1
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Ríos-Tamayo R, Lecumberri R, Cibeira MT, González-Calle V, Alonso R, Domingo-González A, Landete E, Encinas C, Iñigo B, Blanchard MJ, Alejo E, Krsnik I, Gómez-Bueno M, Garcia-Pavia P, Segovia-Cubero J, Rosiñol L, Lahuerta JJ, Martínez-López J, Bladé J. A Simple Frailty Score Predicts Survival and Early Mortality in Systemic AL Amyloidosis. Cancers (Basel) 2024; 16:1689. [PMID: 38730641 PMCID: PMC11083900 DOI: 10.3390/cancers16091689] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Systemic AL amyloidosis is a challenging disease for which many patients are considered frail in daily clinical practice. However, no study has so far addressed frailty and its impact on the outcome of these patients. We built a simple score to predict mortality based on three frailty-associated variables: age, ECOG performance status (<2 vs. ≥2) and NT-proBNP (<8500 vs. ≥8500 ng/L). Four-hundred and sixteen consecutive newly diagnosed patients diagnosed at ten sites from the Spanish Myeloma Group were eligible for the study. The score was developed in a derivation cohort from a referral center, and it was externally validated in a multicenter cohort. Multivariate analysis showed that the three variables were independent predictors of survival. The score was able to discriminate four groups of patients in terms of overall survival and early mortality in both cohorts. Comorbidity was also analyzed with the Charlson comorbidity index, but it did not reach statistical significance in the model. A nomogram was created to easily estimate the mortality risk of each patient at each time point. This score is a simple, robust, and efficient approach to dynamically assess frailty-dependent mortality both at diagnosis and throughout follow-up. The optimal treatment for frail AL amyloidosis patients remains to be determined but we suggest that the estimation of frailty-associated risk could complement current staging systems, adding value in clinical decision-making in this complex scenario.
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Affiliation(s)
- Rafael Ríos-Tamayo
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, 28222 Madrid, Spain
| | - Ramón Lecumberri
- Clínica Universidad de Navarra, CCUN, IDISNA, Universidad de Navarra, 31008 Pamplona, Spain
| | - María Teresa Cibeira
- Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Verónica González-Calle
- University Hospital of Salamanca (HUS/IBSAL), CIBERONC, Center for Cancer Research-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Rafael Alonso
- Hospital Universitario 12 de Octubre, Instituto de Investigación del Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | | | - Elena Landete
- Hospital Universitario Infanta Leonor, 28040 Madrid, Spain
| | - Cristina Encinas
- Hospital General Universitario Gregorio Marañón, IiSGM, 28009 Madrid, Spain
| | - Belén Iñigo
- Hospital Clínico San Carlos, 28040 Madrid, Spain
| | | | - Elena Alejo
- University Hospital of Salamanca (HUS/IBSAL), CIBERONC, Center for Cancer Research-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Isabel Krsnik
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, 28222 Madrid, Spain
| | - Manuel Gómez-Bueno
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, 28222 Madrid, Spain
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, 28222 Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - Javier Segovia-Cubero
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, 28222 Madrid, Spain
| | - Laura Rosiñol
- Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Juan-José Lahuerta
- Hospital Universitario 12 de Octubre, Instituto de Investigación del Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Joaquín Martínez-López
- Hospital Universitario 12 de Octubre, Instituto de Investigación del Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Joan Bladé
- Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, 08007 Barcelona, Spain
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2
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Lakhwani S, Rosiñol L, Puig N, Pico-Picos MA, Medina-González L, Martínez-López J, Paiva B, Cedena MT, Oriol A, Ríos-Tamayo R, Blanchard MJ, Jarque I, Bargay J, Moraleda JM, Carrillo-Cruz E, Sureda A, Krsnik I, González E, Casado LF, Martí JM, Encinas C, De Arriba F, Palomera L, Sampol A, González-Montes Y, Motlló C, De La Cruz J, Alonso R, Mateos MV, Bladé J, Lahuerta JJ, San-Miguel J, Hernández MT. Recovery of uninvolved heavy/light chain pair immunoparesis in newly diagnosed transplant-eligible myeloma patients complements the prognostic value of minimal residual disease detection. Haematologica 2023. [PMID: 38031761 DOI: 10.3324/haematol.2023.284154] [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: 08/25/2023] [Indexed: 12/01/2023] Open
Abstract
Immunoparesis (IP) in multiple myeloma (MM) patients can be measured by classic assessment of immunoglobulin (Ig) levels or by analysis of the uninvolved heavy/light chain pair of the same immunoglobulin (uHLC) by the Hevylite® assay. In this study we evaluate the prognostic value of recovery from IP measured by classic total Ig and uHLC assessment in newly diagnosed MM transplant-eligible (NDMM-TE) patients with intensive treatment and its association with Minimal Residual Disease (MRD). Patients were enrolled and treated in the PETHEMA/GEM2012MENOS65 trial and continued in the PETHEMA/GEM2014MAIN trial. Total Ig (IgG, IgA and IgM) and uHLC were analyzed in a central laboratory at diagnosis, after consolidation treatment and after the first year of maintenance. MRD was analyzed by next generation flow cytometry after consolidation (sensitivity level 2x10-6). We found no differences in progression free survival (PFS) between patients who recovered and patients who didn't recover from IP after consolidation when examining classic total Ig and uHLC. However, after the first year of maintenance, in contrast to patients with classic IP, patients with recovery from uHLC IP had longer PFS than patients without recovery, with hazard ratio of 0.42 (CI95% 0.21-0.81; p=0.008). Multivariate analysis with Cox proportional-hazards regression models confirmed recovery from uHLC IP after the first year of maintenance as an independent prognostic factor for PFS, with an increase in C-statistic of 0.05 (-0.04-0.14; p<0.001) when adding uHLC IP recovery. Moreover, we observed that MRD status and uHLC IP recovery affords complementary information for risk stratification. In conclusion, recovery from uHLC IP after one year of maintenance is an independent prognostic factor for PFS in NDMM-TE patients who receive intensive treatment. Immune reconstitution, measured as recovery from uHLC IP, provides complementary prognostic information to MRD assessment.
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Affiliation(s)
- Sunil Lakhwani
- Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife.
