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Jagannath S, Delimpasi S, Grosicki S, Van Domelen DR, Bentur OS, Špička I, Dimopoulos MA. Association of Selinexor Dose Reductions With Clinical Outcomes in the BOSTON Study. Clin Lymphoma Myeloma Leuk 2023; 23:917-923.e3. [PMID: 37743180 DOI: 10.1016/j.clml.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Dose modifications in response to adverse events (AEs) can maintain tumor response and improve therapy tolerability. We conducted a post-hoc analysis of the efficacy and safety of reduced selinexor doses in the BOSTON trial (NCT03110562). PATIENTS AND METHODS Efficacy, safety, and quality of life (QoL) in 195 patients with relapsed/refractory multiple myeloma randomized to once-weekly (QW) selinexor (100 mg), QW subcutaneous bortezomib (1.3 mg/m2), and twice-weekly dexamethasone (20 mg) were compared between patients with dose reductions and those without. RESULTS In total, 126 patients (65%) had selinexor dose reductions (median dose 71.4 mg/wk). In patients with dose reductions versus those without median progression-free survival was 16.6 months (95% CI 12.9-not evaluable [NE]) versus 9.2 months [95% CI 6.8-15.5]), overall response rate was 81.7% (95% CI 73.9-88.1%) versus 66.7% (95% CI 54.3-77.6%), ≥very good partial response was (51.6% [95% CI 42.5-60.6%] vs. 31.9% [95% CI 21.2-44.2]), median duration of response was not reached (95% CI 13.8-NE) versus 12.0 months (95% CI 8.3-NE), and time to next treatment was 22.6 months (95% CI 14.6-NE) versus 10.5 months (95% CI 6.3-18.2). Mean best change from baseline on the EORTC QLQ-C30 Global Health Status/QoL scale was 10.0 ± 20.5 versus 4.0 ± 20.9. Duration-adjusted AE rates that were lower after selinexor dose reduction included thrombocytopenia (62.5% before vs. 47.6% after), nausea (31.6% vs. 7.3%), fatigue (28.1% vs. 9.9%), decreased appetite (21.5% vs. 6.4%), anemia (17.9% vs. 10.3%), and diarrhea (12.9% vs. 5.2%). CONCLUSION Appropriate dose reductions in response to AEs of the 100 mg selinexor starting dose in the BOSTON study were associated with improved efficacy, reduced AE rates and improved QoL.
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Affiliation(s)
- Sundar Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| | | | | | | | | | - Ivan Špička
- Charles University and General Hospital, Prague, Czech Republic
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Martin T, Dimopoulos MA, Mikhael J, Yong K, Capra M, Facon T, Hajek R, Špička I, Baker R, Kim K, Martinez G, Min CK, Pour L, Leleu X, Oriol A, Koh Y, Suzuki K, Casca F, Macé S, Risse ML, Moreau P. Correction: Isatuximab, carfilzomib, and dexamethasone in patients with relapsed multiple myeloma: updated results from IKEMA, a randomized Phase 3 study. Blood Cancer J 2023; 13:152. [PMID: 37752114 PMCID: PMC10522597 DOI: 10.1038/s41408-023-00923-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Affiliation(s)
- Thomas Martin
- Department of Hematology, University of California at San Francisco, San Francisco, CA, USA.
| | | | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
| | - Kwee Yong
- Department of Haematology, University College Hospital, London, UK
| | - Marcelo Capra
- Centro Integrado de Hematologia e Oncologia, Hospital Mãe de Deus, Porto Alegre, Brazil
| | - Thierry Facon
- Department of Haematology, Lille University Hospital, Lille, France
| | - Roman Hajek
- Department of Hemato-Oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ivan Špička
- Department of Hematology, 1st Faculty of Medicine, Charles University and General Hospital, Prague, Czech Republic
| | - Ross Baker
- Perth Blood Institute, Murdoch University, Perth, Australia
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gracia Martinez
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Chang-Ki Min
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, CHU and CIC Inserm, 1402, Poitiers Cedex, France
| | - Albert Oriol
- Institut Josep Carreras and Institut Catala d'Oncologia, Hospital Germans Trias I Pujol, Badalona, Spain
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kenshi Suzuki
- Myeloma/Amyloidosis Center, Japanese Red Cross Medical Center, Tokyo, Japan
| | | | | | | | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
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3
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Schiller GJ, Lipe BC, Bahlis NJ, Tuchman SA, Bensinger WI, Sutherland HJ, Lentzsch S, Baljevic M, White D, Kotb R, Chen CI, Rossi A, Biran N, LeBlanc R, Grosicki S, Martelli M, Gunsilius E, Špička I, Stevens DA, Facon T, Mesa MG, Zhang C, Van Domelen DR, Bentur OS, Gasparetto C. Selinexor-Based Triplet Regimens in Patients With Multiple Myeloma Previously Treated With Anti-CD38 Monoclonal Antibodies. Clin Lymphoma Myeloma Leuk 2023; 23:e286-e296.e4. [PMID: 37393120 DOI: 10.1016/j.clml.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND The increasing use of anti-CD38 monoclonal antibodies (αCD38 mAbs) for newly diagnosed or early relapsed multiple myeloma (MM), especially in non-transplant eligible patients, may lead to more patients developing αCD38 mAb-refractory disease earlier in the treatment course with fewer treatment options. PATIENTS AND METHODS We analyzed the efficacy and safety of selinexor-based triplets (selinexor+dexamethasone [Sd] plus pomalidomide [SPd, n = 23], bortezomib [SVd, n = 16] or carfilzomib (SKd, n = 23]) in a subset of STOMP (NCT02343042) and BOSTON (NCT03110562) study patients treated previously with αCD38 mAbs. RESULTS Sixty-two patients (median 4 prior therapies, range 1 to 11, 90.3% refractory to αCD38 mAb) were included. Overall response rates (ORR) in the SPd, SVd and SKd cohorts were 52.2%, 56.3%, and 65.2%, respectively. Overall response rate was 47.4% among patients who had MM refractory to the third drug reintroduced in the Sd-based triplet. Median progression-free survival in the SPd, SVd, and SKd cohorts was 8.7, 6.7, and 15.0 months, respectively, and median overall survival was 9.6, 16.9, and 33.0 months, respectively. Median time to discontinuation in the SPd, SVd, and SKd cohorts was 4.4, 5.9, and 10.6 months, respectively. The most common hematological adverse events were thrombocytopenia, anemia, and neutropenia. Nausea, fatigue, and diarrhea were primarily grade 1/2. Adverse events were generally manageable with standard supportive care and dose modifications. CONCLUSION Selinexor-based regimens may offer effective and well-tolerated therapy to patients with relapsed and/or refractory MM who had disease previously exposed or refractory to αCD38 mAb therapy and could help address the unmet clinical need in these high-risk patients.
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Affiliation(s)
- Gary J Schiller
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
| | | | - Nizar J Bahlis
- Charbonneau Cancer Research Institute, Calgary, AB, Canada; Clinical Research Unit, Tom Baker Cancer Center, Calgary, AB, Canada
| | | | | | | | - Suzanne Lentzsch
- Multiple Myeloma and Amyloidosis Service, Columbia University, New York, NY
| | | | - Darrell White
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada
| | - Rami Kotb
- CancerCare Manitoba, Winnipeg, MB, Canada
| | | | | | - Noa Biran
- Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ
| | - Richard LeBlanc
- Maisonneuve-Rosemont Hospital, University of Montreal, QC, Canada
| | - Sebastian Grosicki
- Department of Hematology and Cancer Prevention, Medical University of Silesia, Katowice, Poland
| | - Maurizio Martelli
- Department of Cellular Biotechnology and Hematology, Hematology Center, Umberto I Polyclinic of Rome, Rome, Italy
| | - Eberhard Gunsilius
- Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
| | - Ivan Špička
- First Department of Medicine - Department of Hematology, First Faculty of Medicine, Charles University and General Hospital, Prague, Czech Republic
| | | | - Thierry Facon
- Department of Hematology (Maladies du sang), Hôpital Huriez, CHU, Lille, France
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4
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Martin T, Dimopoulos MA, Mikhael J, Yong K, Capra M, Facon T, Hajek R, Špička I, Baker R, Kim K, Martinez G, Min CK, Pour L, Leleu X, Oriol A, Koh Y, Suzuki K, Casca F, Macé S, Risse ML, Moreau P. Isatuximab, carfilzomib, and dexamethasone in patients with relapsed multiple myeloma: updated results from IKEMA, a randomized Phase 3 study. Blood Cancer J 2023; 13:72. [PMID: 37156782 PMCID: PMC10166682 DOI: 10.1038/s41408-023-00797-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/24/2023] [Accepted: 02/02/2023] [Indexed: 05/10/2023] Open
Abstract
Longer-term outcomes with the anti-CD38 antibody isatuximab in combination with carfilzomib-dexamethasone (Isa-Kd) were evaluated in the randomized Phase 3 trial IKEMA (NCT03275285), in a prespecified, follow-up analysis of progression-free survival (PFS, primary study endpoint), final complete response (CR) using Hydrashift Isa immunofixation assay, minimal residual disease (MRD) negativity, and safety. Enrolled patients had relapsed/refractory multiple myeloma (1-3 prior treatment lines). Isa 10 mg/kg was administered intravenously weekly in cycle 1 then biweekly. Efficacy analyses were performed in the intent-to-treat population (Isa-Kd: n = 179, Kd: n = 123) and safety evaluated in treated patients (Isa-Kd: n = 177, Kd: n = 122). Consistent with the primary interim analysis, the addition of Isa to Kd prolonged PFS (HR 0.58, 95.4% CI: 0.42-0.79; median PFS 35.7 [95% CI: 25.8-44.0] vs 19.2 [95% CI: 15.8-25.0] months). PFS benefit was observed with Isa-Kd across subgroups, including patients with poor prognosis. The stringent CR/CR rate was 44.1% vs 28.5% (odds-ratio: 2.09, 95% CI: 1.26-3.48), the MRD negativity rate 33.5% vs 15.4% (odds-ratio: 2.78, 95% CI: 1.55-4.99) and the MRD negativity CR rate 26.3% vs 12.2%, with Isa-Kd vs Kd. The safety profile of Isa-Kd was similar to that reported in the prior interim analysis. These findings further support Isa-Kd as a standard-of-care treatment for relapsed multiple myeloma patients.Clinical trial information: ClinicalTrials.gov, NCT03275285.
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Affiliation(s)
- Thomas Martin
- Department of Hematology, University of California at San Francisco, San Francisco, CA, USA.
| | | | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
| | - Kwee Yong
- Department of Haematology, University College Hospital, London, UK
| | - Marcelo Capra
- Centro Integrado de Hematologia e Oncologia, Hospital Mãe de Deus, Porto Alegre, Brazil
| | - Thierry Facon
- Department of Haematology, Lille University Hospital, Lille, France
| | - Roman Hajek
- Department of Hemato-Oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ivan Špička
- Department of Hematology, 1st Faculty of Medicine, Charles University and General Hospital, Prague, Czech Republic
| | - Ross Baker
- Perth Blood Institute, Murdoch University, Perth, Australia
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gracia Martinez
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Chang-Ki Min
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, CHU and CIC Inserm, 1402, Poitiers Cedex, France
| | - Albert Oriol
- Institut Josep Carreras and Institut Catala d'Oncologia, Hospital Germans Trias I Pujol, Badalona, Spain
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kenshi Suzuki
- Myeloma/Amyloidosis Center, Japanese Red Cross Medical Center, Tokyo, Japan
| | | | | | | | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
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5
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Paiva B, Manrique I, Dimopoulos MA, Gay F, Min CK, Zweegman S, Špička I, Teipel R, Mateos MV, Giuliani N, Cavo M, Hopkins CR, Fu W, Suryanarayan K, Vorog A, Li C, Wang B, Estevam J, Labotka R, Dash AB. MRD dynamics during maintenance for improved prognostication of 1280 patients with myeloma in the TOURMALINE-MM3 and -MM4 trials. Blood 2023; 141:579-591. [PMID: 36130300 PMCID: PMC10651778 DOI: 10.1182/blood.2022016782] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [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: 05/18/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 11/20/2022] Open
Abstract
Measurable residual disease (MRD) evaluation may help to guide treatment duration in multiple myeloma (MM). Paradoxically, limited longitudinal data exist on MRD during maintenance. We investigated the prognostic value of MRD dynamics in 1280 transplant-eligible and -ineligible patients from the TOURMALINE-MM3 and -MM4 randomized placebo-controlled phase 3 studies of 2-year ixazomib maintenance. MRD status at randomization showed independent prognostic value (median progression-free survival [PFS], 38.6 vs 15.6 months in MRD- vs MRD+ patients; HR, 0.47). However, MRD dynamics during maintenance provided more detailed risk stratification. A 14-month landmark analysis showed prolonged PFS in patients converting from MRD+ to MRD- status vs those with persistent MRD+ status (76.8% vs 27.6% 2-year PFS rates). Prolonged PFS was observed in patients with sustained MRD- status vs those converting from MRD- to MRD+ status (75.0% vs 34.2% 2-year PFS rates). Similar results were observed at a 28-month landmark analysis. Ixazomib maintenance vs placebo improved PFS in patients who were MRD+ at randomization (median, 18.8 vs 11.6 months; HR, 0.65) or at the 14-month landmark (median, 16.8 vs 10.6 months; HR, 0.65); no difference was observed in patients who were MRD-. This is the largest MM population undergoing yearly MRD evaluation during maintenance reported to date. We demonstrate the limited prognostic value of a single-time point MRD evaluation, because MRD dynamics over time substantially impact PFS risk. These findings support MRD- status as a relevant end point during maintenance and confirm the increased progression risk in patients converting to MRD+ from MRD- status. These trials were registered at www.clinicaltrials.gov as #NCT02181413 and #NCT02312258.
