1
|
Nielsen LK, Schjesvold F, Möller S, Guldbrandsen N, Hansson M, Remes K, Peceliunas V, Abildgaard N, Gregersen H, King MT. Health-related quality of life and quality-adjusted progression free survival for carfilzomib and dexamethasone maintenance following salvage autologous stem-cell transplantation in patients with multiple myeloma: a randomized phase 2 trial by the Nordic Myeloma Study Group. J Patient Rep Outcomes 2024; 8:15. [PMID: 38315268 PMCID: PMC10844184 DOI: 10.1186/s41687-024-00691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Decisions regarding maintenance therapy in patients with multiple myeloma should be based on both treatment efficacy and health-related quality of life (HRQL) consequences. In the CARFI trial, patients with first relapse of multiple myeloma underwent salvage autologous stem cell transplantation (salvage ASCT) before randomization to carfilzomib-dexamethasone maintenance therapy (Kd) or observation. The primary clinical endpoint was time to progression, which was extended by 8 months by Kd. The aim of this paper is to present the all HRQL endpoints of the CARFI trial including the HRQL effect of Kd maintenance therapy relative to observation. The primary HRQL endpoint was assessed by EORTC QLQ-C30 Summary score (QLQ-C30-sum) at 8 months follow-up. A key secondary HRQL endpoint was quality-adjusted progression-free-survival (QAPFS). METHODS HRQL was assessed with EORTC QLQ-C30, EORTC QLQ-MY20 and FACT/GOG-Ntx at randomization and every second month during follow-up. HRQL data were analyzed with linear mixed effect models until 8 months follow-up. QAPFS per individual was calculated by multiplying progression-free survival (PFS) by two quality-adjustment metrics, the QLQ-C30-sum and EORTC Quality of Life Utility Measure-Core 10 dimensions (QLU-C10D). The QAPFS per treatment group was estimated with the Kaplan-Meier method. P < 0.05 was used for statistical significance, and a between-group minimal important difference of 10 points was interpreted as clinically relevant for the QLQ-C30-sum. RESULTS 168 patients were randomized. HRQL questionnaire compliance was 93%. For the QLQ-C30-sum, the difference of 4.62 points (95% confidence interval (CI) -8.9: -0.4, p = 0.032) was not clinically relevant. PFS was 19.3 months for the Kd maintenance group and 16.8 months for the observation group; difference = 2.5 months (95% CI 0.5; 4.5). QAPFS based on the QLQ-C30-sum for the Kd maintenance group was 18.0 months (95% CI 16.4; 19.6) and for the observation group 15.0 months (95% CI 13.5; 16.5); difference = 3.0 months (95% CI 0.8-5.3). QAPFS based on the QLU-C10D for the Kd maintenance group was 17.5 months (95% CI 15.9; 19.2) and 14.0 months (95% CI 12.4; 15.5) for the observation group; difference = 3.5 months (95% CI 1.1-5.9). CONCLUSIONS Kd maintenance therapy after salvage ASCT did not adversely affect overall HRQL, but adjustment for HRQL reduced the PFS compared to unadjusted PFS. PFS of maintenance therapy should be quality-adjusted to balance the benefits and HRQL impact.
Collapse
Affiliation(s)
- Lene Kongsgaard Nielsen
- Quality of life Research Center, Department of Hematology, Odense University Hospital, DK-5000, Odense, Denmark.
- Department of Hematology, Gødstrup Hospital, Herning, Denmark.
- Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark.
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway
- KG Jebsen Center for B cell malignancies, University of Oslo, Oslo, Norway
| | - Sören Möller
- Open Patient data Explorative Network, OPEN, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nina Guldbrandsen
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - Markus Hansson
- Department of Hematology, Skåne University Hospital, Lund, Sweden
| | - Kari Remes
- Department of Hematology, Turku University Hospital, Turku, Finland
| | - Valdas Peceliunas
- Department of Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Niels Abildgaard
- Quality of life Research Center, Department of Hematology, Odense University Hospital, DK-5000, Odense, Denmark
- Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark
- Open Patient data Explorative Network, OPEN, Odense University Hospital, Odense, Denmark
| | - Henrik Gregersen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Madeleine T King
- Quality of life Research Center, Department of Hematology, Odense University Hospital, DK-5000, Odense, Denmark
- School of Psychology, University of Sydney, Sydney, Australia
| |
Collapse
|
2
|
Gregersen H, Peceliunas V, Remes K, Schjesvold F, Abildgaard N, Nahi H, Andersen NF, Vangsted AJ, Klausen TW, Helleberg C, Carlson K, Frølund UC, Axelsson P, Stromberg O, Blimark CH, Crafoord J, Tsykunova G, Eshoj HR, Waage A, Hansson M, Gulbrandsen N. Carfilzomib and dexamethasone maintenance following salvage ASCT in multiple myeloma: A randomised phase 2 trial by the Nordic Myeloma Study Group. Eur J Haematol 2021; 108:34-44. [PMID: 34536308 PMCID: PMC9292771 DOI: 10.1111/ejh.13709] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/19/2022]
Abstract
Objective We investigated the efficacy and safety of carfilzomib‐containing induction before salvage high‐dose melphalan with autologous stem‐cell transplantation (salvage ASCT) and maintenance with carfilzomib and dexamethasone after salvage ASCT in multiple myeloma. Methods This randomised, open‐label, phase 2 trial included patients with first relapse of multiple myeloma after upfront ASCT who were re‐induced with four cycles of carfilzomib, cyclophosphamide and dexamethasone. Two months after salvage, ASCT patients were randomised to either observation or maintenance therapy with iv carfilzomib 27 → 56 mg/sqm and p.o. dexamethasone 20 mg every second week. The study enrolled 200 patients of which 168 were randomised to either maintenance with carfilzomib and dexamethasone (n = 82) or observation (n = 86). Results Median time to progression (TTP) after randomisation was 25.1 months (22.5‐NR) in the carfilzomib‐dexamethasone maintenance group and 16.7 months (14.4–21.8) in the control group (HR 0.46, 95% CI 0.30–0.71; P = .0004). The most common adverse events during maintenance were thrombocytopenia, anaemia, hypertension, dyspnoea and bacterial infections. Conclusion In summary, maintenance therapy with carfilzomib and dexamethasone after salvage ASCT prolonged TTP with 8 months. The maintenance treatment was in general well‐tolerated with manageable toxicity.