| | - Laura Rosiñol
- Amyloidosis and Myeloma Unit, Hospital Clínic, Barcelona
| | - Noemí Puig
- University Hospital of Salamanca/IBSAL/CIC/CIBERONC, Salamanca
| | | | | | - Joaquín Martínez-López
- Hospital Universitario 12 de Octubre, Universidad Complutense, Spanish National Cancer Research Center (CNIO), Madrid
| | - Bruno Paiva
- Cancer Center Clínica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona
| | | | - Albert Oriol
- Hospital Germans Trias i Pujol, Institut Català d'Oncologia, Institut Josep Carreras, Badalona
| | | | | | | | - Joan Bargay
- Hospital Son Llàtzer, IdIsBa, Palma de Mallorca
| | - José-María Moraleda
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Pascual Parrilla, University of Murcia, Murcia
| | - Estrella Carrillo-Cruz
- Hospital Universitario V. Rocio, Instituto de Biomedicina de Sevilla (IBIS) / CSIC, Universidad de Sevilla, Sevilla
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia - L'Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona
| | | | | | | | | | | | - Felipe De Arriba
- Hospital Morales Meseguer, IMIB-Pascual Parrilla, Universidad de Murcia, Murcia
| | - Luis Palomera
- Hospital Clínico Universitario "Lozano Blesa", Zaragoza
| | | | | | | | - Javier De La Cruz
- Hospital Universitario 12 De Octubre, Instituto de Investigación Sanitaria, Madrid
| | | | | | - Joan Bladé
- Amyloidosis and Myeloma Unit, Hospital Clínic, Barcelona
| | - Juan-José Lahuerta
- Hospital Universitario 12 De Octubre, Instituto de Investigación Sanitaria, Madrid
| | - Jesús San-Miguel
- Cancer Center Clínica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona
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3
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Rosiñol L, Oriol A, Ríos R, Blanchard MJ, Jarque I, Bargay J, Hernández MT, Cabañas V, Carrillo-Cruz E, Sureda A, Martínez-López J, Krsnik I, González ME, Casado LF, Martí JM, Encinas C, de Arriba F, Palomera L, Sampol A, González-Montes Y, Cabezudo E, Paiva B, Puig N, Cedena MT, de la Cruz J, Mateos MV, San Miguel J, Lahuerta JJ, Bladé J. Lenalidomide and dexamethasone maintenance with or without ixazomib, tailored by residual disease status in myeloma. Blood 2023; 142:1518-1528. [PMID: 37506339 DOI: 10.1182/blood.2022019531] [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: 12/28/2022] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
From November 2014 to May 2017, 332 patients homogeneously treated with bortezomib, lenalidomide, and dexamethasone (VRD) induction, autologous stem cell transplant, and VRD consolidation were randomly assigned to receive maintenance therapy with lenalidomide and dexamethasone (RD; 161 patients) vs RD plus ixazomib (IRD; 171 patients). RD consisted of lenalidomide 15 mg/d from days 1 to 21 plus dexamethasone 20 mg/d on days 1 to 4 and 9 to 12 at 4-week intervals, whereas in the IRD arm, oral ixazomib at a dose of 4 mg on days 1, 8, and 15 was added. Therapy for patients with negative measurable residual disease (MRD) after 24 cycles was discontinued, whereas those who tested positive for MRD remained on maintenance with RD for 36 more cycles. After a median follow-up of 69 months from the initiation of maintenance, the progression-free survival (PFS) was similar in both arms, with a 6-year PFS rate of 61.3% and 55.6% for RD and IRD, respectively (hazard ratio, 1.136; 95% confidence interval, 0.809-1.603). After 2 years of maintenance, treatment was discontinued in 163 patients with negative MRD, whereas 63 patients with positive MRD continued with RD therapy. Maintenance discontinuation in patients tested negative for MRD resulted in a low progression rate (17.2% at 4 years), even in patients with high-risk features. In summary, our results show the efficacy of RD maintenance and support the safety of maintenance therapy discontinuation in patients with negative MRD at 2 years. This trial was registered at www.clinicaltrials.gov as #NCT02406144 and at EudraCT as 2014-00055410.
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Affiliation(s)
- Laura Rosiñol
- Hospital Clinic de Barcelona, Insitut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Albert Oriol
- Hematology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Rafael Ríos
- Hematology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Isidro Jarque
- Hematology Department, Hospital Universitari i Politècnic La Fe, Centro de Investigación Biomédica en Red de Cancer, Valencia, Spain
| | - Joan Bargay
- Hematology Department, Hospital Universitario Son Llatzer, Palma de Mallorca, Spain
| | | | - Valentín Cabañas
- Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria-Pascual Parrilla, Murcia, Spain
| | - Estrella Carrillo-Cruz
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Anna Sureda
- Hospital Duran i Reynals, Institut Català d'OncologiaI L'Hospitalet, Institut d'Investigació Biomèdica de Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Joaquín Martínez-López
- Hospital Universitario 12 de Octubre, Complutense University, Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Isabel Krsnik
- Hematology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Luis Felipe Casado
- Hematology Department, Hospital General Universitario de Toledo, Toledo, Spain
| | - Josep María Martí
- Hematology Department, Hospital Universitario Mútua de Terrassa, Terrassa, Spain
| | - Cristina Encinas
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Felipe de Arriba
- Hospital Universitario Morales Messeguer, Instituto Murciano de Investigación Biosanitaria-Pascual Parrilla, Universidad de Murcia, Murcia, Spain
| | - Luis Palomera
- Hematology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Antonia Sampol
- Hematology Department, Complejo Asistencial Son Espases, Palma de Mallorca, Spain
| | | | - Elena Cabezudo
- Hospital Althaia, Xarxa Assistencial de Manresa, Manresa, Spain
| | - Bruno Paiva
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Universidad de Navarra, Cancer Center Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red de Cancer, Pamplona, Spain
| | - Noemí Puig
- University Hospital of Salamanca, Centro de Investigación Biomédica en Red de Cancer, Center for Cancer Research-Instituto Universitario de Biología Molecular y Celular del Cáncer, Salamanca, Spain
| | | | - Javier de la Cruz
- Instituto de investigación i+12, Hospital Universitario 12 de Octubre, Red de Salud Materno Infantilal y del Desarrollo-Insituto de Salud Carlos III, Madrid, Spain
| | - María-Victoria Mateos
- University Hospital of Salamanca, Centro de Investigación Biomédica en Red de Cancer, Center for Cancer Research-Instituto Universitario de Biología Molecular y Celular del Cáncer, Salamanca, Spain
| | - Jesús San Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Universidad de Navarra, Cancer Center Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red de Cancer, Pamplona, Spain
| | - Juan José Lahuerta
- Hospital Universitario 12 de Octubre, Complutense University, Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Joan Bladé
- Hospital Clinic de Barcelona, Insitut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
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4
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Moreau P, Chari A, Oriol A, Martinez-Lopez J, Haenel M, Touzeau C, Ailawadhi S, Besemer B, de la Rubia Comos J, Encinas C, Mateos MV, Salwender H, Rodriguez-Otero P, Hulin C, Karlin L, Sureda Balari A, Bargay J, Benboubker L, Rosiñol L, Tarantolo S, Terebelo H, Yang S, Wang J, Nnane I, Qi M, Kosh M, Delioukina M, Goldschmidt H. Daratumumab, carfilzomib, and dexamethasone in relapsed or refractory myeloma: final analysis of PLEIADES and EQUULEUS. Blood Cancer J 2023; 13:33. [PMID: 36882409 PMCID: PMC9989580 DOI: 10.1038/s41408-023-00805-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Affiliation(s)
| | - Ajai Chari
