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Durie BGM, Kumar SK, Ammann EM, Fu AZ, Kaila S, Lam A, Usmani SZ, Facon T. Adjusted Indirect Treatment Comparison of Progression-Free Survival with D-Rd and VRd Based on MAIA and SWOG S0777 Individual Patient-Level Data. Adv Ther 2024; 41:1923-1937. [PMID: 38494542 PMCID: PMC11052858 DOI: 10.1007/s12325-024-02807-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/29/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Daratumumab plus lenalidomide and dexamethasone (D-Rd) and bortezomib plus lenalidomide and dexamethasone (VRd) are commonly used treatment combinations for transplant-ineligible (TIE) patients with newly diagnosed multiple myeloma (NDMM). D-Rd and VRd demonstrated superior efficacy relative to lenalidomide and dexamethasone (Rd) in the MAIA and SWOG S0777 trials, respectively, but have not been compared directly in a head-to-head trial. Naïve comparisons of efficacy across the two trials may be biased because MAIA enrolled only TIE patients (median age 73 years), whereas SWOG S0777 enrolled both TIE patients and transplant-eligible patients who chose to defer/refuse frontline stem cell transplantation (median age 63 years). The present study compared progression-free survival (PFS) in TIE patients with NDMM treated with D-Rd versus VRd based on an adjusted indirect treatment comparison (ITC) that leveraged individual patient-level data from MAIA and SWOG S0777. METHODS Harmonized inclusion/exclusion criteria (including age ≥ 65 years as a proxy for transplant ineligibility) and propensity-score weighting were used to balance the trial populations on measured baseline characteristics. After differences in trial populations were adjusted for, an anchored ITC was performed wherein within-trial PFS hazard ratios (HRs) for D-Rd versus Rd and VRd versus Rd were estimated and used to make indirect inference about PFS for D-Rd versus VRd. RESULTS PFS HRs were 0.52 (95% confidence interval [CI] 0.41-0.67) for D-Rd versus Rd based on MAIA data, 0.88 (95% CI 0.63-1.23) for VRd versus Rd based on SWOG S0777 data, and 0.59 (95% CI 0.39-0.90) for the Rd-anchored ITC of D-Rd versus VRd. Sensitivity and subgroup analyses produced results consistent with the primary results. CONCLUSION This anchored ITC demonstrated a greater PFS benefit for D-Rd versus VRd in TIE patients with NDMM. In the absence of head-to-head trials comparing D-Rd and VRd, the present trial may help inform treatment selection in this patient population.
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Affiliation(s)
- Brian G M Durie
- Cedars-Sinai Outpatient Cancer Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
| | - Shaji K Kumar
- Department of Hematology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Alex Z Fu
- Janssen Scientific Affairs, Horsham, PA, USA
- Georgetown University Medical Center, Washington, DC, USA
| | | | - Annette Lam
- Janssen Global Market Access, Raritan, NJ, USA
| | - Saad Z Usmani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thierry Facon
- University of Lille, CHU Lille, Service des Maladies du Sang, Lille, France
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Eythorsson E, Rognvaldsson S, Thorsteinsdottir S, Einarsson Long T, Reed ER, Sigurdardottir GA, Vidarsson B, Onundarson PT, Agnarsson BA, Sigurdardottir M, Olafsson I, Thorsteinsdottir I, Sveinsdottir SV, Sigurdsson F, Thordardottir AR, Palsson R, Indridason OS, Jonsson A, Gislason GK, Olafsson A, Sigurdsson J, Steingrimsdottir H, Hultcrantz M, Durie BGM, Harding S, Landgren O, Aspelund T, Love TJ, Kristinsson SY. Development of a Multivariable Model to Predict the Need for Bone Marrow Sampling in Persons With Monoclonal Gammopathy of Undetermined Significance : A Cohort Study Nested in a Clinical Trial. Ann Intern Med 2024; 177:449-457. [PMID: 38560901 DOI: 10.7326/m23-2540] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) are asymptomatic precursor conditions to multiple myeloma and related disorders. Smoldering multiple myeloma is distinguished from MGUS by 10% or greater bone marrow plasma cells (BMPC) on sampling, has a higher risk for progression, and requires specialist management. OBJECTIVE To develop a multivariable prediction model that predicts the probability that a person with presumed MGUS has 10% or greater BMPC (SMM or worse by bone marrow criteria) to inform the decision to obtain a bone marrow sample and compare its performance to the Mayo Clinic risk stratification model. DESIGN iStopMM (Iceland Screens, Treats or Prevents Multiple Myeloma), a prospective population-based screening study of MGUS. (ClinicalTrials.gov: NCT03327597). SETTING Icelandic population of adults aged 40 years or older. PATIENTS 1043 persons with IgG, IgA, light-chain, and biclonal MGUS detected by screening and an interpretable bone marrow sample. MEASUREMENTS Monoclonal gammopathy of undetermined significance isotype; monoclonal protein concentration; free light-chain ratio; and total IgG, IgM, and IgA concentrations were used as predictors. Bone marrow plasma cells were categorized as 0% to 4%, 5% to 9%, 10% to 14%, or 15% or greater. RESULTS The c-statistic for SMM or worse was 0.85 (95% CI, 0.82 to 0.88), and calibration was excellent (intercept, -0.07; slope, 0.95). At a threshold of 10% predicted risk for SMM or worse, sensitivity was 86%, specificity was 67%, positive predictive value was 32%, and negative predictive value was 96%. Compared with the Mayo Clinic model, the net benefit for the decision to refer for sampling was between 0.13 and 0.30 higher over a range of plausible low-risk thresholds. LIMITATION The prediction model will require external validation. CONCLUSION This accurate prediction model for SMM or worse was developed in a population-based cohort of persons with presumed MGUS and may be used to defer bone marrow sampling and referral to hematology. PRIMARY FUNDING SOURCE International Myeloma Foundation and the European Research Council.
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Affiliation(s)
- Elias Eythorsson
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
| | - Saemundur Rognvaldsson
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
| | - Sigrun Thorsteinsdottir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland, and Department of Hematology, Rigshospitalet, Copenhagen, Denmark (S.T.)
| | - Thorir Einarsson Long
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland, and Skåne University Hospital, Lund, Sweden (T.E.L.)
| | - Elin Ruth Reed
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Gudrun Asta Sigurdardottir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Brynjar Vidarsson
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Pall Torfi Onundarson
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
| | - Bjarni A Agnarsson
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
| | - Margret Sigurdardottir
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Isleifur Olafsson
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Ingunn Thorsteinsdottir
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Signy Vala Sveinsdottir
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Fridbjorn Sigurdsson
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Asdis Rosa Thordardottir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Runolfur Palsson
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
| | - Olafur Skuli Indridason
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
| | | | - Gauti Kjartan Gislason
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Andri Olafsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Jon Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Hlif Steingrimsdottir
- Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland (B.V., M.S., I.O., I.T., S.V.S., F.S., H.S.)
| | - Malin Hultcrantz
- Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, New York (M.H.)
| | - Brian G M Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, California (B.G.M.D.)
| | - Stephen Harding
- The Binding Site, Birmingham, West Midlands, United Kingdom (S.H.)
| | - Ola Landgren
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida (O.L.)
| | - Thor Aspelund
- Center for Public Health Sciences, University of Iceland, Reykjavík, Iceland (T.A.)
| | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.R.R., G.A.S., A.R.T., G.K.G., A.O., J.S., T.J.L.)
| | - Sigurdur Yngvi Kristinsson
- Landspítali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavík, Iceland (E.E., S.R., P.T.O., B.A.A., R.P., O.S.I., S.Y.K.)
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Ballas L, Ailawadhi S, Narang M, Gasparetto CJ, Lee HC, Hardin JW, Durie BGM, Toomey K, Omel J, Wagner LI, Abonour R, Terebelo HR, Joshi P, Yu E, Liu L, Rifkin RM, Jagannath S. Real-World Utilization of Radiation Therapy in Multiple Myeloma: An Analysis of the Connect MM Registry. Pract Radiat Oncol 2024; 14:e141-e149. [PMID: 37984714 DOI: 10.1016/j.prro.2023.11.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/08/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Radiation therapy (RT) is an important treatment modality for patients with multiple myeloma (MM). Although patients are living longer with MM, they are more likely to have comorbidities related to treatment, such as bone pain; however, RT can provide symptom relief. To date, the characterization of patients who have received RT in the real-world setting has been limited. METHODS AND MATERIALS The Connect® MM Registry is a large, US multicenter, prospective observational cohort study of adult patients with newly diagnosed MM from mostly community sites. RT utilization and outcomes were analyzed quarterly throughout treatment. Factors associated with RT use were identified via multivariable analysis. RESULTS A total of 3011 patients were enrolled in the Connect MM Registry with 903 patients (30%) having received RT at any time. There was a significant difference (P < .05) in overall RT use among patients with an Eastern Cooperative Oncology Group performance status of 0 to 1 versus ≥2, International Staging System disease stage I/II versus III, a history of plasmacytoma or a novel agent in their first regimen, and any number of bone lesions or severe osteoporosis/fracture. RT use was associated with having bone lesions or severe osteoporosis (vs not having bone lesions). Additionally, RT use was associated with ethnicity (Hispanic vs not) and Connect MM Registry cohort (cohort 1 [enrolled 2009-2011] vs 2 [enrolled 2012-2016]). In the 6 months before death, increased RT use was associated with increasing number of treatment lines (P < .0001) and high- versus standard-risk disease (per International Myeloma Working Group criteria; P = .0028). CONCLUSIONS Real-world results from the Connect MM Registry show RT is frequently used and is associated with clinical factors, including performance status and disease stage. Earlier in MM diagnosis, RT may be used as an adjunct to palliate symptoms or delay systemic therapy. Toward the end of life, RT is more frequently used for palliation when treatment options are often limited.
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Affiliation(s)
- Leslie Ballas
- Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
| | | | - Mohit Narang
- US Oncology Research, Maryland Oncology Hematology, Columbia, Maryland
| | | | - Hans C Lee
- The Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James W Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | - Brian G M Durie
- Department of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kathleen Toomey
- Department of Internal Medicine, Medical Oncology, and Hematology, Steeplechase Cancer Center, Somerville, New Jersy
| | - James Omel
- Myeloma Research Advocate/Advisor, Grand Island, Nebraska
| | - Lynne I Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rafat Abonour
- Department of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Howard R Terebelo
- Department of Hematology, Internal Medicine, and Medical Oncology, Providence Cancer Institute, Southfield, Michigan
| | | | - Edward Yu
- Bristol Myers Squibb, Princeton, New Jersey
| | - Liang Liu
- Bristol Myers Squibb, Princeton, New Jersey
| | - Robert M Rifkin
- Department of Medical Oncology/Hematology, Rocky Mountain Cancer Centers, US Oncology, Denver, Colorado
| | - Sundar Jagannath
- Department of Hematology and Medical Oncology, Mount Sinai Hospital, New York, New York
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Rögnvaldsson S, Thorsteinsdóttir S, Syriopoulou E, Sverrisdottir I, Turesson I, Eythorsson E, Oskarsson JT, Long TE, Vidarsson B, Onundarson PT, Agnarsson BA, Sigurdardottir M, Olafsson I, Thorsteinsdottir I, Aspelund T, Gislason GK, Olafsson A, Sigurdsson JK, Hultcrantz M, Durie BGM, Harding S, Bjorkholm M, Landgren O, Love TJ, Kristinsson SY. Prior cancer and risk of monoclonal gammopathy of undetermined significance: a population-based study in Iceland and Sweden. Haematologica 2024. [PMID: 38205512 DOI: 10.3324/haematol.2023.284365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 01/12/2024] Open
Abstract
There is some evidence that a prior cancer is a risk factor for the development of multiple myeloma (MM). If this is true, prior cancer should be associated with higher prevalence or increased progression rate of monoclonal gammopathy of undetermined significance (MGUS), the precursor of MM and related disorders. Those with a history of cancer might therefore present a target population for MGUS screening. This two-part study is the first study to evaluate the relationship of MGUS and prior cancers. First, we evaluated whether prior cancers were associated with having MGUS at the time of screening in the Iceland Screens Treats or Prevents Multiple Myeloma (iStopMM) study that includes 75,422 individuals screened for MGUS. Next, we evaluated the association of prior cancer and the progression of MGUS to MM and related disorders in a population-based cohort of 13,790 Swedish individuals with MGUS. A history of prior cancer was associated with a modest increase in the risk of MGUS (odds ratio (OR)= 1.10; 95% confidence interval (CI): 1.00-1.20). This excess risk was limited to prior cancers in the year preceding MGUS screening. A history of prior cancer associated with the progression of MGUS, except for myeloid malignancies which were associated with lower risk of progression (hazard ratio (HR)=0.37; 95%CI: 0.16-0.89; p=0.028). Our findings indicate that a prior cancer are not a significant aetiological factor in plasma cell disorders. The findings do not warrant MGUS screening or different management of MGUS in those with a prior cancer.