Collapse
Affiliation(s)
- Henrik Gregersen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Valdas Peceliunas
- Department of Haematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kari Remes
- Department of Haematology, Turku University Hospital, Turku, Finland
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, Oslo, Norway.,KG Jebsen Center for B cell malignancies, University of Oslo, Oslo, Norway
| | - Niels Abildgaard
- Department of Haematology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hareth Nahi
- Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | | | - Kristina Carlson
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden
| | | | - Per Axelsson
- Department of Haematology, Helsingborg Hospital, Helsingborg, Sweden
| | - Olga Stromberg
- Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jacob Crafoord
- Department of Haematology, Örebro University Hospital, Örebro, Sweden
| | - Galina Tsykunova
- Department of Haematology, Haukeland University Hospital, Bergen, Norway
| | - Henrik Rode Eshoj
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, Denmark
| | - Anders Waage
- Department of Haematology, St Olavs hospital and Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Markus Hansson
- Department of Haematology, Skåne University Hospital, Lund, Sweden
| | | |
Collapse
|
3
|
Gamberi B, Berthou C, Hernandez M, Semenzato G, Tholouli E, Hájek R, Caers J, Dimopoulos M, Minnema MC, Andreasson B, Parreira J, Crotty G, Remes K, Kueenburg E, Rosettani B, Di Micco A, Peters S, Bacon P, Blau IW. A Noninterventional, Observational, European Post-Authorization Safety Study of Patients With Relapsed/Refractory Multiple Myeloma Treated With Lenalidomide. Clin Lymphoma Myeloma Leuk 2020; 20:e629-e644. [PMID: 32605897 DOI: 10.1016/j.clml.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Lenalidomide plus dexamethasone is effective and well tolerated in relapsed/refractory multiple myeloma (RRMM). In this observational, noninterventional European post-authorization safety study, the safety profile of lenalidomide plus dexamethasone was investigated and compared with that of other agents in the treatment of RRMM in a real-world setting. PATIENTS AND METHODS Patients had received ≥ 1 prior antimyeloma therapy; prior lenalidomide was excluded. Treatment was per investigator's routine practice. Adverse events were analyzed by incidence rates per 100 person-years to account for differences in observation length and treatment duration. RESULTS In total, 2150 patients initiated lenalidomide, and 1479 initiated any other antimyeloma therapy, predominately bortezomib (80.3%), which was primarily administered intravenously (74.3%). The incidence rate of neuropathy was lower with lenalidomide (10.5) than with bortezomib (78.9) or thalidomide (38.7). Lenalidomide also had a lower incidence rate of infections (68.7) versus bortezomib (95.9) and thalidomide (76.0). Conversely, the incidence rate of neutropenia was higher with lenalidomide (38.0) than with bortezomib (18.2) or thalidomide (25.7). The incidence rates of thrombocytopenia were 24.4, 40.4, and 14.4 with lenalidomide, bortezomib, and thalidomide, respectively. CONCLUSION No new safety signals for lenalidomide were identified in this study, which is the largest prospective real-world European study of lenalidomide in patients with RRMM to date. These results confirm that the safety profile of lenalidomide plus dexamethasone in RRMM in a real-world setting is comparable to that reported in clinical trials.
Collapse
Affiliation(s)
- Barbara Gamberi
- Department of Hematology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Christian Berthou
- Centre Hospitalier Régional Universitaire, Hôpital Auguste Morvan, Brest, France
| | - Miguel Hernandez
- Hemotherapy Service, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Eleni Tholouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Roman Hájek
- Department of Clinic Subjects, University Hospital Ostrava and Faculty of Medicine Ostrava, Ostrava, Czech Republic
| | - Jo Caers
- Department of Hematology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Meletios Dimopoulos
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Joana Parreira
- Instituto de Histologia e Biologia do Desenvolvimento, Faculdade de Medicina, Universidade de Lisboa and Instiuto Português de Oncologia, Francisco Gentil, Lisboa, Portugal
| | - Gerard Crotty
- Department of Haematology, Midland Regional Hospital, Tullamore, Ireland
| | - Kari Remes
- Department of Internal Medicine, Turku University Hospital, Turku, Finland
| | - Elisabeth Kueenburg
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Barbara Rosettani
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Antonia Di Micco
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Sarah Peters
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Pamela Bacon
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Igor Wolfgang Blau
- Department of Internal Medicine III, Charité Campus Benjamin Franklin, Berlin, Germany
| |
Collapse
|
4
|
Remes K, Järvenpää A, Fabritius T. Contactless online characterization of large-area conductive thin films by thermography and induction. Opt Lett 2019; 44:2574-2577. [PMID: 31090735 DOI: 10.1364/ol.44.002574] [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] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/17/2019] [Indexed: 06/09/2023]
Abstract
Testing and characterization techniques intended for traditional electronics production are rarely compatible with modern large-area, thin film electronics manufacturing processes such as roll-to-roll fabrication. Online quality monitoring of conductive thin films is necessary for upscaling and maintaining high-yield production. Thermography has already shown its usefulness in these kinds of applications, but has suffered from the lack of proper non-contact electrical heating. Now a fully contactless quality inspection technique based on thermal imaging and induction heating is implemented and evaluated. This approach is capable of discovering defected areas and estimating conductivity degradation online with full coverage over conductive thin films.
