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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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2
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González-López TJ, Sánchez-González B, Jarque I, Bernat S, Fernández-Fuertes F, Caparrós I, Soto I, Fernández-Rodríguez A, Bolaños E, Pérez-Rus G, Pascual C, Hernández-Rivas JA, López-Ansoar E, Gómez-Nuñez M, Martínez-Robles V, Olivera P, Yera Cobo M, Peñarrubia MJ, Fernández-Miñano C, de Cabo E, Martínez Badas MP, Perdomo G, García-Frade LJ. Use of eltrombopag for patients 65 years old or older with immune thrombocytopenia. Eur J Haematol 2020; 104:259-270. [PMID: 31840311 DOI: 10.1111/ejh.13370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/08/2019] [Revised: 12/03/2019] [Accepted: 12/11/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Eltrombopag is useful for immune thrombocytopenia (ITP). However, results of clinical trials may not accurately mirror clinical practice reality. Here we evaluated eltrombopag for primary and secondary ITP in our ≥65-year-old population. METHODS A total of 106 primary ITP patients (16 with newly diagnosed ITP, 16 with persistent ITP, and 74 with chronic ITP) and 39 secondary ITP patients (20 with ITP secondary to immune disorders, 7 with ITP secondary to infectious diseases, and 12 with ITP secondary to lymphoproliferative disorders [LPD]) were retrospectively evaluated. RESULTS Median age of our cohort was 76 (interquartile range, IQR, 70-81) years. 75.9% of patients yielded a platelet response including 66.2% complete responders. Median time to platelet response was 14 (IQR, 8-21) days. Median time on response was 320 (IQR, 147-526) days. Sixty-three adverse events (AEs), mainly grade 1-2, occurred. The most common were hepatobiliary laboratory abnormalities (HBLAs) and headaches. One transient ischemic attack in a newly diagnosed ITP and two self-limited pulmonary embolisms in secondary ITP were the only thrombotic events observed. CONCLUSION Eltrombopag showed efficacy and safety in ITP patients aged ≥65 years with primary and secondary ITP. However, efficacy results in LPD-ITP were poor. A relatively high number of deaths were observed.
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Affiliation(s)
- Tomás José González-López
- Department of Hematology, Hospital Universitario de Burgos, Burgos, Spain.,Department of Health Sciences, University of Burgos, Burgos, Spain
| | | | - Isidro Jarque
- Department of Hematology, Hospital Universitario La Fé, Valencia, Spain
| | - Silvia Bernat
- Department of Hematology, Hospital de La Plana, Castellón, Spain
| | - Fernando Fernández-Fuertes
- Department of Hematology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Isabel Caparrós
- Department of Hematology, Hospital Clínico de Málaga, Málaga, Spain
| | - Inmaculada Soto
- Department of Hematology, Hospital Universitario Central de Asturias, Oviedo (Asturias), Spain
| | | | - Estefanía Bolaños
- Department of Hematology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Gloria Pérez-Rus
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Pascual
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Elsa López-Ansoar
- Department of Hematology, Complejo Hospitalario Universitario de Orense, Orense, Spain
| | - Marta Gómez-Nuñez
- Department of Hematology, Hospital Parc Taulí, Sabadell (Barcelona), Spain
| | | | - Pavel Olivera
- Department of Hematology, Hospital Universitario Vall de Hebron, Barcelona, Spain
| | - Maria Yera Cobo
- Department of Hematology, Hospital Puerta del Mar, Cádiz, Spain
| | | | | | - Erik de Cabo
- Department of Hematology, Hospital del Bierzo, Ponferrada (León), Spain
| | | | - Germán Perdomo