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Affiliation(s)
- Sæmundur Rögnvaldsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík.
| | - Sigrun Thorsteinsdóttir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Elias Eythorsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík
| | | | - Thorir Einarsson Long
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Skåne University Hospital, Lund
| | - Brynjar Vidarsson
- Landspítali - The National University Hospital of Iceland, Reykjavík
| | - Pall Torfi Onundarson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík
| | - Bjarni A Agnarsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík
| | | | - Isleifur Olafsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík
| | | | - Thor Aspelund
- Faculty of Medicine, University of Iceland, Reykjavík
| | | | | | | | - Malin Hultcrantz
- Myeloma Service, Dept. of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Brian G M Durie
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Outpatient Cancer Center, Los Angeles, CA
| | | | - Magnus Bjorkholm
- Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm
| | - Ola Landgren
- Myeloma Program, Department of Medicine, University of Miami, Sylvester Comprehensive Cancer Center, Miami
| | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík
| | - Sigurdur Yngvi Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík
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Paiva B, Zherniakova A, Nuñez-Córdoba JM, Rodriguez-Otero P, Shi Q, Munshi NC, Durie BGM, San-Miguel J. Impact of treatment effect on MRD and PFS: an aggregate data analysis from randomized clinical trials in multiple myeloma. Blood Adv 2024; 8:219-223. [PMID: 37639322 PMCID: PMC10805640 DOI: 10.1182/bloodadvances.2023010821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- Bruno Paiva
- Cancer Center Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada, Instituto de Investigacion Sanitaria de Navarra, Cedars-Sinai Medical Center CB16/12/00369, Pamplona, Spain
| | - Anastasiia Zherniakova
- Cancer Center Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada, Instituto de Investigacion Sanitaria de Navarra, Cedars-Sinai Medical Center CB16/12/00369, Pamplona, Spain
| | - Jorge M. Nuñez-Córdoba
- Cancer Center Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada, Instituto de Investigacion Sanitaria de Navarra, Cedars-Sinai Medical Center CB16/12/00369, Pamplona, Spain
| | - Paula Rodriguez-Otero
- Cancer Center Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada, Instituto de Investigacion Sanitaria de Navarra, Cedars-Sinai Medical Center CB16/12/00369, Pamplona, Spain
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Nikhil C. Munshi
- Dana-Farber Cancer Institute and Boston VA Healthcare System, Boston, MA
| | | | - Jesus San-Miguel
- Cancer Center Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada, Instituto de Investigacion Sanitaria de Navarra, Cedars-Sinai Medical Center CB16/12/00369, Pamplona, Spain
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Sigurbergsdóttir AÝ, Rögnvaldsson S, Thorsteinsdóttir S, Sverrisdóttir I, Sigurðardóttir GÁ, Viðarsson B, Önundarson PT, Agnarsson BA, Sigurðardóttir M, Þorsteinsdóttir I, Ólafsson Í, Þórðardóttir ÁR, Gíslason GK, Ólafsson A, Hultcrantz M, Durie BGM, Harding S, Landgren O, Löve TJ, Kristinsson SY. Disease associations with monoclonal gammopathy of undetermined significance can only be evaluated using screened cohorts: results from the population-based iStopMM study. Haematologica 2023; 108:3392-3398. [PMID: 37439374 PMCID: PMC10690899 DOI: 10.3324/haematol.2023.283191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic precursor condition that precedes multiple myeloma and related disorders but has also been associated with other medical conditions. Since systematic screening is not recommended, MGUS is typically diagnosed due to underlying diseases and most cases are not diagnosed. Most previous studies on MGUS disease associations have been based on clinical cohorts, possibly resulting in selection bias. Here we estimate this selection bias by comparing clinically diagnosed and screened individuals with MGUS with regards to demographics, laboratory features, and comorbidities. A total of 75,422 participants in the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) study were screened for MGUS by serum protein electrophoresis, immunofixation and free light chain assay (clinicaltrials gov. Identifier: NCT03327597). We identified 3,352 individuals with MGUS, whereof 240 had previously been clinically diagnosed (clinical MGUS), and crosslinked our data with large, nationwide registries for information on comorbidities. Those with clinical MGUS were more likely to have at least one comorbidity (odds ratio=2.24; 95% confidence interval: 1.30-4.19), and on average had more comorbidities than the screened MGUS group (3.23 vs. 2.36, mean difference 0.68; 95% confidence interval: 0.46-0.90). They were also more likely to have rheumatological disease, neurological disease, chronic kidney disease, liver disease, heart failure, or endocrine disorders. These findings indicate that individuals with clinical MGUS have more comorbidities than the general MGUS population and that previous studies have been affected by significant selection bias. Our findings highlight the importance of screening data when studying biological and epidemiological implications of MGUS.
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Affiliation(s)
| | - Sæmundur Rögnvaldsson
- University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík
| | | | | | | | - Brynjar Viðarsson
- Landspítali - The National University Hospital of Iceland, Reykjavík
| | - Páll Torfi Önundarson
- University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík
| | | | | | | | - Ísleifur Ólafsson
- Landspítali - The National University Hospital of Iceland, Reykjavík
| | | | | | | | | | | | | | - Ola Landgren
- Sylvester Comprehensive Cancer Center, Miami, FL
| | - Thorvarður Jón Löve
- University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík
| | - Sigurður Yngvi Kristinsson
- University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík.
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7
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Óskarsson JÞ, Rögnvaldsson S, Thorsteinsdottir S, Aspelund T, Gunnarsson SB, Hákonardóttir GK, Sigurðardóttir GÁ, Þórðardóttir ÁR, Gíslason GK, Ólafsson A, Sigurðsson JK, Eyþórsson E, Jónsson Á, Viðarsson B, Önundarson PT, Agnarsson BA, Pálmason R, Sigurðardóttir M, Þorsteinsdóttir I, Ólafsson Í, Harding S, Flores-Montero J, Orfao A, Durie BGM, Love TJ, Kristinsson SY. Determining hemodilution in diagnostic bone marrow aspirated samples in plasma cell disorders by next-generation flow cytometry: Proposal for a bone marrow quality index. Blood Cancer J 2023; 13:177. [PMID: 38040702 PMCID: PMC10692231 DOI: 10.1038/s41408-023-00951-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/03/2023] Open
Abstract
Hemodilution of bone marrow (BM) aspirates is a limitation of multiparameter flow cytometry (MFC) in plasma cell disorders. There is a need for a validated approach for assessing sample quality and the distribution of non-plasma cell BM populations by MFC could provide a solution. We evaluated BM-associated cell populations, assessed by next-generation flow cytometry (NGF) and white blood cell (WBC) count in 351 BM aspirated samples from 219 participants with plasma cell disorders in the Iceland Screens, Treats, or Prevents MM study (iStopMM), as markers of hemodilution by their discriminatory ability between first and (generally more hemodiluted) second pull BM aspirated samples. The most discriminating markers were used to derive a novel BM quality index (BMQI). Nucleated red blood cells and myeloid precursors provided the greatest discriminatory ability between first vs second pull samples (area under the curve (AUC): 0.87 and 0.85, respectively), significantly better than B cell precursors (AUC = 0.64; p < 0.001), mast cells (AUC = 0.65; p < 0.001), and the BM WBC count (AUC = 0.77; p < 0.05). We generated a novel BMQI that is intrinsic to current NGF protocols, for evaluating quality of diagnostic BM samples and suggest the use of a BMQI scoring system for interpreting results and guiding appropriate actions.
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Affiliation(s)
| | - Sæmundur Rögnvaldsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Landspítali University Hospital, Reykjavík, Iceland
| | - Sigrun Thorsteinsdottir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Thor Aspelund
- Public Health Sciences, University of Iceland, Reykjavík, Iceland
| | | | | | | | | | | | - Andri Ólafsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | | | | | | | | | | | | | - Róbert Pálmason
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Landspítali University Hospital, Reykjavík, Iceland
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | | | | | | | | | - Juan Flores-Montero
- Cancer Research Center (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca; Biomedical Research Institute of Salamanca (IBSAL) and CIBERONC, Salamanca, Spain
| | - Alberto Orfao
- Cancer Research Center (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca; Biomedical Research Institute of Salamanca (IBSAL) and CIBERONC, Salamanca, Spain
| | - Brian G M Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, CA, USA
| | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Landspítali University Hospital, Reykjavík, Iceland
| | - Sigurdur Yngvi Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Landspítali University Hospital, Reykjavík, Iceland
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8
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Dimopoulos MA, Merlini G, Bridoux F, Leung N, Mikhael J, Harrison SJ, Kastritis E, Garderet L, Gozzetti A, van de Donk NWCJ, Weisel KC, Badros AZ, Beksac M, Hillengass J, Mohty M, Ho PJ, Ntanasis-Stathopoulos I, Mateos MV, Richardson P, Blade J, Moreau P, San-Miguel J, Munshi N, Rajkumar SV, Durie BGM, Ludwig H, Terpos E. Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group. Lancet Oncol 2023; 24:e293-e311. [PMID: 37414019 DOI: 10.1016/s1470-2045(23)00223-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 07/08/2023]
Abstract
Here, the International Myeloma Working Group (IMWG) updates its clinical practice recommendations for the management of multiple myeloma-related renal impairment on the basis of data published until Dec 31, 2022. All patients with multiple myeloma and renal impairment should have serum creatinine, estimated glomerular filtration rate, and free light chains (FLCs) measurements together with 24-h urine total protein, electrophoresis, and immunofixation. If non-selective proteinuria (mainly albuminuria) or involved serum FLCs value less than 500 mg/L is detected, then a renal biopsy is needed. The IMWG criteria for the definition of renal response should be used. Supportive care and high-dose dexamethasone are required for all patients with myeloma-induced renal impairment. Mechanical approaches do not increase overall survival. Bortezomib-based regimens are the cornerstone of the management of patients with multiple myeloma and renal impairment at diagnosis. New quadruplet and triplet combinations, including proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies, improve renal and survival outcomes in both newly diagnosed patients and those with relapsed or refractory disease. Conjugated antibodies, chimeric antigen receptor T-cells, and T-cell engagers are well tolerated and effective in patients with moderate renal impairment.
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Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Frank Bridoux
- Department of Nephrology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Nelson Leung
- Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
| | - Simon J Harrison
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Alessandro Gozzetti
- Department of Hematology, University of Siena, Policlinico S Maria alle Scotte, Siena, Italy
| | - Niels W C J van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Katja C Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ashraf Z Badros
- Department of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Meral Beksac
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | | | - Mohamad Mohty
- Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM UMRs 938, Paris, France
| | - P Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Paul Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Joan Blade
- Department of Hematology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Philippe Moreau
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Jesus San-Miguel
- Cancer Center Clinica Universidad de Navarra, CCUN, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Spain
| | - Nikhil Munshi
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Brian G M Durie
- Department of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, First Department of Medicine, Clinic Ottakring, Vienna, Austria
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece.
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9
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Thorsteinsdóttir S, Gíslason GK, Aspelund T, Rögnvaldsson S, Óskarsson JÞ, Sigurðardóttir GÁ, Þórðardóttir ÁR, Viðarsson B, Önundarson PT, Agnarsson BA, Sigurðardóttir M, Þorsteinsdóttir I, Ólafsson Í, Eyþórsson E, Jónsson Á, Berlanga O, Hultcrantz M, Durie BGM, Löve TJ, Harding S, Landgren O, Kristinsson SY. Author Correction: Prevalence of smoldering multiple myeloma based on nationwide screening. Nat Med 2023:10.1038/s41591-023-02308-5. [PMID: 36941333 DOI: 10.1038/s41591-023-02308-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Affiliation(s)
- Sigrún Thorsteinsdóttir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | | | - Thor Aspelund
- Public Health Sciences, University of Iceland, Reykjavík, Iceland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Brian G M Durie
- Cedars-Sinai Samual Oschin Cancer Center, Los Angeles, CA, USA
| | | | | | - Ola Landgren
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sigurður Y Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
- Landspítali University Hospital, Reykjavík, Iceland.
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10
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Rögnvaldsson S, Love TJ, Thorsteinsdottir S, Reed ER, Óskarsson JÞ, Pétursdóttir Í, Sigurðardóttir GÁ, Viðarsson B, Önundarson PT, Agnarsson BA, Sigurðardóttir M, Þorsteinsdóttir I, Ólafsson Í, Þórðardóttir ÁR, Eyþórsson E, Jónsson Á, Björnsson AS, Gunnarsson GÞ, Pálsson R, Indriðason ÓS, Gíslason GK, Ólafsson A, Hákonardóttir GK, Brinkhuis M, Halldórsdóttir SL, Ásgeirsdóttir TL, Steingrímsdóttir H, Danielsen R, Dröfn Wessman I, Kampanis P, Hultcrantz M, Durie BGM, Harding S, Landgren O, Kristinsson SY. Correction: Iceland screens, treats, or prevents multiple myeloma (iStopMM): a population-based screening study for monoclonal gammopathy of undetermined significance and randomized controlled trial of follow-up strategies. Blood Cancer J 2023; 13:39. [PMID: 36935437 PMCID: PMC10025257 DOI: 10.1038/s41408-023-00814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Affiliation(s)
| | | | - Sigrun Thorsteinsdottir
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
- Dept of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Elín Ruth Reed
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
| | | | | | | | | | - Páll Torfi Önundarson
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
- Landspítali University Hospital, Reykjavík, Iceland
| | - Bjarni A Agnarsson
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
- Landspítali University Hospital, Reykjavík, Iceland
| | | | | | | | | | | | | | | | - Gunnar Þór Gunnarsson
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
- Akureyri Hospital, Akureyri, Iceland
| | - Runólfur Pálsson
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
- Landspítali University Hospital, Reykjavík, Iceland
| | - Ólafur Skúli Indriðason
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
- Landspítali University Hospital, Reykjavík, Iceland
| | | | - Andri Ólafsson
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
| | | | - Manje Brinkhuis
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
| | | | | | | | | | | | | | | | - Brian G M Durie
- Cedar-Sinai Samual Oschin Cancer Center, Los Angeles, CA, USA
| | | | - Ola Landgren
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sigurður Yngvi Kristinsson
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland.
- Landspítali University Hospital, Reykjavík, Iceland.
