignancy characterized by the aberrant expansion of plasma cells within the bone marrow, as well as at extramedullary sites. Decades of scientific research are now beginning to unravel the intricate biology that underlies the pathophysiology of MM. In particular, the roles of cellular differentiation, molecular pathogenesis, and oncogenes involved in the natural history of MM are becoming clearer. This has enabled the identification of specific cytokines, adhesion molecules, and stromal cells that affect MM cell development, disease progression, and treatment responses. This review describes our current understanding regarding the biology of MM, and how this has led to a robust pipeline of novel therapeutic agents with the potential to overcome resistance to existing MM therapies and, therefore, further improve outcomes in patients with MM.
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Affiliation(s)
- Anuj Mahindra
- Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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27
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Santo L, Hideshima T, Cirstea D, Bandi M, Nelson EA, Gorgun G, Rodig S, Vallet S, Pozzi S, Patel K, Unitt C, Squires M, Hu Y, Chauhan D, Mahindra A, Munshi NC, Anderson KC, Raje N. Antimyeloma activity of a multitargeted kinase inhibitor, AT9283, via potent Aurora kinase and STAT3 inhibition either alone or in combination with lenalidomide. Clin Cancer Res 2011; 17:3259-71. [PMID: 21430070 DOI: 10.1158/1078-0432.ccr-10-3012] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Aurora kinases, whose expression is linked to genetic instability and cellular proliferation, are being investigated as novel therapeutic targets in multiple myeloma (MM). In this study, we investigated the preclinical activity of a small-molecule multitargeted kinase inhibitor, AT9283, with potent activity against Aurora kinase A, Aurora kinase B, and Janus kinase 2/3. EXPERIMENTAL DESIGN We evaluated the in vitro antimyeloma activity of AT9283 alone and in combination with lenalidomide and the in vivo efficacy by using a xenograft mouse model of human MM. RESULTS Our data showed that AT9283 induced cell-growth inhibition and apoptosis in MM. Studying the apoptosis mechanism of AT9283 in MM, we observed features consistent with both Aurora kinase A and Aurora kinase B inhibition, such as increase of cells with polyploid DNA content, decrease in phospho-histone H3, and decrease in phospho-Aurora A. Importantly, AT9283 also inhibited STAT3 tyrosine phosphorylation in MM cells. Genetic depletion of STAT3, Aurora kinase A, or Aurora kinase B showed growth inhibition of MM cells, suggesting a role of AT9283-induced inhibition of these molecules in the underlying mechanism of MM cell death. In vivo studies showed decreased MM cell growth and prolonged survival in AT9283-treated mice compared with controls. Importantly, combination studies of AT9283 with lenalidomide showed significant synergistic cytotoxicity in MM cells, even in the presence of bone marrow stromal cells. Enhanced cytotoxicity was associated with increased inhibition of phosphorylated STAT3 and phosphorylated extracellular signal-regulated kinase. CONCLUSIONS Demonstration of in vitro and in vivo anti-MM activity of AT9283 provides the rationale for the clinical evaluation of AT9283 as monotherapy and in combination therapy for treating patients with MM.
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Affiliation(s)
- Loredana Santo
- Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center, Jerome Lipper Multiple Myeloma Disease Center, Dana-Farber Cancer Institute, Boston, Massachusetts 02114, USA
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28
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Abstract
The past decade has witnessed a dramatic improvement in the therapeutic options in multiple myeloma (MM). Several novel biologically targeted agents are in clinical use and have resulted in improved outcomes. However, the disease remains incurable, underscoring the need for continued efforts towards understanding MM biology, better risk stratification and exploitation of novel therapeutic approaches. Novel agents that target tumor and stromal compartments can be categorized as those that target protein dynamics (e.g., heat shock protein 90 and the ubiquitin–proteasome system), intracellular signaling kinases (e.g., JAK/STAT, PI3k/Akt/mTOR and MAPK pathways), cell cycle molecular machinery (e.g., cyclin-dependent kinase inhibitor and Aurora kinase inhibitors), membrane-bound receptors (e.g., IGF-1, VEGF and CD40), epigenetic modulators (e.g., DNA methyltransferase and histone deacetylase), tumor vasculature and microenvironment (e.g., angiogenesis and integrins) and agents modulating anti-MM immune responses. This article focuses on a series of new therapeutic targets that have shown promising preclinical results and early evidence of anti-MM activity in clinical studies, either alone or in combination with other conventional or novel anti-MM treatments.