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Affiliation(s)
- Bruno Paiva
- Clinica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), CIBERONC (CB16/12/00369), Pamplona, Spain
| | - Irene Manrique
- Clinica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), CIBERONC (CB16/12/00369), Pamplona, Spain
| | - Meletios A. Dimopoulos
- Hematology and Medical Oncology, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesca Gay
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria City of Health and Science of Turin, Turin, Italy
| | - Chang-Ki Min
- Department of Internal Medicine, Seoul St Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
| | - Sonja Zweegman
- Department of Hematology, Amsterdam University Medical Center, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Ivan Špička
- Department of Hematology, Charles University, Prague, Czech Republic
| | - Raphael Teipel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum TU Dresden, Dresden, Germany
| | | | - Nicola Giuliani
- Myeloma Unit, Department of Clinical and Experimental Medicine, University of Parma, and Ematologia e CTMO, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | | | - Weijun Fu
- Department of Hematology, Shanghai Changzheng Hospital, Shanghai, China
- Department of Hematology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | | | | | - Cong Li
- Takeda Development Center Americas, Lexington, MA
| | - Bingxia Wang
- Takeda Development Center Americas, Lexington, MA
| | - Jose Estevam
- Takeda Development Center Americas, Lexington, MA
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6
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Sandecka V, Pour L, Špička I, Minařík J, Radocha J, Jelínek T, Pavlíček P, Jungová A, Kessler P, Wróbel M, Štork M, Štraub J, Pika T, Čápková L, Ševčíková S, Maisnar V, Hájek R. Real-world evidence of efficacy and safety of pomalidomide and dexamethasone in relapsed/refractory multiple myeloma patients: Czech registry data. Neoplasma 2022; 69:1474-1479. [PMID: 36591805 DOI: 10.4149/neo_2022_220813n827] [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: 08/13/2022] [Accepted: 11/29/2022] [Indexed: 12/31/2022]
Abstract
We assessed the outcomes of pomalidomide and dexamethasone treatment in relapsed/refractory multiple myeloma (RRMM) patients with ≥1 prior line of therapy. We analyzed the data of all RRMM patients treated with pomalidomide and dexamethasone at nine Czech centers between 2013 and 2018. The source of the data was the Registry of Monoclonal Gammopathies of the Czech Republic. Primary endpoints included response rates based on International Myeloma Working Group criteria and survival measures, including progression-free survival (PFS) and overall survival (OS). Secondary endpoints were toxicities and previous treatment patterns, including refractory to lenalidomide, and their impact on final outcomes. The overall response rate was 51.8% and the clinical benefit rate (including patients with minimal response) was 67.1%, with 0.6% of complete responses, 8.5% of very good partial responses, and 42.1% of partial responses (PR). Overall, 16.5% of patients had a minimal response, and 32.3% had stable disease /progression. Median PFS was 8.8 months and the median OS was 14.2 months. In patients who achieved ≥PR, the median PFS and OS were significantly longer compared to non-responders (median PFS (12.1 vs. 4.5 months, p≤0.001 respectively), median OS (22.1 vs. 7.7 months, p≤0.001, respectively). The most frequent adverse events (AEs) were neutropenia (29.9%) and anemia (18.9%), non-hematological AEs included infections (14.6%) and fatigue (7.3%). Our analysis confirmed the effectiveness of pomalidomide and dexamethasone in a real-world setting. This therapy achieved reasonable outcomes comparable to the data from clinical trials even though this was an unbiased cohort of patients.
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Affiliation(s)
- Viera Sandecka
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivan Špička
- 1st Department of Medicine-Department of Hematology, First Faculty of Medicine, Charles University and General Hospital,, Prague, Czech Republic
| | - Jiří Minařík
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Jakub Radocha
- 4th Department of Internal Medicine-Hematology, University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Tomáš Jelínek
- Department of Hematooncology, University Hospital, Ostrava, Czech Republic.,Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Petr Pavlíček
- Department of Internal Medicine and Hematology, 3rd Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Alexandra Jungová
- Hematology and Oncology Department, Charles University Hospital Pilsen, Pilsen, Czech Republic
| | - Petr Kessler
- Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Pelhrimov, Czech Republic
| | - Marek Wróbel
- Department of Clinical Hematology, Hospital Novy Jicin, Novy Jicin, Czech Republic
| | - Martin Štork
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Štraub
- 1st Department of Medicine-Department of Hematology, First Faculty of Medicine, Charles University and General Hospital,, Prague, Czech Republic
| | - Tomáš Pika
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Lenka Čápková
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Sabina Ševčíková
- Babak Myeloma Group, Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Internal Medicine-Hematology, University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Roman Hájek
- Department of Hematooncology, University Hospital, Ostrava, Czech Republic.,Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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7
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Schjesvold FH, Dimopoulos MA, Delimpasi S, Robak P, Coriu D, Legiec W, Pour L, Špička I, Masszi T, Doronin V, Minarik J, Salogub G, Alekseeva Y, Lazzaro A, Maisnar V, Mikala G, Rosiñol L, Liberati AM, Symeonidis A, Moody V, Thuresson M, Byrne C, Harmenberg J, Bakker NA, Hájek R, Mateos MV, Richardson PG, Sonneveld P, Schjesvold F, Delimpasi S, Robak P, Coriu D, Nikolayeva A, Tomczak W, Pour L, Spicka I, Dimopoulos MA, Masszi T, Doronin V, Minarik J, Salogub G, Alekseeva Y, Maisnar V, Mikala G, Rosinol L, Konstantinova T, Lazzaro A, Liberati AM, Symeonidis A, Gatt M, Illes A, Abdulhaq H, Dungarwalla M, Grosicki S, Hajek R, Leleu X, Myasnikov A, Richardson PG, Avivi I, Deeren D, Gironella M, Hernandez-Garcia MT, Martinez Lopez J, Newinger-Porte M, Ribas P, Samoilova O, Voog E, Arnao-Herraiz M, Carrillo-Cruz E, Corradini P, Dodlapati J, Granell Gorrochategui M, Huang SY, Jenner M, Karlin L, Kim JS, Kopacz A, Medvedeva N, Min CK, Mina R, Palk K, Shin HJ, Sohn SK, Sonneveld P, Tache J, Anagnostopoulos A, Arguiñano JM, Cavo M, Filicko J, Garnes M, Halka J, Herzog-Tzarfati K, Ipatova N, Kim K, Krauth MT, Kryuchkova I, Lazaroiu MC, Luppi M, Proydakov A, Rambaldi A, Rudzianskiene M, Yeh SP, Alcalá-Peña MM, Alegre Amor A, Alizadeh H, Bendandi M, Brearton G, Brown R, Cavet J, Dally N, Egyed M, Hernández-Rivas JÁ, Kaare A, Karsenti JM, Kloczko J, Kreisle W, Lee JJ, Legiec W, Machherndl-Spandl S, Manda S, Mateos MV, Moiseev I, Moreb J, Nagy Z, Nair S, Oriol-Rocafiguera A, Osswald M, Otero-Rodriguez P, Peceliunas V, Plesner T, Rey P, Rossi G, Stevens D, Suriu C, Tarella C, Verlinden A, Zannetti A. Melflufen or pomalidomide plus dexamethasone for patients with multiple myeloma refractory to lenalidomide (OCEAN): a randomised, head-to-head, open-label, phase 3 study. The Lancet Haematology 2022; 9:e98-e110. [DOI: 10.1016/s2352-3026(21)00381-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/30/2022]
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8
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Radocha J, Špička I, Pour L, Jelinek T, Jungova A, Minarik J, Heindorfer A, Stejskal L, Ullrychova J, Obernauerova J, Kessler P, Wrobel M, Pavlíček P, Sykora M, Mikula P, Maisnar V, Hájek R. OAB-046: COVID-19 infection in multiple myeloma patients – retrospective analysis of 371 Czech patients. Clinical Lymphoma Myeloma and Leukemia 2021. [PMCID: PMC8580181 DOI: 10.1016/s2152-2650(21)02120-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background COVID-19 disease caused by SARS-CoV-2 coronavirus has affected millions of people worldwide. The mortality of this infection varies with age and comorbidities up to more than 10% in very elderly population. The aim of our study was to determine the disease pattern and mortality rate among multiple myeloma patients. Methods We retrospectively analyzed entries in the Czech Registry of Monoclonal Gammopathies from patients who were infected with SARS-CoV-2 from March 2020 until May 2021. Demographic data, treatment patterns, comorbidities, symptoms of COVID-19, treatment modalities and healthcare utilization was compared in survivors and non-survivors. Results Overall, 371 patients with MM and COVID-19 infection were identified. Median age at covid-19 diagnosis was 69 years (37-91 years), 53.4% (198/371) were males. There were 70.1% (260/371) survivors and 20.8% (77/371) deceased patients, outcome of 9.2% (34/371) of patients is unknown. PCR positivity was seen with median 20 days (1-84 days) in 79 evaluable patients. 6 patients were vaccinated prior to infection (5-68 days). Infection was acquired during actual treatment in 53.1% of patients (197/371). Median number of previous lines administered was 1 (0-7). Treatment preceding infection was most frequently composed of lenalidomide in 50.3%, bortezomib in 42.1% and daratumumab in 19.8%. Symptomatic infection was seen in 74.9% (278/371) of patients with fever being the leading symptom (49.6%) followed by cough (39.1%) and shortness of breath (35.0%). Inpatient treatment was needed in 45.0% (167/371) of patients, intensive care unit was required in 38.9% (65/167) of patients. Median length of in-hospital stay was 11 days (1-53 days). Artificial lung ventilation was necessary in 10.8% (18/167) patients, 24.6% (41/167) needed non-invasive ventilation or high flow oxygen and 35.3% (59/167) of patients needed low flow oxygen. Remdesivir was administered to 10.0% (37/371) and convalescent plasma to 4.9% (18/371) of patients. No difference was seen in mortality according to ISS stage (p=0.609), administered lines of therapy (p=0.119) or achieved treatment response (p=0.418). Conclusions The mortality of MM patients with COVID-19 was very high (20.8%). Healthcare utilization was high with almost half of the infected myeloma patients needing inpatient treatment. No apparent risk factors in terms of disease status or previous treatment were identified. Supported by MH CZ - DRO (UHHK, 00169906) and by the program PROGRES Q40/8.