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Albert Oriol
- Institut Català d'Oncologia and Institut Josep Carreras, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Joaquin Martinez-Lopez
- Hospital 12 de Octubre, H12O-CNIO, Haematological Malignancies Clinical Research Unit, Universidad Complutense, CIBERONC, Madrid, Spain
| | | | | | | | - Britta Besemer
- Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tübingen, Germany
| | - Javier de la Rubia Comos
- Hospital La Fe, School of Medicine and Dentistry, Catholic University of Valencia, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Cristina Encinas
- Hospital General Universitario Gregorio Marañón (HGUGM), IiSGM, Madrid, Spain
| | - Maria-Victoria Mateos
- University Hospital of Salamanca/IBSAL/Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Hans Salwender
- Asklepios Tumorzentrum Hamburg, AK Altona and AK St. Georg, Hamburg, Germany
| | | | - Cyrille Hulin
- Department of Hematology, Hôpital Haut Lévêque, University Hospital, Pessac, France
| | - Lionel Karlin
- Department of Hematology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Anna Sureda Balari
- Hematology Department, Institut Català d'Oncologia - Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
| | - Joan Bargay
- Hospital Universitari Son Llàtzer, IdISBa, Palma de Mallorca, Illes Balears, Spain
| | - Lotfi Benboubker
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Bretonneau, Centre Hospitalier Régional Universitaire (CHRU), Tours, France
| | - Laura Rosiñol
- Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | | | | | - Shiyi Yang
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Jianping Wang
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Ivo Nnane
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Ming Qi
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Michele Kosh
- Janssen Research & Development, LLC, Spring House, PA, USA
| | | | - Hartmut Goldschmidt
- GMMG-Study Group at University Hospital Heidelberg, Internal Medicine V, Heidelberg, Germany
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5
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Villalba A, Gonzalez-Rodriguez AP, Arzuaga-Mendez J, Puig N, Arnao M, Arguiñano JM, Jimenez M, Canet M, Teruel AI, Sola M, Díaz FJ, Encinas C, Garcia A, Rosiñol L, Suárez A, Gonzalez MS, Izquierdo I, Hernández MT, Infante MS, Sánchez MJ, Sampol A, de la Rubia J. Single versus tandem autologous stem-cell transplantation in patients with newly diagnosed multiple myeloma and high-risk cytogenetics. A retrospective, open-label study of the PETHEMA/Spanish Myeloma Group (GEM). Leuk Lymphoma 2022; 63:3438-3447. [PMID: 36124538 DOI: 10.1080/10428194.2022.2123229] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Tandem ASCT has been suggested as a valid approach to improve the prognosis of patients with MM and HR cytogenetic. In this observational, retrospective study, 213 patients with newly diagnosed MM and HR cytogenetic in 35 hospitals from the Spanish Myeloma Group underwent single or tandem ASCT between January 2015 and December 2019 after induction with VTD/VRD. HR cytogenetic was defined as having ≥1 of the following: del17p, t(4;14), t(14;16) or gain 1q21. More patients in the tandem group had R-ISS 3 and >1 cytogenetic abnormality at diagnosis. With a median follow-up of 31 months (range, 10-82), PFS after single ASCT was 41 months versus 48 months with tandem ASCT (p = 0.33). PFS in patients with del17p undergoing single ASCT was 41 months, while 52% of patients undergoing tandem ASCT were alive and disease free at 48 months. In conclusion, tandem ASCT partly overcomes the bad prognosis of HR cytogenetic.
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Affiliation(s)
- Ana Villalba
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Javier Arzuaga-Mendez
- Hematology Department, Grupo de Cáncer Hematológico, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, Spain
| | - Noemí Puig
- Hematology Department, Hospital Universitario de Salamanca (HUSAL), IBSAL, IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Mario Arnao
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - María Jimenez
- Hematology Department, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Marta Canet
- Hematology Department, Hospital Universitari Mútua Terrasa, Terrasa, Spain
| | - Ana I Teruel
- Hematology Department, Hospital Clínico Universitario, Valencia, Spain
| | - María Sola
- Hematology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Francisco J Díaz
- Hematology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Cristina Encinas
- Hematology Department, Hospital General Universitario Gregorio Marañón (HGUGM), IiSGM, Madrid, Spain
| | - Antonio Garcia
- Hematology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Laura Rosiñol
- Hematology Department, Hospital Clinic, Barcelona, Spain
| | - Alexia Suárez
- Hematology Department, Hospital de Gran Canaria Doctor Negrín, Las Palmas de Gran Canarias, Municipality of Las Palmas, Spain
| | - Marta Sonia Gonzalez
- Hematology Department, H. Clínico Universitario Santiago de Compostela, La Coruña, Spain
| | - Isabel Izquierdo
- Hematology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - María José Sánchez
- Hematology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Antonia Sampol
- Hematology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Javier de la Rubia
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Hematology Department, Universidad Católica "San Vicente Mártir", Valencia, Spain.,CIBERONC CB16/12/00284, Valencia, Spain
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6
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Encinas C, Hernandez-Rivas JÁ, Oriol A, Rosiñol L, Blanchard MJ, Bellón JM, García-Sanz R, de la Rubia J, de la Guía AL, Jímenez-Ubieto A, Jarque I, Iñigo B, Dourdil V, de Arriba F, Pérez-Ávila CC, Gonzalez Y, Hernández MT, Bargay J, Granell M, Rodríguez-Otero P, Silvent M, Cabrera C, Rios R, Alegre A, Gironella M, Gonzalez MS, Sureda A, Sampol A, Ocio EM, Krsnik I, García A, García-Mateo A, Soler JA, Martín J, Arguiñano JM, Mateos MV, Bladé J, San-Miguel JF, Lahuerta JJ, Martínez-López J. A simple score to predict early severe infections in patients with newly diagnosed multiple myeloma. Blood Cancer J 2022; 12:68. [PMID: 35440057 PMCID: PMC9018751 DOI: 10.1038/s41408-022-00652-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/11/2022] [Revised: 02/21/2022] [Accepted: 03/21/2022] [Indexed: 12/30/2022] Open
Abstract
Infections remain a common complication in patients with multiple myeloma (MM) and are associated with morbidity and mortality. A risk score to predict the probability of early severe infection could help to identify the patients that would benefit from preventive measures. We undertook a post hoc analysis of infections in four clinical trials from the Spanish Myeloma Group, involving a total of 1347 patients (847 transplant candidates). Regarding the GEM2010 > 65 trial, antibiotic prophylaxis was mandatory, so we excluded it from the final analysis. The incidence of severe infection episodes within the first 6 months was 13.8%, and majority of the patients experiencing the first episode before 4 months (11.1%). 1.2% of patients died because of infections within the first 6 months (1% before 4 months). Variables associated with increased risk of severe infection in the first 4 months included serum albumin ≤30 g/L, ECOG > 1, male sex, and non-IgA type MM. A simple risk score with these variables facilitated the identification of three risk groups with different probabilities of severe infection within the first 4 months: low-risk (score 0-2) 8.2%; intermediate-risk (score 3) 19.2%; and high-risk (score 4) 28.3%. Patients with intermediate/high risk could be candidates for prophylactic antibiotic therapies.