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11
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Lee HC, Ramasamy K, Weisel K, Abonour R, Hardin JW, Rifkin RM, Ailawadhi S, Terebelo HR, Durie BGM, Tang D, Joshi P, Liu L, Jou YM, Che M, Hernandez G, Narang M, Toomey K, Gasparetto C, Wagner LI, Jagannath S. Treatment Patterns, Survival, Quality of Life, and Healthcare Resource Use Among Patients With Triple-Class Refractory Multiple Myeloma in US Clinical Practice: Findings From the Connect MM Disease Registry. Clin Lymphoma Myeloma Leuk 2023; 23:112-122. [PMID: 36567211 DOI: 10.1016/j.clml.2022.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adults with triple-class refractory (TCR) multiple myeloma (MM) have limited treatment options and poor prognosis, but the burden of TCR MM has not been well characterized. This study evaluated treatment patterns, overall survival (OS), health-related quality of life (HRQoL), and healthcare resource use (HCRU) among patients with TCR MM in US clinical practice. PATIENTS AND METHODS Patients with TCR MM in the Connect MM Registry (NCT01081028; a large, US, multicenter, prospective observational cohort study of patients with newly diagnosed MM) were included. Patient characteristics, treatment patterns, HRQoL, and HCRU were analyzed using descriptive statistics. OS was calculated using Kaplan-Meier methodology for the overall cohort and for patients with/without ≥1 post-TCR line of therapy (LOT). RESULTS A total of 232 patients with TCR MM were included; 155 (67%) had ≥1 post-TCR LOT (post-TCR-Treated subgroup; median 9.9 months of follow-up). Most common post-TCR treatments were carfilzomib (47%), pomalidomide (40%), and daratumumab (26%); median treatment duration was 3.3 months. Median OS was 9.9 months in the overall population, 10.8 months in post-TCR-Treated patients, and 2.6 months for those with no new post-TCR LOT. HRQoL deteriorated and pain increased over 1 year of follow-up, with clinically meaningfully changes in EQ-5D (mean, -0.06 points) and FACT-G (mean, -9.9 points). 124 (53%) patients had ≥1 all-cause hospitalization and 58 (25%) had ≥1 MM-related hospitalization; median annualized length of stay was 35.3 and 42.9 days, respectively. CONCLUSION The burden of TCR MM is substantial, emphasizing the need for more effective treatment options in the TCR setting.
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Affiliation(s)
- Hans C Lee
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karthik Ramasamy
- Department of Haematology, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Katja Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - Rafat Abonour
- Indiana University School of Medicine, Indianapolis, IN
| | | | - Robert M Rifkin
- Rocky Mountain Cancer Centers/US Oncology Research, Denver, CO
| | | | | | | | | | | | | | | | - Min Che
- Bristol Myers Squibb, Princeton, NJ
| | - Gabriela Hernandez
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
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12
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Thorsteinsdóttir S, Gíslason GK, Aspelund T, Rögnvaldsson S, Óskarsson JÞ, Sigurðardóttir GÁ, Þórðardóttir ÁR, Viðarsson B, Önundarson PT, Agnarsson BA, Sigurðardóttir M, Þorsteinsdóttir I, Ólafsson Í, Eyþórsson E, Jónsson Á, Berlanga O, Hultcrantz M, Durie BGM, Löve TJ, Harding S, Landgren O, Kristinsson SY. Prevalence of smoldering multiple myeloma based on nationwide screening. Nat Med 2023; 29:467-472. [PMID: 36747117 DOI: 10.1038/s41591-022-02183-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/13/2022] [Indexed: 02/08/2023]
Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic precursor to multiple myeloma. Here we define the epidemiological characteristics of SMM in the general population in Iceland. The iStopMM study (ClinicalTrials.gov ID: NCT03327597 ) is a nationwide screening study for multiple myeloma precursors where all residents in Iceland 40 years or older were invited to participate. SMM was defined as 10-60% bone marrow plasma cells and/or monoclonal (M) protein concentration ≥3 g dl-1, in the absence of myeloma-defining events. Of the 80,759 who gave informed consent to participate, 75,422 (93%) were screened. The prevalence of SMM in the total population was 0.53% (95% confidence interval (CI) = 0.49-0.57%) in individuals 40 years or older. In men and women, the prevalence of SMM was 0.67% (95% CI = 0.62-0.73%) and 0.39% (95% CI = 0.35-0.43%), respectively; it increased with age in both sexes. For the 193 individuals with SMM, median age was 70 years (range 44-92 years) and 60% were males. The mean M protein concentration of individuals with SMM was 0.62 g dl-1 (range 0.01-3.5 g dl-1) and 73% had 11-20% bone marrow plasma cell infiltration. The high prevalence of SMM has implications for future treatment policies in multiple myeloma as the evidence supporting treatment initiation at the SMM stage is emerging.
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Affiliation(s)
- Sigrún Thorsteinsdóttir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | | | - Thor Aspelund
- Public Health Sciences, University of Iceland, Reykjavík, Iceland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Brian G M Durie
- Cedars-Sinai Samual Oschin Cancer Center, Los Angeles, CA, USA
| | | | | | - Ola Landgren
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sigurður Y Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
- Landspítali University Hospital, Reykjavík, Iceland.
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13
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Lee HC, Ailawadhi S, Gasparetto CJ, Jagannath S, Rifkin RM, Durie BGM, Narang M, Terebelo HR, Toomey K, Hardin JW, Wagner L, Omel JL, Dhalla M, Liu L, Joshi P, Abonour R. Treatment patterns and outcomes in elderly patients with newly diagnosed multiple myeloma: results from the Connect ® MM Registry. Blood Cancer J 2021; 11:134. [PMID: 34301916 PMCID: PMC8302734 DOI: 10.1038/s41408-021-00524-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Hans C Lee
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | | | | | - Robert M Rifkin
- Rocky Mountain Cancer Centers US Oncology Research, Denver, CO, USA
| | | | - Mohit Narang
- Maryland Oncology Hematology, US Oncology Research, Columbia, MD, USA
| | | | | | | | - Lynne Wagner
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James L Omel
- Myeloma Research Advocate/Advisor, Grand Island, NE, USA
| | | | - Liang Liu
- Bristol Myers Squibb, Princeton, NJ, USA
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14
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Rögnvaldsson S, Love TJ, Thorsteinsdottir S, Reed ER, Óskarsson JÞ, Pétursdóttir Í, Sigurðardóttir GÁ, Viðarsson B, Önundarson PT, Agnarsson BA, Sigurðardóttir M, Þorsteinsdóttir I, Ólafsson Í, Þórðardóttir ÁR, Eyþórsson E, Jónsson Á, Björnsson AS, Gunnarsson GÞ, Pálsson R, Indriðason ÓS, Gíslason GK, Ólafsson A, Hákonardóttir GK, Brinkhuis M, Halldórsdóttir SL, Ásgeirsdóttir TL, Steingrímsdóttir H, Danielsen R, Dröfn Wessman I, Kampanis P, Hultcrantz M, Durie BGM, Harding S, Landgren O, Kristinsson SY. Iceland screens, treats, or prevents multiple myeloma (iStopMM): a population-based screening study for monoclonal gammopathy of undetermined significance and randomized controlled trial of follow-up strategies. Blood Cancer J 2021; 11:94. [PMID: 34001889 PMCID: PMC8128921 DOI: 10.1038/s41408-021-00480-w] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 02/08/2023] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) precedes multiple myeloma (MM). Population-based screening for MGUS could identify candidates for early treatment in MM. Here we describe the Iceland Screens, Treats, or Prevents Multiple Myeloma study (iStopMM), the first population-based screening study for MGUS including a randomized trial of follow-up strategies. Icelandic residents born before 1976 were offered participation. Blood samples are collected alongside blood sampling in the Icelandic healthcare system. Participants with MGUS are randomized to three study arms. Arm 1 is not contacted, arm 2 follows current guidelines, and arm 3 follows a more intensive strategy. Participants who progress are offered early treatment. Samples are collected longitudinally from arms 2 and 3 for the study biobank. All participants repeatedly answer questionnaires on various exposures and outcomes including quality of life and psychiatric health. National registries on health are cross-linked to all participants. Of the 148,704 individuals in the target population, 80 759 (54.3%) provided informed consent for participation. With a very high participation rate, the data from the iStopMM study will answer important questions on MGUS, including potentials harms and benefits of screening. The study can lead to a paradigm shift in MM therapy towards screening and early therapy.
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Affiliation(s)
| | | | - Sigrun Thorsteinsdottir
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
- Dept of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Elín Ruth Reed
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
| | | | | | | | | | - Páll Torfi Önundarson
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
- Landspítali University Hospital, Reykjavík, Iceland
| | - Bjarni A Agnarsson
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
- Landspítali University Hospital, Reykjavík, Iceland
| | | | | | | | | | | | | | | | - Gunnar Þór Gunnarsson
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
- Akureyri Hospital, Akureyri, Iceland
| | - Runólfur Pálsson
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
- Landspítali University Hospital, Reykjavík, Iceland
| | - Ólafur Skúli Indriðason
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
- Landspítali University Hospital, Reykjavík, Iceland
| | | | - Andri Ólafsson
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
| | | | - Manje Brinkhuis
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland
| | | | | | | | | | | | | | | | - Brian G M Durie
- Cedar-Sinai Samual Oschin Cancer Center, Los Angeles, CA, USA
| | | | - Ola Landgren
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sigurður Yngvi Kristinsson
- Faculty of Medicine, Univeristy of Iceland, Reykjavík, Iceland.
- Landspítali University Hospital, Reykjavík, Iceland.
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15
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Abonour R, Rifkin RM, Gasparetto C, Toomey K, Durie BGM, Hardin JW, Terebelo HR, Jagannath S, Narang M, Ailawadhi S, Omel JL, Lee HC, Srinivasan S, Kitali A, Agarwal A, Wagner L. Effect of initial treatment on health-related quality of life in patients with newly diagnosed multiple myeloma without immediate stem cell transplant intent: results from the Connect ® MM Registry. Br J Haematol 2021; 193:93-100. [PMID: 33118614 PMCID: PMC8048460 DOI: 10.1111/bjh.17131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022]
Abstract
Although new multiple myeloma (MM) therapies are effective in alleviating some disease-associated symptoms (e.g. bone pain, fatigue, functional decline), they can result in additional toxicities, further impacting health-related quality of life (HRQoL). Here, we compared HRQoL and safety of lenalidomide-bortezomib-dexamethasone [RVd (n = 445)], bortezomib-melphalan-prednisone [VMP (n = 77)] and Vd or VMP (n = 588) in patients with newly diagnosed MM (NDMM) from the Connect® MM Registry, a large, USA, multicentre, prospective observational cohort study. Functional Assessment of Cancer Therapy-Multiple Myeloma subscale, EuroQol-5D overall score and Bone Pain Inventory HRQoL scores were significantly improved with RVd versus Vd/VMP. Serious adverse event rates were similar in all groups. Treatment with RVd maintained HRQoL in this real-world, largely community-based population of patients with NDMM.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Hans C. Lee
- The University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | | | | | | | - Lynne Wagner
- Wake Forest School of MedicineWinston‐SalemNCUSA
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16
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Terpos E, Zamagni E, Lentzsch S, Drake MT, García-Sanz R, Abildgaard N, Ntanasis-Stathopoulos I, Schjesvold F, de la Rubia J, Kyriakou C, Hillengass J, Zweegman S, Cavo M, Moreau P, San-Miguel J, Dimopoulos MA, Munshi N, Durie BGM, Raje N. Treatment of multiple myeloma-related bone disease: recommendations from the Bone Working Group of the International Myeloma Working Group. Lancet Oncol 2021; 22:e119-e130. [PMID: 33545067 DOI: 10.1016/s1470-2045(20)30559-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/06/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022]
Abstract
In this Policy Review, the Bone Working Group of the International Myeloma Working Group updates its clinical practice recommendations for the management of multiple myeloma-related bone disease. After assessing the available literature and grading recommendations using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) method, experts from the working group recommend zoledronic acid as the preferred bone-targeted agent for patients with newly diagnosed multiple myeloma, with or without multiple myeloma-related bone disease. Once patients achieve a very good partial response or better, after receiving monthly zoledronic acid for at least 12 months, the treating physician can consider decreasing the frequency of or discontinuing zoledronic acid treatment. Denosumab can also be considered for the treatment of multiple myeloma-related bone disease, particularly in patients with renal impairment. Denosumab might prolong progression-free survival in patients with newly diagnosed multiple myeloma who have multiple myeloma-related bone disease and who are eligible for autologous stem-cell transplantation. Denosumab discontinuation is challenging due to the rebound effect. The Bone Working Group of the International Myeloma Working Group also found cement augmentation to be effective for painful vertebral compression fractures. Radiotherapy is recommended for uncontrolled pain, impeding or symptomatic spinal cord compression, or pathological fractures. Surgery should be used for the prevention and restoration of long-bone pathological fractures, vertebral column instability, and spinal cord compression with bone fragments within the spinal route.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Elena Zamagni
- Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S Orsola Malpighi Hospital, Bologna, Italy
| | - Suzanne Lentzsch
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Matthew T Drake
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition and Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ramón García-Sanz
- Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
| | - Niels Abildgaard
- Hematology Research Unit, Department of Clinical Research, and Department of Hematology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, and KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | - Javier de la Rubia
- Department of Hematology, University Hospital Doctor Peset, School of Medicine and Dentistry, Catholic University of Valencia, Valencia, Spain
| | | | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, S Orsola Malpighi Hospital, Bologna, Italy
| | - Philippe Moreau
- Department of Hematology, University Hospital Hotel-Dieu, Nantes, France
| | - Jesus San-Miguel
- Center for Applied Medical Research, Clínica Universidad de Navarra, University of Navarra, and Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikhil Munshi
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Brian G M Durie
- Department of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Noopur Raje
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
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Durie BGM, Kumar SK, Usmani SZ, Nonyane BAS, Ammann EM, Lam A, Kobos R, Maiese EM, Facon T. Daratumumab-lenalidomide-dexamethasone vs standard-of-care regimens: Efficacy in transplant-ineligible untreated myeloma. Am J Hematol 2020; 95:1486-1494. [PMID: 32804408 PMCID: PMC7754114 DOI: 10.1002/ajh.25963] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/27/2022]
Abstract
Daratumumab in combination with lenalidomide‐dexamethasone (D‐Rd) recently received FDA approval for the treatment of transplant‐ineligible patients with newly diagnosed multiple myeloma (NDMM). The present PEGASUS study compared progression‐free survival (PFS) in patients treated with D‐Rd in the MAIA trial and patients treated with common standard‐of‐care regimens from the Flatiron Health electronic health record‐derived deidentified database, which has data from patients treated primarily at community‐based oncology practices in the United States. Individual‐level patient data from both data sources were used to perform an anchored indirect treatment comparison (ITC) of D‐Rd to bortezomib‐lenalidomide‐dexamethasone (VRd) and bortezomib‐dexamethasone (Vd); lenalidomide‐dexamethasone (Rd) was the common anchor for the ITC. Hazard ratios (HRs) reflecting direct comparisons of PFS within MAIA (D‐Rd vs Rd) and Flatiron Health (VRd vs Rd; Vd vs Rd) were used to make ITCs for D‐Rd vs VRd and Vd, respectively. After application of MAIA inclusion/exclusion criteria and propensity‐score weighting, the Flatiron Health patients resembled the MAIA trial population on measured baseline characteristics. Based on the direct comparison within MAIA, treatment with D‐Rd was associated with a significantly lower risk of progression or death compared to Rd (HR 0.54; 95% CI 0.42, 0.71). Based on the ITCs, D‐Rd was associated with a significantly lower risk of progression or death compared to VRd (HR 0.68; 95% CI 0.48, 0.98) and Vd (HR 0.48; 95% CI 0.33, 0.69). In the absence of head‐to‐head trials comparing D‐Rd to VRd or Vd, the present ITC may help inform treatment selection in transplant‐ineligible patients with NDMM.