- Department of Health Sciences, University of Burgos, Burgos, Spain
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3
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Magnano L, Alonso-Alvarez S, Alcoceba M, Rivas-Delgado A, Muntañola A, Nadeu F, Setoain X, Rodríguez S, Andrade-Campos M, Espinosa-Lara N, Rodríguez G, Sancho JM, Moreno M, Mercadal S, Carro I, Salar A, Garcia-Pallarols F, Arranz R, Cannata J, Terol MJ, Teruel AI, Jiménez-Ubieto A, Rodriguez A, González de Villambrosía S, Bello JL, López L, Novelli S, de Cabo E, Infante ME, Pardal E, Monsalvo S, González M, Martín A, Caballero MD, López-Guillermo A. Life expectancy of follicular lymphoma patients in complete response at 30 months is similar to that of the Spanish general population. Br J Haematol 2019; 185:480-491. [PMID: 30793290 DOI: 10.1111/bjh.15805] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 09/14/2018] [Accepted: 12/21/2018] [Indexed: 12/29/2022]
Abstract
The use of immunochemotherapy has improved the outcome of follicular lymphoma (FL). Recently, complete response at 30 months (CR30) has been suggested as a surrogate for progression-free survival. This study aimed to analyse the life expectancy of FL patients according to their status at 30 months from the start of treatment in comparison with the sex and age-matched Spanish general population (relative survival; RS). The training series comprised 263 patients consecutively diagnosed with FL in a 10-year period who needed therapy and were treated with rituximab-containing regimens. An independent cohort of 693 FL patients from the Grupo Español de Linfomas y Trasplante Autólogo de Médula Ósea (GELTAMO) group was used for validation. In the training cohort, 188 patients were in CR30, with a 10-year overall survival (OS) of 53% and 87% for non-CR30 and CR30 patients, respectively. Ten-year RS was 73% and 100%, showing no decrease in life expectancy for CR30 patients. Multivariate analysis indicated that the FL International Prognostic Index was the most important variable predicting OS in the CR30 group. The impact of CR30 status on RS was validated in the independent GELTAMO series. In conclusion, FL patients treated with immunochemotherapy who were in CR at 30 months showed similar survival to a sex- and age-matched Spanish general population.
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Affiliation(s)
- Laura Magnano
- Haematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - Sara Alonso-Alvarez
- Haematology Department, Hospital Universitario de Salamanca and IBSAL, Salamanca, Spain
| | - Miguel Alcoceba
- CIBERONC, Madrid, Spain.,Haematology Department, Hospital Universitario de Salamanca and IBSAL, Salamanca, Spain
| | - Alfredo Rivas-Delgado
- Haematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - Anna Muntañola
- Haematology Department, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
| | - Ferran Nadeu
- Lymphoid Neoplasms Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Setoain
- Nuclear Medicine Department, Hospital Clinic de Barcelona, Barcelona, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)2, Barcelona, Spain
| | - Sonia Rodríguez
- Nuclear Medicine Department, Hospital Clinic de Barcelona, Barcelona, Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)2, Barcelona, Spain
| | | | | | | | - Juan Manuel Sancho
- Haematology Department, Hospital GermansTrias i Pujol (ICO-IJC), Badalona, Spain
| | - Miriam Moreno
- Haematology Department, Hospital GermansTrias i Pujol (ICO-IJC), Badalona, Spain
| | - Santiago Mercadal
- Haematology Department, Hospital Duran i Reynals (ICO), Hospitalet, Spain
| | - Itziar Carro
- Haematology Department, Hospital Duran i Reynals (ICO), Hospitalet, Spain
| | - Antonio Salar
- Haematology Department, Hospital del Mar, Barcelona, Spain