Collapse
|
5
|
Remes K, Anttila P, Silvennoinen R, Putkonen M, Ollikainen H, Terävä V, Sinisalo M, Kananen K, Schain F, Castren-Kortegangas P, Järvinen TM, Pisini M, Wahl F, Dixon T, Leval A. Real-world treatment outcomes in multiple myeloma: Multicenter registry results from Finland 2009-2013. PLoS One 2018; 13:e0208507. [PMID: 30517181 PMCID: PMC6281251 DOI: 10.1371/journal.pone.0208507] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022] Open
Abstract
Outcomes for patients with multiple myeloma (MM) have improved with the advent of novel therapies, however, real-world evidence of outcomes in clinical practice is scarce. We conducted a multi-center registry study to build a reliable picture of treatment and patient outcomes in Finland. The aim of this study was also to understand any methodological challenges in assessing treatment outcomes using disease registry data. Methods: We carried out a retrospective, observational study using data from the national Finnish Hematology Registry (FHR) to provide real-world evidence of outcomes for all adult patients diagnosed with and treated for MM between 2009–2013 at one of the six regional hospitals, with at least six months of recorded follow-up. Patients were identified within the FHR by applying eligibility criteria of a diagnosis of MM and verifiable records of medical treatment and lines of treatment during the study period. Patients receiving allogenic stem cell transplantation were excluded from the cohort, as were individuals who only had monoclonal gammopathy of undetermined significance diagnosis and patients who had not initiated treatment during this period. Kaplan Meier curves were used to calculate overall survival and time to next treatment. Stratification was carried out by drug status (conventional/novel) and by autologous stem cell transplant (ASCT) status. Results: A total of 321 patients met the inclusion criteria and were included in this study. Overall survival (OS) was longest in patients who received first-line novel therapy and ASCT (median not reached during 60-month follow-up) versus 46.2 months for novel first-line therapy without ASCT and 25.6 months for first-line conventional therapy without ASCT. Similarly, median time to next treatment were 33.9 months, 12.6 months and 7.8 months, respectively. Conclusions: The adoption of novel treatments in MM in Finland has had substantial impact on patient outcomes. Given the reality of complex treatment combinations for MM and relatively low patient numbers, assessing individual treatment effectiveness will require substantial cohort sizes and advanced, collaborative analytics on an international scale.
Collapse
Affiliation(s)
- Kari Remes
- Turku University Hospital and University of Turku, Dept of Clinical Hematology, Turku, Finland
| | - Pekka Anttila
- University of Helsinki and Helsinki University Hospital Comprehensive Cancer Center, Department of Hematology, Helsinki, Finland
| | | | - Mervi Putkonen
- Turku University Hospital and University of Turku, Dept of Clinical Hematology, Turku, Finland
| | | | | | - Marjatta Sinisalo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Kristiina Kananen
- Kainuu Joint Authority for Social and Health Care, Clinic of Internal Medicine, Kajaani, Finland
| | | | | | | | | | - Felix Wahl
- Department of Mathematics, Stockholm University, SE, Stockholm, Sweden
| | - Tricia Dixon
- JB Medical Ltd, The Old Brickworks, Sudbury, Suffolk, United Kingdom
| | - Amy Leval
- Janssen Cilag AB, Solna, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Instutitet, Stockholm, Sweden
- * E-mail:
| |
Collapse
|
6
|
Remes K, Leppänen K, Fabritius T. Thermography based online characterization of conductive thin films in large-scale electronics fabrication. Opt Express 2018; 26:1219-1229. [PMID: 29401998 DOI: 10.1364/oe.26.001219] [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] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/02/2018] [Indexed: 06/07/2023]
Abstract
Flexible electronics is an emerging thin film based technology enabling completely new types of products and applications compared to conventional electronics. Since the quality of films defines the functionality of fabricated devices, the lack of suitable online manufacturing quality assessment tools has been identified to be a critical bottleneck while upscaling the volume and the yield of thin film electronics manufacturing. In order to solve that problem, a synchronized thermography (ST) based online measurement system was built. Applicability of proposed roll-to-roll compatible ST based system was demonstrated by characterizing a moving plastic film with conductive indium tin oxide on top. Obtained results show that ST can be utilized for online homogeneity characterization and sheet resistance estimation of large area thin films which are not possible with other existing methods.
Collapse
|
7
|
Rissanen E, Remes K, Airas L. Severe neutropenia after rituximab-treatment of multiple sclerosis. Mult Scler Relat Disord 2017; 20:3-5. [PMID: 29253744 DOI: 10.1016/j.msard.2017.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/13/2017] [Accepted: 12/11/2017] [Indexed: 01/08/2023]
Abstract
We present here the first MS-case where rituximab-treatment led to grade IV neutropenia, with hospitalization and treatment of a serious infection with broad-spectrum antibiotics. The neutropenia resolved promptly with granulocyte-colony stimulating factor-treatment and the patient recovered well. Due to risk of recurring neutropenia rituximab-treatment was not re-administered. We discuss the mechanisms and occurrence of neutropenia as a side effect to rituximab-treatment of MS, and remind of the importance of monitoring rituximab-treated MS-patients for this rare but potentially dangerous side effect.
Collapse
Affiliation(s)
- Eero Rissanen
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Kari Remes
- Department of clinical haematology and stem cell transplantation, Turku University Hospital and University of Turku, Turku, Finland
| | - Laura Airas
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland.
| |
Collapse
|
8
|
Törlén J, Ringdén O, Garming-Legert K, Ljungman P, Winiarski J, Remes K, Itälä-Remes M, Remberger M, Mattsson J. A prospective randomized trial comparing cyclosporine/methotrexate and tacrolimus/sirolimus as graft-versus-host disease prophylaxis after allogeneic hematopoietic stem cell transplantation. Haematologica 2016; 101:1417-1425. [PMID: 27662016 DOI: 10.3324/haematol.2016.149294] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/01/2016] [Indexed: 12/29/2022] Open
Abstract
Improvement of graft-versus-host disease prophylaxis remains an important goal in allogeneic hematopoietic stem cell transplantation. Based on reports of possibly preferential properties of sirolimus, we compared the standard regimen of cyclosporine and methotrexate (n=106) with a combination of tacrolimus and sirolimus (n=103) as graft-versus-host disease prophylaxis after allogeneic hematopoietic stem cell transplantation in a prospective, open, randomized trial. The hypothesis was that the tacrolimus/sirolimus regimen would lead to less acute graft-versus-host disease and reduced transplant-related mortality. There was no significant difference in the cumulative incidence of acute graft-versus-host disease of grades II-IV (41% vs. 51%; P=0.19) or grades III-IV (13% vs. 7%; P=0.09) between the groups. Time to neutrophil engraftment (18 days vs. 17 days; P=0.24) was similar, but time to platelet engraftment was longer in cyclosporine/methotrexate patients (14 vs. 12 days; P<0.01). No significant differences in incidence of oropharyngeal mucositis, time to full donor chimerism, or number of cytomegalovirus infections were seen between the two treatment arms, and transplant-related toxicities were equally distributed. Triglyceride (P=0.005) and cholesterol (P=0.009) levels were higher in tacrolimus/sirolimus patients. Transplant-related mortality (18% vs. 12%; P=0.40) and 5-year overall survival (72% vs. 71%; P=0.71) were similar. Five-year relapse-free survival in patients with malignant diagnoses was 65% in the cyclosporine/methotrexate group and 63% in the tacrolimus/sirolimus group (P=0.73). We conclude that tacrolimus/sirolimus remains a valid and safe alternative to cyclosporine/methotrexate as graft-versus-host disease prophylaxis after allogeneic hematopoietic stem cell transplantation, with comparable transplant-related outcomes. The trial was registered at clinicaltrials.gov identifier: 00993343.