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Affiliation(s)
- Cristina Encinas
- Hospital General Universitario Gregorio Marañón (HGUGM), IiSGM, Madrid, Spain
| | | | - Albert Oriol
- Hospital Universitario Germans Trias i Pujol, Badalona (Barcelona), Barcelona, Spain
| | | | | | - José-María Bellón
- Hospital General Universitario Gregorio Marañón (HGUGM), IiSGM, Madrid, Spain
| | - Ramón García-Sanz
- University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
| | | | | | | | - Isidro Jarque
- Hospital Universitario la Fe, CIBERONC, Valencia, Spain
| | | | - Victoria Dourdil
- Hospital Clínico Universitario "Lozano Blesa", Zaragoza, IIS Aragón, Spain
| | | | | | | | | | - Joan Bargay
- Hospital Son Llatzer, Palma de Mallorca, Spain
| | | | | | | | | | - Rafael Rios
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Adrián Alegre
- Hospital Universitario de la Princesa y Hospital Universitario Quirónsalud, Madrid, Spain
| | | | | | - Anna Sureda
- ICO-L'Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Antonia Sampol
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Enrique M Ocio
- Hospital Universitario Marqués de Valdecilla, (IDIVAL). Universidad de Cantabria, Santander, Spain
| | - Isabel Krsnik
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | | | - Jesús Martín
- Complejo Hospitalario Regional Virgen del Rocío, CIBERONC, Sevilla, Spain
| | | | - María-Victoria Mateos
- University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Joan Bladé
- Hospital Clinic, CIBERONC, Barcelona, Spain
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7
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Hernández-Rivas JÁ, Ríos-Tamayo R, Encinas C, Alonso R, Lahuerta JJ. The changing landscape of relapsed and/or refractory multiple myeloma (MM): fundamentals and controversies. Biomark Res 2022; 10:1. [PMID: 35000618 PMCID: PMC8743063 DOI: 10.1186/s40364-021-00344-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 12/13/2022] Open
Abstract
The increase in the number of therapeutic alternatives for both newly diagnosed and relapsed/refractory multiple myeloma (RRMM) patients has widened the clinical scenario, leading to a level of complexity that no algorithm has been able to cover up to date. At present, this complexity increases due to the wide variety of clinical situations found in MM patients before they reach the status of relapsed/refractory disease. These different backgrounds may include primary refractoriness, early relapse after completion of first-line therapy with latest-generation agents, or very late relapse after chemotherapy or autologous transplantation. It is also important to bear in mind that many patient profiles are not fully represented in the main randomized clinical trials (RCT), and this further complicates treatment decision-making. In RRMM patients, the choice of previously unused drugs and the number and duration of previous therapeutic regimens until progression has a greater impact on treatment efficacy than the adverse biological characteristics of MM itself. In addition to proteasome inhibitors, immunomodulatory drugs, anti-CD38 antibodies and corticosteroids, a new generation of drugs such as XPO inhibitors, BCL-2 inhibitors, new alkylators and, above all, immunotherapy based on conjugated anti-BCMA antibodies and CAR-T cells, have been developed to fight RRMM. This comprehensive review addresses the fundamentals and controversies regarding RRMM, and discusses the main aspects of management and treatment. The basis for the clinical management of RRMM (complexity of clinical scenarios, key factors to consider before choosing an appropriate treatment, or when to treat), the arsenal of new drugs with no cross resistance with previously administered standard first line regimens (main phase 3 clinical trials), the future outlook including the usefulness of abandoned resources, together with the controversies surrounding the clinical management of RRMM patients will be reviewed in detail.
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Affiliation(s)
| | - Rafael Ríos-Tamayo
- Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria, Granada, Spain
| | - Cristina Encinas
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Rafael Alonso
- Hospital Universitario 12 de Octubre, Instituto de Investigación del Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan-José Lahuerta
- Hospital Universitario 12 de Octubre, Instituto de Investigación del Hospital Universitario 12 de Octubre, Madrid, Spain.
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8
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Gómez-Centurión I, Oarbeascoa G, García MC, López Fresneña MC, Martínez Carreño MJ, Escudero Vilaplana V, González-Haba E, Bailén R, Dorado N, Juárez LM, Rodríguez Macías G, Font López P, Encinas C, Bastos-Oreiro M, Anguita J, Sanjurjo M, Díez-Martin JL, Kwon M. Implementation of a hospital-at-home (HAH) unit for hematological patients during the COVID-19 pandemic: safety and feasibility. Int J Hematol 2021; 115:61-68. [PMID: 34553338 PMCID: PMC8457036 DOI: 10.1007/s12185-021-03219-2] [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: 06/11/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 12/23/2022]
Abstract
Background “Hospital-at-home” (HAH) programs have been shown to optimize resource utilization, shorten hospitalization and prevent nosocomial infection. Methods We retrospectively analysed data regarding implementation of an HAH unit for caring patients with hematological malignancies in our center, during the COVID-19 pandemic. Results Between January and November 2020, 105 patients were treated in the HAH unit for a total of 204 episodes. Nine patients with multiple myeloma (MM) received autologous HSCT (auto-HSCT). Three patients with acute myeloid leukemia (AML) received consolidation therapy, 32 patients underwent clinical and analytical monitoring, 20 were transplant recipients early discharged (5 auto-HSCT and 15 allo-HSCT) and 2 had received CART cells therapy. Azacitidine, bortezomib and carfilzomib were administered at home to 54 patients with AML, myelodysplastic syndrome (MDS) or MM. A median of 17 (IQR 13–19) days of admission per patient and a total of 239 visits to the Hematology day-care hospital were avoided. Overall, 28 patients (14% of all episodes) needed admission to the hospital, 4 of them due to COVID-19. Conclusions Implementation of a Hematology HAH unit was feasible and safe, and provided thorough advanced care to a high-risk population. Advanced care-at-home strategies can be crucial during times of COVID-19 to minimize treatment interruptions and reduce the risk of cross-infections.
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Affiliation(s)
- Ignacio Gómez-Centurión
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain.
- Gregorio Marañón Institute of Health Research, Madrid, Spain.