| | | | - Reyes Arranz
- Haematology Department, Hospital de la Princesa, Madrid, Spain
| | - Jimena Cannata
- Haematology Department, Hospital de la Princesa, Madrid, Spain
| | - María J Terol
- Haematology Department, Hospital Clínico de Valencia, Valencia, Spain
| | - Ana I Teruel
- Haematology Department, Hospital Clínico de Valencia, Valencia, Spain
| | | | | | | | - José L Bello
- Haematology Department, Hospital de Nuestra Señora de la Esperanza, Santiago de Compostela, Spain
| | - Lourdes López
- Haematology Department, Hospital MD Anderson, Madrid, Spain
| | | | - Erik de Cabo
- Haematology Department, Hospital del Bierzo, Ponferrada, Spain
| | - María E Infante
- Haematology Department, Hospital Infanta Leonor, Madrid, Spain
| | - Emilia Pardal
- Haematology Department, Hospital Virgen del Puerto, Plasencia, Spain
| | - Silvia Monsalvo
- Haematology Department, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Marcos González
- CIBERONC, Madrid, Spain.,Haematology Department, Hospital Universitario de Salamanca and IBSAL, Salamanca, Spain
| | - Alejandro Martín
- CIBERONC, Madrid, Spain.,Haematology Department, Hospital Universitario de Salamanca and IBSAL, Salamanca, Spain
| | - M Dolores Caballero
- Haematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - Armando López-Guillermo
- Haematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
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4
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Alonso-Álvarez S, Magnano L, Alcoceba M, Andrade-Campos M, Espinosa-Lara N, Rodríguez G, Mercadal S, Carro I, Sancho JM, Moreno M, Salar A, García-Pallarols F, Arranz R, Cannata J, Terol MJ, Teruel AI, Rodríguez A, Jiménez-Ubieto A, González de Villambrosia S, Bello JL, López L, Monsalvo S, Novelli S, de Cabo E, Infante MS, Pardal E, García-Álvarez M, Delgado J, González M, Martín A, López-Guillermo A, Caballero MD. Risk of, and survival following, histological transformation in follicular lymphoma in the rituximab era. A retrospective multicentre study by the Spanish GELTAMO group. Br J Haematol 2017; 178:699-708. [PMID: 28782811 DOI: 10.1111/bjh.14831] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 02/06/2017] [Accepted: 05/05/2017] [Indexed: 11/28/2022]
Abstract
The diagnostic criteria for follicular lymphoma (FL) transformation vary among the largest series, which commonly exclude histologically-documented transformation (HT) mandatorily. The aims of this retrospective observational multicentre study by the Spanish Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea, which recruited 1734 patients (800 males/934 females; median age 59 years), diagnosed with FL grades 1-3A, were, (i) the cumulative incidence of HT (CI-HT); (ii) risk factors associated with HT; and (iii) the role of treatment and response on survival following transformation (SFT). With a median follow-up of 6·2 years, 106 patients developed HT. Ten-year CI-HT was 8%. Considering these 106 patients who developed HT, median time to transformation was 2·5 years. High-risk FL International Prognostic Index [Hazard ratio (HR) 2·6, 95% confidence interval (CI): 1·5-4·5] and non-response to first-line therapy (HR 2·9, 95% CI: 1·3-6·8) were associated with HT. Seventy out of the 106 patients died (5-year SFT, 26%). Response to HT first-line therapy (HR 5·3, 95% CI: 2·4-12·0), autologous stem cell transplantation (HR 3·9, 95% CI: 1·5-10·1), and revised International Prognostic Index (HR 2·2, 95% CI: 1·1-4·2) were significantly associated with SFT. Response to treatment and HT were the variables most significantly associated with survival in the rituximab era. Better therapies are needed to improve response. Inclusion of HT in clinical trials with new agents is mandatory.