Collapse
Affiliation(s)
- Johan Törlén
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden .,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Olle Ringdén
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Garming-Legert
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Per Ljungman
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital and Division of Hematology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jacek Winiarski
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Kari Remes
- Department of Internal Medicine, Turku University Hospital, Finland.,Turku University, Finland
| | | | - Mats Remberger
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Mattsson
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
9
|
Varmavuo V, Silvennoinen R, Anttila P, Säily M, Sankelo M, Putkonen M, Ahonen J, Mahlamäki E, Mäntymaa P, Savolainen ER, Remes K, Jantunen E. Cost analysis of a randomized stem cell mobilization study in multiple myeloma. Ann Hematol 2016; 95:1653-9. [DOI: 10.1007/s00277-016-2772-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/26/2016] [Indexed: 02/07/2023]
|
10
|
Valtola J, Silvennoinen R, Ropponen A, Siitonen T, Säily M, Sankelo M, Terävä V, Putkonen M, Kuittinen T, Pelkonen J, Mäntymaa P, Remes K, Varmavuo V, Jantunen E. Blood graft cellular composition and posttransplant outcomes in myeloma patients mobilized with or without low-dose cyclophosphamide: a randomized comparison. Transfusion 2016; 56:1394-401. [PMID: 27041692 DOI: 10.1111/trf.13574] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Autologous stem cell transplantation is a standard treatment in multiple myeloma (MM). Blood grafts are usually collected after mobilization with granulocyte-colony-stimulating factor (G-CSF) alone or in a combination with cyclophosphamide (CY). There is limited knowledge of the possible effects of different mobilization regimens on blood graft characteristics and posttransplant outcomes. STUDY DESIGN AND METHODS Thirty-eight patients with MM were included in this study. The patients were randomly assigned at registration to mobilization with either low-dose CY plus G-CSF (Arm A) or G-CSF alone (Arm B) and received three cycles of lenalidomide, bortetzomib, and dexamethasone induction. Flow cytometry analysis of lymphocyte subsets in the blood grafts after cryopreservation was performed. Hematologic and immune recovery were evaluated up to 12 months posttransplant. RESULTS The blood grafts in Arm A contained significantly more CD34+ cells but in Arm B there was a greater proportion of CD34+CD38- cells and higher numbers of T and B lymphocytes as well as natural killer (NK) cells. The engraftment was comparable but lymphocyte count at 15 days posttransplant was higher in Arm B (0.8 × 10(9) /L vs. 0.5 × 10(9) /L, p = 0.033). At 3 and 6 months posttransplant the total number of NK cells was also higher in G-CSF-mobilized patients. There was no difference in progression-free survival between the study arms. CONCLUSION CY plus G-GSF yields more CD34+ cells but seems to diminish lymphocyte and NK cell counts in the grafts and hampers immune recovery after transplantation. Thus G-CSF alone might be a preferred mobilization method due to more rapid immune recovery posttransplant.
Collapse
Affiliation(s)
- Jaakko Valtola
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Raija Silvennoinen
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Antti Ropponen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
| | - Timo Siitonen
- Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - Marjaana Säily
- Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - Marja Sankelo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Venla Terävä
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Mervi Putkonen
- Department of Medicine, Turku University Hospital, Turku, Finland
| | | | - Jukka Pelkonen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland.,Laboratory Center of Eastern Finland, Kuopio, Finland
| | | | - Kari Remes
- Department of Medicine, Turku University Hospital, Turku, Finland.,University of Turku, Turku, Finland
| | - Ville Varmavuo
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Esa Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
11
|
Ilmakunnas M, Remes K, Hiippala S, Mäkisalo H, Åberg F. [Prophylactic platelet transfusions]. Duodecim 2016; 132:1041-1049. [PMID: 27400590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The consumption of platelet products in Finland is exceptionally high. For the most part, platelets are transfused pre-operatively to thrombocytopenic patients in order to prevent hemorrhage. Most of the minor procedures could, however, be conducted even if the patients'platelet levels would be lower than usual. In cardiac surgery, platelets are used because of the hemorrhagic diathesis associated with platelet inhibitors. Platelet inhibitors will, however, also bind to transfused platelets, whereby instead of prophylactic platelet transfusions it would be more sensible to leave the thorax open and not carry out ineffective platelet transfusions until the effect of the inhibitors has run out. We outline the prophylactic use of platelets based on recent international clinical practice guidelines.
Collapse
|
12
|
Järvenpää J, Itälä-Remes M, Kauko T, Salmenniemi U, Kauppila M, Putkonen M, Salmi T, Remes K. Treatment of adult acute myeloid leukemia. Duodecim 2016; 132:1465-1473. [PMID: 29188934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of this study was to analyze the treatment results of 180 adult AML patients treated at Turku University Hospital from 2002 to 2012. 124 patients received intensive therapy according to the protocol of the Finnish Leukemia Group. 86% of them achieved remission. 46 patients underwent allogeneic stem cell transplantation which was beneficial for high and intermediate risk disease. 60 - 70% of patients under 60 years old can be cured. The genetic profile of the disease, patient age and treatment response had a significant impact on survival. Our treatment results are comparable with data in literature.