| | - Gillen Oarbeascoa
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
- Gregorio Marañón Institute of Health Research, Madrid, Spain
| | - María Carmen García
- Gregorio Marañón Institute of Health Research, Madrid, Spain
- Nursing Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Carmen López Fresneña
- Gregorio Marañón Institute of Health Research, Madrid, Spain
- Nursing Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Josefa Martínez Carreño
- Gregorio Marañón Institute of Health Research, Madrid, Spain
- Nursing Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Vicente Escudero Vilaplana
- Gregorio Marañón Institute of Health Research, Madrid, Spain
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eva González-Haba
- Gregorio Marañón Institute of Health Research, Madrid, Spain
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rebeca Bailén
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
- Gregorio Marañón Institute of Health Research, Madrid, Spain
| | - Nieves Dorado
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
- Gregorio Marañón Institute of Health Research, Madrid, Spain
| | - Luis Miguel Juárez
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
- Gregorio Marañón Institute of Health Research, Madrid, Spain
| | - Gabriela Rodríguez Macías
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
- Gregorio Marañón Institute of Health Research, Madrid, Spain
| | - Patricia Font López
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
- Gregorio Marañón Institute of Health Research, Madrid, Spain
| | - Cristina Encinas
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
- Gregorio Marañón Institute of Health Research, Madrid, Spain
| | - Mariana Bastos-Oreiro
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
- Gregorio Marañón Institute of Health Research, Madrid, Spain
| | - Javier Anguita
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
- Gregorio Marañón Institute of Health Research, Madrid, Spain
| | - María Sanjurjo
- Gregorio Marañón Institute of Health Research, Madrid, Spain
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Luis Díez-Martin
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
- Gregorio Marañón Institute of Health Research, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
- Gregorio Marañón Institute of Health Research, Madrid, Spain
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9
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Martinez-Lopez J, Alonso R, Wong SW, Rios R, Shah N, Ruiz-Heredia Y, Sanchez-Pina JM, Sanchez R, Bahri N, Zamanillo I, Poza M, Buenache N, Encinas C, Juarez L, Miras F, Collado L, Barrio S, Martin T, Cedena MT, Wolf J. Making clinical decisions based on measurable residual disease improves the outcome in multiple myeloma. J Hematol Oncol 2021; 14:126. [PMID: 34404440 PMCID: PMC8369640 DOI: 10.1186/s13045-021-01135-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 06/29/2021] [Accepted: 08/04/2021] [Indexed: 01/29/2023] Open
Abstract
The assessment of measurable residual disease (MRD) in bone marrow has proven of prognostic relevance in patients with multiple myeloma (MM). Nevertheless, and unlike other hematologic malignancies, the use of MRD results to make clinical decisions in MM has been underexplored to date. In this retrospective study, we present the results from a multinational and multicenter series of 400 patients with MRD monitoring during front-line therapy with the aim of exploring how clinical decisions made based on those MRD results affected outcomes. As expected, achievement of MRD negativity at any point was associated with improved PFS versus persistent MRD positivity (median PFS 104 vs. 45 months, p < 0.0001). In addition, however, 67 out of 400 patients underwent a clinical decision (treatment discontinuation, intensification or initiation of a new therapy) based on MRD results. Those patients in whom a treatment change was made showed a prolonged PFS in comparison with those 333 patients in which MRD results were not acted upon (respectively, mPFS 104 vs. 62 months, p = 0.005). In patients who achieved MRD negativity during maintenance (n = 186) on at least one occasion, stopping therapy in 24 patients vs. continuing in 162 did not alter PFS (mPFS 120 months vs. 82 months, p = 0.1). Most importantly, however, in patients with a positive MRD during maintenance (n = 214), a clinical decision (either intensification or change of therapy) (n = 43) resulted in better PFS compared to patients in whom no adjustment was made (n = 171) (mPFS NA vs. 39 months, p = 0.02). Interestingly, there were no significant differences when MRD was assessed by flow cytometry or by next-generation sequencing. Herein, we find that MRD is useful in guiding clinical decisions during initial therapy and has a positive impact on PFS in MM patients. This potentially opens a new dimension for the use of MRD in MM, but this role still remains to be confirmed in prospective, randomized clinical trials.
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Affiliation(s)
- Joaquin Martinez-Lopez
- Hematology Department, Hospital 12 de Octubre i+12, CNIO, Complutense University, Madrid, Spain. .,Department of Medicine, Division of Hematology-Oncology, University of California San Francisco, San Francisco, USA.
| | - Rafael Alonso
- Hematology Department, Hospital 12 de Octubre i+12, CNIO, Complutense University, Madrid, Spain
| | - Sandy W Wong
- Department of Medicine, Division of Hematology-Oncology, University of California San Francisco, San Francisco, USA
| | - Rafael Rios
- Hematology Department, Hospital Virgen de Las Nieves, Granada, Spain
| | - Nina Shah
- Department of Medicine, Division of Hematology-Oncology, University of California San Francisco, San Francisco, USA
| | - Yanira Ruiz-Heredia
- Hematology Department, Hospital 12 de Octubre i+12, CNIO, Complutense University, Madrid, Spain
| | - Jose Maria Sanchez-Pina
- Hematology Department, Hospital 12 de Octubre i+12, CNIO, Complutense University, Madrid, Spain
| | - Ricardo Sanchez
- Hematology Department, Hospital 12 de Octubre i+12, CNIO, Complutense University, Madrid, Spain
| | - Natasha Bahri
- Department of Medicine, Division of Hematology-Oncology, University of California San Francisco, San Francisco, USA
| | - Irene Zamanillo
- Hematology Department, Hospital 12 de Octubre i+12, CNIO, Complutense University, Madrid, Spain
| | - Maria Poza
- Hematology Department, Hospital 12 de Octubre i+12, CNIO, Complutense University, Madrid, Spain
| | - Natalia Buenache
- Hematology Department, Hospital 12 de Octubre i+12, CNIO, Complutense University, Madrid, Spain
| | - Cristina Encinas
- Hematology Department, Hospital General Univesitario Gregorio Marañon, Madrid, Spain
| | - Luis Juarez
- Hematology Department, Hospital General Univesitario Gregorio Marañon, Madrid, Spain
| | - Fatima Miras
- Hematology Department, Hospital 12 de Octubre i+12, CNIO, Complutense University, Madrid, Spain
| | - Luis Collado
- Medicine Department, Complutense University, Madrid, Spain
| | - Santiago Barrio
- Hematology Department, Hospital 12 de Octubre i+12, CNIO, Complutense University, Madrid, Spain
| | - Thomas Martin
- Department of Medicine, Division of Hematology-Oncology, University of California San Francisco, San Francisco, USA
| | - Maria Teresa Cedena
- Hematology Department, Hospital 12 de Octubre i+12, CNIO, Complutense University, Madrid, Spain
| | - Jeffrey Wolf
- Department of Medicine, Division of Hematology-Oncology, University of California San Francisco, San Francisco, USA
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10
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Puig N, Hernández MT, Rosiñol L, González E, de Arriba F, Oriol A, González-Calle V, Escalante F, de la Rubia J, Gironella M, Ríos R, García-Sánchez R, Arguiñano JM, Alegre A, Martín J, Gutiérrez NC, Calasanz MJ, Martín ML, Couto MDC, Casanova M, Arnao M, Pérez-Persona E, Garzón S, González MS, Martín-Sánchez G, Ocio EM, Coleman M, Encinas C, Vale AM, Teruel AI, Cortés-Rodríguez M, Paiva B, Cedena MT, San-Miguel JF, Lahuerta JJ, Bladé J, Niesvizky R, Mateos MV. Lenalidomide and dexamethasone with or without clarithromycin in patients with multiple myeloma ineligible for autologous transplant: a randomized trial. Blood Cancer J 2021; 11:101. [PMID: 34021118 PMCID: PMC8139975 DOI: 10.1038/s41408-021-00490-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/18/2021] [Revised: 03/28/2021] [Accepted: 04/30/2021] [Indexed: 11/21/2022] Open
Abstract
Although case-control analyses have suggested an additive value with the association of clarithromycin to continuous lenalidomide and dexamethasone (Rd), there are not phase III trials confirming these results. In this phase III trial, 286 patients with MM ineligible for ASCT received Rd with or without clarithromycin until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS). With a median follow-up of 19 months (range, 0–54), no significant differences in the median PFS were observed between the two arms (C-Rd 23 months, Rd 29 months; HR 0.783, p = 0.14), despite a higher rate of complete response (CR) or better in the C-Rd group (22.6% vs 14.4%, p = 0.048). The most common G3–4 adverse events were neutropenia [12% vs 19%] and infections [30% vs 25%], similar between the two arms; however, the percentage of toxic deaths was higher in the C-Rd group (36/50 [72%] vs 22/40 [55%], p = 0.09). The addition of clarithromycin to Rd in untreated transplant ineligible MM patients does not improve PFS despite increasing the ≥CR rate due to the higher number of toxic deaths in the C-Rd arm. Side effects related to overexposure to steroids due to its delayed clearance induced by clarithromycin in this elderly population could explain these results. The trial was registered in clinicaltrials.gov with the name GEM-CLARIDEX: Ld vs BiRd and with the following identifier NCT02575144. The full trial protocol can be accessed from ClinicalTrials.gov. This study received financial support from BMS/Celgene.