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Affiliation(s)
| | | | | | | | | | - Annette Lam
- Janssen Global Services Raritan New Jersey USA
| | - Rachel Kobos
- Janssen Research & Development Raritan New Jersey USA
| | | | - Thierry Facon
- Department of Haematology Lille University Hospital Lille France
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Ailawadhi S, Jagannath S, Lee HC, Narang M, Rifkin RM, Terebelo HR, Durie BGM, Toomey K, Hardin JW, Gasparetto CJ, Wagner L, Omel JL, He M, Yue L, Flick ED, Agarwal A, Abonour R. Association between race and treatment patterns and survival outcomes in multiple myeloma: A Connect MM Registry analysis. Cancer 2020; 126:4332-4340. [PMID: 32706404 PMCID: PMC7540439 DOI: 10.1002/cncr.33089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022]
Abstract
Background Studies have reported racial disparities in access to and use of multiple myeloma (MM) treatments between African American (AA) and White patients. Although AA patients demonstrate longer disease‐specific survival, this has not uniformly translated into improved survival over time. The association between race and treatment patterns and survival outcomes was analyzed using data from the Connect MM Registry. Methods The Connect MM Registry is a large US, multicenter, prospective observational cohort study of patients with newly diagnosed MM. Patients who received first‐line (1L) stem cell transplantation (SCT) or who did not receive SCT (non‐SCT or non–stem cell transplantation [NSCT]) were grouped by raceEffects of race and transplantation status on the use of triplet treatment were estimated using logistic regression. Results Treatment patterns in 1L (types and duration of induction, posttransplantation maintenance) were similar between AA and White patients. SCT rates in 1L (32% vs 36%) and triplet treatment use (AA: 44% for NSCT patients and 72% for SCT patients; and White: 48% for NSCT patients and 72% for SCT patients) during first induction were similar. No significant effect of race or transplantation status on 1L triplet treatment use was observed. Race was not found to be associated with survival outcomes among patients who underwent NSCT; however, AA patients who received SCT had significantly longer overall survival compared with White patients who underwent SCT (not reached vs 88.2 months; hazard ratio, 0.56; 95% CI, 0.35‐0.89 [P = .0141]). Conclusions AA and White patients were found to have similar treatment patterns in the Connect MM Registry, suggesting that both groups had equal access to health care. In this real‐world setting, AA patients received standard‐of‐care treatment, which might have contributed to better MM‐specific survival compared with White patients. Real‐world data from the mostly community‐based Connect MM Registry demonstrated that African American patients have multiple myeloma treatment patterns that are similar to those of White patients. Similar (progression‐free survival) and better (overall survival) survival outcomes are reported in African American individuals.
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Affiliation(s)
| | | | - Hans C Lee
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Robert M Rifkin
- Rocky Mountain Cancer Centers, US Oncology Research, Denver, Colorado
| | | | | | | | | | | | - Lynne Wagner
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James L Omel
- Myeloma Research Advocate/Advisor, Grand Island, Nebraska
| | - Mia He
- Bristol-Myers Squibb, Summit, New Jersey
| | - Lihua Yue
- Bristol-Myers Squibb, Summit, New Jersey
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19
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Ailawadhi S, Jagannath S, Narang M, Rifkin RM, Terebelo HR, Toomey K, Durie BGM, Hardin JW, Gasparetto CJ, Wagner L, Omel JL, Kumar V, Yue L, Kitali A, Agarwal A, Abonour R. Connect MM Registry as a national reference for United States multiple myeloma patients. Cancer Med 2019; 9:35-42. [PMID: 31701679 PMCID: PMC6943143 DOI: 10.1002/cam4.2656] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023] Open
Abstract
Background The Surveillance, Epidemiology, and End Results (SEER) database and National Cancer Database (NCDB) show improved overall survival (OS) in patients with multiple myeloma (MM) over the last 15 years. This analysis evaluated the validity of the largely community‐based Connect MM Registry as a national reference for MM. Methods Baseline disease characteristics and survival in US newly diagnosed MM patients were examined using the Connect MM Registry as well as SEER and NCDB databases. Baseline characteristics predictive of longer survival in Connect MM were also identified. Results As of February 2017, 3011 patients were enrolled in the Connect MM Registry; 2912 were treated. Median age at time of MM diagnosis and age range were numerically similar from 2010 to 2015 across all 3 registries; SEER had a higher representation of nonwhite racial groups than that in the other 2 registries. OS rates suggest proportionate improvement with year of diagnosis among the 3 registries. A Cox proportional hazards model suggests that younger age (<65 years) is associated with longer survival (vs ≥75; HR, 0.39; 95% confidence interval, 0.34‐0.46) in the Connect MM Registry. However, sex (HR, 0.91; P = .15) and race (black vs white; HR, 0.88; P = .21) were not associated with longer OS. Conclusions Data from the Connect MM Registry appear to be largely representative of national trends, comprehensive, and reliable representations of the national MM population. Baseline characteristics were comparable, and survival similarly improved over time among the 3 registries. ClinicalTrials.gov, identifier NCT01081028.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Lynne Wagner
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James L Omel
- Myeloma Research Advocate/Advisor, Grand Island, NE, USA
| | - Vivek Kumar
- Brigham and Women's Hospital, Boston, MA, USA
| | - Lihua Yue
- Celgene Corporation, Summit, NJ, USA
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20
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Terebelo HR, Abonour R, Gasparetto CJ, Toomey K, Durie BGM, Hardin JW, Jagannath S, Wagner L, Narang M, Flick ED, Srinivasan S, Yue L, Kitali A, Agarwal A, Rifkin RM. Development of a prognostic model for overall survival in multiple myeloma using the Connect ® MM Patient Registry. Br J Haematol 2019; 187:602-614. [PMID: 31382320 PMCID: PMC6899784 DOI: 10.1111/bjh.16139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/10/2019] [Indexed: 02/02/2023]
Abstract
Median overall survival (OS) has improved for patients with newly diagnosed multiple myeloma (NDMM), but prognosis varies depending on baseline patient characteristics. Current models use data from selected clinical trial populations, which prevent application to patients in an unselected community setting that reflects routine clinical practice. Using data from the Connect® MM Registry, a large, US, multicentre, prospective observational cohort study (Cohort 1: 2009-2011; Cohort 2: 2012-2016) of 3011 patients with NDMM, we identified prognostic variables for OS via the multivariable analysis of baseline patient characteristics in Cohort 1 (n = 1493) and developed a tool to examine individual outcomes. Factors associated with OS (n = 1450 treated patients; P < 0·05) were age, del(17p), triplet therapy use, EQ-5D mobility, International Staging System stage, solitary plasmacytoma, history of diabetes, platelet count, Eastern Cooperative Oncology Group performance status and serum creatinine, which were used to create survival matrices for 3- and 5-year OS. The model was internally and externally validated using Connect MM Cohort 2 (Harrell's concordance index, 0·698), MM-015 (0·649), and the phase 3 FIRST (0·647) clinical trials. This novel prognostic tool may help inform outcomes for NDMM in the era of triplet therapy use with novel agents.
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Affiliation(s)
| | | | | | | | | | | | | | - Lynne Wagner
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | - Lihua Yue
- Celgene Corporation, Summit, NJ, USA
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21
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Blocka J, Durie BGM, Huhn S, Mueller-Tidow C, Försti A, Hemminki K, Goldschmidt H. Familial Cancer: How to Successfully Recruit Families for Germline Mutations Studies? Multiple Myeloma as an Example. Clin Lymphoma Myeloma Leuk 2019; 19:635-644.e2. [PMID: 31377209 DOI: 10.1016/j.clml.2019.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/15/2019] [Accepted: 06/27/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Identification of germline mutations related to an increased cancer risk enables diagnostic, preventive, and therapeutic measures for individuals carrying the disease variant. However, recruitment of families for studies on these mutations can be challenging. Herein we present some of the obstacles that can arise during such studies. We suggest solutions for overcoming or avoiding these difficulties, enabling an efficient and ethically correct family recruitment. PATIENTS AND METHODS We describe a study on germline mutations associated with familial risk of multiple myeloma using next-generation sequencing of the whole genome. To date, the study has recruited 54 participants/16 families from different centers in Germany. It was performed at the University Hospital of Heidelberg and German Cancer Research Center. RESULTS We were confronted with ethical/psychological concerns of patients and family members, a large number of ineligible families, a profound time investment by the participants and the study team, incidental findings, and participants' death. We present solutions to these difficulties such as: knowledge of and adherence to the laws protecting participants' rights, an exact clarification of the inclusion and exclusion criteria, a clear division of tasks within members of the study team, a collaboration with general practitioners/oncologists and patients' support groups, a detailed and understandable informed consent including information about incidental findings, and a choice of a representative in case of participant's death. CONCLUSION A successful recruitment for studies on familial cancer is challenging, yet possible. It can be facilitated by applying the previously mentioned strategies.
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Affiliation(s)
- Joanna Blocka
- Department of Hematology, Oncology, and Rheumatology, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Brian G M Durie
- Department of Hematology and Oncology, Cedars-Sinai Outpatient Cancer Center, Los Angeles, CA
| | - Stefanie Huhn
- Department of Hematology, Oncology, and Rheumatology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Carsten Mueller-Tidow
- Department of Hematology, Oncology, and Rheumatology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Asta Försti
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Kari Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Hematology, Oncology, and Rheumatology, University Hospital of Heidelberg, Heidelberg, Germany; Department of Hematology and Oncology, National Center of Tumor Diseases, Heidelberg, Germany
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22
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Abonour R, Wagner L, Durie BGM, Jagannath S, Narang M, Terebelo HR, Gasparetto CJ, Toomey K, Hardin JW, Kitali A, Gibson CJ, Srinivasan S, Swern AS, Rifkin RM. Impact of post-transplantation maintenance therapy on health-related quality of life in patients with multiple myeloma: data from the Connect® MM Registry. Ann Hematol 2018; 97:2425-2436. [PMID: 30056582 PMCID: PMC6208675 DOI: 10.1007/s00277-018-3446-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022]
Abstract
Maintenance therapy after autologous stem cell transplantation (ASCT) is recommended for use in multiple myeloma (MM); however, more data are needed on its impact on health-related quality of life (HRQoL). Presented here is an analysis of HRQoL in a Connect MM registry cohort of patients who received ASCT ± maintenance therapy. The Connect MM Registry is one of the earliest and largest, active, observational, prospective US registry of patients with symptomatic newly diagnosed MM. Patients completed the Functional Assessment of Cancer Therapy-MM (FACT-MM) version 4, EuroQol-5D (EQ-5D) questionnaire, and Brief Pain Inventory (BPI) at study entry and quarterly thereafter until death or study discontinuation. Patients in three groups were analyzed: any maintenance therapy (n = 244), lenalidomide-only maintenance therapy (n = 169), and no maintenance therapy (n = 137); any maintenance and lenalidomide-only maintenance groups were not mutually exclusive. There were no significant differences in change from pre-ASCT baseline between any maintenance (P = 0.60) and lenalidomide-only maintenance (P = 0.72) versus no maintenance for the FACT-MM total score. There were also no significant differences in change from pre-ASCT baseline between any maintenance and lenalidomide-only maintenance versus no maintenance for EQ-5D overall index, BPI, FACT-MM Trial Outcomes Index, and myeloma subscale scores. In all three groups, FACT-MM, EQ-5D Index, and BPI scores improved after ASCT; FACT-MM and BPI scores deteriorated at disease progression. These data suggest that post-ASCT any maintenance or lenalidomide-only maintenance does not negatively impact patients' HRQoL. Additional research is needed to verify these findings.