Collapse
|
13
|
Grövdal M, Nahi H, Gahrton G, Liwing J, Waage A, Abildgaard N, Pedersen PT, Hammerstrøm J, Laaksonen A, Bazia P, Terava V, Ollikainen H, Silvennoinen R, Putkonen M, Anttila P, Porkka K, Remes K. Autologous stem cell transplantation versus novel drugs or conventional chemotherapy for patients with relapsed multiple myeloma after previous ASCT. Bone Marrow Transplant 2015; 50:808-12. [PMID: 25867654 DOI: 10.1038/bmt.2015.39] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/17/2015] [Accepted: 02/02/2015] [Indexed: 12/16/2022]
Abstract
High-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) is the most common first-line treatment for patients with multiple myeloma (MM) under 65 years of age. A second ASCT at first relapse is frequently used but is challenged by the use of novel drugs. We retrospectively studied the outcome of second-line treatment in MM patients from the Nordic countries with relapse after first-line HDT and ASCT. Patients that underwent a second ASCT (n=111) were compared with patients re-treated with conventional cytotoxic drugs only (n=91) or with regimens including novel drugs (proteasome inhibitors and/or immunomodulatory drugs) (n=362) without a second ASCT. For patients receiving a second ASCT median overall survival was 4.0 years compared with 3.3 years (P<0.001) for the group treated with novel drugs and 2.5 years (P<0.001) for those receiving conventional cytotoxic drugs only. A second ASCT also resulted in a significantly longer second time to progression and a significantly longer time to next treatment. We conclude that, irrespective of the addition of novel drugs, MM patients in first relapse after ASCT still appear to benefit from a second ASCT. A second ASCT should be considered for all physically fit patients.
Collapse
Affiliation(s)
- M Grövdal
- Department of Medicine, Karolinska Institutet, Center for Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - H Nahi
- Department of Medicine, Karolinska Institutet, Center for Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - G Gahrton
- Department of Medicine, Karolinska Institutet, Center for Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - J Liwing
- Department of Medicine, Karolinska Institutet, Center for Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - A Waage
- 1] Saint Olavs Hospital, Norwegian University of Science and Technology, Trondheim, Norway [2] KG Jebsen Center for Myeloma Research, IKM, Norwegian University of Science and Technology, Trondheim, Norway
| | - N Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - P T Pedersen
- Department of Hematology, Esbjerg Hospital, Esbjerg, Denmark
| | - J Hammerstrøm
- 1] Saint Olavs Hospital, Norwegian University of Science and Technology, Trondheim, Norway [2] KG Jebsen Center for Myeloma Research, IKM, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Laaksonen
- Department of Hematology, Turku University Hospital, Turku University, Turku, Finland
| | - P Bazia
- Department of Hematology, Kainuu Central Hospital, Kajaani, Finland
| | - V Terava
- Department of Hematology, Tampere University Hospital, Tampere, Finland
| | - H Ollikainen
- Department of Hematology, Satakunta Central Hospital, Pori, Finland
| | - R Silvennoinen
- Department of Hematology, Kuopio University Hospital, Kuopio, Finland
| | - M Putkonen
- Department of Hematology, Turku University Hospital, Turku University, Turku, Finland
| | - P Anttila
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - K Porkka
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - K Remes
- Department of Hematology, Turku University Hospital, Turku University, Turku, Finland
| |
Collapse
|
14
|
Remes K, Raade M, Karhumäki L, Timonen T, Välimäki MJ. [Hemolysis and metastatic cancer in an elderly man]. Duodecim 2015; 131:671-675. [PMID: 26233985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sometimes correct diagnoses is reached after many years and even after decades. Our patient had for decades suffered from a hemolytic disease, life-threatening, metastatic cancer at the age of almost 90 years was also suspected. The patient was finally diagnosed as having mild hereditary spherocytosis and the associated paraspinal extramedullar hematopoiesis as well as an osteoporotic vertebral fracture caused by osteoporosis.
Collapse
|
15
|
Oksman MJ, Itälä-Remes M, Kauppila M, Putkonen M, Salmenniemi U, Salmi T, Remes K. Bisphosphonates do not delay engraftment after autologous SCT in patients with newly diagnosed myeloma. Bone Marrow Transplant 2014; 50:157. [PMID: 25310301 DOI: 10.1038/bmt.2014.225] [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: 11/09/2022]
Affiliation(s)
- M J Oksman
- Division of Medicine, Department of Hematology and Stem Cell Transplantation, Turku University Hospital, Turku, Finland
| | - M Itälä-Remes
- Division of Medicine, Department of Hematology and Stem Cell Transplantation, Turku University Hospital, Turku, Finland
| | - M Kauppila
- Division of Medicine, Department of Hematology and Stem Cell Transplantation, Turku University Hospital, Turku, Finland
| | - M Putkonen
- Division of Medicine, Department of Hematology and Stem Cell Transplantation, Turku University Hospital, Turku, Finland
| | - U Salmenniemi
- Division of Medicine, Department of Hematology and Stem Cell Transplantation, Turku University Hospital, Turku, Finland
| | - T Salmi
- Division of Medicine, Department of Hematology and Stem Cell Transplantation, Turku University Hospital, Turku, Finland
| | - K Remes
- Division of Medicine, Department of Hematology and Stem Cell Transplantation, Turku University Hospital, Turku, Finland
| |
Collapse
|
16
|
Silvennoinen R, Lundan T, Kairisto V, Pelliniemi TT, Putkonen M, Anttila P, Huotari V, Mäntymaa P, Siitonen S, Uotila L, Penttilä TL, Juvonen V, Selander T, Remes K. Comparative analysis of minimal residual disease detection by multiparameter flow cytometry and enhanced ASO RQ-PCR in multiple myeloma. Blood Cancer J 2014; 4:e250. [PMID: 25303369 PMCID: PMC4220647 DOI: 10.1038/bcj.2014.69] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 08/24/2014] [Accepted: 08/28/2014] [Indexed: 01/02/2023] Open
Abstract
Multiparameter flow cytometry (MFC) and allele-specific oligonucleotide real-time quantitative PCR (ASO RQ-PCR) are the two most sensitive methods to detect minimal residual disease (MRD) in multiple myeloma (MM). We compared these methods in 129 paired post-therapy samples from 22 unselected, consecutive MM patients in complete/near complete remission. Appropriate immunophenotypic and ASO RQ-PCR-MRD targets could be detected and MRD analyses constructed for all patients. The high PCR coverage could be achieved by gradual widening of the primer sets used for clonality detection. In addition, for 13 (55%) of the patients, reverse orientation of the ASO primer and individual design of the TaqMan probe improved the sensitivity and specificity of ASO RQ-PCR analysis. A significant nonlinear correlation prevailed between MFC-MRD and PCR-MRD when both were positive. Discordance between the methods was found in 32 (35%) paired samples, which were negative by MFC-MRD, but positive by ASO RQ-PCR. The findings suggest that with the described technique, ASO RQ-PCR can be constructed for all patients with MM. ASO RQ-PCR is slightly more sensitive in MRD detection than 6-10-color flow cytometry. Owing to technical demands ASO RQ-PCR could be reserved for patients in immunophenotypic remission, especially in efficacy comparisons between different drugs and treatment modalities.