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Sanchez L, Leleu X, Beaumont JL, Yu H, Hudgens S, Simonova M, Auner HW, Quach H, Delimpasi S, Špička I, Pour L, Kriachok I, Dimopoulos MA, Usenko G, Hájek R, Benjamin R, Sinha DK, Venner C, Illmer T, Garg MK, Stevens DA, Jagannath S, Levy M, Anderson LD, Bahlis NJ, Facon T, Cavo M, Chai Y, Ma X, Tang S, Leong H, Shah J, Shacham S, Kauffman M, Richardson P, Grosicki S. Peripheral neuropathy symptoms, pain, and functioning in previously treated multiple myeloma patients treated with selinexor, bortezomib, and dexamethasone. Am J Hematol 2021; 96:E383-E386. [PMID: 34161627 DOI: 10.1002/ajh.26282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Larysa Sanchez
- Icahn School of Medicine at Mount Sinai New York New York USA
| | - Xavier Leleu
- CHU de Poitiers ‐ Hôpital La Milétrie Service d'Hématologie et Thérapie Cellulaire, Pôle Régional de Cancérologie Poitiers France
| | | | - Hailin Yu
- Clinical Outcomes Solutions Tucson Arizona USA
| | | | - Maryana Simonova
- Institute of Blood Pathology & Transfusion Medicine of National Academy of Medical Sciences of Ukraine Lviv Ukraine
| | - Holger W. Auner
- Hugh and Josseline Langmuir Centre for Myeloma Research Imperial College London London UK
| | - Hang Quach
- St Vincent's Hospital University of Melbourne Melbourne Victoria Australia
| | - Sosana Delimpasi
- Evangelismos Hospital Hematology/Lymphomas and BMT Unit Athens Greece
| | - Ivan Špička
- 1st Internal Clinic ‐ Clinic of Hematology General University Hospital in Prague Prague Czechia
| | - Ludĕk Pour
- University Hospital Brno Clinic of Internal Medicine ‐ Hematology and Oncology Brno Czechia
| | - Iryna Kriachok
- Scientific Research Department of Chemotherapy of Hemoblastoses and Adjuvant Treatment Methods National Cancer Institute Rockville Maryland USA
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital Athens Greece
| | - Ganna Usenko
- City Clinical Hospital No.4 of Dnipro City Council City Hematology Center Dnipro Ukraine
| | - Roman Hájek
- Department of Hemato‐oncology University Hospital Ostrava Ostrava Czechia
| | | | - Dinesh Kumar Sinha
- State Cancer Institute Indira Gandhi Institute of Medical Sciences, Patna India
| | | | - Thomas Illmer
- Group Practice for Hematology and Oncology Dresden Germany
| | | | | | | | - Moshe Levy
- Baylor University Medical Center Dallas Texas USA
| | - Larry D. Anderson
- Simmons Comprehensive Cancer Center UT Southwestern Medical Center Dallas Texas USA
| | - Nizar Jacques Bahlis
- University of Calgary Charbonneau Cancer Research Institute Calgary Alberta Canada
| | | | | | - Yi Chai
- Karyopharm Therapeutics Newton Massachusetts USA
| | - Xiwen Ma
- Karyopharm Therapeutics Newton Massachusetts USA
| | - Shijie Tang
- Karyopharm Therapeutics Newton Massachusetts USA
| | - Hoyee Leong
- Karyopharm Therapeutics Newton Massachusetts USA
| | - Jatin Shah
- Karyopharm Therapeutics Newton Massachusetts USA
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Hájek R, Jelinek T, Moreau P, Martin T, Pour L, Mikala G, Symeonidis A, Bringhen S, Rawlings A, Risse ML, van de Velde H, Špička I. P-196: Isatuximab plus Carfilzomib and Dexamethasone in patients with relapsed Multiple Myeloma and soft-tissue Plasmacytomas: IKEMA subgroup analysis. Clinical Lymphoma Myeloma and Leukemia 2021. [DOI: 10.1016/s2152-2650(21)02323-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Sandecká V, Pour L, Špička I, Minařík J, Radocha J, Jelínek T, Heindorfer A, Pavlíček P, Sýkora M, Jungová A, Kessler P, Wróbel M, Starostka D, Ullrychová J, Stejskal L, Štork M, Straub J, Pika T, Brožová L, Ševčíková S, Maisnar V, Hájek R. Bortezomib-based therapy for newly diagnosed multiple myeloma patients ineligible for autologous stem cell transplantation: Czech Registry Data. Eur J Haematol 2021; 107:466-474. [PMID: 34272773 DOI: 10.1111/ejh.13683] [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: 04/03/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study compared the use of bortezomib in different combination regimens in newly diagnosed multiple myeloma (NDMM) patients who were transplant ineligible. PATIENTS AND METHODS We analyzed data from the Registry of Monoclonal Gammopathies (RMG) of the Czech Myeloma Group (CMG) to provide real-world evidence of outcome for 794 newly diagnosed MM transplant ineligible patients. The most frequently used regimen was VCd (bortezomib-cyclophosphamide-dexamethasone) (47.5%) over VMP (bortezomib-melphalan-prednisone) (21.7%), BDd (bortezomib-doxorubicin-dexamethasone) (9.8%), and VTd (bortezomib-thalidomide-dexamethasone) (2.9%). RESULTS The overall response rate (ORR) was 69.2% (478/691), including 12.6% (≥ CR); 34.7% very good partial responses (VGPR); and 21.9% partial responses (PR). Among triplet regimens, VMP was the most effective regimen compared to VCd, BDd, and VTd. Median PFS was 22.3 vs. 18.5 vs. 13.7 vs. 13.8 mo, (P = .275), respectively, and median OS was 49 vs. 41.7 vs. 37.9 vs. 32.2 mo (P = .004), respectively. The most common grade 3-4 toxicities were anemia in 17.4% and infections in 18% of patients. CONCLUSION Our study confirmed that bortezomib-based treatment is effective and safe in NDMM transplant ineligible patients, especially VMP, which was identified as superior between bortezomib-based induction regimens not only in clinical trials, but also in real clinical practice.
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Affiliation(s)
- Viera Sandecká
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Ivan Špička
- 1st Department of Medicine, Department of Hematology, Charles University and General Hospital, Prague, Czech Republic
| | - Jiří Minařík
- Department of Hemato-Oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jakub Radocha
- 4th Department of Internal Medicine, Hematology, University Hospital and Charles University in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Tomáš Jelínek
- Department of Hematooncology, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | | | - Petr Pavlíček
- Department of Internal Medicine and Hematology, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michal Sýkora
- Department of Clinical Hematology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Alexandra Jungová
- Hematology and Oncology Department, Charles University Hospital Pilsen, Pilsen, Czech Republic
| | - Petr Kessler
- Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Czech Republic
| | - Marek Wróbel
- Department of Clinical Hematology, Hospital Novy Jicin, Czech Republic
| | - David Starostka
- Department of Clinical Hematology, Hospital Havirov, Czech Republic
| | - Jana Ullrychová
- Department of Clinical Hematology, Regional Health Corporation, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - Lukáš Stejskal
- Department of Hematology, Silesian Hospital in Opava, Opava, Czech Republic
| | - Martin Štork
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Jan Straub
- 1st Department of Medicine, Department of Hematology, Charles University and General Hospital, Prague, Czech Republic
| | - Tomáš Pika
- Department of Hemato-Oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Lucie Brožová
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Sabina Ševčíková
- Babak Myeloma Group, Department of Pathophysiology, Masaryk University, Brno, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Internal Medicine, Hematology, University Hospital and Charles University in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Roman Hájek
- Department of Hematooncology, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
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Moreau P, Dimopoulos MA, Mikhael J, Yong K, Capra M, Facon T, Hajek R, Špička I, Baker R, Kim K, Martinez G, Min CK, Pour L, Leleu X, Oriol A, Koh Y, Suzuki K, Risse ML, Asset G, Macé S, Martin T. Isatuximab, carfilzomib, and dexamethasone in relapsed multiple myeloma (IKEMA): a multicentre, open-label, randomised phase 3 trial. Lancet 2021; 397:2361-2371. [PMID: 34097854 DOI: 10.1016/s0140-6736(21)00592-4] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/16/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Isatuximab is an anti-CD38 monoclonal antibody approved in combination with pomalidomide-dexamethasone and carfilzomib-dexamethasone for relapsed or refractory multiple myeloma. This phase 3, open-label study compared the efficacy of isatuximab plus carfilzomib-dexamethasone versus carfilzomib-dexamethasone in patients with relapsed multiple myeloma. METHODS This was a prospective, randomised, open-label, parallel-group, phase 3 study done at 69 study centres in 16 countries across North America, South America, Europe, and the Asia-Pacific region. Patients with relapsed or refractory multiple myeloma aged at least 18 years who had received one to three previous lines of therapy and had measurable serum or urine M-protein were eligible. Patients were randomly assigned (3:2) to isatuximab plus carfilzomib-dexamethasone (isatuximab group) or carfilzomib-dexamethasone (control group). Patients in the isatuximab group received isatuximab 10 mg/kg intravenously weekly for the first 4 weeks, then every 2 weeks. Both groups received the approved schedule of intravenous carfilzomib and oral or intravenous dexamethasone. Treatment continued until progression or unacceptable toxicity. The primary endpoint was progression-free survival and was assessed in the intention-to-treat population according to assigned treatment. Safety was assessed in all patients who received at least one dose according to treatment received. The study is registered at ClinicalTrials.gov, NCT03275285. FINDINGS Between Nov 15, 2017, and March 21, 2019, 302 patients with a median of two previous lines of therapy were enrolled. 179 were randomly assigned to the isatuximab group and 123 to the control group. Median progression-free survival was not reached in the isatuximab group compared with 19·15 months (95% CI 15·77-not reached) in the control group, with a hazard ratio of 0·53 (99% CI 0·32-0·89; one-sided p=0·0007). Treatment-emergent adverse events (TEAEs) of grade 3 or worse occurred in 136 (77%) of 177 patients in the isatuximab group versus 82 (67%) of 122 in the control group, serious TEAEs occurred in 105 (59%) versus 70 (57%) patients, and TEAEs led to discontinuation in 15 (8%) versus 17 (14%) patients. Fatal TEAEs during study treatment occurred in six (3%) versus four (3%) patients. INTERPRETATION The addition of isatuximab to carfilzomib-dexamethasone significantly improves progression-free survival and depth of response in patients with relapsed multiple myeloma, representing a new standard of care for this patient population. FUNDING Sanofi. VIDEO ABSTRACT.