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Affiliation(s)
- Sara Alonso-Álvarez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Laura Magnano
- Hospital Clinic of Barcelona, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Miguel Alcoceba
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO).,CIBERONC, Spain
| | - Marcio Andrade-Campos
- Hospital Universitario Miguel Servet de Zaragoza - CIBERER, IIS-Aragón (ISCIII), Zaragoza, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Natalia Espinosa-Lara
- Hospital Universitario Miguel Servet de Zaragoza - CIBERER, IIS-Aragón (ISCIII), Zaragoza, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Guillermo Rodríguez
- Hospital Virgen del Rocío Sevilla, Sevilla, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Santiago Mercadal
- Instituto Catalán de Oncología (ICO) Duran i Reynals, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Itziar Carro
- Instituto Catalán de Oncología (ICO) Duran i Reynals, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Juan M Sancho
- Instituto Catalán de Oncología (ICO-IJC) German Trias i Pujol, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Miriam Moreno
- Instituto Catalán de Oncología (ICO-IJC) German Trias i Pujol, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Antonio Salar
- Hospital del Mar, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Francesc García-Pallarols
- Hospital del Mar, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Reyes Arranz
- Hospital La Princesa, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Jimena Cannata
- Hospital La Princesa, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - María José Terol
- Hospital Clínico, Valencia, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Ana I Teruel
- Hospital Clínico, Valencia, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Antonia Rodríguez
- Hospital 12 de Octubre, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Ana Jiménez-Ubieto
- Hospital 12 de Octubre, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Sonia González de Villambrosia
- Hospital Marqués de Valdecilla, Santander, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - José L Bello
- Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Lourdes López
- Hospital MD Anderson, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Silvia Monsalvo
- Hospital Fundación Jiménez Díaz, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Silvana Novelli
- Hospital Sant Pau, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Erik de Cabo
- Hospital del Bierzo, Ponferrada, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - María S Infante
- Hospital Infanta Leonor, Madrid, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Emilia Pardal
- Hospital Virgen del Puerto, Plasencia, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - María García-Álvarez
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO)
| | - Julio Delgado
- Hospital Clinic of Barcelona, Barcelona, Spain.,CIBERONC, Spain
| | - Marcos González
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO).,CIBERONC, Spain
| | - Alejandro Martín
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO).,CIBERONC, Spain
| | - Armando López-Guillermo
- Hospital Clinic of Barcelona, Barcelona, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO).,CIBERONC, Spain
| | - María D Caballero
- Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain.,Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea (GELTAMO).,CIBERONC, Spain
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5
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González-López TJ, Fernández-Fuertes F, Hernández-Rivas JA, Sánchez-González B, Martínez-Robles V, Alvarez-Román MT, Pérez-Rus G, Pascual C, Bernat S, Arrieta-Cerdán E, Aguilar C, Bárez A, Peñarrubia MJ, Olivera P, Fernández-Rodríguez A, de Cabo E, García-Frade LJ, González-Porras JR. Efficacy and safety of eltrombopag in persistent and newly diagnosed ITP in clinical practice. Int J Hematol 2017; 106:508-516. [DOI: 10.1007/s12185-017-2275-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 01/19/2023]
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6
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González-López TJ, Alvarez-Román MT, Pascual C, Sánchez-González B, Fernández-Fuentes F, Jarque I, Pérez-Rus G, Pérez-Crespo S, Bernat S, Hernández-Rivas JA, Andrade MM, Cortés M, Gómez-Nuñez M, Olivera P, Martínez-Robles V, Fernández-Rodríguez A, Fuertes-Palacio MA, Fernández-Miñano C, de Cabo E, Fisac R, Aguilar C, Bárez A, Peñarrubia MJ, García-Frade LJ, González-Porras JR. Eltrombopag safety and efficacy for primary chronic immune thrombocytopenia in clinical practice. Eur J Haematol 2016; 97:297-302. [PMID: 26709028 DOI: 10.1111/ejh.12725] [Citation(s) in RCA: 25] [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] [Accepted: 12/17/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Eltrombopag is effective and safe in chronic immune thrombocytopenia (ITP). However, clinical trials may not accurately reflect what happens in clinical practice. We evaluated the efficacy and safety of eltrombopag in primary chronic ITP in a real-world setting. METHODS A total of 164 primary patients with chronic ITP from 40 Spanish centers, who had been treated with eltrombopag, were retrospectively evaluated. RESULTS The median age of our cohort (72% women) was 63 yr (interquartile range, IQR, 45-75 yr). The median time with ITP diagnosis was 81 months (IQR, 30-192 months). The median number of therapies prior to eltrombopag was 3 (IQR, 2-4). At the time of eltrombopag start, 45 patients (30%) were receiving concomitant treatment for ITP. Forty-six patients (30%) had bleeding signs/symptoms the month before the treatment started. The median platelet count at eltrombopag initiation was 22 × 10(9) /L (IQR, 8-39 × 10(9) /L). A total of 135 patients (88.8%) achieved a platelet response. The median time to platelet response was 12 d (95% CI, 9-13 d). Maintained platelet response rate during the 15-month period under examination was 75.2%. Twenty-eight patients (18.4%) experienced adverse events, mainly grades 1-2. CONCLUSION Eltrombopag is highly effective and well tolerated in unselected patients with primary chronic ITP.