Collapse
Affiliation(s)
- R Silvennoinen
- 1] Department of Medicine, Tampere University Hospital, Tampere, Finland [2] Department of Medicine and Hematology, Kuopio University Hospital, Kuopio, Finland
| | - T Lundan
- TYKSLAB, Laboratory of Molecular Genetics, Turku University Hospital, Turku, Finland
| | - V Kairisto
- TYKSLAB, Laboratory of Molecular Genetics, Turku University Hospital, Turku, Finland
| | - T-T Pelliniemi
- 1] Fimlab Medical Laboratories Ltd, Tampere University Hospital, Tampere, Finland [2] Department of Clinical Chemistry, Turku University, Turku, Finland
| | - M Putkonen
- Department of Internal Medicine, Turku University Hospital, Turku University, Turku, Finland
| | - P Anttila
- Helsinki University Hospital, Helsinki, Finland
| | - V Huotari
- 1] NordLab Oulu, Oulu University Hospital, Oulu, Finland [2] Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - P Mäntymaa
- Laboratory of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - S Siitonen
- HUSLAB, Laboratory of Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland
| | - L Uotila
- HUSLAB, Laboratory of Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland
| | - T-L Penttilä
- TYKSLAB, Laboratory of Clinical Haematology, Turku University Hospital, Turku, Finland
| | - V Juvonen
- TYKSLAB, Laboratory of Molecular Genetics, Turku University Hospital, Turku, Finland
| | - T Selander
- Science Services Center, Kuopio University Hospital, Kuopio, Finland
| | - K Remes
- Department of Internal Medicine, Turku University Hospital, Turku University, Turku, Finland
| |
Collapse
|
17
|
Hjorth-Hansen H, Stenke L, Söderlund S, Dreimane A, Ehrencrona H, Gedde-Dahl T, Gjertsen BT, Höglund M, Koskenvesa P, Lotfi K, Majeed W, Markevärn B, Ohm L, Olsson-Strömberg U, Remes K, Suominen M, Simonsson B, Porkka K, Mustjoki S, Richter J. Dasatinib induces fast and deep responses in newly diagnosed chronic myeloid leukaemia patients in chronic phase: clinical results from a randomised phase-2 study (NordCML006). Eur J Haematol 2014; 94:243-50. [PMID: 25082346 PMCID: PMC4365700 DOI: 10.1111/ejh.12423] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2014] [Indexed: 12/24/2022]
Abstract
We randomised 46 newly diagnosed patients with chronic myeloid leukaemia (median age 56) to receive dasatinib 100 mg QD or imatinib 400 mg QD and report outcome as an intention-to-treat analysis with 36 months follow-up. Early cytogenetic and molecular responses were superior in the dasatinib group, with a tendency that imatinib patients caught up with time. For instance, MR3.0 was reached at 3 months in 36% vs. 8% (P = 0.02), at 12 months in 81% vs. 46% (P = 0.02) and at 18 months in 73% vs. 65% (n.s.) of the patients in the two groups. In contrast, MR4.5 was consistently superior in the dasatinib group at all time points from 6 months onwards, reaching 61% vs. 21% (P < 0.05) at 36 months. Sixty-four vs. 71% of the patients in the dasatinib and imatinib arms, respectively, remained on assigned drug. Dasatinib dose was frequently reduced, but with maintained excellent effect. One imatinib patient progressed to blastic phase, but no CML-related deaths occurred. In conclusion, our data compare favourably with those of the dasatinib registration study, DASISION. The fast and deep molecular responses induced by dasatinib compared with imatinib may be exploited to increase the proportion of patients who can achieve a treatment-free remission after treatment discontinuation.
Collapse
Affiliation(s)
- Henrik Hjorth-Hansen
- Department of Hematology, St Olavs Hospital, Trondheim, Norway; Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Koskenvesa P, Kreutzman A, Rohon P, Pihlman M, Vakkila E, Räsänen A, Vapaatalo M, Remes K, Lundán T, Hjorth-Hansen H, Vakkila J, Simonsson B, Mustjoki S, Porkka K. Imatinib and pegylated IFN-α2b discontinuation in first-line chronic myeloid leukemia patients following a major molecular response. Eur J Haematol 2014; 92:413-20. [DOI: 10.1111/ejh.12258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2013] [Indexed: 02/05/2023]
Affiliation(s)
- Perttu Koskenvesa
- Hematology Research Unit Helsinki; Department of Medicine; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
| | - Anna Kreutzman
- Hematology Research Unit Helsinki; Department of Medicine; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
| | - Peter Rohon
- Hematology Research Unit Helsinki; Department of Medicine; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
- Department of Hemato-Oncology; Faculty Hospital Olomouc and Faculty of Medicine and Dentistry; Palacky University; Olomouc Czech Republic
| | - Markus Pihlman
- Hematology Research Unit Helsinki; Department of Medicine; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
| | - Emmi Vakkila
- Hematology Research Unit Helsinki; Department of Medicine; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
| | | | - Mirja Vapaatalo
- Department of Medicine; Helsinki University central Hospital; Helsinki Finland
| | - Kari Remes
- Turku University Central Hospital; Turku Finland
| | - Tuija Lundán
- Hematology Research Unit Helsinki; Department of Medicine; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
- TYKSLAB; Turku University Central Hospital; Turku Finland
| | - Henrik Hjorth-Hansen
- Department of Hematology; St Olavs Hospital; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- Department of Cancer Research and Molecular Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Jukka Vakkila
- Hematology Research Unit Helsinki; Department of Medicine; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
| | | | - Satu Mustjoki
- Hematology Research Unit Helsinki; Department of Medicine; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
| | - Kimmo Porkka
- Hematology Research Unit Helsinki; Department of Medicine; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
| |
Collapse
|
19
|
Nylund R, Itälä-Remes M, Kauko T, Kauppila M, Putkonen M, Salmenniemi U, Salmi T, Remes K. [Adult acute lymphoblastic leukemia - 20-year treatment results at TYKS]. Duodecim 2014; 130:714-720. [PMID: 24772789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Approximately 30 cases of adult acute lymphoblastic leukemia (ALL) emerge in Finland yearly. In literature 35 to 40% of those under the age of 60 are reported to recover from their illness. Of the 67 adult ALL patients treated at the Turku University Hospital from 1990 to 2010, 96% achieved remission. The five-year survival rate was 53%. After remission, an allogeneic stem cell transplant was performed for 22 patients (37%), with 38 patients (63%) continuing on cytotoxic drugs. There was no difference in survival between modes of treatment or risk groups.