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Affiliation(s)
- Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
| | | | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
| | - Kwee Yong
- Department of Haematology, University College Hospital, London, UK
| | - Marcelo Capra
- Centro Integrado de Hematologia e Oncologia, Hospital Mãe de Deus, Porto Alegre, Brazil
| | | | - Roman Hajek
- Department of Hemato-Oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ivan Špička
- 1st Department of Medicine-Department of Hematology, 1st Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Ross Baker
- Perth Blood Institute, Murdoch University, Perth, WA, Australia
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gracia Martinez
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paolo, Brazil
| | - Chang-Ki Min
- Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul, South Korea
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, CHU and CIC Inserm 1402, Poitiers, France
| | - Albert Oriol
- Institut Josep Carreras and Institut Catala d'Oncologia, Hospital Germans Trias I Pujol, Badalona, Spain
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kenshi Suzuki
- Myeloma/Amyloidosis Center, Japanese Red Cross Medical Center, Tokyo, Japan
| | | | | | | | - Thomas Martin
- Department of Hematology, University of California San Francisco, San Francisco, CA, USA
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13
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Mateos MV, Gavriatopoulou M, Facon T, Auner HW, Leleu X, Hájek R, Dimopoulos MA, Delimpasi S, Simonova M, Špička I, Pour L, Kriachok I, Pylypenko H, Doronin V, Usenko G, Benjamin R, Dolai TK, Sinha DK, Venner CP, Garg M, Stevens DA, Quach H, Jagannath S, Moreau P, Levy M, Badros AZ, Anderson LD, Bahlis NJ, Cavo M, Chai Y, Jeha J, Arazy M, Shah J, Shacham S, Kauffman MG, Richardson PG, Grosicki S. Effect of prior treatments on selinexor, bortezomib, and dexamethasone in previously treated multiple myeloma. J Hematol Oncol 2021; 14:59. [PMID: 33849608 PMCID: PMC8045319 DOI: 10.1186/s13045-021-01071-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
Therapeutic regimens for previously treated multiple myeloma (MM) may not provide prolonged disease control and are often complicated by significant adverse events, including peripheral neuropathy. In patients with previously treated MM in the Phase 3 BOSTON study, once weekly selinexor, once weekly bortezomib, and 40 mg dexamethasone (XVd) demonstrated a significantly longer median progression-free survival (PFS), higher response rates, deeper responses, a trend to improved survival, and reduced incidence and severity of bortezomib-induced peripheral neuropathy when compared with standard twice weekly bortezomib and 80 mg dexamethasone (Vd). The pre-specified analyses described here evaluated the influence of the number of prior lines of therapy, prior treatment with lenalidomide, prior proteasome inhibitor (PI) therapy, prior immunomodulatory drug therapy, and prior autologous stem cell transplant (ASCT) on the efficacy and safety of XVd compared with Vd. In this 1:1 randomized study, enrolled patients were assigned to receive once weekly oral selinexor (100 mg) with once weekly subcutaneous bortezomib (1.3 mg/m2) and 40 mg per week dexamethasone (XVd) versus standard twice weekly bortezomib and 80 mg per week dexamethasone (Vd). XVd significantly improved PFS, overall response rate, time-to-next-treatment, and showed reduced all grade and grade ≥ 2 peripheral neuropathy compared with Vd regardless of prior treatments, but the benefits of XVd over Vd were more pronounced in patients treated earlier in their disease course who had either received only one prior therapy, had never been treated with a PI, or had prior ASCT. Treatment with XVd improved outcomes as compared to Vd regardless of prior therapies as well as manageable and generally reversible adverse events. XVd was associated with clinical benefit and reduced peripheral neuropathy compared to standard Vd in previously treated MM. These results suggest that the once weekly XVd regimen may be optimally administered to patients earlier in their course of disease, as their first bortezomib-containing regimen, and in those relapsing after ASCT.Trial registration: ClinicalTrials.gov (NCT03110562). Registered 12 April 2017. https://clinicaltrials.gov/ct2/show/NCT03110562 .
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Affiliation(s)
| | - Maria Gavriatopoulou
- Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Thierry Facon
- CHU Lille Service Des Maladies du Sang, 59000, Lille, France
| | | | - Xavier Leleu
- Department of Hematology, CHU La Miletrie and Inserm CIC 1402, Poitiers, France
| | - Roman Hájek
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | | | | | - Maryana Simonova
- Institute of Blood Pathology and Transfusion Medicine of NAMS of Ukraine, Lviv, Ukraine
| | - Ivan Špička
- Charles University and General Hospital, Prague, Czech Republic
| | - Ludĕk Pour
- University Hospital Brno, Brno, Czech Republic
| | | | | | - Vadim Doronin
- City Clinical Hospital #40, Moscow, Russian Federation
| | - Ganna Usenko
- City Clinical Hospital No. 4 of Dnipro City Council, Dnipro, Ukraine
| | | | - Tuphan K Dolai
- Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Dinesh K Sinha
- State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, India
| | | | - Mamta Garg
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Don A Stevens
- Norton Cancer Institute, St. Matthews Campus, Louisville, KY, USA
| | - Hang Quach
- St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Sundar Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Moshe Levy
- Baylor University Medical Center, Dallas, TX, USA
| | - Ashraf Z Badros
- Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Larry D Anderson
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nizar J Bahlis
- Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, USA
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Yi Chai
- Karyopharm Therapeutics Inc, Newton, MA, USA
| | | | | | - Jatin Shah
- Karyopharm Therapeutics Inc, Newton, MA, USA
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Abstract
INTRODUCTION Although new drug classes have significantly extended survival of patients with multiple myeloma, they continue to experience multiple relapses and/or become refractory to treatment. Therefore, novel therapies and treatment combinations with different mechanisms of action are needed to improve the outcomes of patients with relapsed/refractory multiple myeloma. AREAS COVERED Here, the authors review the published data regarding the development and clinical investigation of isatuximab, a CD38 monoclonal antibody, for treatment of patients with relapsed/refractory multiple myeloma. The mechanisms of action, clinical efficacy, and safety of isatuximab treatment are summarized. EXPERT OPINION Isatuximab is approved in combination with pomalidomide/dexamethasone for the treatment of adults with relapsed/refractory multiple myeloma who have received at least two prior therapies, including lenalidomide and a proteasome inhibitor. Isatuximab displays a manageable safety profile, with infusion reactions being the most common adverse events. Isatuximab is currently being further evaluated in combination with other backbone regimens in relapsed/refractory and newly diagnosed multiple myeloma.
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Affiliation(s)
- Paul G Richardson
- Division of Hematologic Malignancy, Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Harvard Medical School, Dana-Farber Cancer Institute , Boston, MA, USA
| | - Meral Beksaç
- Department of Hematology, School of Medicine, Ankara University , Ankara, Turkey
| | - Ivan Špička
- 1st Department of Medicine - Department of Hematology, First Faculty of Medicine, Charles University and General Hospital , Prague, Czech Republic
| | - Joseph Mikhael
- Applied Cancer Research and Drug Discovery, Translational Genomics Research Institute, City of Hope Cancer Center , Phoenix, AZ, USA
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Dimopoulos MA, Špička I, Quach H, Oriol A, Hájek R, Garg M, Beksac M, Bringhen S, Katodritou E, Chng WJ, Leleu X, Iida S, Mateos MV, Morgan G, Vorog A, Labotka R, Wang B, Palumbo A, Lonial S. Ixazomib as Postinduction Maintenance for Patients With Newly Diagnosed Multiple Myeloma Not Undergoing Autologous Stem Cell Transplantation: The Phase III TOURMALINE-MM4 Trial. J Clin Oncol 2020; 38:4030-4041. [PMID: 33021870 PMCID: PMC7768338 DOI: 10.1200/jco.20.02060] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Maintenance therapy prolongs progression-free survival (PFS) in patients with newly diagnosed multiple myeloma (NDMM) not undergoing autologous stem cell transplantation (ASCT) but has generally been limited to immunomodulatory agents. Other options that complement the induction regimen with favorable toxicity are needed.
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Affiliation(s)
- Meletios A Dimopoulos
- Hematology and Medical Oncology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ivan Špička
- First Department of Medicine, Department of Hematology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Hang Quach
- Department of Hematology, University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Albert Oriol
- Institut d'Investigació contra la Leucèmia Josep Carreras and Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Roman Hájek
- Department of Hemato-oncology, University Hospital Ostrava, University of Ostrava, and Faculty of Medicine, Ostrava, Czech Republic
| | - Mamta Garg
- Hematology, Leicester Royal Infirmary/University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Meral Beksac
- Department of Hematology, Ankara University, Ankara, Turkey
| | - Sara Bringhen
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Eirini Katodritou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - Wee-Joo Chng
- Department of Hematology-Oncology, National University Cancer Institute, National University Health System, and Yong Loo Lin School of Medicine and Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Xavier Leleu
- Pôle Régional de Cancérologie, Department of Haematology, Centre Hospitalier Universitaire La Milétrie-Poitiers, Poitiers, France
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - María-Victoria Mateos
- Hematology, Hospital Universitario de Salamanca, University Hospital of Salamanca, Centro de Investigación del Cáncer, Instituto de Biología Molecular y Celular del Cáncer, (Universitario de Salamanca Consejo Superior de Investigaciones Científicas), Salamanca, Spain
| | - Gareth Morgan
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | - Alexander Vorog
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Richard Labotka
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Bingxia Wang
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Antonio Palumbo
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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Dimopoulos MA, Lonial S, White D, Moreau P, Weisel K, San-Miguel J, Shpilberg O, Grosicki S, Špička I, Walter-Croneck A, Magen H, Mateos MV, Belch A, Reece D, Beksac M, Spencer A, Oakervee H, Orlowski RZ, Taniwaki M, Röllig C, Einsele H, Matsumoto M, Wu KL, Anderson KC, Jou YM, Ganetsky A, Singhal AK, Richardson PG. Elotuzumab, lenalidomide, and dexamethasone in RRMM: final overall survival results from the phase 3 randomized ELOQUENT-2 study. Blood Cancer J 2020; 10:91. [PMID: 32887873 PMCID: PMC7474076 DOI: 10.1038/s41408-020-00357-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [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: 04/09/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 12/17/2022] Open
Abstract
Prolonging overall survival (OS) remains an unmet need in relapsed or refractory multiple myeloma (RRMM). In ELOQUENT-2 (NCT01239797), elotuzumab plus lenalidomide/dexamethasone (ERd) significantly improved progression-free survival (PFS) versus lenalidomide/dexamethasone (Rd) in patients with RRMM and 1–3 prior lines of therapy (LoTs). We report results from the pre-planned final OS analysis after a minimum follow-up of 70.6 months, the longest reported for an antibody-based triplet in RRMM. Overall, 646 patients with RRMM and 1–3 prior LoTs were randomized 1:1 to ERd or Rd. PFS and overall response rate were co-primary endpoints. OS was a key secondary endpoint, with the final analysis planned after 427 deaths. ERd demonstrated a statistically significant 8.7-month improvement in OS versus Rd (median, 48.3 vs 39.6 months; hazard ratio, 0.82 [95.4% Cl, 0.68–1.00]; P = 0.0408 [less than allotted α of 0.046]), which was consistently observed across key predefined subgroups. No additional safety signals with ERd at extended follow-up were reported. ERd is the first antibody-based triplet regimen shown to significantly prolong OS in patients with RRMM and 1–3 prior LoTs. The magnitude of OS benefit was greatest among patients with adverse prognostic factors, including older age, ISS stage III, IMWG high-risk disease, and 2–3 prior LoTs.
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Affiliation(s)
| | - Sagar Lonial
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Darrell White
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada
| | | | - Katja Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - Jesus San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, IDISNA, CIBERONC, Pamplona, Spain
| | - Ofer Shpilberg
- Institute of Haematology, Assuta Medical Centers, Tel Aviv, Israel
| | | | - Ivan Špička
- Charles University in Prague and General Teaching Hospital, Prague, Czech Republic
| | | | - Hila Magen
- Department of Hematology Chaim Sheba Medical Center, Ramat-Gan, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maria-Victoria Mateos
- University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Andrew Belch
- Cross Cancer Institute and University of Alberta, Edmonton, AB, Canada
| | - Donna Reece
- Princess Margaret Hospital, Toronto, ON, Canada
| | | | - Andrew Spencer
- Alfred Health-Monash University, Melbourne, VIC, Australia
| | | | | | | | - Christoph Röllig
- Universitätsklinikum der Technischen Universität, Dresden, Germany
| | | | - Morio Matsumoto
- National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | - Ka Lung Wu
- Ziekenhuis Netwerk Antwerpen Stuivenberg, Antwerp, Belgium
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17
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Fassmannová D, Sedlák F, Sedláček J, Špička I, Grantz Šašková K. Nelfinavir Inhibits the TCF11/Nrf1-Mediated Proteasome Recovery Pathway in Multiple Myeloma. Cancers (Basel) 2020; 12:cancers12051065. [PMID: 32344880 PMCID: PMC7281108 DOI: 10.3390/cancers12051065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022] Open
Abstract
Proteasome inhibitors are the backbone of multiple myeloma therapy. However, disease progression or early relapse occur due to development of resistance to the therapy. One important cause of resistance to proteasome inhibition is the so-called bounce-back response, a recovery pathway driven by the TCF11/Nrf1 transcription factor, which activates proteasome gene re-synthesis upon impairment of the proteasome function. Thus, inhibiting this recovery pathway potentiates the cytotoxic effect of proteasome inhibitors and could benefit treatment outcomes. DDI2 protease, the 3D structure of which resembles the HIV protease, serves as the key player in TCF11/Nrf1 activation. Previous work found that some HIV protease inhibitors block DDI2 in cell-based experiments. Nelfinavir, an oral anti-HIV drug, inhibits the proteasome and/or pAKT pathway and has shown promise for treatment of relapsed/refractory multiple myeloma. Here, we describe how nelfinavir inhibits the TCF11/Nrf1-driven recovery pathway by a dual mode of action. Nelfinavir decreases the total protein level of TCF11/Nrf1 and inhibits TCF11/Nrf1 proteolytic processing, likely by interfering with the DDI2 protease, and therefore reduces the TCF11/Nrf1 protein level in the nucleus. We propose an overall mechanism that explains nelfinavir’s effectiveness in the treatment of multiple myeloma.