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Affiliation(s)
- Rafat Abonour
- Indiana University, Indianapolis, IN, USA. .,Hematology/Oncology, Indiana Cancer Pavilion, 535 Barnhill Drive, Suite 446, Indianapolis, IN, 46202-5289, USA.
| | - Lynne Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
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23
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Rifkin RM, Jagannath S, Durie BGM, Narang M, Terebelo HR, Gasparetto CJ, Toomey K, Hardin JW, Wagner L, Parikh K, Abouzaid S, Srinivasan S, Kitali A, Zafar F, Abonour R. Treatment Outcomes and Health Care Resource Utilization in Patients With Newly Diagnosed Multiple Myeloma Receiving Lenalidomide-only Maintenance, Any Maintenance, or No Maintenance: Results from the Connect MM Registry. Clin Ther 2018; 40:1193-1202.e1. [PMID: 30007443 DOI: 10.1016/j.clinthera.2018.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 05/03/2018] [Accepted: 05/28/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Maintenance therapy after autologous stem cell transplantation (ASCT) improves clinical outcomes in multiple myeloma (MM), but the effect of continued treatment with lenalidomide-only maintenance, or any maintenance, on health care resource utilization (HCRU) is largely unknown. METHODS Here we present an analysis of HCRU and clinical outcomes in a cohort of patients from the Connect MM registry, the largest, ongoing, observational, prospective US registry of patients with symptomatic newly diagnosed MM. In this study, patients with newly diagnosed MM who completed induction and single ASCT without subsequent consolidation received lenalidomide-only maintenance (n = 180), any maintenance (n = 256), or no maintenance (n = 165). HCRU (hospitalization, surgery/procedures, and concurrent medications [growth factors, bisphosphonates, or neuropathic pain medication]) was assessed starting from 100 days post-ASCT for up to 2 years. FINDINGS Although the rates of hospitalization per 100 person-years were similar across groups at the end of years 1 and 2, the median duration of hospitalization was numerically longer with no maintenance. The rates of use of growth factors, bisphosphonates, and neuropathic pain medication were generally similar in all 3 groups. The receipt of any maintenance was associated with significantly reduced use of neuropathic pain medications during year 1. Of note, lenalidomide-only maintenance was associated with significantly longer progression-free survival (54.5 vs 30.4 months; hazard ratio [HR] = 0.58; 95% CI, 0.43-0.79; P = 0.0005) and overall survival (OS) (median OS not reached in either group; HR = 0.45; 95% CI, 0.28-0.73; P = 0.001) compared with no maintenance. Likewise, the group treated with any maintenance had significantly longer median progression-free survival (44.7 vs 30.4 months; HR = 0.62; 95% CI, 0.47-0.82; P = 0.0008) and OS (median OS not reached in either group; HR = 0.50; 95% CI, 0.33-0.76; P = 0.001) than did the group that did not receive maintenance. IMPLICATIONS These findings suggest that in this largely community-based study population, post-ASCT maintenance therapy, including lenalidomide-only maintenance, improves clinical outcomes without negatively affecting HCRU. ClinicalTrials.gov identifier: NCT01081028.
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Affiliation(s)
- Robert M Rifkin
- US Oncology Research, Rocky Mountain Cancer Centers, Denver, Colorado.
| | | | - Brian G M Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, California
| | - Mohit Narang
- US Oncology Research, Maryland Oncology Hematology, Columbia, Maryland
| | | | | | | | | | - Lynne Wagner
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | | | | | | | | | - Rafat Abonour
- Indiana University Simon Cancer Center, Indianapolis, Indiana
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24
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Jagannath S, Abonour R, Durie BGM, Gasparetto C, Hardin JW, Narang M, Terebelo HR, Toomey K, Wagner L, Srinivasan S, Kitali A, Yue L, Flick ED, Agarwal A, Rifkin RM. Heterogeneity of Second-Line Treatment for Patients With Multiple Myeloma in the Connect MM Registry (2010-2016). Clin Lymphoma Myeloma Leuk 2018; 18:480-485.e3. [PMID: 29844008 DOI: 10.1016/j.clml.2018.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/20/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The treatment landscape for multiple myeloma (MM) has undergone recent changes with the regulatory approval of several new therapies indicated for second- and later-line disease. Using data from Connect MM, the largest multisite, primarily community-based, prospective, observational registry of MM patients in the United States, selection of second-line treatments was evaluated during a 5-year period from 2010 to 2016. PATIENTS AND METHODS Eligible patients were aged ≥ 18 years, had newly diagnosed MM ≤ 2 months before study entry, and were followed for up to 8 years. Patients who received ≥ 2 lines of therapy were analyzed. "Tepee" plots of stacked area graphs differentiated treatments by color to allow visualization of second-line treatment trends in MM patients. RESULTS As of February 2017, 855 of 2897 treated patients had progressed to second-line treatment. Treatment selection was heterogeneous; shifting patterns of treatment choices coincided with the approval status of newer agents. The most common treatment regimens in the early part of the decade were lenalidomide and/or bortezomib, with or without dexamethasone, with increasing use of newer agents (carfilzomib, pomalidomide, daratumumab, and elotuzumab) and triplet combinations over time. The influence of the baseline patient characteristics of age, history of diabetes, peripheral neuropathy, and renal function on treatment choice was also examined. CONCLUSION These findings indicate that community physicians are current in their MM management practices, with uptake of new drugs and acquaintance with results of randomized clinical trials using combinations almost concurrent with their regulatory approval and publication.
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Affiliation(s)
| | - Rafat Abonour
- Indiana University Simon Cancer Center, Indianapolis, IN
| | | | | | | | - Mohit Narang
- US Oncology Research, Maryland Oncology Hematology, Columbia, MD
| | | | | | - Lynne Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | | | | | | | - Robert M Rifkin
- US Oncology Research, Rocky Mountain Cancer Centers, Denver, CO
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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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26
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Cavo M, Terpos E, Nanni C, Moreau P, Lentzsch S, Zweegman S, Hillengass J, Engelhardt M, Usmani SZ, Vesole DH, San-Miguel J, Kumar SK, Richardson PG, Mikhael JR, da Costa FL, Dimopoulos MA, Zingaretti C, Abildgaard N, Goldschmidt H, Orlowski RZ, Chng WJ, Einsele H, Lonial S, Barlogie B, Anderson KC, Rajkumar SV, Durie BGM, Zamagni E. Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol 2017; 18:e206-e217. [PMID: 28368259 DOI: 10.1016/s1470-2045(17)30189-4] [Citation(s) in RCA: 315] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/21/2016] [Accepted: 11/29/2016] [Indexed: 12/26/2022]
Abstract
The International Myeloma Working Group consensus aimed to provide recommendations for the optimal use of 18fluorodeoxyglucose (18F-FDG) PET/CT in patients with multiple myeloma and other plasma cell disorders, including smouldering multiple myeloma and solitary plasmacytoma. 18F-FDG PET/CT can be considered a valuable tool for the work-up of patients with both newly diagnosed and relapsed or refractory multiple myeloma because it assesses bone damage with relatively high sensitivity and specificity, and detects extramedullary sites of proliferating clonal plasma cells while providing important prognostic information. The use of 18F-FDG PET/CT is mandatory to confirm a suspected diagnosis of solitary plasmacytoma, provided that whole-body MRI is unable to be performed, and to distinguish between smouldering and active multiple myeloma, if whole-body X-ray (WBXR) is negative and whole-body MRI is unavailable. Based on the ability of 18F-FDG PET/CT to distinguish between metabolically active and inactive disease, this technique is now the preferred functional imaging modality to evaluate and to monitor the effect of therapy on myeloma-cell metabolism. Changes in FDG avidity can provide an earlier evaluation of response to therapy compared to MRI scans, and can predict outcomes, particularly for patients who are eligible to receive autologous stem-cell transplantation. 18F-FDG PET/CT can be coupled with sensitive bone marrow-based techniques to detect minimal residual disease (MRD) inside and outside the bone marrow, helping to identify those patients who are defined as having imaging MRD negativity.
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Affiliation(s)
- Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Cristina Nanni
- Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Philippe Moreau
- Haematology Department, University Hospital of Nantes, Nantes, France
| | | | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - Jens Hillengass
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Monika Engelhardt
- Department of Medicine, Hematology, Oncology & Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Saad Z Usmani
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - David H Vesole
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ, USA
| | | | - Shaji K Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paul G Richardson
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joseph R Mikhael
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Fernando Leal da Costa
- Myeloma Clinic, Hematology Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | | | | | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Wee Joo Chng
- National University Cancer Institute, National University Health System, Singapore
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Bart Barlogie
- Tisch Cancer Institute/Multiple Myeloma Program, Mt. Sinai Cancer Institute, New York, NY, USA
| | - Kenneth C Anderson
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian G M Durie
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Elena Zamagni
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
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Smith BD, DeZern AE, Bastian AW, Durie BGM. Meaningful endpoints for therapies approved for hematologic malignancies. Cancer 2017; 123:1689-1694. [DOI: 10.1002/cncr.30622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 01/21/2023]
Affiliation(s)
| | - Amy E. DeZern
- Kimmel Cancer Center/Johns Hopkins; Baltimore Maryland
| | | | - Brian G. M. Durie
- Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute; Los Angeles California
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Durie BGM, Hoering A, Abidi MH, Rajkumar SV, Epstein J, Kahanic SP, Thakuri M, Reu F, Reynolds CM, Sexton R, Orlowski RZ, Barlogie B, Dispenzieri A. Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trial. Lancet 2017; 389:519-527. [PMID: 28017406 PMCID: PMC5546834 DOI: 10.1016/s0140-6736(16)31594-x] [Citation(s) in RCA: 601] [Impact Index Per Article: 85.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/09/2016] [Accepted: 08/26/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Lenalidomide plus dexamethasone is a reference treatment for patients with newly diagnosed myeloma. The combination of the proteasome inhibitor bortezomib with lenalidomide and dexamethasone has shown significant efficacy in the setting of newly diagnosed myeloma. We aimed to study whether the addition of bortezomib to lenalidomide and dexamethasone would improve progression-free survival and provide better response rates in patients with previously untreated multiple myeloma who were not planned for immediate autologous stem-cell transplant. METHODS In this randomised, open-label, phase 3 trial, we recruited patients with newly diagnosed multiple myeloma aged 18 years and older from participating Southwest Oncology Group (SWOG) and National Clinical Trial Network (NCTN) institutions (both inpatient and outpatient settings). Key inclusion criteria were presence of CRAB (C=calcium elevation; R=renal impairment; A=anaemia; B=bone involvement) criteria with measurable disease (measured by assessment of free light chains), Eastern Cooperative Oncology Group (ECOG) performance status of 0-3, haemoglobin concentration 9 g/dL or higher, absolute neutrophil count 1 × 103 cells per mm3 or higher, and a platelet count of 80 000/mm3 or higher. We randomly assigned (1:1) patients to receive either an initial treatment of bortezomib with lenalidomide and dexamethasone (VRd group) or lenalidomide and dexamethasone alone (Rd group). Randomisation was stratified based on International Staging System stage (I, II, or III) and intent to transplant (yes vs no). The VRd regimen was given as eight 21-day cycles. Bortezomib was given at 1·3 mg/m2 intravenously on days 1, 4, 8, and 11, combined with oral lenalidomide 25 mg daily on days 1-14 plus oral dexamethasone 20 mg daily on days 1, 2, 4, 5, 8, 9, 11, and 12. The Rd regimen was given as six 28-day cycles. The standard Rd regimen consisted of 25 mg oral lenalidomide once a day for days 1-21 plus 40 mg oral dexamethasone once a day on days 1, 8, 15, and 22. The primary endpoint was progression-free survival using a prespecified one-sided stratified log rank test at a significance level of 0·02. Analyses were intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00644228. FINDINGS Between April, 2008, and February, 2012, we randomly assigned 525 patients at 139 participating institutions (264 to VRd and 261 to Rd). In the randomly assigned patients, 21 patients in the VRd group and 31 in the Rd group were deemed ineligible based mainly on missing, insufficient, or early or late baseline laboratory data. Median progression-free survival was significantly improved in the VRd group (43 months vs 30 months in the Rd group; stratified hazard ratio [HR] 0·712, 96% CI 0·56-0·906; one-sided p value 0·0018). The median overall survival was also significantly improved in the VRd group (75 months vs 64 months in the Rd group, HR 0·709, 95% CI 0·524-0·959; two-sided p value 0·025). The rates of overall response (partial response or better) were 82% (176/216) in the VRd group and 72% (153/214) in the Rd group, and 16% (34/216) and 8% (18/214) of patients who were assessable for response in these respective groups had a complete response or better. Adverse events of grade 3 or higher were reported in 198 (82%) of 241 patients in the VRd group and 169 (75%) of 226 patients in the Rd group; 55 (23%) and 22 (10%) patients discontinued induction treatment because of adverse events, respectively. There were no treatment-related deaths in the Rd group, and two in the VRd group. INTERPRETATION In patients with newly diagnosed myeloma, the addition of bortezomib to lenalidomide and dexamethasone resulted in significantly improved progression-free and overall survival and had an acceptable risk-benefit profile. FUNDING NIH, NCI, NCTN, Millennium Pharmaceuticals, Takeda Oncology Company, and Celgene Corporation.