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Affiliation(s)
| | | | - Cristina Pascual
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Fernando Fernández-Fuentes
- Department of Hematology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Isidro Jarque
- Department of Hematology, Hospital Universitario La Fé, Valencia, Spain
| | - Gloria Pérez-Rus
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Susana Pérez-Crespo
- Department of Hematology, Hospital de Santiago de Compostela, Santiago de Compostela (La Coruña), Spain
| | - Silvia Bernat
- Department of Hematology, Hospital de La Plana, Castellón, Spain
| | | | - Marcio M Andrade
- Department of Hematology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Montserrat Cortés
- Department of Hematology, Fundació Hospital Asil de Granollers, Granollers (Barcelona), Spain
| | - Marta Gómez-Nuñez
- Department of Hematology, Hospital Parc Taulí, Sabadell (Barcelona), Spain
| | - Pavel Olivera
- Department of Hematology, Hospital Universitario Vall de Hebron, Barcelona, Spain
| | | | | | | | | | - Erik de Cabo
- Department of Hematology, Hospital del Bierzo, Ponferrada (León), Spain
| | - Rosa Fisac
- Department of Hematology, Hospital de Segovia, Segovia, Spain
| | - Carlos Aguilar
- Department of Hematology, Hospital de Soria, Soria, Spain
| | - Abelardo Bárez
- Department of Hematology, Hospital de Avila, Avila, Spain
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González-López TJ, Pascual C, Álvarez-Román MT, Fernández-Fuertes F, Sánchez-González B, Caparrós I, Jarque I, Mingot-Castellano ME, Hernández-Rivas JA, Martín-Salces M, Solán L, Beneit P, Jiménez R, Bernat S, Andrade MM, Cortés M, Cortti MJ, Pérez-Crespo S, Gómez-Núñez M, Olivera PE, Pérez-Rus G, Martínez-Robles V, Alonso R, Fernández-Rodríguez A, Arratibel MC, Perera M, Fernández-Miñano C, Fuertes-Palacio MA, Vázquez-Paganini JA, Gutierrez-Jomarrón I, Valcarce I, de Cabo E, Sainz A, Fisac R, Aguilar C, Paz Martínez-Badas M, Peñarrubia MJ, Calbacho M, de Cos C, González-Silva M, Coria E, Alonso A, Casaus A, Luaña A, Galán P, Fernández-Canal C, Garcia-Frade J, González-Porras JR. Successful discontinuation of eltrombopag after complete remission in patients with primary immune thrombocytopenia. Am J Hematol 2015; 90:E40-3. [PMID: 25400215 DOI: 10.1002/ajh.23900] [Citation(s) in RCA: 108] [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: 10/01/2014] [Revised: 11/04/2014] [Accepted: 11/10/2014] [Indexed: 01/05/2023]
Abstract
Eltrombopag is effective and safe in immune thrombocytopenia (ITP). Some patients may sustain their platelet response when treatment is withdrawn but the frequency of this phenomenon is unknown. We retrospectively evaluated 260 adult primary ITP patients (165 women and 95 men; median age, 62 years) treated with eltrombopag after a median time from diagnosis of 24 months. Among the 201 patients who achieved a complete remission (platelet count >100 × 10(9) /l), eltrombopag was discontinued in 80 patients. Reasons for eltrombopag discontinuation were: persistent response despite a reduction in dose over time (n = 33), platelet count >400 × 10(9) /l (n = 29), patient's request (n = 5), elevated aspartate aminotransferase (n = 3), diarrhea (n = 3), thrombosis (n = 3), and other reasons (n = 4). Of the 49 evaluable patients, 26 patients showed sustained response after discontinuing eltrombopag without additional ITP therapy, with a median follow-up of 9 (range, 6-25) months. These patients were characterized by a median time since ITP diagnosis of 46.5 months, with 4/26 having ITP < 1 year. Eleven patients were male and their median age was 59 years. They received a median of 4 previous treatment lines and 42% were splenectomized. No predictive factors of sustained response after eltrombopag withdrawal were identified. Platelet response following eltrombopag cessation may be sustained in an important percentage of adult primary ITP patients who achieved CR with eltrombopag. However, reliable markers for predicting which patients will have this response are needed.