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Affiliation(s)
- Dominika Fassmannová
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Flemingovo n. 2, 16610 Prague, Czech Republic
- Department of Genetics and Microbiology, Charles University, Viničná 5, 12843 Prague, Czech Republic
- First Faculty of Medicine, Charles University, Kateřinská 32, 12108 Prague, Czech Republic
| | - František Sedlák
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Flemingovo n. 2, 16610 Prague, Czech Republic
- Department of Genetics and Microbiology, Charles University, Viničná 5, 12843 Prague, Czech Republic
- First Faculty of Medicine, Charles University, Kateřinská 32, 12108 Prague, Czech Republic
- 1st Department Medicine—Department of Hematology, Charles University, U Nemocnice 2, 12808 Prague, Czech Republic
| | - Jindřich Sedláček
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Flemingovo n. 2, 16610 Prague, Czech Republic
- Department of Genetics and Microbiology, Charles University, Viničná 5, 12843 Prague, Czech Republic
| | - Ivan Špička
- First Faculty of Medicine, Charles University, Kateřinská 32, 12108 Prague, Czech Republic
- 1st Department Medicine—Department of Hematology, Charles University, U Nemocnice 2, 12808 Prague, Czech Republic
| | - Klára Grantz Šašková
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Flemingovo n. 2, 16610 Prague, Czech Republic
- Department of Genetics and Microbiology, Charles University, Viničná 5, 12843 Prague, Czech Republic
- Correspondence: ; Tel.: +420-220-183-518
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18
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Hájek R, Sandecka V, Špička I, Raab M, Goldschmidt H, Beck S, Minařík J, Pavlíček P, Radocha J, Heindorfer A, Jelínek T, Stejskal L, Brožová L, Ševčíková S, Straub J, Pika T, Pour L, Maisnar V, Seckinger A, Hose D. Identification of patients with smouldering multiple myeloma at ultra-high risk of progression using serum parameters: the Czech Myeloma Group model. Br J Haematol 2020; 190:189-197. [PMID: 32163180 DOI: 10.1111/bjh.16572] [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: 12/04/2019] [Accepted: 02/18/2020] [Indexed: 12/31/2022]
Abstract
Smouldering multiple myeloma (SMM) presents without MM defining symptoms. We aimed to identify patients with SMM with an 80% risk of progression within 2 years using only serum parameters. In total, 527 patients with SMM were included and divided into a training group (287 patients from the Czech Myeloma Group [CMG]) and an independent validation group (240 patients from Heidelberg). The median follow-up was 2·4 and 2·5 years, respectively. Progression to MM occurred in 51·9% of the CMG and 38·8% of the Heidelberg patients, respectively. The median risk of progression was 11·0% (CMG) and 9·7% (Heidelberg) per year, during the 5 years after diagnosis. A serum involved/uninvolved free light-chain ratio of >30, immunoparesis, and serum monoclonal (M) protein of ≥2·3 g/dl emerged as powerful predictors of 2-year progression rate with a hazard ratio (HR) of 2·49 (95% confidence interval [CI] 1·49-4·17), HR of 2·01 (95% CI 1·36-2·96) and HR of 2·00 (95% CI 1·44-2·79) (P < 0·001) in univariate Cox regression analysis, respectively. Based on this, the CMG model identified patients with SMM with a 2-year risk of progression of 78·7% (95% CI 53·1-95·7; HR 6·8; P < 0·001, CMG) and 81·3% (95% CI 47·1-98·8; HR 38·63; P < 0·001, Heidelberg). Serum parameters in the CMG model allow identification of patients with SMM with an 80% risk of progression to symptomatic MM within 2 years.
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Affiliation(s)
- Roman Hájek
- Department of Hemato-Oncology, University Hospital, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Viera Sandecka
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Ivan Špička
- 1st Department of Medicine, 1st Faculty of Medicine, Charles University and General Hospital in Prague, Praha, Czech Republic
| | - Marc Raab
- Internal Medicine V and National Center for Tumor Diseases (NCT), University Clinic Heidelberg, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Internal Medicine V and National Center for Tumor Diseases (NCT), University Clinic Heidelberg, Heidelberg, Germany
| | - Susanne Beck
- Labor für Myelomforschung, University Clinic Heidelberg, Heidelberg, Germany
| | - Jiří Minařík
- Department of Hemato-Oncology, University Hospital, Olomouc, Czech Republic
| | - Petr Pavlíček
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Praha, Czech Republic
| | - Jakub Radocha
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Adriana Heindorfer
- Department of Clinical Hematology, Hospital Liberec, Liberec, Czech Republic
| | - Tomáš Jelínek
- Department of Hemato-Oncology, University Hospital, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lukáš Stejskal
- Department of Hematology and Transfusion, Hospital Opava, Opava, Czech Republic
| | - Lucie Brožová
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Sabina Ševčíková
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Straub
- 1st Department of Medicine, 1st Faculty of Medicine, Charles University and General Hospital in Prague, Praha, Czech Republic
| | - Tomáš Pika
- Department of Hemato-Oncology, University Hospital, Olomouc, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Anja Seckinger
- Labor für Myelomforschung, University Clinic Heidelberg, Heidelberg, Germany
| | - Dirk Hose
- Labor für Myelomforschung, University Clinic Heidelberg, Heidelberg, Germany
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19
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Hajek R, Pour L, Ozcan M, Martin Sánchez J, García Sanz R, Anagnostopoulos A, Oriol A, Cascavilla N, Terjung A, Lee Y, Briso EM, Dobkowska E, Hauns B, Špička I. A phase 2 study of ibrutinib in combination with bortezomib and dexamethasone in patients with relapsed/refractory multiple myeloma. Eur J Haematol 2020; 104:435-442. [PMID: 31883396 PMCID: PMC7216833 DOI: 10.1111/ejh.13377] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/01/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/18/2022]
Abstract
Objective We evaluated ibrutinib, a once‐daily inhibitor of Bruton's tyrosine kinase, combined with bortezomib and dexamethasone in patients with relapsed or relapsed/refractory multiple myeloma who had received 1‐3 prior therapies. Methods This was a phase 2, single‐arm, open‐label, multicentre study (NCT02902965). The primary endpoint was progression‐free survival (PFS). Results Seventy‐six patients were enrolled; 74 received ≥1 dose of study treatment. After median follow‐up of 19.6 months, median PFS was 8.5 months (95% CI: 6.2‐10.8); median overall survival was not reached. Overall response rate was 57% (95% CI: 45‐68), and median duration of response was 9.5 months (95% CI: 6.9‐10.6). Grade 3/4 AEs occurred in 73% of patients and fatal AEs occurred in 15% of patients. Incidence of major haemorrhage was 5%; one patient died from cerebral haemorrhage. After an observed increased incidence of serious (42%) and fatal (11%) infections, enrolment was suspended to implement risk‐minimisation measures. The safety profile was otherwise consistent with known safety profiles of the individual drugs. Conclusion Ibrutinib combined with bortezomib and dexamethasone elicited clinical responses. However, efficacy assessments conducted at potential restart of enrolment indicated that the targeted PFS could not be reached with additional patient enrolment, and the study was terminated.
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Affiliation(s)
- Roman Hajek
- University Hospital of Ostrava, Ostrava-Poruba-Poruba, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ludek Pour
- University Hospital Brno, Brno, Czech Republic
| | - Muhit Ozcan
- Ankara University School of Medicine, Ankara, Turkey
| | | | | | | | - Albert Oriol
- Institut Català d'Oncologia and Institut Josep Carreras, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Nicola Cascavilla
- IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Andreas Terjung
- Pharmacyclics Switzerland GmbH, an AbbVie Company, Schaffhausen, Switzerland
| | - Yihua Lee
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA, USA
| | - Eva M Briso
- Pharmacyclics Switzerland GmbH, an AbbVie Company, Schaffhausen, Switzerland
| | - Edyta Dobkowska
- Pharmacyclics Switzerland GmbH, an AbbVie Company, Schaffhausen, Switzerland
| | - Bernhard Hauns
- Pharmacyclics Switzerland GmbH, an AbbVie Company, Schaffhausen, Switzerland
| | - Ivan Špička
- 1st Department of Medicine - Department of Hematology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
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20
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Dušek O, Fichtl M, Rezková L, Dubská Z, Heissigerová J, Růžičková E, Vráblík M, Špička I, Svozílková P. Acute elevation of intraocular pressure in patient with hyperlipidemic myeloma. Cesk Slov Oftalmol 2020; 76:172-180. [PMID: 33297702 DOI: 10.31348/2020/27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To introduce a rare case of patient with hyperlipidemic myeloma and ocular manifestation in form of masquerade syndrome with acute elevation of intraocular pressure (IOP) and hyperviscous retinopathy. RESULTS 55-year-old man with newly diagnosed hyperlipidemic myeloma and hyperviscous syndrome was acutely referred to our glaucoma outpatient clinic due to problems with his left eye: sudden pain, blurred vision, redness of the eye and IOP of 44 mm Hg. We excluded attack of angle closure glaucoma and found presence of whitish material in the anterior chamber and blood obstructing the iridocorneal angle. Glaucoma therapy was initiated and lavage of the anterior chamber of the left eye with sampling of the aqueous humour for biochemical and cytological examination was performed. Identification of trace amount of cryoprotein in the samples of humour proved diagnosis of masquerade syndrome. Finding of the hyperviscous retinopathy and nonperfusion of wide peripheral areas of retina in both eyes was indicated to laser coagulation of these areas. The patient underwent in the meantime three times plasmapheresis, four cycles of biological therapy and autologous stem cell transplantation reaching complete remission of the myeloma. Local and systemic therapy led to significant clinical finding improvement on the anterior segment and fundus of both eyes. CONCLUSIONS Masquerade syndrome can be complicated by acute elevation of IOP. Diagnostic lavage of the anterior chamber, local therapy, systemic therapy and close interdisciplinary cooperation contributed to right diagnosis, IOP normalisation, ocular and general condition improvement.
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21
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Radocha J, Hájek R, Brožová L, Pour L, Špička I, Minařík J, Gregora E, Jungová A, Jelínek T, Heindorfer A, Sýkora M, Maisnar V. Simplified novel prognostic score for real-life older adults with multiple myeloma-registry-based analysis. Ann Hematol 2018; 98:951-962. [PMID: 30539278 DOI: 10.1007/s00277-018-3568-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/26/2018] [Indexed: 11/24/2022]
Abstract
The main goal was to find a simple prognostic to evaluate overall survival of patients older than 65 years of age with myeloma. Retrospective registry-based analysis from the Registry of Monoclonal Gammopathies was conducted. Patients over 65 years with symptomatic myeloma were included. The four major parameters with impact on survival were identified: male gender, age > 75, creatinine > 152 μmol/L, and ECOG performance status 2-4. The patients were scored as good (0 points), intermediate good (1 point), intermediate poor (2 points), poor (3-4 points). Patients (1410 MM) were included. Median OS (months) was 65.7 (95% CI 49.8-81.7) for good, 51.0 (44.1-57.8) for intermediate good, 32.2 (26.2-38.2) for intermediate poor, and 18.9 (15.1-22.7) for poor. The differences in OS were statistically significant (p < 0.0001). Good score was used as reference for hazard ratios, which for each other score were 1.43 (1.09-1.84) for intermediate good, 2.58 (2.00-3.33) for intermediate poor, and 3.88 (2.94-5.10) for poor. Time to progression showed medians (months) 20.5 (17.4-62.4) for good, 19.3 (17.0-21.7) for intermediate good, 19.6 (16.2-23.0) for intermediate poor, and 13.0 (10.8-15.2) for poor. The suggested scoring system provides readily available information about the prognosis of MM patients above 65 years.