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Affiliation(s)
- Brian G M Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, CA, USA.
| | | | - Muneer H Abidi
- Spectrum Health Cancer Center, Michigan State University, Grand Rapids, MI, USA
| | | | - Joshua Epstein
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stephen P Kahanic
- Siouxland Regional Cancer Center, Sanford NCORP of the Northern Central Plains, Sioux City, IA, USA
| | - Mohan Thakuri
- Southeast Clinical Oncology Research Consortium NCORP, Cancer Care of Western North Carolina, Asheville, NC, USA
| | - Frederic Reu
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | | | | | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bart Barlogie
- Myeloma Program, Mount Sinai School of Medicine, New York, NY, USA
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Rifkin RM, Abonour R, Shah JJ, Mehta J, Narang M, Terebelo H, Gasparetto C, Toomey K, Hardin JW, Lu JJ, Kenvin L, Srinivasan S, Knight R, Nagarwala Y, Durie BGM. Connect MM® - the Multiple Myeloma Disease Registry: incidence of second primary malignancies in patients treated with lenalidomide. Leuk Lymphoma 2016; 57:2228-31. [PMID: 26766599 DOI: 10.3109/10428194.2015.1132419] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Rafat Abonour
- b Indiana University Cancer Center , Indianapolis , IN , USA
| | - Jatin J Shah
- c Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jayesh Mehta
- d Division of Hematology-Oncology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Mohit Narang
- e Maryland Oncology Hematology , Columbia , MD , USA
| | | | - Cristina Gasparetto
- g Division of Cellular Therapy , Duke University Medical Center , Durham , NC , USA
| | | | - James W Hardin
- i Epidemiology and Biostatistics, University of South Carolina , Columbia , SC , USA
| | | | | | | | | | | | - Brian G M Durie
- k Cedars-Sinai Outpatient Cancer Center at the Samuel Oschin Comprehensive Cancer Institute , Los Angeles , CA , USA
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Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L, Richardson P, Caltagirone S, Lahuerta JJ, Facon T, Bringhen S, Gay F, Attal M, Passera R, Spencer A, Offidani M, Kumar S, Musto P, Lonial S, Petrucci MT, Orlowski RZ, Zamagni E, Morgan G, Dimopoulos MA, Durie BGM, Anderson KC, Sonneveld P, San Miguel J, Cavo M, Rajkumar SV, Moreau P. Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group. J Clin Oncol 2015; 33:2863-9. [PMID: 26240224 DOI: 10.1200/jco.2015.61.2267] [Citation(s) in RCA: 1287] [Impact Index Per Article: 143.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The clinical outcome of multiple myeloma (MM) is heterogeneous. A simple and reliable tool is needed to stratify patients with MM. We combined the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization after CD138 plasma cell purification and serum lactate dehydrogenase (LDH) to evaluate their prognostic value in newly diagnosed MM (NDMM). PATIENTS AND METHODS Clinical and laboratory data from 4,445 patients with NDMM enrolled onto 11 international trials were pooled together. The K-adaptive partitioning algorithm was used to define the most appropriate subgroups with homogeneous survival. RESULTS ISS, CA, and LDH data were simultaneously available in 3,060 of 4,445 patients. We defined the following three groups: revised ISS (R-ISS) I (n = 871), including ISS stage I (serum β2-microglobulin level < 3.5 mg/L and serum albumin level ≥ 3.5 g/dL), no high-risk CA [del(17p) and/or t(4;14) and/or t(14;16)], and normal LDH level (less than the upper limit of normal range); R-ISS III (n = 295), including ISS stage III (serum β2-microglobulin level > 5.5 mg/L) and high-risk CA or high LDH level; and R-ISS II (n = 1,894), including all the other possible combinations. At a median follow-up of 46 months, the 5-year OS rate was 82% in the R-ISS I, 62% in the R-ISS II, and 40% in the R-ISS III groups; the 5-year PFS rates were 55%, 36%, and 24%, respectively. CONCLUSION The R-ISS is a simple and powerful prognostic staging system, and we recommend its use in future clinical studies to stratify patients with NDMM effectively with respect to the relative risk to their survival.
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Affiliation(s)
- Antonio Palumbo
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Hervé Avet-Loiseau
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Stefania Oliva
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Henk M Lokhorst
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Hartmut Goldschmidt
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Laura Rosinol
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Paul Richardson
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Simona Caltagirone
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Juan José Lahuerta
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Thierry Facon
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Sara Bringhen
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Francesca Gay
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Michel Attal
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Roberto Passera
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Andrew Spencer
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Massimo Offidani
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Shaji Kumar
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Pellegrino Musto
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Sagar Lonial
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Maria T Petrucci
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Robert Z Orlowski
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Elena Zamagni
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Gareth Morgan
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Meletios A Dimopoulos
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Brian G M Durie
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Kenneth C Anderson
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Pieter Sonneveld
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Jésus San Miguel
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Michele Cavo
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - S Vincent Rajkumar
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Philippe Moreau
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
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Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BGM, Miguel JFS. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15:e538-48. [PMID: 25439696 DOI: 10.1016/s1470-2045(14)70442-5] [Citation(s) in RCA: 2686] [Impact Index Per Article: 268.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This International Myeloma Working Group consensus updates the disease definition of multiple myeloma to include validated biomarkers in addition to existing requirements of attributable CRAB features (hypercalcaemia, renal failure, anaemia, and bone lesions). These changes are based on the identification of biomarkers associated with near inevitable development of CRAB features in patients who would otherwise be regarded as having smouldering multiple myeloma. A delay in application of the label of multiple myeloma and postponement of therapy could be detrimental to these patients. In addition to this change, we clarify and update the underlying laboratory and radiographic variables that fulfil the criteria for the presence of myeloma-defining CRAB features, and the histological and monoclonal protein requirements for the disease diagnosis. Finally, we provide specific metrics that new biomarkers should meet for inclusion in the disease definition. The International Myeloma Working Group recommends the implementation of these criteria in routine practice and in future clinical trials, and recommends that future studies analyse any differences in outcome that might occur as a result of the new disease definition.
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Affiliation(s)
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Giampaolo Merlini
- Amyloidosis Center, University Hospital Policlinico San Matteo, Pavia, Italy
| | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jens Hillengass
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece
| | | | - Ola Landgren
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bruno Paiva
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain
| | | | - Brendan Weiss
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | - Elena Zamagni
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | | | | | - Jo Caers
- Department of Hematology, CHU de Liege, Liege, Belgium
| | - Saad Z Usmani
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Juan José Lahuerta
- Servicio de Hematología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Hans Erik Johnsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Meral Beksac
- Ankara University School of Medicine, Ankara, Turkey
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Hartmut Goldschmidt
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Evangelos Terpos
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Brian G M Durie
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Jesus F San Miguel
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain
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Ocio EM, Richardson PG, Rajkumar SV, Palumbo A, Mateos MV, Orlowski R, Kumar S, Usmani S, Roodman D, Niesvizky R, Einsele H, Anderson KC, Dimopoulos MA, Avet-Loiseau H, Mellqvist UH, Turesson I, Merlini G, Schots R, McCarthy P, Bergsagel L, Chim CS, Lahuerta JJ, Shah J, Reiman A, Mikhael J, Zweegman S, Lonial S, Comenzo R, Chng WJ, Moreau P, Sonneveld P, Ludwig H, Durie BGM, Miguel JFS. New drugs and novel mechanisms of action in multiple myeloma in 2013: a report from the International Myeloma Working Group (IMWG). Leukemia 2014; 28:525-42. [PMID: 24253022 PMCID: PMC4143389 DOI: 10.1038/leu.2013.350] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [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: 08/27/2013] [Revised: 10/23/2013] [Accepted: 11/07/2013] [Indexed: 01/08/2023]
Abstract
Treatment in medical oncology is gradually shifting from the use of nonspecific chemotherapeutic agents toward an era of novel targeted therapy in which drugs and their combinations target specific aspects of the biology of tumor cells. Multiple myeloma (MM) has become one of the best examples in this regard, reflected in the identification of new pathogenic mechanisms, together with the development of novel drugs that are being explored from the preclinical setting to the early phases of clinical development. We review the biological rationale for the use of the most important new agents for treating MM and summarize their clinical activity in an increasingly busy field. First, we discuss data from already approved and active agents (including second- and third-generation proteasome inhibitors (PIs), immunomodulatory agents and alkylators). Next, we focus on agents with novel mechanisms of action, such as monoclonal antibodies (MoAbs), cell cycle-specific drugs, deacetylase inhibitors, agents acting on the unfolded protein response, signaling transduction pathway inhibitors and kinase inhibitors. Among this plethora of new agents or mechanisms, some are specially promising: anti-CD38 MoAb, such as daratumumab, are the first antibodies with clinical activity as single agents in MM. Moreover, the kinesin spindle protein inhibitor Arry-520 is effective in monotherapy as well as in combination with dexamethasone in heavily pretreated patients. Immunotherapy against MM is also being explored, and probably the most attractive example of this approach is the combination of the anti-CS1 MoAb elotuzumab with lenalidomide and dexamethasone, which has produced exciting results in the relapsed/refractory setting.
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Affiliation(s)
- E M Ocio
- Department of Hematology, University Hospital and Cancer Research Center, University of Salamanca-IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain
| | - P G Richardson
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - S V Rajkumar
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Palumbo
- Department of Hematology, University of Torino, Torino, Italy
| | - M V Mateos
- Department of Hematology, University Hospital and Cancer Research Center, University of Salamanca-IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain
| | - R Orlowski
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - S Kumar
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Usmani
- M.I.R.T. UAMS, Little Rock, AR, USA
| | - D Roodman
- Director of Hematology/Oncology, Indiana University, Indianapolis, IN, USA
| | - R Niesvizky
- Department of Hematology, Weill Cornell Medical College, New York, NY, USA
| | - H Einsele
- Department of Internal Medicine, University of Wurzburg, Wurzburg, Germany
| | - K C Anderson
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M A Dimopoulos
- School of Medicine, University of Athens, Athens, Greece
| | - H Avet-Loiseau
- Department of Hematology, University of Toulouse, Toulouse, France
| | - U-H Mellqvist
- Department of Medicine, Section of Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I Turesson
- Department of Medicine, Section of Hematology, Skane University Hospital, Malmo, Sweden
| | - G Merlini
- Department of Molecular Medicine, Univeristy of Pavia, Pavia, Italy
| | - R Schots
- Department of Clinical Hematology and Stem Cell Laboratory, University Ziekenhuis, Brussels, Belgium
| | - P McCarthy
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - L Bergsagel
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - C S Chim
- Department of Hematology, Queen Mary Hospital, Hong Kong
| | - J J Lahuerta
- Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Shah
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - A Reiman
- Department of Oncology, University of New Brunswick, Saint John Regional Hospital, St John, NB, Canada
| | - J Mikhael
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - S Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Lonial
- Department of Hematology and Medical Oncology, Shanghai Chang Zheng Hospital, Atlanta, GA, USA
| | - R Comenzo
- Department of Hematology, Tufts Medical School, Boston, MA, USA
| | - W J Chng
- Department of Hematology Oncology, National University Cancer Institute, Singapore
| | - P Moreau
- Department of Hematology, University Hospital, Nantes, France
| | - P Sonneveld
- Department of Hematology, Erasmus MC, Rotterdam, The Netherlands
| | - H Ludwig
- Department of Medicine, Center for Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria
| | | | - J F S Miguel
- 1] Department of Hematology, University Hospital and Cancer Research Center, University of Salamanca-IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain [2] Department of Clinical and Translational Medicine, University of Navarra, Pamplona, Spain
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Tripathy D, Durie BGM, Mautner B, Ferenz KS, Moul JW. Awareness, concern, and communication between physicians and patients on bone health in cancer. Support Care Cancer 2014; 22:1601-10. [PMID: 24477326 DOI: 10.1007/s00520-014-2127-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aims to explore physician-patient communications about bone metastases and cancer treatment-induced bone loss (CTIBL). METHODS The study utilizes online survey of patients with breast cancer, prostate cancer, and multiple myeloma, and the physicians who treat them. RESULTS Even though 69 and 48 % of patients with nonmetastatic breast and prostate cancer aware of treatment-induced bone loss, only 39 and 23 %, respectively, were concerned about bone loss. Yet, 62 and 71 % of oncologists treating breast and prostate cancer felt that their patients were concerned. Among patients with metastatic breast and prostate cancer, two thirds had not discussed treatment for bone metastases with their doctor; when discussed, 88 and 91 % of discussions were initiated by the doctor, usually prior to initiating treatment. Most myeloma patients (77 %) had discussed treatment options with their physicians; 99 % of hematologists reported discussing treatment of bone disease with patients. CONCLUSIONS Physicians are primary sources of information to patients regarding bone health. There is a gap between what physicians assume their patients know about bone health and the patients' perceptions, presenting a need for systematic awareness and education.
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Affiliation(s)
- Debu Tripathy
- USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave., #3447, Los Angeles, CA, 90033, USA,
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Palumbo A, Rajkumar SV, San Miguel JF, Larocca A, Niesvizky R, Morgan G, Landgren O, Hajek R, Einsele H, Anderson KC, Dimopoulos MA, Richardson PG, Cavo M, Spencer A, Stewart AK, Shimizu K, Lonial S, Sonneveld P, Durie BGM, Moreau P, Orlowski RZ. International Myeloma Working Group consensus statement for the management, treatment, and supportive care of patients with myeloma not eligible for standard autologous stem-cell transplantation. J Clin Oncol 2014; 32:587-600. [PMID: 24419113 DOI: 10.1200/jco.2013.48.7934] [Citation(s) in RCA: 273] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To provide an update on recent advances in the management of patients with multiple myeloma who are not eligible for autologous stem-cell transplantation. METHODS A comprehensive review of the literature on diagnostic criteria is provided, and treatment options and management of adverse events are summarized. RESULTS Patients with symptomatic disease and organ damage (ie, hypercalcemia, renal failure, anemia, or bone lesions) require immediate treatment. The International Staging System and chromosomal abnormalities identify high- and standard-risk patients. Proteasome inhibitors, immunomodulatory drugs, corticosteroids, and alkylating agents are the most active agents. The presence of concomitant diseases, frailty, or disability should be assessed and, if present, treated with reduced-dose approaches. Bone disease, renal damage, hematologic toxicities, infections, thromboembolism, and peripheral neuropathy are the most frequent disabling events requiring prompt and active supportive care. CONCLUSION These recommendations will help clinicians ensure the most appropriate care for patients with myeloma in everyday clinical practice.
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Affiliation(s)
- Antonio Palumbo
- Antonio Palumbo and Alessandra Larocca, University of Torino, Torino; Michele Cavo, Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Jesus F. San Miguel, University Hospital of Salamanca, Salamanca, Spain; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Gareth Morgan, Royal Marsden Hospital, London, United Kingdom; Ola Landgren, National Cancer Institute, Bethesda, MD; Roman Hajek, University of Ostrava School of Medicine and University Hospital Ostrava, Ostrava, Czech Republic; Hermann Einsele, University of Wurzburg, Wurzburg, Germany; Kenneth C. Anderson and Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA; Meletios A. Dimopoulos, University of Athens School of Medicine, Athens, Greece; Andrew Spencer, Alfred Hospital, Melbourne, Victoria, Australia; A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Kazuyuki Shimizu, Aichi Gakuin Hospital, Nagoya, Japan; Sagar Lonial, Emory University, Atlanta, GA; Pieter Sonneveld, Erasmus Medical Centre, Rotterdam, the Netherlands; Brian G.M. Durie, Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA; Philippe Moreau, University Hospital, Nantes, France; and Robert Z. Orlowski, MD Anderson Cancer Center, Houston, TX
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Tan D, Chng WJ, Chou T, Nawarawong W, Hwang SY, Chim CS, Chen W, Durie BGM, Lee JH. Management of multiple myeloma in Asia: resource-stratified guidelines. Lancet Oncol 2013; 14:e571-81. [PMID: 24176575 DOI: 10.1016/s1470-2045(13)70404-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Treatment of multiple myeloma has undergone substantial developments in the past 10 years. The introduction of novel drugs has changed the treatment of the disease and substantially improved survival outcomes. Clinical practice guidelines based on evidence have been developed to provide recommendations on standard treatment approaches. However, the guidelines do not take into account resource limitations encountered by developing countries. The huge disparities in economy, health-care infrastructure, and access to novel drugs in Asian countries hinder the delivery of optimum care to every patient with multiple myeloma in Asia. In this Review we outline the guidelines that correspond with different levels of health-care resources and expertise, with the aim to unify diagnostic and therapeutic guidelines and help with the design of future studies in Asia.