Collapse
|
20
|
Ruutu T, Juvonen E, Remberger M, Remes K, Volin L, Mattsson J, Nihtinen A, Hägglund H, Ringdén O. Improved survival with ursodeoxycholic acid prophylaxis in allogeneic stem cell transplantation: long-term follow-up of a randomized study. Biol Blood Marrow Transplant 2013; 20:135-8. [PMID: 24141008 DOI: 10.1016/j.bbmt.2013.10.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [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: 06/23/2013] [Accepted: 10/15/2013] [Indexed: 12/12/2022]
Abstract
We report the long-term results of a prospective randomized study on the use of ursodeoxycholic acid (UDCA) for prevention of hepatic complications after allogeneic stem cell transplantation. Two hundred forty-two patients, 232 with malignant disease, were randomized to receive (n = 123) or not to receive (n = 119) UDCA from the beginning of the conditioning until 90 days post-transplantation. The results were reported after 1-year follow-up. UDCA administration reduced significantly the proportion of patients developing high serum bilirubin levels as well as the incidence of severe acute graft-versus-host disease (GVHD), liver GVHD, and intestinal GVHD. In the UDCA prophylaxis group, nonrelapse mortality (NRM) was lower and overall survival better than in the control group. After a 10-year follow-up, the difference in the survival and NRM in favor of the UDCA-treated group, seen at 1 year, was maintained (survival 48% versus 38%, P = .037; NRM 28% versus 41%, P = .01). A landmark analysis in patients surviving at 1 year post-transplantation showed no significant differences between the study groups in the long-term follow-up in chronic GVHD, relapse rate, NRM, disease-free survival, or overall survival. These long-term results continue to support the useful role of UDCA in the prevention of transplant-related complications in allogeneic transplantation.
Collapse
Affiliation(s)
- Tapani Ruutu
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
| | - Eeva Juvonen
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Finnish Red Cross Blood Transfusion Service, Helsinki, Finland
| | - Mats Remberger
- Centre for Allogeneic Stem Cell Transplantation, Departments of Clinical Immunology and Medicine, Karolinska Hospital, Huddinge University Hospital, Huddinge, Sweden
| | - Kari Remes
- Department of Medicine, Turku University Hospital, Turku, Finland
| | - Liisa Volin
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Jonas Mattsson
- Centre for Allogeneic Stem Cell Transplantation, Departments of Clinical Immunology and Medicine, Karolinska Hospital, Huddinge University Hospital, Huddinge, Sweden
| | - Anne Nihtinen
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Hans Hägglund
- Centre for Allogeneic Stem Cell Transplantation, Departments of Clinical Immunology and Medicine, Karolinska Hospital, Huddinge University Hospital, Huddinge, Sweden
| | - Olle Ringdén
- Centre for Allogeneic Stem Cell Transplantation, Departments of Clinical Immunology and Medicine, Karolinska Hospital, Huddinge University Hospital, Huddinge, Sweden
| | | |
Collapse
|
21
|
Silvennoinen R, Kairisto V, Pelliniemi TT, Putkonen M, Anttila P, Säily M, Sikiö A, Opas J, Penttilä K, Kuittinen T, Honkanen T, Lundán T, Juvonen V, Luukkaala T, Remes K. Assessment of molecular remission rate after bortezomib plus dexamethasone induction treatment and autologous stem cell transplantation in newly diagnosed multiple myeloma patients. Br J Haematol 2012. [PMID: 23206270 DOI: 10.1111/bjh.12139] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
22
|
Salmenniemi U, Remes K. Thrombotic microangiopathy associated with bortezomib treatment in a patient with relapsed multiple myeloma. Hematol Rep 2012; 4:e13. [PMID: 22826795 PMCID: PMC3401134 DOI: 10.4081/hr.2012.e13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 04/21/2012] [Accepted: 06/12/2012] [Indexed: 01/23/2023] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) and hemolytic-uremic syndrome (HUS) describe microvascular occlusive disorders characterized by thrombocytopenia due to increased platelet aggregation and fragmentation hemolysis. We report here what to our knowledge is the second case of TTP/HUS associated with bortezomib treatment.