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Affiliation(s)
- J Radocha
- 4th Department of Internal Medicine - Hematology, Faculty Hospital, Charles University, Hradec Králové, Czech Republic. .,Czech Myeloma Group, Brno, Czech Republic.
| | - R Hájek
- Czech Myeloma Group, Brno, Czech Republic.,Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - L Brožová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - L Pour
- Czech Myeloma Group, Brno, Czech Republic.,Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine Masaryk Universtiy, University Hospital Brno, Brno, Czech Republic
| | - I Špička
- Czech Myeloma Group, Brno, Czech Republic.,1st Medical Department - Clinical Department of Haematology of the First Faculty of Medicine and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - J Minařík
- Czech Myeloma Group, Brno, Czech Republic.,Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, Olomouc, Czech Republic
| | - E Gregora
- Czech Myeloma Group, Brno, Czech Republic.,Department of Internal Medicine and Hematology, 3rd Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - A Jungová
- Czech Myeloma Group, Brno, Czech Republic.,Hematology and Oncology Department, Charles University Hospital Pilsen, Prague, Czech Republic
| | - T Jelínek
- Czech Myeloma Group, Brno, Czech Republic.,Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - A Heindorfer
- Czech Myeloma Group, Brno, Czech Republic.,Department of Clinical Hematology, Hospital Liberec, Liberec, Czech Republic
| | - M Sýkora
- Czech Myeloma Group, Brno, Czech Republic.,Department of Clinical Hematology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - V Maisnar
- 4th Department of Internal Medicine - Hematology, Faculty Hospital, Charles University, Hradec Králové, Czech Republic.,Czech Myeloma Group, Brno, Czech Republic
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22
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Radocha J, Maisnar V, Pour L, Špička I, Minařík J, Szeligová L, Pavlíček P, Jungová A, Krejčí M, Pika T, Straub J, Brožová L, Stejskal L, Heindorfer A, Jindra P, Kessler P, Mikula P, Sýkora M, Wróbel M, Jarkovský J, Hájek R. Validation of multiple myeloma risk stratification indices in routine clinical practice: Analysis of data from the Czech Myeloma Group Registry of Monoclonal Gammopathies. Cancer Med 2018; 7:4132-4145. [PMID: 29931775 PMCID: PMC6089168 DOI: 10.1002/cam4.1620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/15/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022] Open
Abstract
This study used data from the Czech Myeloma Group Registry of Monoclonal Gammopathies to validate the International Myeloma Working Group (IMWG) and revised International Staging System (R-ISS) indices for risk stratification in patients with multiple myeloma (MM) in clinical practice. Patients were included if they had symptomatic MM, complete data allowing R-ISS and IMWG staging (including cytogenetic information regarding t(4;14), t(14;16), and del(17p)), and key parameters for treatment evaluation. Median overall survival (OS) in included patients (n = 550) was 47.7 (95% CI: 39.5-55.9) and 46.2 (95% CI: 38.9-53.5) months from diagnosis and initiation of first-line therapy, respectively. Patients categorized as higher vs lower risk had reduced survival; median OS from diagnosis was 35.4 (95% CI: 30.5-40.3) vs 58.3 (95% CI: 53.8-62.9) months in high-risk vs other patients (IMWG; P = .001) and 34.1 (95% CI: 30.2-38.0) vs 47.2 (95% CI: 43.4-51.0) months in Stage III vs Stage II patients (R-ISS; P < .001). In conclusion, IMWG and R-ISS risk stratification indices are applicable to patients with MM in a real-world setting.
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Affiliation(s)
- Jakub Radocha
- 4th Department of Medicine - Haematology, Faculty of Medicine, Charles University Hospital, Hradec Králové, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Medicine - Haematology, Faculty of Medicine, Charles University Hospital, Hradec Králové, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Ivan Špička
- 1st Medical Department - Clinical Department of Haematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jiři Minařík
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czech Republic
| | - Lenka Szeligová
- Department of Haemato-Oncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Petr Pavlíček
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Alexandra Jungová
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Marta Krejčí
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Tomáš Pika
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czech Republic
| | - Jan Straub
- 1st Medical Department - Clinical Department of Haematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Lucie Brožová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lukáš Stejskal
- Department of Hematology, Hospital Opava, Opava, Czech Republic
| | | | - Pavel Jindra
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Petr Kessler
- Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Pelhrimov, Czech Republic
| | - Peter Mikula
- Department of Clinical Haematology, Hospital in Havirov, Havirov, Czech Republic
| | - Michal Sýkora
- Department of Clinical Hematology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Marek Wróbel
- Department of Hematology, Hospital Novy Jicin, Novy Jicin, Czech Republic
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Hájek
- Department of Haemato-Oncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
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23
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Hájek R, Jarkovsky J, Maisnar V, Pour L, Špička I, Minařík J, Gregora E, Kessler P, Sýkora M, Fraňková H, Campioni M, DeCosta L, Treur M, Gonzalez-McQuire S, Bouwmeester W. Real-world Outcomes of Multiple Myeloma: Retrospective Analysis of the Czech Registry of Monoclonal Gammopathies. Clinical Lymphoma Myeloma and Leukemia 2018; 18:e219-e240. [DOI: 10.1016/j.clml.2018.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/06/2018] [Accepted: 04/11/2018] [Indexed: 01/20/2023]
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Jelínek T, Maisnar V, Pour L, Špička I, Minařík J, Gregora E, Kessler P, Sýkora M, Fraňková H, Adamová D, Wróbel M, Mikula P, Jarkovský J, Diels J, Gatopoulou X, Veselá Š, Besson H, Brožová L, Ito T, Hájek R. Adjusted comparison of daratumumab monotherapy versus real-world historical control data from the Czech Republic in heavily pretreated and highly refractory multiple myeloma patients. Curr Med Res Opin 2018; 34:775-783. [PMID: 29172760 DOI: 10.1080/03007995.2017.1410121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We conducted an adjusted comparison of progression-free survival (PFS) and overall survival (OS) for daratumumab monotherapy versus standard of care, as observed in a real-world historical cohort of heavily pretreated multiple myeloma patients from Czech Republic. METHODS Using longitudinal chart data from the Registry of Monoclonal Gammopathies (RMG) of the Czech Myeloma Group, patient-level data from the RMG was pooled with pivotal daratumumab monotherapy studies (GEN501 and SIRIUS; 16 mg/kg). RESULTS From the RMG database, we identified 972 treatment lines in 463 patients previously treated with both a proteasome inhibitor and an immunomodulatory drug. Treatment initiation dates for RMG patients were between March 2006 and March 2015. The most frequently used treatment regimens were lenalidomide-based regimens (33.4%), chemotherapy (18.1%), bortezomib-based regimens (13.6%), thalidomide-based regimens (8.0%), and bortezomib plus thalidomide (5.3%). Few patients were treated with carfilzomib-based regimens (2.5%) and pomalidomide-based regimens (2.4%). Median observed PFS for daratumumab and the RMG cohort was 4.0 and 5.8 months (unadjusted hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.94-1.39), respectively, and unadjusted median OS was 20.1 and 11.9 months (unadjusted HR, 0.61; 95% CI, 0.48-0.78), respectively. Statistical adjustments for differences in baseline characteristics were made using patient-level data. The adjusted HRs (95% CI) for PFS and OS for daratumumab versus the RMG cohort were 0.79 (0.56-1.12; p = .192) and 0.33 (0.21-0.52; p < .001), respectively. CONCLUSIONS Adjusted comparisons between trial data and historical cohorts can provide useful insights to clinicians and reimbursement decision makers on relative treatment efficacies in the absence of head-to-head comparison studies for daratumumab monotherapy.
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Affiliation(s)
- Tomáš Jelínek
- a Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine and Faculty of Science , University of Ostrava , Poruba , Czech Republic
| | - Vladimír Maisnar
- b 4th Department of Internal Medicine - Hematology, Charles University Faculty Hospital and Faculty of Medicine , Hradec Králové , Czech Republic
| | - Luděk Pour
- c Department of Internal Medicine, Hematology and Oncology , University Hospital Brno and Faculty of Medicine Masaryk University , Jihlavská 340/20, 625 00 Brno-Bohunice-Brno-Starý Lískovec , Czech Republic
| | - Ivan Špička
- d Department of Internal Medicine , Charles University in Prague, First Faculty of Medicine and General Teaching Hospital , Hradec Králové , Czech Republic
| | - Jiří Minařík
- e Department of Hemato-Oncology , University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc , Olomouc , Czech Republic
| | - Evžen Gregora
- f Department of Internal Medicine and Hematology , University Hospital Kralovske Vinohrady , Praha , Czech Republic
| | - Petr Kessler
- g Department of Hematology and Transfusion Medicine , Pelhrimov Hospital , Pelhřimov , Czech Republic
| | - Michal Sýkora
- h Department of Clinical Hematology , Hospital Ceske Budejovice , České Budějovice , Czech Republic
| | - Hana Fraňková
- i Department of Hematology , General Hospital Liberec , Liberec , Czech Republic
| | - Dagmar Adamová
- j Department of Clinical Hematology , Silesian Hospital Opava , Opava , Czech Republic
| | - Marek Wróbel
- k Department of Hematology , Hospital Novy Jicin , Nový Jičín , Czech Republic
| | - Peter Mikula
- l Department of Clinical Hematology , General Hospital Havirov , Havířov , Czech Republic
| | - Jiří Jarkovský
- m Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Science , Masaryk University , Brno , Czech Republic
| | - Joris Diels
- n Janssen Health Economics & Market Access EMEA Statistics & Modelling , Beerse , Belgium
| | - Xenia Gatopoulou
- o Janssen Health Economics & Market Access EMEA , Athens , Greece
| | - Šárka Veselá
- p Janssen - Cilag s.r.o. , Smíchov-Anděl , Czech Republic
| | - Hervé Besson
- n Janssen Health Economics & Market Access EMEA Statistics & Modelling , Beerse , Belgium
| | - Lucie Brožová
- m Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Science , Masaryk University , Brno , Czech Republic
| | - Tetsuro Ito
- q Janssen Health Economics & Market Access EMEA , High Wycombe , UK
| | - Roman Hájek
- r Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine , University of Ostrava , Ostrava , Czech Republic
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Stewart AK, Dimopoulos MA, Masszi T, Špička I, Oriol A, Hájek R, Rosiñol L, Siegel DS, Niesvizky R, Jakubowiak AJ, San-Miguel JF, Ludwig H, Buchanan J, Cocks K, Yang X, Xing B, Zojwalla N, Tonda M, Moreau P, Palumbo A. Health-Related Quality-of-Life Results From the Open-Label, Randomized, Phase III ASPIRE Trial Evaluating Carfilzomib, Lenalidomide, and Dexamethasone Versus Lenalidomide and Dexamethasone in Patients With Relapsed Multiple Myeloma. J Clin Oncol 2017; 34:3921-3930. [PMID: 27601539 DOI: 10.1200/jco.2016.66.9648] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose To determine the effects of carfilzomib, lenalidomide, and dexamethasone (KRd) versus lenalidomide and dexamethasone (Rd) on health-related quality of life (HR-QoL) in the Carfilzomib, Lenalidomide, and Dexamethasone Versus Lenalidomide and Dexamethasone for the Treatment of Patients With Relapsed Multiple Myeloma (ASPIRE) trial. Methods Patients with relapsed multiple myeloma were randomly assigned to receive KRd or Rd. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and myeloma-specific module were administered at baseline; day 1 of cycles 3, 6, 12, and 18; and after treatment. The Global Health Status/Quality of Life (GHS/QoL) scale and seven subscales (fatigue, nausea and vomiting, pain, physical functioning, role functioning, disease symptoms, and adverse effects of treatment) were compared between groups using a mixed model for repeated measures. The percentages of responders with ≥ 5- or 15-point GHS/QoL improvement at each cycle were compared between groups. Results Baseline questionnaire compliance was excellent (94.1% of randomly assigned patients). KRd patients had higher GHS/QoL scores versus Rd patients over 18 treatment cycles (two-sided P < .001). The minimal important difference was met at cycle 12 (5.6 points) and approached at cycle 18 (4.8 points). There was no difference between groups for the other prespecified subscales from ASPIRE. A higher proportion of KRd patients met the GHS/QoL responder definition (≥ 5-point improvement) with statistical differences at cycle 12 (KRd v Rd patients, 25.5% v 17.4%, respectively) and 18 (KRd v Rd patients, 24.2% v 12.9%, respectively). Conclusion KRd improves GHS/QoL without negatively affecting patient-reported symptoms when compared with Rd. These data further support the benefit of KRd in patients with relapsed multiple myeloma.