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Affiliation(s)
- Daryl Tan
- Raffles Cancer Center, Raffles Hospital, Singapore, Singapore; Department of Haematology, Singapore General Hospital, Singapore, Singapore.
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Terpos E, Morgan G, Dimopoulos MA, Drake MT, Lentzsch S, Raje N, Sezer O, García-Sanz R, Shimizu K, Turesson I, Reiman T, Jurczyszyn A, Merlini G, Spencer A, Leleu X, Cavo M, Munshi N, Rajkumar SV, Durie BGM, Roodman GD. International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease. J Clin Oncol 2013; 31:2347-57. [PMID: 23690408 DOI: 10.1200/jco.2012.47.7901] [Citation(s) in RCA: 235] [Impact Index Per Article: 21.4] [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] Open
Abstract
PURPOSE The aim of the International Myeloma Working Group was to develop practice recommendations for the management of multiple myeloma (MM) -related bone disease. METHODOLOGY An interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations based on published data through August 2012. Expert consensus was used to propose additional recommendations in situations where there were insufficient published data. Levels of evidence and grades of recommendations were assigned and approved by panel members. RECOMMENDATIONS Bisphosphonates (BPs) should be considered in all patients with MM receiving first-line antimyeloma therapy, regardless of presence of osteolytic bone lesions on conventional radiography. However, it is unknown if BPs offer any advantage in patients with no bone disease assessed by magnetic resonance imaging or positron emission tomography/computed tomography. Intravenous (IV) zoledronic acid (ZOL) or pamidronate (PAM) is recommended for preventing skeletal-related events in patients with MM. ZOL is preferred over oral clodronate in newly diagnosed patients with MM because of its potential antimyeloma effects and survival benefits. BPs should be administered every 3 to 4 weeks IV during initial therapy. ZOL or PAM should be continued in patients with active disease and should be resumed after disease relapse, if discontinued in patients achieving complete or very good partial response. BPs are well tolerated, but preventive strategies must be instituted to avoid renal toxicity or osteonecrosis of the jaw. Kyphoplasty should be considered for symptomatic vertebral compression fractures. Low-dose radiation therapy can be used for palliation of uncontrolled pain, impending pathologic fracture, or spinal cord compression. Orthopedic consultation should be sought for long-bone fractures, spinal cord compression, and vertebral column instability.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece.
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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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Avet-Loiseau H, Durie BGM, Cavo M, Attal M, Gutierrez N, Haessler J, Goldschmidt H, Hajek R, Lee JH, Sezer O, Barlogie B, Crowley J, Fonseca R, Testoni N, Ross F, Rajkumar SV, Sonneveld P, Lahuerta J, Moreau P, Morgan G. Combining fluorescent in situ hybridization data with ISS staging improves risk assessment in myeloma: an International Myeloma Working Group collaborative project. Leukemia 2012; 27:711-7. [PMID: 23032723 DOI: 10.1038/leu.2012.282] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The combination of serum β2-microglobulin and albumin levels has been shown to be highly prognostic in myeloma as the International Staging System (ISS). The aim of this study was to assess the independent contributions of ISS stage and cytogenetic abnormalities in predicting outcomes. A retrospective analysis of international studies looking at both ISS and cytogenetic abnormalities was performed in order to assess the potential role of combining ISS stage and cytogenetics to predict survival. This international effort used the International Myeloma Working Group database of 12 137 patients treated worldwide for myeloma at diagnosis, of whom 2309 had cytogenetic studies and 5387 had analyses by fluorescent in situ hybridization (iFISH). Comprehensive analyses used 2642 patients with sufficient iFISH data available. Using the comprehensive iFISH data, combining both t(4;14) and deletion (17p), along with ISS stage, significantly improved the prognostic assessment in terms of progression-free survival and overall survival. The additional impact of patient age and use of high-dose therapy was also demonstrated. In conclusion, the combination of iFISH data with ISS staging significantly improves risk assessment in myeloma.
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Affiliation(s)
- H Avet-Loiseau
- Unité de Génomique du Myélome, Laboratoire UGM, University Hospital, CHU Rangueil, Toulouse, France
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Richardson PG, Delforge M, Beksac M, Wen P, Jongen JL, Sezer O, Terpos E, Munshi N, Palumbo A, Rajkumar SV, Harousseau JL, Moreau P, Avet-Loiseau H, Lee JH, Cavo M, Merlini G, Voorhees P, Chng WJ, Mazumder A, Usmani S, Einsele H, Comenzo R, Orlowski R, Vesole D, Lahuerta JJ, Niesvizky R, Siegel D, Mateos MV, Dimopoulos M, Lonial S, Jagannath S, Bladé J, Miguel JS, Morgan G, Anderson KC, Durie BGM, Sonneveld P, Sonneveld P. Management of treatment-emergent peripheral neuropathy in multiple myeloma. Leukemia 2012; 26:595-608. [PMID: 22193964 DOI: 10.1038/leu.2011.346] [Citation(s) in RCA: 189] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Peripheral neuropathy (PN) is one of the most important complications of multiple myeloma (MM) treatment. PN can be caused by MM itself, either by the effects of the monoclonal protein or in the form of radiculopathy from direct compression, and particularly by certain therapies, including bortezomib, thalidomide, vinca alkaloids and cisplatin. Clinical evaluation has shown that up to 20% of MM patients have PN at diagnosis and as many as 75% may experience treatment-emergent PN during therapy. The incidence, symptoms, reversibility, predisposing factors and etiology of treatment-emergent PN vary among MM therapies, with PN incidence also affected by the dose, schedule and combinations of potentially neurotoxic agents. Effective management of treatment-emergent PN is critical to minimize the incidence and severity of this complication, while maintaining therapeutic efficacy. Herein, the state of knowledge regarding treatment-emergent PN in MM patients and current management practices are outlined, and recommendations regarding optimal strategies for PN management during MM treatment are provided. These strategies include early and regular monitoring with neurological evaluation, with dose modification and treatment discontinuation as indicated. Areas requiring further research include the development of MM-specific, patient-focused assessment tools, pharmacogenomic analysis of patient DNA, and trials to assess the efficacy of pharmacological interventions.
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40
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Ludwig H, Durie BGM, McCarthy P, Palumbo A, San Miguel J, Barlogie B, Morgan G, Sonneveld P, Spencer A, Andersen KC, Facon T, Stewart KA, Einsele H, Mateos MV, Wijermans P, Waage A, Beksac M, Richardson PG, Hulin C, Niesvizky R, Lokhorst H, Landgren O, Bergsagel PL, Orlowski R, Hinke A, Cavo M, Attal M. IMWG consensus on maintenance therapy in multiple myeloma. Blood 2012; 119:3003-15. [PMID: 22271445 PMCID: PMC3321864 DOI: 10.1182/blood-2011-11-374249] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 01/06/2012] [Indexed: 12/23/2022] Open
Abstract
Maintaining results of successful induction therapy is an important goal in multiple myeloma. Here, members of the International Myeloma Working Group review the relevant data. Thalidomide maintenance therapy after autologous stem cell transplantation improved the quality of response and increased progression-free survival (PFS) significantly in all 6 studies and overall survival (OS) in 3 of them. In elderly patients, 2 trials showed a significant prolongation of PFS, but no improvement in OS. A meta-analysis revealed a significant risk reduction for PFS/event-free survival and death. The role of thalidomide maintenance after melphalan, prednisone, and thalidomide is not well established. Two trials with lenalidomide maintenance treatment after autologous stem cell transplantation and one study after conventional melphalan, prednisone, and lenalidomide induction therapy showed a significant risk reduction for PFS and an increase in OS in one of the transplant trials. Maintenance therapy with single-agent bortezomib or in combination with thalidomide or prednisone has been studied. One trial revealed a significantly increased OS with a bortezomib-based induction and bortezomib maintenance therapy compared with conventional induction and thalidomide maintenance treatment. Maintenance treatment can be associated with significant side effects, and none of the drugs evaluated is approved for maintenance therapy. Treatment decisions for individual patients must balance potential benefits and risks carefully, as a widely agreed-on standard is not established.
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Affiliation(s)
- Heinz Ludwig
- Department of Medicine I, Center for Oncology and Hematology, Wilhelminenspital, Vienna, Austria.
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Kumar SK, Lee JH, Lahuerta JJ, Morgan G, Richardson PG, Crowley J, Haessler J, Feather J, Hoering A, Moreau P, LeLeu X, Hulin C, Klein SK, Sonneveld P, Siegel D, Bladé J, Goldschmidt H, Jagannath S, Miguel JS, Orlowski R, Palumbo A, Sezer O, Rajkumar SV, Durie BGM. Risk of progression and survival in multiple myeloma relapsing after therapy with IMiDs and bortezomib: a multicenter international myeloma working group study. Leukemia 2011; 26:149-57. [PMID: 21799510 DOI: 10.1038/leu.2011.196] [Citation(s) in RCA: 593] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Promising new drugs are being evaluated for treatment of multiple myeloma (MM), but their impact should be measured against the expected outcome in patients failing current therapies. However, the natural history of relapsed disease in the current era remains unclear. We studied 286 patients with relapsed MM, who were refractory to bortezomib and were relapsed following, refractory to or ineligible to receive, an IMiD (immunomodulatory drug), had measurable disease, and ECOG PS of 0, 1 or 2. The date patients satisfied the entry criteria was defined as time zero (T(0)). The median age at diagnosis was 58 years, and time from diagnosis to T(0) was 3.3 years. Following T(0), 213 (74%) patients had a treatment recorded with one or more regimens (median=1; range 0-8). The first regimen contained bortezomib in 55 (26%) patients and an IMiD in 70 (33%). A minor response or better was seen to at least one therapy after T(0) in 94 patients (44%) including ≥ partial response in 69 (32%). The median overall survival and event-free survival from T(0) were 9 and 5 months, respectively. This study confirms the poor outcome, once patients become refractory to current treatments. The results provide context for interpreting ongoing trials of new drugs.
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Affiliation(s)
- S K Kumar
- Divison of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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Cavo M, Rajkumar SV, Palumbo A, Moreau P, Orlowski R, Bladé J, Sezer O, Ludwig H, Dimopoulos MA, Attal M, Sonneveld P, Boccadoro M, Anderson KC, Richardson PG, Bensinger W, Johnsen HE, Kroeger N, Gahrton G, Bergsagel PL, Vesole DH, Einsele H, Jagannath S, Niesvizky R, Durie BGM, San Miguel J, Lonial S. International Myeloma Working Group consensus approach to the treatment of multiple myeloma patients who are candidates for autologous stem cell transplantation. Blood 2011; 117:6063-73. [PMID: 21447828 PMCID: PMC3293742 DOI: 10.1182/blood-2011-02-297325] [Citation(s) in RCA: 226] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 03/16/2011] [Indexed: 02/08/2023] Open
Abstract
The role of high-dose therapy followed by autologous stem cell transplantation (ASCT) in the treatment of multiple myeloma (MM) continues to evolve in the novel agent era. The choice of induction therapy has moved from conventional chemotherapy to newer regimens incorporating the immunomodulatory derivatives thalidomide or lenalidomide and the proteasome inhibitor bortezomib. These drugs combine well with traditional therapies and with one another to form various doublet, triplet, and quadruplet regimens. Up-front use of these induction treatments, in particular 3-drug combinations, has affected unprecedented rates of complete response that rival those previously seen with conventional chemotherapy and subsequent ASCT. Autotransplantation applied after novel-agent-based induction regimens provides further improvement in the depth of response, a gain that translates into extended progression-free survival and, potentially, overall survival. High activity shown by immunomodulatory derivatives and bortezomib before ASCT has recently led to their use as consolidation and maintenance therapies after autotransplantation. Novel agents and ASCT are complementary treatment strategies for MM. This article reviews the current literature and provides important perspectives and guidance on the major issues surrounding the optimal current management of younger, transplantation-eligible MM patients.
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Affiliation(s)
- Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
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Johnson DC, Corthals SL, Walker BA, Ross FM, Gregory WM, Dickens NJ, Lokhorst HM, Goldschmidt H, Davies FE, Durie BGM, Van Ness B, Child JA, Sonneveld P, Morgan GJ. Genetic factors underlying the risk of thalidomide-related neuropathy in patients with multiple myeloma. J Clin Oncol 2011; 29:797-804. [PMID: 21245421 DOI: 10.1200/jco.2010.28.0792] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To indentify genetic variation that can modulate and predict the risk of developing thalidomide-related peripheral neuropathy (TrPN). PATIENTS AND METHODS We analyzed DNA from 1,495 patients with multiple myeloma. Using a custom-built single nucleotide polymorphism (SNP) array, we tested the association of TrPN with 3,404 SNPs. The SNPs were selected in predicted functional regions within 964 genes spanning 67 molecular pathways thought to be involved in the pathogenesis, treatment response, and adverse effects associated with myeloma and its therapy. Patient cases and controls were derived from two large clinical trials that compared thalidomide with conventional-based treatment in myeloma patients (Medical Research Council Myeloma-IX and HOVON-50/GMMG-HD3). RESULTS We report TrPN associations with SNPs-ABCA1 (rs363717), ICAM1 (rs1799969), PPARD (rs2076169), SERPINB2 (rs6103), and SLC12A6 (rs7164902)-where we show cross validation of the associations in both trials. To investigate whether TrPN SNP associations were related to exposure to thalidomide only or general drug-related peripheral neuropathy, we performed a second analysis on patients treated with vincristine. We report SNPs associated with vincristine neuropathy, with a seemingly distinct underlying genetic mechanism. CONCLUSION Our results are consistent with the hypothesis that an individual's risk of developing a peripheral neuropathy after thalidomide treatment can be mediated by polymorphisms in genes governing repair mechanisms and inflammation in the peripheral nervous system. These findings will contribute to the development of future neuroprotective strategies with thalidomide therapy and the better use of this important compound.