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Affiliation(s)
- Anuj Mahindra
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Diana Cirstea
- Leebow Institute of Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Disease Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Noopur Raje
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA and Leebow Institute of Myeloma Therapeutics & Jerome Lipper Multiple Myeloma Disease Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Fonseca R, Richardson P, Giralt S, Lonial S, Rajkumar SV, Stewart AK, Bensinger W, Somlo G, Vescio R, Mikhael J, Reeder C, Tiedemann R, Tricot G, Rifkin R, Shaughnessy J, Munshi N, Raje N, Ghobrial I, Laubach J, Schlossman R, Treon S, Mahindra A, Avigan D, Rosenblatt J, Jagannath S, Niesvizky R, Landau H, Chen-Kiang S, Siegel DS, Zimmerman T, Mehta J, Vesole D, Rosen S, Hofmeister C, Lacy M, Dispenzieri A, Borrello I, Hayman SR, Kumar S, Buadi F, Dingli D, Russell S, Melissa Alsina MA, Fernandez H, Roy V, Pereira D, Stadtmauer E, Vij R, Jakubowiak A, Lentzsch S, Song K, Trudel S, Chen C, Reece D, Stewart D, Singhal S, Comenzo R, Gertz MA, Greipp PR, Durie B, Barlogie B, Anderson K, Dalton W, Coleman M, Novis S, Kyle RA. Conflicts of interest, authorship, and disclosures in industry-related scientific publications. Mayo Clin Proc 2010; 85:197-9; author reply 201-4. [PMID: 20118399 PMCID: PMC2813833 DOI: 10.4065/mcp.2009.0559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Laubach JP, Mitsiades CS, Mahindra A, Schlossman RL, Hideshima T, Chauhan D, Carreau NA, Ghobrial IM, Raje N, Munshi NC, Anderson KC, Richardson PG. Novel Therapies in the Treatment of Multiple Myeloma. J Natl Compr Canc Netw 2009; 7:947-60. [DOI: 10.6004/jnccn.2009.0062] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 09/08/2009] [Indexed: 11/17/2022]
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31
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Laubach JP, Mahindra A, Mitsiades CS, Schlossman RL, Munshi NC, Ghobrial IM, Carreau N, Hideshima T, Anderson KC, Richardson PG. The use of novel agents in the treatment of relapsed and refractory multiple myeloma. Leukemia 2009; 23:2222-32. [PMID: 19741729 DOI: 10.1038/leu.2009.179] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although outcomes for patients with multiple myeloma (MM) have improved over the past decade, the disease remains incurable and even patients who respond well to induction therapy ultimately relapse and require additional treatment. Conventional chemotherapy and high-dose therapy with stem cell transplantation (SCT) have historically been utilized in the management of relapsed MM, but in recent years the immunomodulatory drugs (IMiDs) thalidomide and lenalidomide, as well as the proteasome inhibitor bortezomib, have assumed a primary role in this setting. This review focuses on the role of thalidomide, lenalidomide and bortezomib in relapsed and refractory MM, with additional discussion dedicated to emerging drugs in relapsed MM that may prove beneficial to patients with this disease.
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Affiliation(s)
- J P Laubach
- Department of Medical Oncology, Harvard Medical School, Dana Farber Cancer Institute, Boston, MA, USA.
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32
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Mahindra A, Bolwell B, Sobecks R, Rybicki L, Pohlman B, Dean R, Andresen S, Sweetenham J, Kalaycio M, Copelan E. Elevated pretransplant ferritin is associated with a lower incidence of chronic graft-versus-host disease and inferior survival after myeloablative allogeneic haematopoietic stem cell transplantation. Br J Haematol 2009; 146:310-6. [PMID: 19508292 DOI: 10.1111/j.1365-2141.2009.07774.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Elevated pretransplant serum ferritin levels have been associated with an increased incidence of morbidity and mortality after allogeneic haematopoietic stem cell transplantation (HCT). We studied 222 patients who underwent myeloablative allogeneic HCT in whom pretransplantation serum ferritin levels were available. Pretransplantation ferritin > 1910 microg/l was associated with lower overall survival (P = 0.003), lower relapse-free survival (P = 0.003), decreased chronic graft-versus-host disease (GVHD) (P = 0.019) and increased non-relapse mortality (NRM) (P = 0.042). Similar results were obtained when pretransplantation ferritin was analysed as a continuous variable and by quartiles. Our results indicate that an elevated pretransplant ferritin level adversely impacts transplantation outcomes. The adverse impact of elevated ferritin on NRM and survival was despite its association with lower incidences of acute and chronic GVHD, which are major causes of NRM. The association of ferritin with iron overload and its influence on HCT outcomes requires further prospective validation.
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Affiliation(s)
- Anuj Mahindra
- Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
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Mahindra A, Bolwell B, Rybicki L, Dean R, Pohlman B, Sobecks R, Andresen S, Sweetenham J, Kalaycio M, Copelan E. Busulfan and Cyclophosphamide has Similar Outcomes to High Dose Melphalan as a Preparative Regimen for Autologous Stem Cell Transplantation In Patients With Multiple Myeloma. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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34
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Mahindra A, Bolwell B, Sobecks R, Rybicki L, Pohlman B, Dean R, Andresen S, Sweetenham J, Kalaycio M, Copelan E. Elevated Ferritin Is Associated with Relapse after Autologous Hematopoietic Stem Cell Transplantation for Lymphoma. Biol Blood Marrow Transplant 2008; 14:1239-44. [DOI: 10.1016/j.bbmt.2008.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 08/22/2008] [Indexed: 11/28/2022]
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Abstract
Lenalidomide is an immunomodulatory drug that was developed by modification of the first-generation immunomodulatory drug thalidomide in a drug discovery program. Lenalidomide more potently regulates cellular immune and cytokine responses, while lacking the side-effect profile of thalidomide. The promising activity seen in multiple myeloma and myelodysplastic syndrome has led to its approval by the U.S. Food and Drug Administration in these conditions. The clinical results that we have seen so far, which demonstrate significant efficacy with a tolerable toxicity profile, provide a strong basis for the use of lenalidomide in other malignancies. Combination therapy with lenalidomide could enhance this agent's antineoplastic role; this is likely the position it will occupy in the armamentarium against cancer.
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Affiliation(s)
- Sujith Kalmadi
- Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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