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Affiliation(s)
- A Keith Stewart
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Meletios A Dimopoulos
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Tamás Masszi
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Ivan Špička
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Albert Oriol
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Roman Hájek
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Laura Rosiñol
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - David S Siegel
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Ruben Niesvizky
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Andrzej J Jakubowiak
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Jesus F San-Miguel
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Heinz Ludwig
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Jacqui Buchanan
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Kim Cocks
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Xinqun Yang
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Biao Xing
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Naseem Zojwalla
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Margaret Tonda
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Philippe Moreau
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
| | - Antonio Palumbo
- A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Meletios A. Dimopoulos, Alexandra Hospital, Athens, Greece; Tamás Masszi, St. István and St. László Hospital, Semmelweis University, Budapest, Hungary; Ivan Špička, General University Hospital in Prague, Prague; Roman Hájek, University Hospital Brno and University of Ostrava, Brno, Czech Republic; Albert Oriol, Institut Català d'Oncologia, Institut Josep Carreras, Hospital Germans Trias i Pujol; Laura Rosiñol, Hospital Clínic de Barcelona, Barcelona; Jesus F. San-Miguel, Clinica Universidad de Navarra/El Centro de Investigacíon Médica Aplicada, Instituto de Investigacíon Sanitaria de Navarra, Pamplona, Spain; David S. Siegel, John Theurer Cancer Center at Hackensack University, Hackensack, NJ; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Andrzej J. Jakubowiak, University of Chicago Medicine, Chicago, IL; Heinz Ludwig, Wilhelminen Cancer Research Institute, Wilheminenspital, Vienna, Austria; Jacqui Buchanan, Xinqun Yang, Biao Xing, Naseem Zojwalla, and Margaret Tonda, Onyx Pharmaceuticals, South San Francisco, CA; Kim Cocks, KCStats Consultancy, Leeds, United Kingdom; Philippe Moreau, University of Nantes, Nantes, France; and Antonio Palumbo, University of Torino, Torino, Italy
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Pytlík R, Heissigerová J, Karolová J, Klimová A, Svozílková P, Brichová M, Říhová E, Mrázová K, Špička I, Blahovcová P, Trněný M. Characteristics and natural history of primary vitreoretinal lymphoma (PVL) compared to the primary lymphoma of the CNS (PCNSL). Hematol Oncol 2017. [DOI: 10.1002/hon.2439_105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- R. Pytlík
- 1st Department of Medicine; General University Hospital; Prague, Praha 2 Czech Republic
| | - J. Heissigerová
- Department of Ophtalmology; General University Hospital; Praha 2 Czech Republic
| | - J. Karolová
- 1st Department of Medicine; General University Hospital; Prague, Praha 2 Czech Republic
| | - A. Klimová
- Department of Ophtalmology; General University Hospital; Praha 2 Czech Republic
| | - P. Svozílková
- Department of Ophtalmology; General University Hospital; Praha 2 Czech Republic
| | - M. Brichová
- Department of Ophtalmology; General University Hospital; Praha 2 Czech Republic
| | - E. Říhová
- Department of Ophtalmology; General University Hospital; Praha 2 Czech Republic
| | - K. Mrázová
- Institute of Clinical Biochemistry and Laboratory Medicine; General University Hospital; Praha 2 Czech Republic
| | - I. Špička
- 1st Department of Medicine; General University Hospital; Prague, Praha 2 Czech Republic
| | - P. Blahovcová
- 1st Department of Medicine; General University Hospital; Prague, Praha 2 Czech Republic
| | - M. Trněný
- 1st Department of Medicine; General University Hospital; Prague, Praha 2 Czech Republic
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27
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Sandecká V, Hájek R, Pour L, Špička I, Ščudla V, Gregora E, Radocha J, Walterová L, Kessler P, Zahradová L, Adamová D, Valentova K, Vonke I, Obernauerová J, Starostka D, Wróbel M, Brožová L, Jarkovský J, Mikulášová A, Říhová L, Ševčíková S, Straub J, Minařík J, Adam Z, Krejčí M, Král Z, Maisnar V. A first Czech analysis of 1887 cases with monoclonal gammopathy of undetermined significance. Eur J Haematol 2017; 99:80-90. [PMID: 28384387 DOI: 10.1111/ejh.12894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/26/2022]
Abstract
INTRODUCTION Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant condition with a risk of malignant conversion. PATIENTS AND METHODS With the aim to estimate the cumulative risk MGUS progression to hematologic malignancies, we analyzed a nationwide population-based cohort of 1887 MGUS patients from the Czech Registry of Monoclonal Gammopathies (RMG) between 2007 and 2013. RESULTS During the follow-up period (median 4 years; range 0.6-34.8), progression to hematologic malignancies was observed in 8.6% (162 of 1887) of patients. Factors associated with progression were as follows: M-protein concentration ≥1.5 g/dL, pathological sFLC (<0.26 or >1.65) ratio, bone marrow plasma cells (BMPCs) in cytology >5%, immunoparesis, age ≥69 years, and the level of serum hemoglobin at baseline <12.0 g/dL. Combining these factors, we propose a new risk model (CMG model). The risk of progression at 10 years was 1.6%, 16.9%, 22.9%, 39.4%, and 52.3%, respectively, if 0 (reference group), one, two, three, or four to five risk factors are present (P<.001) with HR 63 times higher compared to the reference MGUS group. CONCLUSION The new CMG model was established with an advantage for better identification of MGUS patients at low risk.
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Affiliation(s)
- Viera Sandecká
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Roman Hájek
- Department of Clinical Hematology, University Hospital, Ostrava, Czech Republic.,Babak Myeloma Group, Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Ivan Špička
- Department of Internal Medicine, University Hospital, Praha, Czech Republic
| | - Vlastimil Ščudla
- Department of Hemato-Oncology, University Hospital, Olomouc, Czech Republic
| | - Evžen Gregora
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Praha, Czech Republic
| | - Jakub Radocha
- Department of Medicine - Hematology, University Hospital, Hradec Kralove, Czech Republic
| | - Lenka Walterová
- Department of Clinical Hematology, Hospital Liberec, Czech Republic
| | - Petr Kessler
- Department of Hematology and Transfusion Medicine, Hospital Pelhřimov, Czech Republic
| | - Lenka Zahradová
- Department of Clinical Hematology, University Hospital, Ostrava, Czech Republic
| | - Dagmar Adamová
- Department of Hematology and Transfusion, Hospital Opava, Czech Republic
| | - Kamila Valentova
- Department of Clinical Hematology, Thomayer Hospital, Praha, Czech Republic
| | - Ivan Vonke
- Department of Clinical Hematology, Hospital České Budejovice, Czech Republic
| | - Jarmila Obernauerová
- Department of Hematology and Transfusion, Hospital Mlada Boleslav, Czech Republic
| | - David Starostka
- Department of Clinical Hematology, Hospital Havířov, Czech Republic
| | - Marek Wróbel
- Department of Clinical Hematology, Hospital Nový Jičín, Czech Republic
| | - Lucie Brožová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Aneta Mikulášová
- Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic.,Laboratory of Molecular Cytogenetics, Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Lucie Říhová
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Sabina Ševčíková
- Babak Myeloma Group, Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Ján Straub
- Department of Internal Medicine, University Hospital, Praha, Czech Republic
| | - Jiří Minařík
- Department of Hemato-Oncology, University Hospital, Olomouc, Czech Republic
| | - Zdeněk Adam
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Marta Krejčí
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Zdeněk Král
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Vladimír Maisnar
- Department of Medicine - Hematology, University Hospital, Hradec Kralove, Czech Republic
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Dimopoulos MA, Stewart AK, Masszi T, Špička I, Oriol A, Hájek R, Rosiñol L, Siegel D, Mihaylov GG, Goranova‐Marinova V, Rajnics P, Suvorov A, Niesvizky R, Jakubowiak A, San‐Miguel J, Ludwig H, Palumbo A, Obreja M, Aggarwal S, Moreau P. Carfilzomib, lenalidomide, and dexamethasone in patients with relapsed multiple myeloma categorised by age: secondary analysis from the phase 3 ASPIRE study. Br J Haematol 2017; 177:404-413. [PMID: 28211560 PMCID: PMC5412871 DOI: 10.1111/bjh.14549] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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: 09/22/2016] [Accepted: 12/01/2016] [Indexed: 01/08/2023]
Abstract
A primary analysis of the ASPIRE study found that the addition of carfilzomib to lenalidomide and dexamethasone (carfilzomib group) significantly improved progression-free survival (PFS) compared with lenalidomide and dexamethasone alone (control group) in patients with relapsed multiple myeloma (RMM). This post hoc analysis examined outcomes from ASPIRE in patients categorised by age. In the carfilzomib group, 103/396 patients were ≥70 years old, and in the control group, 115/396 patients were ≥70 years old. Median PFS for patients <70 years old was 28·6 months for the carfilzomib group versus 17·6 months for the control group [hazard ratio (HR), 0·701]. Median PFS for patients ≥70 years old was 23·8 months for the carfilzomib group versus 16·0 months for the control group (HR, 0·753). For patients <70 years the overall response rate (ORR) was 86·0% (carfilzomib group) and 66·9% (control group); for patients ≥70 years old the ORR was 90·3% (carfilzomib group) and 66·1% (control group). Within the carfilzomib group, grade ≥3 cardiovascular adverse events occurred more frequently among patients ≥70 years old compared with patients <70 years old. Carfilzomib-lenalidomide-dexamethasone has a favourable benefit-risk profile for patients with RMM, including elderly patients ≥70 years old. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT01080391.
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Affiliation(s)
| | | | - Tamás Masszi
- St István and St Laszlo Hospital3rd Dept. of Internal MedicineSemmelweis UniversityBudapestHungary
| | - Ivan Špička
- First Faculty of MedicineCharles University in PraguePragueCzech Republic
| | - Albert Oriol
- Institut Català d'OncologiaHospital Germans Trias i PujolBarcelonaSpain
| | - Roman Hájek
- University Hospital Ostrava and Faculty of MedicineUniversity of OstravaOstravaCzech Republic
| | | | - David Siegel
- John Theurer Cancer Center at Hackensack UniversityHackensackNJUSA
| | | | | | - Péter Rajnics
- Department of HaematologyMór Kaposi Teaching HospitalKaposvárHungary
| | - Aleksandr Suvorov
- Haematological DepartmentFirst Republican Clinical Hospital of UdmurtiaIzhevskRussia
| | | | | | | | - Heinz Ludwig
- Wilhelminen Cancer Research InstituteWilhelminenspitalViennaAustria
| | | | - Mihaela Obreja
- Onyx Pharmaceuticals, Inc. an Amgen subsidiarySouth San FranciscoCAUSA
| | - Sanjay Aggarwal
- Onyx Pharmaceuticals, Inc. an Amgen subsidiarySouth San FranciscoCAUSA
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Radocha J, Pour L, Pika T, Maisnar V, Špička I, Gregora E, Krejčí M, Minařík J, Machálková K, Straub J, Pavlíček P, Hájek R, Žák P. Multicentered patient-based evidence of the role of free light chain ratio normalization in multiple myeloma disease relapse. Eur J Haematol 2015; 96:119-27. [PMID: 25816709 DOI: 10.1111/ejh.12556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 03/24/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The normalization of free light chain ratio (FLCr) has been introduced as a marker of stringent complete remission (CR) of multiple myeloma (MM). There is currently a lack of literature assessing the role of FLCr on MM disease progression and remission status. PATIENTS AND METHODS A multicentered retrospective review of 125 patients with MM in CR and various FLCr values was completed. Parameters of interest included patient demographics, FLCr values, complete remission (CR)/relapse status, and time to progression (TTP). The FLCr values were recorded to provide time-dependent findings on the role of FLCr on progression-free survival and overall survival (OS). RESULTS The mean follow-up time of 125 patients from five hospitals in the Czech Republic was 31 months. A total of 47.2% of patients relapsed (54 of 125) during the follow-up period. The median TTP of patients with normal FLCr (n = 66) was 54.4 and 40.2 months for patients with abnormal FLCr (n = 59) (P = 0.217). None of the patients reached median overall survival regardless of FLCr values (P = 0.821). In the subgroup of newly diagnosed patients after upfront autologous stem cell transplantation (ASCT), there were 55.6% of patients (35 of 63) with normal FLCr and 44.4% (28 of 64) with abnormal FLCr. A total of 34.9% of patients (22 of 63) relapsed in this subgroup. Within the abnormal FLCr patients, a median TTP was 56.3 months, but no median TTP was reached among the normal FLCr patients (P = 0.746). Median OS in patients with normal (nFLCr) and abnormal FLCr (aFLCr) was not reached (P = 0.787). CONCLUSION We did not observe any benefit from FLCr normalization in CR in myeloma patients in terms of progression-free survival or overall survival.