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Affiliation(s)
- Noemi Puig
- Hematology Department, Hospital Universitario de Salamanca (HUSAL), IBSAL, IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | | | - Laura Rosiñol
- Hematology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | | | - Felipe de Arriba
- Hospital Morales Meseguer, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Albert Oriol
- Institut Català d'Oncologia and Institut Josep Carreras, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Verónica González-Calle
- Hematology Department, Hospital Universitario de Salamanca (HUSAL), IBSAL, IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | | | - Javier de la Rubia
- Hematology Department, Catholic University of Valencia and Hospital Doctor Peset, Valencia, Spain
| | | | - Rafael Ríos
- Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria IBS GRANADA, Granada, Spain
| | | | | | - Adrián Alegre
- Hospital Universitario de La Princesa, Sevilla, Spain
| | - Jesús Martín
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Norma C Gutiérrez
- Hematology Department, Hospital Universitario de Salamanca (HUSAL), IBSAL, IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - María J Calasanz
- Clínica Universidad de Navarra, CIMA, CIBERONC, IDISNA, Pamplona, Spain
| | - María L Martín
- Hospital Universitario 12 de Octubre, CIBERONC, Instituto de Investigación, IMAS12, Madrid, Spain
| | | | - María Casanova
- Hematology Department, Hospital Costa del Sol de Marbella, Marbella, Spain
| | - Mario Arnao
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ernesto Pérez-Persona
- Bioaraba Health Research Institute, Oncohematology Research Group; Osakidetza, Álava University Hospital, Hematology Department, Vitoria-Gasteiz, Spain
| | | | - Marta S González
- Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Enrique M Ocio
- Hematology Department, Hospital Universitario de Salamanca (HUSAL), IBSAL, IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain
| | - Morton Coleman
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Ana I Teruel
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - María Cortés-Rodríguez
- Hematology Department, Hospital Universitario de Salamanca (HUSAL), IBSAL, IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain.,Statistics Department, University of Salamanca, Salamanca, Spain
| | - Bruno Paiva
- Clínica Universidad de Navarra, CIMA, CIBERONC, IDISNA, Pamplona, Spain
| | - M Teresa Cedena
- Hospital Universitario 12 de Octubre, CIBERONC, Instituto de Investigación, IMAS12, Madrid, Spain
| | | | - Juan J Lahuerta
- Instituto de Investigación del Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Joan Bladé
- Hematology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Ruben Niesvizky
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, NY, USA
| | - María-Victoria Mateos
- Hematology Department, Hospital Universitario de Salamanca (HUSAL), IBSAL, IBMCC (USAL-CSIC), CIBERONC, Salamanca, Spain.
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11
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Rodriguez-Otero P, Sirvent M, González-Rodríguez AP, Lavilla E, de Coca AG, Arguiñano JM, Martí JM, Cabañas V, Motlló C, de Cabo E, Encinas C, Murillo I, Hernández-Rivas JÁ, Pérez-Persona E, Casado F, Sampol A, García R, Blanchard MJ, Anguita M, Lafuente AP, Iñigo B, López A, Ribas P, Arnao M, Maldonado R, Bladé J, Mateos MV, Lahuerta JJ, San Miguel JF. Pomalidomide, Cyclophosphamide, and Dexamethasone for the Treatment of Relapsed/Refractory Multiple Myeloma: Real-World Analysis of the Pethema-GEM Experience. Clin Lymphoma Myeloma Leuk 2021; 21:413-420. [PMID: 33741302 DOI: 10.1016/j.clml.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Treatment of relapsed/refractory multiple myeloma (RRMM) is highly challenging, especially for patients with disease refractory to initial therapy, and in particular for disease developing refractoriness to lenalidomide. Indeed, with currently approved treatments, median progression-free survival (PFS) in the lenalidomide-refractory setting is less than 10 months, reflecting the difficulty in treating this patient population. Pomalidomide is a second-generation immunomodulatory drug that has shown activity in lenalidomide-refractory disease in the setting of different combinations. PATIENTS AND METHODS A real-world study was conducted by the Spanish Myeloma group in a cohort of patients with RRMM treated with pomalidomide, cyclophosphamide, and dexamethasone (PomCiDex). One hundred patients were treated with a median of 3 prior lines of therapy. RESULTS Overall response rate was 39%, with a clinical benefit rate of 93%. Median PFS was 7.6 months; median overall survival (OS) was 12.6 months. Median PFS and OS survival were consistent across the different subgroups analyzed. Prolonged PFS and OS were found in patients with responsive disease. CONCLUSION Our results compared favorably with those obtained with different pomalidomide-based combinations in a similar patient population. PomCiDex remains a manageable, cost-effective, and all-oral triplet combination for RRMM patients.