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8
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González-López TJ, Sánchez-González B, Pascual C, Arefi M, de Cabo E, Alonso A, Martín-Salces M, Jiménez-Bárcenas R, Calbacho M, Galan P, Barez A, González-Porras JR. Sustained response after discontinuation of short-and medium-term treatment with eltrombopag in patients with immune thrombocytopenia. Platelets 2014; 26:83-6. [PMID: 24499036 DOI: 10.3109/09537104.2013.870987] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Eltrombopag is effective and safe in chronic immune thrombocytopenia (ITP) patients not responding to previous therapy. However, when eltrombopag is discontinued, platelet counts usually return to baseline within 2 weeks. Here, we describe the clinical characteristics of the, to the best of our knowledge, largest case series of patients with ITP, who presented sustained responses after discontinuing eltrombopag (n = 12). The median time from diagnosis to eltrombopag initiation was 24 months (range, 1-480). The median number of prior therapies was 5 (range, 1-7), and the median duration of eltrombopag treatment was 5 months (range, 1-13). Three patients received eltrombopag for only 1 month. The treatment was well-tolerated. The median (range) follow-up of this case series was of 7 months (6-20), during which all patients maintained a safe platelet count without the need for anti-ITP treatment. The communication of such cases may support the conduction of new studies to investigate which predictive factors could identify ITP patients with sustained responses after discontinuing eltrombopag without additional therapy. The need of long-term use of eltrombopag should be re-examined.
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Gonzalez-Porras JR, Escalante F, Pardal E, Sierra M, Garcia-Frade LJ, Redondo S, Arefi M, Aguilar C, Ortega F, de Cabo E, Fisac RM, Sanz O, Esteban C, Alberca I, Sanchez-Barba M, Santos MT, Fernandez A, Gonzalez-Lopez TJ. Safety and efficacy of splenectomy in over 65-yrs-old patients with immune thrombocytopenia. Eur J Haematol 2013; 91:236-241. [PMID: 23679653 DOI: 10.1111/ejh.12146] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2013] [Indexed: 11/27/2022]
Abstract
AIM Few studies specifically focus on elderly splenectomized immune thrombocytopenia (ITP) patients. Older patients with ITP and excellent health are often excluded from surgery splenectomy. We aimed to compare the safety and efficacy of splenectomy in elderly and non-elderly ITP patients and to examine the effect of age on therapeutic response. MATERIAL AND METHODS We carried out a retrospective analysis of a series of 218 patients who had undergone splenectomy for ITP. We compared the data from the elderly group (≥65 yrs, 57 patients) with the young group (<65 yrs, 162 patients). RESULTS Surgical technique (laparoscopy or open laparotomy splenectomy) was comparable between the two age groups. The adjusted risk of major bleeding following splenectomy for elderly patients was three times that for young patients (OR 3.05, 95% CI: 1.44-6.52). The median duration of postoperative hospital stay was longer for elderly than for young patients (8 d vs. 4 d, P < 0.001). However, we identified a subgroup of elderly ITP patients, those aged between 65 and 70 yrs who had undergone laparoscopic splenectomy, with a low risk of postoperative complications. Of the 218 patients, 89% achieved a favorable response to splenectomy. A favorable response was significantly less common in elderly than in young people (79% vs. 92%, P = 0.005). However, we observed an acceptable long-term control of ITP in the elderly group, in which the probability of maintaining response for 14 yrs after splenectomy was 56%. CONCLUSIONS Patients aged ≥65 yrs experienced negative effects on safety and efficacy outcomes of splenectomy for ITP, but further studies are needed to identify predictors of postsplenectomy outcomes in this group.
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