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Affiliation(s)
- Jakub Radocha
- 4th Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine Hradec, Králové, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine-Hematooncology, University Hospital Brno, Brno, Czech Republic
| | - Tomáš Pika
- Department of Internal Medicine III, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine Hradec, Králové, Czech Republic
| | - Ivan Špička
- First Department of Medicine-Department of Hematology, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Evžen Gregora
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Marta Krejčí
- Department of Internal Medicine-Hematooncology, University Hospital Brno, Brno, Czech Republic
| | - Jiří Minařík
- Department of Internal Medicine III, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Kateřina Machálková
- 4th Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine Hradec, Králové, Czech Republic
| | - Jan Straub
- First Department of Medicine-Department of Hematology, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Petr Pavlíček
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Roman Hájek
- Department of Clinical Hematology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Pavel Žák
- 4th Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine Hradec, Králové, Czech Republic
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30
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Vyhlídalová I, Uherková L, Pleschnerová M, Špička I, Březinová J, Michalová K, Čermáková K, Polanská V, Jedelský PL, Hamšíková E, Kuželová K, Stöckbauer P. Characterization of a new human plasma cell leukemia cell line UHKT-944. Eur J Haematol 2015; 95:352-60. [PMID: 25600340 DOI: 10.1111/ejh.12505] [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] [Accepted: 12/11/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A new interleukin-6 (IL-6)-dependent plasma cell leukemia cell line UHKT-944 was established from bone marrow cells derived from a 55-yr-old man with plasma cell leukemia. RESULTS The cell line possesses phenotypic characteristics of plasma cells including the production of a monoclonal immunoglobulin IgA1-kappa. VH3-9 region of IgVH genes was rearranged and somatically hypermutated. The UHKT-944 cells were found to be negative for most of tested B-cell, T-cell, and myeloid markers. According to cytogenetic analysis, the cells were classified as near tetraploid with several numerical and structural abnormalities including the t(14;20) involving IgH locus. CONCLUSION The established permanent plasma cell leukemia cell line is a suitable model for the study of cellular and molecular mechanisms of pathogenesis of this rare malignant disease.
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Affiliation(s)
- Ilona Vyhlídalová
- Department of Cellular Biochemistry, Institute of Hematology and Blood Transfusion (IHBT), Prague, Czech Republic.,Department of Biochemistry, Faculty of Science, Charles University, Prague, Czech Republic
| | - Lenka Uherková
- Department of Cellular Biochemistry, Institute of Hematology and Blood Transfusion (IHBT), Prague, Czech Republic
| | - Markéta Pleschnerová
- Department of Immunology, Faculty of Science, Charles University, Prague, Czech Republic
| | - Ivan Špička
- 1st Department of Internal Medicine, Division of Hematology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - Jana Březinová
- Department of Cytogenetics, IHBT, Prague, Czech Republic
| | - Kyra Michalová
- Department of Cytogenetics, IHBT, Prague, Czech Republic
| | - Kamila Čermáková
- Leukemia PCR Diagnostics Laboratory, IHBT, Prague, Czech Republic
| | | | - Petr L Jedelský
- Faculty of Science, Charles University, Prague, Czech Republic.,Faculty of Arts, Charles University, Prague, Czech Republic
| | - Eva Hamšíková
- Department of Experimental Virology, IHBT, Prague, Czech Republic
| | - Kateřina Kuželová
- Department of Cellular Biochemistry, Institute of Hematology and Blood Transfusion (IHBT), Prague, Czech Republic
| | - Petr Stöckbauer
- Department of Cellular Biochemistry, Institute of Hematology and Blood Transfusion (IHBT), Prague, Czech Republic
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31
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Stewart AK, Rajkumar SV, Dimopoulos MA, Masszi T, Špička I, Oriol A, Hájek R, Rosiñol L, Siegel DS, Mihaylov GG, Goranova-Marinova V, Rajnics P, Suvorov A, Niesvizky R, Jakubowiak AJ, San-Miguel JF, Ludwig H, Wang M, Maisnar V, Minarik J, Bensinger WI, Mateos MV, Ben-Yehuda D, Kukreti V, Zojwalla N, Tonda ME, Yang X, Xing B, Moreau P, Palumbo A. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. N Engl J Med 2015; 372:142-52. [PMID: 25482145 DOI: 10.1056/nejmoa1411321] [Citation(s) in RCA: 987] [Impact Index Per Article: 109.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lenalidomide plus dexamethasone is a reference treatment for relapsed multiple myeloma. The combination of the proteasome inhibitor carfilzomib with lenalidomide and dexamethasone has shown efficacy in a phase 1 and 2 study in relapsed multiple myeloma. METHODS We randomly assigned 792 patients with relapsed multiple myeloma to carfilzomib with lenalidomide and dexamethasone (carfilzomib group) or lenalidomide and dexamethasone alone (control group). The primary end point was progression-free survival. RESULTS Progression-free survival was significantly improved with carfilzomib (median, 26.3 months, vs. 17.6 months in the control group; hazard ratio for progression or death, 0.69; 95% confidence interval [CI], 0.57 to 0.83; P=0.0001). The median overall survival was not reached in either group at the interim analysis. The Kaplan-Meier 24-month overall survival rates were 73.3% and 65.0% in the carfilzomib and control groups, respectively (hazard ratio for death, 0.79; 95% CI, 0.63 to 0.99; P=0.04). The rates of overall response (partial response or better) were 87.1% and 66.7% in the carfilzomib and control groups, respectively (P<0.001; 31.8% and 9.3% of patients in the respective groups had a complete response or better; 14.1% and 4.3% had a stringent complete response). Adverse events of grade 3 or higher were reported in 83.7% and 80.7% of patients in the carfilzomib and control groups, respectively; 15.3% and 17.7% of patients discontinued treatment owing to adverse events. Patients in the carfilzomib group reported superior health-related quality of life. CONCLUSIONS In patients with relapsed multiple myeloma, the addition of carfilzomib to lenalidomide and dexamethasone resulted in significantly improved progression-free survival at the interim analysis and had a favorable risk-benefit profile. (Funded by Onyx Pharmaceuticals; ClinicalTrials.gov number, NCT01080391.).
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Orlowski RZ, Gercheva L, Williams C, Sutherland H, Robak T, Masszi T, Goranova-Marinova V, Dimopoulos MA, Cavenagh JD, Špička I, Maiolino A, Suvorov A, Bladé J, Samoylova O, Puchalski TA, Reddy M, Bandekar R, van de Velde H, Xie H, Rossi JF. A phase 2, randomized, double-blind, placebo-controlled study of siltuximab (anti-IL-6 mAb) and bortezomib versus bortezomib alone in patients with relapsed or refractory multiple myeloma. Am J Hematol 2015; 90:42-9. [PMID: 25294016 DOI: 10.1002/ajh.23868] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/03/2014] [Indexed: 11/12/2022]
Abstract
We compared the safety and efficacy of siltuximab (S), an anti-interleukin-6 chimeric monoclonal antibody, plus bortezomib (B) with placebo (plc) + B in patients with relapsed/refractory multiple myeloma in a randomized phase 2 study. Siltuximab was given by 6 mg/kg IV every 2 weeks. On progression, B was discontinued and high-dose dexamethasone could be added to S/plc. Response and progression-free survival (PFS) were analyzed pre-dexamethasone by European Group for Blood and Marrow Transplantation (EBMT) criteria. For the 281 randomized patients, median PFS for S + B and plc + B was 8.0 and 7.6 months (HR 0.869, P = 0.345), overall response rate was 55 versus 47% (P = 0.213), complete response rate was 11 versus 7%, and median overall survival (OS) was 30.8 versus 36.8 months (HR 1.353, P = 0.103). Sustained suppression of C-reactive protein, a marker reflective of inhibition of interleukin-6 activity, was seen with S + B. Siltuximab did not affect B pharmacokinetics. Siltuximab/placebo discontinuation (75 versus 66%), grade ≥3 neutropenia (49 versus 29%), thrombocytopenia (48 versus 34%), and all-grade infections (62 versus 49%) occurred more frequently with S + B. The addition of siltuximab to bortezomib did not appear to improve PFS or OS despite a numerical increase in response rate in patients with relapsed or refractory multiple myeloma.
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Affiliation(s)
- Robert Z. Orlowski
- Department of Lymphoma/Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Liana Gercheva
- University Hospital for Active Treatment “St. Marina,”; Varna Bulgaria
| | - Cathy Williams
- Nottingham University Hospitals NHS Trust; Nottingham United Kingdom
| | | | - Tadeusz Robak
- Medical University of Łódź and Copernicus Memorial Hospital; Łódź Poland
| | - Tamás Masszi
- St. Istvan and St. Laszlo Hospital of Budapest and Semmelweis University; Budapest Hungary
| | | | | | | | - Ivan Špička
- Charles University in Prague; Prague Czech Republic
| | - Angelo Maiolino
- Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | | | - Joan Bladé
- Hospital Clinic i Provincial and Institut d'Investigacions Biomediques August Pi I Sunyer; Barcelona Spain
| | - Olga Samoylova
- Nizhniy Novgorod Region Clinical Hospital; Nizniy Novgorod Russia
| | | | - Manjula Reddy
- Janssen Research & Development; Spring House Pennsylvania
| | | | | | - Hong Xie
- Janssen Research & Development; Spring House Pennsylvania
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Špička I, Klánová M. [Multiple myeloma]. Vnitr Lek 2013; 59:627-630. [PMID: 23909272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Multiple myeloma is one of the most common hematological malignancies with increasing prevalence. Not until the introduction of 1 or 2 cycles of highdose therapy with the support of hematopoietic cells meant a certain progress in the prognosis of patients. The radical change in the therapy efficiency was not made possible until the so-called new or targeting drugs - thalidomide, bortezomib and lenalidomide. The 2 latter preparations have particularly changed the approach to the disease itself from one of the least prognostically favourable hematological tumours to a longterm controllable malignancy with a potential to treat at least some of the patients. Currently, 3 ways of further progress towards more efficient treatment methods are under investigation: a) maintenance or consolidation treatment aimed at further intensification of therapeutic response, b) combination of targeting drugs and c) efficiency of the "second generation" targeting drugs.
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Affiliation(s)
- I Špička
- I. interní klinika 1. lékařské fakulty UK a VFVN Praha.
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Neuwirtová R, Klamová H, Špička I, Benešová K, Obrtlíková P, Jonášová A. [Not Available]. Vnitr Lek 2013; 59:622-623. [PMID: 23909270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- R Neuwirtová
- I. interní klinika 1. lékařské fakulty UK a VFVN Praha.
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Ryšavá R, Straub J, Vacková B, Kořen J, Trněný M, Potyšová Z, Špička I. Results of autologous stem cell transplantation for AL amyloidosis in one Czech center. Amyloid 2011; 18 Suppl 1:139-41. [PMID: 21838464 DOI: 10.3109/13506129.2011.574354052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- R Ryšavá
- Nephrology Clinic, 1st Faculty of Medicine and the Faculty teaching hospital, Charles University, Prague, Czech Republic.
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