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Affiliation(s)
| | - Maialen Sirvent
- Department of Hematology, Hospital Donostia, San Sebastian, Spain
| | | | | | - Alfonso García de Coca
- Department of Hematology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Josep M Martí
- Department of Hematology, Hospital Universitari Mutua Terrassa, Terrassa, Spain
| | - Valentin Cabañas
- Department of Hematology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Cristina Motlló
- Department of Hematology, Hospital de Sant Joan de Déu, Fundació Althaia, Manresa, Spain
| | - Erik de Cabo
- Department of Hematology, Hospital de El Bierzo, León, Spain
| | - Cristina Encinas
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ilda Murillo
- Department of Hematology, Hospital General San Jorge, Huesca, Spain
| | | | | | - Felipe Casado
- Department of Hematology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Antonia Sampol
- Department of Hematology, Hospital Universitario Son Espases, Mallorca, Spain
| | - Ricarda García
- Department of Hematology, Complejo Hospitalario de Especialidades Virgen de la Victoria, Málaga, Spain
| | | | | | | | - Belén Iñigo
- Department of Hematology, Hospital Clinico San Carlos, Madrid, Spain
| | - Aurelio López
- Department of Hematology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Paz Ribas
- Department of Hematology, Hospital Universitario Dr Peset Aleixandre, Valencia, Spain
| | - Mario Arnao
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain
| | | | - Joan Bladé
- Department of Hematology, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Juan José Lahuerta
- Department of Hematology, Hospital Universitario 12 de octubre, Madrid, Spain
| | - Jesús F San Miguel
- Department of Hematology, Clínica Universidad de Navarra, Pamplona, Spain
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12
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Cejalvo MJ, Legarda M, Abella E, Cabezudo E, Encinas C, García‐Feria A, Gironella M, Iñigo B, Martín J, Ribas P, Ruíz MÁ, González Y, Vicuña I, Ramírez Á, Fernández P, Rubia J. Single‐agent daratumumab in patients with relapsed and refractory multiple myeloma requiring dialysis: results of a Spanish retrospective, multicentre study. Br J Haematol 2019; 190:e289-e292. [DOI: 10.1111/bjh.16286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- María J. Cejalvo
- Department of Hematology University Hospital Doctor Peset Valencia Spain
| | - Mario Legarda
- Department of Hematology University Hospital Doctor Peset Valencia Spain
| | - Eugenia Abella
- Department of Hematology Hospital del Mar Barcelona Spain
| | - Elena Cabezudo
- Department of Hematology Hospital Sant Joan de Déu Barcelona Spain
| | | | | | | | - Belén Iñigo
- Department of Hematology Hospital Clínico San Carlos Madrid Spain
| | - Jesús Martín
- Department of Hematology Hospital Virgen del Rocío Sevilla Spain
| | - Paz Ribas
- Department of Hematology University Hospital Doctor Peset Valencia Spain
| | - Mª Ángeles Ruíz
- Department of Hematology Hospital Francesc Borja Gandía Spain
| | - Yolanda González
- Department of Hematology Instituto Catalán de Oncología Girona Spain
| | - Isabel Vicuña
- Department of Hematology Hospital La Princesa Madrid Spain
| | - Ángel Ramírez
- Department of Hematology Hospital Central de Asturias Oviedo Spain
| | | | - Javier Rubia
- Department of Hematology University Hospital Doctor Peset Valencia Spain
- Internal Medicine School of Medicine and Dentistry Catholic University of Valencia Valencia Spain
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13
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Rodríguez-Otero P, Mateos MV, Martínez-López J, Martín-Calvo N, Hernández MT, Ocio EM, Rosiñol L, Martínez R, Teruel AI, Gutiérrez NC, Bargay J, Bengoechea E, González Y, de Oteyza JP, Gironella M, Encinas C, Martín J, Cabrera C, Palomera L, de Arriba F, Cedena MT, Paiva B, Puig N, Oriol A, Bladé J, Lahuerta JJ, Miguel JFS. Correction: Early myeloma-related death in elderly patients: development of a clinical prognostic score and evaluation of response sustainability role. Leukemia 2019; 33:1056. [DOI: 10.1038/s41375-019-0408-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Varea S, Pich J, Cruceta A, Encinas C, Arnaiz J. Increasing needs of support on clinical trials in advanced Therapies. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Caballero-Velázquez T, López-Corral L, Encinas C, Castilla-Llorente C, Martino R, Rosiñol L, Sampol A, Caballero D, Serrano D, Heras I, San Miguel J, Pérez-Simón JA. Phase II clinical trial for the evaluation of bortezomib within the reduced intensity conditioning regimen (RIC) and post-allogeneic transplantation for high-risk myeloma patients. Br J Haematol 2013; 162:474-82. [PMID: 23772672 DOI: 10.1111/bjh.12410] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 03/27/2013] [Indexed: 11/27/2022]
Abstract
The current study was designed to assess the safety and efficacy of bortezomib in combination with fludarabine and melphalan as reduced intensity conditioning before allogeneic stem cell transplantation in patients with high risk multiple myeloma. Sixteen patients were evaluable. The median number of previous line of treatment was 3; all patients had relapsed following a prior autograft and 13 had previously received bortezomib. Fifteen of them either remained stable or improved disease status at day +100 post-transplant, including 11 patients with active disease. More specifically, nine patients (56%) and five patients (31%) reached complete remission and partial response, respectively. 25% developed grade III acute graft-versus-host disease. The cumulative incidence of non-relapse mortality, relapse and overall survival were 25%, 54% and 41%, respectively, at 3 years. Regarding the non-haematological toxicity (grade>2), two patients developed peripheral neuropathy, two patients liver toxicity and 1 pulmonary toxicity early post-transplant. The haematological toxicity was only observed during the first three cycles mostly related to low haemoglobin and platelet levels. The current trial is the first one evaluating the safety and efficacy of bortezomib as part of a reduced intensity conditioning regimen among patients with high risk multiple myeloma.
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Affiliation(s)
- Teresa Caballero-Velázquez
- Servicio de Hematología, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
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Martín A, Ibañez S, Blázquez C, Muñoz BM, Franco MT, Fernández AI, Rodriguez M, Pérez R, Encinas C. OHP-080 Use of Chemotherapy Near the End of Life. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
The purpose of this study was to evaluate the poly-axial locked plating system inserted through a minimally invasive approach for the treatment of three-part fractures of the proximal humerus. Twenty-three patients with a three-part fracture of the proximal humerus treated with a poly-axial locking plate through a percutaneous approach were available for clinical and radiological analysis at a minimum of 2 years follow up (average 36 months; range, 24-54 months). To assess objective and subjective outcomes the Constant Score (CS) and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were obtained. All complications were recorded. There were 17 women and 6 men, with a mean age of 62 years (range, 18-86). All fractures healed. At final follow up, the mean forward flexion, external rotation and internal rotation were 126°, 44° and L1, respectively; the mean CS was 64 and the mean DASH score was 23. Twelve patients (52%) had a postoperative complication, which included screw cut-out, stiffness and infection. The poly-axial locked plating system through a minimally-invasive approach may be an appropriate treatment for three-part fractures of the proximal humerus and may reduce the biological aggression of conventional plate fixation.
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Affiliation(s)
- R Barco
- Shoulder and Elbow Unit, Orthopedic Department, Hospital La Paz, Madrid, Spain.
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Silva F, Pérez-Simón JA, Caballero Velazquez T, Encinas C, Sánchez-Guijo FM, Díez-Campelo M, Colado E, Martín J, Villanueva-Gomez F, Vazquez L, Del Cañizo C, Caballero D, San Miguel J. Liver function tests and absolute lymphocyte count at day +100 are predictive factors for extensive and severe chronic graft-versus-host disease after allogeneic peripheral blood stem cell transplant. Am J Hematol 2010; 85:290-3. [PMID: 20162543 DOI: 10.1002/ajh.21613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Pérez-Simón JA, Encinas C, Silva F, Arcos MJ, Díez-Campelo M, Sánchez-Guijo FM, Colado E, Martín J, Vazquez L, Del Cañizo C, Caballero D, San Miguel J. Prognostic factors of chronic graft-versus-host disease following allogeneic peripheral blood stem cell transplantation: the national institutes health scale plus the type of onset can predict survival rates and the duration of immunosuppressive therapy. Biol Blood Marrow Transplant 2008; 14:1163-1171. [PMID: 18804047 DOI: 10.1016/j.bbmt.2008.07.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 07/31/2008] [Indexed: 10/21/2022]
Abstract
Several grading systems have been developed in the bone marrow transplantation setting in attempts to predict survival in patients with chronic graft-versus-host disease (cGVHD). In this study, we evaluated the prognostic value of the National Institutes of Health (NIH) scoring system and investigated for any additional prognostic factors in a series of 171 patients undergoing peripheral blood stem cell transplantation (PBSCT) from matched related donors. The cumulative incidence of cGVHD was 70%; cumulative incidences of mild, moderate, and severe cGVHD were 29%, 42% and 28%, respectively. Overall, 68% of patients were free from immunosuppression 5 years after transplantation. Absence of previous acute GVHD (aGVHD; hazard ratio [HR] = 2; P = .004) and mild cGVHD (HR = 4.2; P = .007) increased the probability of being off immunosuppressive treatment by the last follow-up. Overall survival (OS) at 5 years was 52%. Severe cGVHD, according to the NIH scoring system (HR = 13.27; P = .001) adversely influenced outcome, whereas de novo onset (HR = 0.094; P = .003) had a more favorable impact on survival. The combination of both variables allowed us to identify 4 different subgroups of patients with OS of 82%, 70%, 50%, and 25%. Our findings indicate that the NIH scoring system has some prognostic value in patients undergoing PBSCT and, together with the type of onset, must be considered to predict the possible outcome of patients who develop cGVHD.