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Zonder JA, Crowley J, Hussein MA, Bolejack V, Moore DF, Whittenberger BF, Abidi MH, Durie BGM, Barlogie B. Lenalidomide and high-dose dexamethasone compared with dexamethasone as initial therapy for multiple myeloma: a randomized Southwest Oncology Group trial (S0232). Blood 2010; 116:5838-41. [PMID: 20876454 PMCID: PMC3031379 DOI: 10.1182/blood-2010-08-303487] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 09/15/2010] [Indexed: 12/13/2022] Open
Abstract
The Southwest Oncology Group conducted a randomized trial comparing lenalidomide (LEN) plus dexamethasone (DEX; n = 97) to placebo (PLC) plus DEX (n = 95) in newly diagnosed myeloma. Three 35-day induction cycles applied DEX 40 mg/day on days 1 to 4, 9 to 12, and 17 to 20 together with LEN 25 mg/day for 28 days or PLC. Monthly maintenance used DEX 40 mg/day on days 1 to 4 and 15 to 18 along with LEN 25 mg/day for 21 days or PLC. Crossover from PLC-DEX to LEN-DEX was encouraged on progression. One-year progression-free survival, overall response rate, and very good partial response rate were superior with LEN-DEX (78% vs 52%, P = .002; 78% vs 48%, P < .001; 63% vs 16%, P < .001), whereas 1-year overall survival was similar (94% vs 88%; P = .25). Toxicities were more pronounced with LEN-DEX (neutropenia grade 3 or 4: 21% vs 5%, P < .001; thromboembolic events despite aspirin prophylaxis: 23.5% [initial LEN-DEX or crossover] vs 5%; P < .001). This trial was registered at www.clinicaltrials.gov as #NCT00064038.
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Affiliation(s)
- Jeffrey A Zonder
- Division of Hematology/Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA.
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Barlogie B, Attal M, Crowley J, van Rhee F, Szymonifka J, Moreau P, Durie BGM, Harousseau JL. Long-term follow-up of autotransplantation trials for multiple myeloma: update of protocols conducted by the intergroupe francophone du myelome, southwest oncology group, and university of arkansas for medical sciences. J Clin Oncol 2010; 28:1209-14. [PMID: 20085933 PMCID: PMC2834471 DOI: 10.1200/jco.2009.25.6081] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 10/26/2009] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The purpose of this study was to update outcomes of autotransplantation trials for myeloma conducted by the Intergroupe Francophone du Myelome (IFM), the Southwest Oncology Group, and the University of Arkansas for Medical Sciences (Total Therapy [TT]). METHODS IFM90 (N = 194), IFM04 (N = 402), IFM9902 (N = 692), IFM9904 (N = 197), S9321 (N = 817), TT1 (N = 231), TT2 (N = 668), and TT3 (N = 303) were updated, and results were compared with original reports. RESULTS Superior survival with single transplantation versus standard therapy in IFM90 was confirmed (P = .004), and a trend in favor of tandem versus single transplantation was maintained in IFM94 (P = .08). S9321 data were validated, with comparable survival in single transplantation and standard treatment arms (P = .35). A survival benefit from thalidomide maintenance in IFM9902 was not confirmed (P = .39) but emerged for the thalidomide arm of TT2 (P = .04). On multivariate analysis, survival was superior in TT2, TT3, and IFM9902 (all P < .001); tandem transplantations were superior to both single transplantations and standard therapies (P < .001), as were tandem transplantations with added thalidomide versus trials without thalidomide (P < .001). Postrelapse survival (PRS) was superior when initial event-free survival (EFS) exceeded 1280 days and when tandem transplantations had been administered, whereas PRS was shorter when EFS lasted 803 days or less and when trials had included thalidomide and bortezomib. CONCLUSION These long-term follow-up data of transplantation trials provide a crucial framework of reference for outcome reporting of novel agent-based trials reportedly exhibiting remarkable short-term efficacy approaching high-dose therapy results.
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Affiliation(s)
- Bart Barlogie
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, 4301 West Markham, #816, Little Rock, AR 72205;
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Bensinger WI, Jagannath S, Vescio R, Camacho E, Wolf J, Irwin D, Capo G, McKinley M, Potts P, Vesole DH, Mazumder A, Crowley J, Becker P, Hilger J, Durie BGM. Phase 2 study of two sequential three-drug combinations containing bortezomib, cyclophosphamide and dexamethasone, followed by bortezomib, thalidomide and dexamethasone as frontline therapy for multiple myeloma. Br J Haematol 2009; 148:562-8. [PMID: 19919652 DOI: 10.1111/j.1365-2141.2009.07981.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Novel sequential combination therapy for induction may improve the quality of response and therefore prolong survival in newly diagnosed multiple myeloma (MM) patients. We report results from a phase 2 study of two sequential three-drug combinations. Forty-four previously untreated, symptomatic MM patients received: bortezomib 1.3 mg/m(2) (days 1, 4, 8, 11), cyclophosphamide 300 mg/m(2) (days 1, 8), plus dexamethasone 40 mg (day of and day after bortezomib) for three 21-day cycles, followed by bortezomib 1.0 mg/m(2), dexamethasone 40 mg and thalidomide 100 mg daily for three cycles. Overall response rate for 42 evaluable patients was 95%, including 19% stringent complete response (sCR), 26% CR, and 57%>/= very good partial response. Twenty-two patients have undergone stem-cell transplantation. After a median follow-up of 20.9 months, five patients have died; none was induction therapy-related. Median event-free survival (EFS) and overall survival (OS) have not been reached; estimated 1-year EFS and OS rates were 81% and 91% respectively. Both three-drug combinations were well tolerated; 82% of patients completed all six cycles. Toxicities were predictable and manageable; the most-commonly reported grade 3/4 toxicity was neuropathy (11%). This novel sequential three-drug combination therapy is effective and well-tolerated in previously untreated MM patients.
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Affiliation(s)
- William I Bensinger
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., Seattle, WA 98109, USA.
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Engelhardt M, Kleber M, Frydrychowicz A, Pache G, Schmitt-Gräff A, Wäsch R, Durie BGM. Superiority of magnetic resonance imaging over conventional radiographs in multiple myeloma. Anticancer Res 2009; 29:4745-4750. [PMID: 20032430] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Bone lesions in multiple myeloma (MM) are screened with radiological skeletal survey (RSS) due to its widespread availability. Although bone lesions can be missed by RSS, more sensitive radiological surveys are not as yet recommended for routine use due to the low availability of the methodology and economical considerations. CASE REPORT We report on a 68-year-old male with IgG kappa stage IIIA MM presenting with skeletal pain, fatigue and osteolytic lesions. Since the patient refrained from more intensive therapy, including autologous stem cell transplantation (auto-SCT), he was treated with vertebral irradiation and included in an institutionally guided study which randomized melphalan, prednisone (MP)-lenalidomide (MPR) to MP alone. Although he initially responded, his bone pain reoccurred after three MP cycles. The repeated RSS showed minor, if any changes. Therefore, an MRI was added which revealed extensive osteolyses and extramedullary disease. Justified by these results it was possible to convince the patient that a more intensive therapy approach, including auto-SCT, local irradiation and thalidomide maintenance, was appropriate. CONCLUSION This case calls for an earlier integration of MRI and/or PET/CT scanning in MM, even if RSS remains unchanged, especially if initial bone disease is substantial and/or MM-related symptoms recur. The time course of information and linked decision-making point towards the future significance of an intensified integration of imaging methodologies in the classification and disease management of MM.
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Affiliation(s)
- Monika Engelhardt
- Department of Hematology and Oncology, University Medical Center Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany.
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48
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Fonseca R, Bergsagel PL, Drach J, Shaughnessy J, Gutierrez N, Stewart AK, Morgan G, Van Ness B, Chesi M, Minvielle S, Neri A, Barlogie B, Kuehl WM, Liebisch P, Davies F, Chen-Kiang S, Durie BGM, Carrasco R, Sezer O, Reiman T, Pilarski L, Avet-Loiseau H. International Myeloma Working Group molecular classification of multiple myeloma: spotlight review. Leukemia 2009; 23:2210-21. [PMID: 19798094 DOI: 10.1038/leu.2009.174] [Citation(s) in RCA: 624] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Myeloma is a malignant proliferation of monoclonal plasma cells. Although morphologically similar, several subtypes of the disease have been identified at the genetic and molecular level. These genetic subtypes are associated with unique clinicopathological features and dissimilar outcome. At the top hierarchical level, myeloma can be divided into hyperdiploid and non-hyperdiploid subtypes. The latter is mainly composed of cases harboring IgH translocations, generally associated with more aggressive clinical features and shorter survival. The three main IgH translocations in myeloma are the t(11;14)(q13;q32), t(4;14)(p16;q32) and t(14;16)(q32;q23). Trisomies and a more indolent form of the disease characterize hyperdiploid myeloma. A number of genetic progression factors have been identified including deletions of chromosomes 13 and 17 and abnormalities of chromosome 1 (1p deletion and 1q amplification). Other key drivers of cell survival and proliferation have also been identified such as nuclear factor- B-activating mutations and other deregulation factors for the cyclin-dependent pathways regulators. Further understanding of the biological subtypes of the disease has come from the application of novel techniques such as gene expression profiling and array-based comparative genomic hybridization. The combination of data arising from these studies and that previously elucidated through other mechanisms allows for most myeloma cases to be classified under one of several genetic subtypes. This paper proposes a framework for the classification of myeloma subtypes and provides recommendations for genetic testing. This group proposes that genetic testing needs to be incorporated into daily clinical practice and also as an essential component of all ongoing and future clinical trials.
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Affiliation(s)
- R Fonseca
- Department of Hematology-Oncology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AR 85259-5494, USA.
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49
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Durie BGM, Van Ness B, Ramos C, Stephens O, Haznadar M, Hoering A, Haessler J, Katz MS, Mundy GR, Kyle RA, Morgan GJ, Crowley J, Barlogie B, Shaughnessy J. Genetic polymorphisms of EPHX1, Gsk3beta, TNFSF8 and myeloma cell DKK-1 expression linked to bone disease in myeloma. Leukemia 2009; 23:1913-9. [PMID: 19657367 DOI: 10.1038/leu.2009.129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Bone disease in myeloma occurs as a result of complex interactions between myeloma cells and the bone marrow microenvironment. A custom-built DNA single nucleotide polymorphism (SNP) chip containing 3404 SNPs was used to test genomic DNA from myeloma patients classified by the extent of bone disease. Correlations identified with a Total Therapy 2 (TT2) (Arkansas) data set were validated with Eastern Cooperative Oncology Group (ECOG) and Southwest Oncology Group (SWOG) data sets. Univariate correlates with bone disease included: EPHX1, IGF1R, IL-4 and Gsk3beta. SNP signatures were linked to the number of bone lesions, log(2) DKK-1 myeloma cell expression levels and patient survival. Using stepwise multivariate regression analysis, the following SNPs: EPHX1 (P=0.0026); log(2) DKK-1 expression (P=0.0046); serum lactic dehydrogenase (LDH) (P=0.0074); Gsk3beta (P=0.02) and TNFSF8 (P=0.04) were linked to bone disease. This assessment of genetic polymorphisms identifies SNPs with both potential biological relevance and utility in prognostic models of myeloma bone disease.
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Affiliation(s)
- B G M Durie
- Hematology/Oncology, Cedars-Sinai Outpatient Cancer Center at the Samuel Oschin Comprehensive Cancer Institute & Aptium Oncology, Los Angeles, CA 90048, USA.
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50
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Jagannath S, Durie BGM, Wolf JL, Camacho ES, Irwin D, Lutzky J, McKinley M, Potts P, Gabayan AE, Mazumder A, Crowley J, Vescio R. Extended follow-up of a phase 2 trial of bortezomib alone and in combination with dexamethasone for the frontline treatment of multiple myeloma. Br J Haematol 2009; 146:619-26. [PMID: 19622094 DOI: 10.1111/j.1365-2141.2009.07803.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
High-quality response to multiple myeloma (MM) therapy can be predictive for improved outcomes. Novel agents may improve the depth of responses and therefore prolong survival. We report on the extended follow-up of a phase II study in frontline MM of bortezomib alone and in combination with dexamethasone. Forty-nine previously untreated, symptomatic MM patients received bortezomib 1.3 mg/m(2), days 1, 4, 8, 11, for up to six 3-week cycles. High-dose dexamethasone was added for patients not reaching either a partial response after cycle 2 or a complete response (CR) after cycle 4. The overall response rate in 48 evaluable patients was 90%, with 42% achieving at least a very good partial response, of which 19% were CR/near CR. Thirty-six patients received high-dose dexamethasone with 28 (77%) showing improved response. Twenty-seven patients have undergone successful stem-cell transplantation (SCT). After median follow-up of 49 months, 15 patients have died; median overall survival has still not been reached, with an estimated survival at 4 years of 67%. Overall survival with and without SCT was not different (P = 0.54). Grade 3/4 adverse events included neutropenia (10%), sensory neuropathy (6% grade 3), neuropathic pain (4% grade 3), and diarrhoea (4% grade 3). Bortezomib +/- dexamethasone is an effective and well-tolerated induction regimen for the frontline treatment of MM.
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Affiliation(s)
- Sundar Jagannath
- St. Vincent's Comprehensive Cancer Center, New York, NY 10011, USA.
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