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Affiliation(s)
- José A Pérez-Simón
- Department of Hematology, University Hospital of Salamanca Cancer Research Center (CIC/CSIC) of Salamanca and Center of Regenerative Medicine and Cellular Therapy of Castilla y Leon, Spain.
| | - Cristina Encinas
- Department of Hematology, University Hospital of Salamanca Cancer Research Center (CIC/CSIC) of Salamanca and Center of Regenerative Medicine and Cellular Therapy of Castilla y Leon, Spain
| | - Fernando Silva
- Department of Hematology, University Hospital of Salamanca Cancer Research Center (CIC/CSIC) of Salamanca and Center of Regenerative Medicine and Cellular Therapy of Castilla y Leon, Spain
| | - Maria José Arcos
- Department of Hematology, University Hospital of Salamanca Cancer Research Center (CIC/CSIC) of Salamanca and Center of Regenerative Medicine and Cellular Therapy of Castilla y Leon, Spain
| | - María Díez-Campelo
- Department of Hematology, University Hospital of Salamanca Cancer Research Center (CIC/CSIC) of Salamanca and Center of Regenerative Medicine and Cellular Therapy of Castilla y Leon, Spain
| | - Fermín M Sánchez-Guijo
- Department of Hematology, University Hospital of Salamanca Cancer Research Center (CIC/CSIC) of Salamanca and Center of Regenerative Medicine and Cellular Therapy of Castilla y Leon, Spain
| | - Enrique Colado
- Department of Hematology, University Hospital of Salamanca Cancer Research Center (CIC/CSIC) of Salamanca and Center of Regenerative Medicine and Cellular Therapy of Castilla y Leon, Spain
| | - Jesús Martín
- Department of Hematology, University Hospital of Salamanca Cancer Research Center (CIC/CSIC) of Salamanca and Center of Regenerative Medicine and Cellular Therapy of Castilla y Leon, Spain
| | - Lourdes Vazquez
- Department of Hematology, University Hospital of Salamanca Cancer Research Center (CIC/CSIC) of Salamanca and Center of Regenerative Medicine and Cellular Therapy of Castilla y Leon, Spain
| | - Consuelo Del Cañizo
- Department of Hematology, University Hospital of Salamanca Cancer Research Center (CIC/CSIC) of Salamanca and Center of Regenerative Medicine and Cellular Therapy of Castilla y Leon, Spain
| | - Dolores Caballero
- Department of Hematology, University Hospital of Salamanca Cancer Research Center (CIC/CSIC) of Salamanca and Center of Regenerative Medicine and Cellular Therapy of Castilla y Leon, Spain
| | - Jesús San Miguel
- Department of Hematology, University Hospital of Salamanca Cancer Research Center (CIC/CSIC) of Salamanca and Center of Regenerative Medicine and Cellular Therapy of Castilla y Leon, Spain
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Gonzalez-Porras JR, Graciani IF, Perez-Simon JA, Martin-Sanchez J, Encinas C, Conde MP, Nieto MJ, Corral M. Prospective evaluation of a transfusion policy of D+ red blood cells into D- patients. Transfusion 2008; 48:1318-24. [PMID: 18422846 DOI: 10.1111/j.1537-2995.2008.01700.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although D- patients should receive red blood cells (RBCs) from D- donors, the scarcity of D- blood components in certain situations makes the transfusion of D+ RBCs unavoidable. Therefore it is recommended that guidelines be developed in order to standardize transfusion policy in these scenarios. STUDY DESIGN AND METHODS We have prospectively evaluated a policy for the use of D+ RBCs in 905 D- patients. The amount of D- RBCs saved as well as the incidence of hemolytic reactions and anti-D alloimmunization were assessed. RESULTS 554 patients received D- RBCs while 351 received a total of 1032 D+ RBCs, all of them within our criteria for the acceptable use of D+ RBCs. This strategy allowed us to save 25.6 percent of D- RBCs (1032 out of 4024 RBCs requested). No hemolytic reactions were reported. The incidence of alloimmunization was 21.4 percent. Most patients who developed anti-D did so within the first 2 or 4 RBCs transfused (64% after the first 2 RBCs transfused and 88% after the first 4). In multivariate analysis the age of less than 77 years was the only predictor for alloimmuization (HR = 2.48 [95% CI = 1.21-3.81]; p = 0.014). CONCLUSION The use of D+ RBCs in selected D- patients does not induce adverse reactions and allows the saving of a significant number of D- RBCs.
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Affiliation(s)
- Jose R Gonzalez-Porras
- The Transfusion Service, Department of Hematology, University Hospital of Salamanca, Paseo de San Vicente, 58-182, Salamanca, 37007, Spain.
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Pérez-Persona E, Mateos-Mazón JJ, López-Villar O, Arcos MJ, Encinas C, Graciani IF, Ocio EM, Sánchez-Guijo FM, Caballero MD. Complete remission of subcutaneous panniculitic T-cell lymphoma after allogeneic transplantation. Bone Marrow Transplant 2006; 38:821-2. [PMID: 17057727 DOI: 10.1038/sj.bmt.1705527] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Arcos M, Diez-Campelo M, Caballero M, Vidan J, Perez-Simon J, Vazquez L, Canizo M, Castilla C, Mateos J, Lopez O, Perez E, Encinas C, Graciani I, San Miguel J. Pentostatin in refractory acute and chronic GVHD. A single center experience. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Miltsov S, Rivera L, Encinas C, Alonso J. Boron trifluoride–methanol complex—mild and powerful reagent for deprotection of labile acetylated amines. Tetrahedron Lett 2003. [DOI: 10.1016/s0040-4039(03)00271-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Galindo PA, Borja J, Feo F, Gómez E, Encinas C, García R. Nonpigmented fixed drug eruption caused by paracetamol. J Investig Allergol Clin Immunol 1999; 9:399-400. [PMID: 10664936] [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: 02/15/2023] Open
Abstract
Fixed drug eruption from paracetamol is not rare but no cases of nonpigmented fixed drug eruption caused by paracetamol have been previously described. We present the case of a woman who developed a nonpigmented fixed drug eruption following administration of paracetamol. Patch tests performed on affected and unaffected skin with paracetamol were negative. The diagnosis was made by a double-blind oral challenge with paracetamol. The patient tolerated aspirin.
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Affiliation(s)
- P A Galindo
- Allergy Section, Hospital Complex of Ciudad Real, Spain
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Affiliation(s)
- P A Galindo
- Allergy Section, Ciudad Real Hospital Complex, Spain
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Encinas C, Turon-Vicière M. [Endoprosthesis of the bile ducts. Taking charge of the patient]. Soins Chir 1993:36-41. [PMID: 8303132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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