Collapse
|
23
|
Cwynarski K, van Biezen A, de Wreede L, Stilgenbauer S, Bunjes D, Metzner B, Koza V, Mohty M, Remes K, Russell N, Nagler A, Scholten M, de Witte T, Sureda A, Dreger P. Autologous and Allogeneic Stem-Cell Transplantation for Transformed Chronic Lymphocytic Leukemia (Richter's Syndrome): A Retrospective Analysis From the Chronic Lymphocytic Leukemia Subcommittee of the Chronic Leukemia Working Party and Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol 2012; 30:2211-7. [DOI: 10.1200/jco.2011.37.4108] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with Richter's syndrome (RS) have a poor prognosis with conventional chemotherapy. The aim of this study was to evaluate the outcome after autologous stem-cell transplantation (autoSCT) or allogeneic stem-cell transplantation (alloSCT) in RS. Patients and Methods A survey was sent to all European Group for Blood and Marrow Transplantation centers assessing transplantations performed for RS. Eligibility criteria included a diagnosis of RS or secondary lymphoma before SCT, age ≥ 18 years, and SCT performed from 1997 to 2007. Data were analyzed by descriptive statistics and methods from survival analysis. Results Fifty-nine patients were registered. Thirty-four patients had received autoSCT, mostly because of chemotherapy-sensitive disease, and 25 had received alloSCT, with 36% being refractory to chemotherapy at SCT. In 18 allograft recipients (72%), reduced-intensity conditioning (RIC) was used. Three-year estimates of the probabilities of overall survival and relapse-free survival (RFS) and the cumulative incidences of relapse and nonrelapse mortality were 36%, 27%, 47%, and 26% for alloSCT and 59%, 45%, 43%, and 12% for autoSCT, respectively. Taking into account the limitations set by the low number of events and age younger than 60 years, chemotherapy-sensitive disease and RIC were found to be associated with superior RFS after alloSCT in multivariate analysis. Factors with a significant impact on autoSCT could not be identified. Conclusion Patients with RS who are sensitive to induction chemotherapy appear to benefit from consolidation with transplantation strategies, and prolonged survival was observed in a proportion of patients.
Collapse
Affiliation(s)
- Kate Cwynarski
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Anja van Biezen
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Liesbeth de Wreede
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Stephan Stilgenbauer
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Donald Bunjes
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Bernd Metzner
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Vladimir Koza
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Mohamad Mohty
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Kari Remes
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Nigel Russell
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Arnon Nagler
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Marijke Scholten
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Theo de Witte
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Anna Sureda
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| | - Peter Dreger
- Kate Cwynarski, Royal Free Hospital, London; Nigel Russell, Nottingham City Hospital, Nottingham; Anna Sureda, Addenbrooke's Hospital, Cambridge, United Kingdom; Anja van Biezen, Liesbeth de Wreede, and Marijke Scholten, Leiden University Medical Center, Leiden; Theo de Witte, University Medical Center Radboud Nijmegen, Nijmegen, the Netherlands; Stephan Stilgenbauer and Donald Bunjes, Internal Medicine III, Ulm University, Ulm; Bernd Metzner, Klinikum Oldenburg, Oldenburg; Peter Dreger, University of
| |
Collapse
|
24
|
Abelsson J, Merup M, Birgegård G, WeisBjerrum O, Brinch L, Brune M, Johansson P, Kauppila M, Lenhoff S, Liljeholm M, Malm C, Remes K, Vindelöv L, Andréasson B. The outcome of allo-HSCT for 92 patients with myelofibrosis in the Nordic countries. Bone Marrow Transplant 2011; 47:380-6. [PMID: 21552298 DOI: 10.1038/bmt.2011.91] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Between 1982 and 2009 a total of 92 patients with myelofibrosis (MF) in chronic phase underwent allo-SCT in nine Nordic transplant centers. Myeloablative conditioning (MAC) was given to 40 patients, and reduced intensity conditioning (RIC) was used in 52 patients. The mean age in the two groups at transplantation was 46±12 and 55±8 years, respectively (P<0.001). When adjustment for age differences was made, the survival of the patients treated with RIC was significantly better (P=0.003). Among the RIC patients, the survival was significantly (P=0.003) better for the patients with age <60 years (a 10-year survival close to 80%) than for the older patients. The type of stem cell donor did not significantly affect the survival. No significant difference was found in TRM at 100 days between the MAC- and the RIC-treated patients. The probability of survival at 5 years was 49% for the MAC-treated patients and 59% in the RIC group (P=0.125). Patients treated with RIC experienced significantly less aGVHD compared with patients treated with MAC (P<0.001). The OS at 5 years was 70, 59 and 41% for patients with Lille score 0, 1 and 2, respectively (P=0.038, when age adjustment was made). Twenty-one percent of the patients in the RIC group were given donor lymphocyte infusion because of incomplete donor chimerism, compared with none of the MAC-treated patients (P<0.002). Nine percent of the patients needed a second transplant because of graft failure, progressive disease or transformation to AML, with no significant difference between the groups. Our conclusions are (1) allo-SCT performed with RIC gives a better survival compared with MAC. (2) age over 60 years is strongly related to a worse outcome and (3) patients with higher Lille score had a shorter survival.
Collapse
Affiliation(s)
- J Abelsson
- Department of Internal Medicine, NU Hospital Organization, Uddevalla, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Toivari A, Itälä-Remes M, Kauppila M, Putkonen M, Salmenniemi U, Remes K. [Stem cell transplantation in myelofibrosis]. Duodecim 2011; 127:2375-2382. [PMID: 22238916] [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: 05/31/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (ASCT) offers the only potentially curative therapy for myelofibrosis, a malignant myeloproliferative disease. The transplant-related mortality is still high, 10-48%, but use of reduced-intensity conditioning is less toxic and allows transplantation to be performed up to 65-70 years of age. Fabourable treatment response will be attained at least in a third of patients, in another third the disease will progress, and nearly one third will succumb due to transplant complications. Thirteen patients with myelofibrosis underwent ASCT at our institution between 1999 and 2009. The outcome of the patients treated with reduced-intensity conditioning corresponds well with those reported in the literature.
Collapse
|
26
|
Putkonen M, Kairisto V, Juvonen V, Pelliniemi TT, Rauhala A, Itälä-Remes M, Remes K. Depth of response assessed by quantitative ASO-PCR predicts the outcome after stem cell transplantation in multiple myeloma. Eur J Haematol 2010; 85:416-23. [PMID: 20722702 DOI: 10.1111/j.1600-0609.2010.01510.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Achievement of complete response (CR) is a new goal of therapy for multiple myeloma (MM). By sensitive methods, the depth of response can be measured even among the patients in CR. We used a sensitive real-time quantitative polymerase chain reaction by allele-specific primers (qASO-PCR) to assess the level of minimal residual disease (MRD) in bone marrow of 37 patients with myeloma who had achieved CR/near-to-CR after autologous or allogeneic stem cell transplantation (SCT). Allele-specific primers could be successfully designed for 86% of patients. Three to six months after autotransplantation, the PCR target was not detectable in 53% of patients (16/30 patients), and the respective figure after allotransplantation was 71% (5/7 patients); the median sensitivity of PCR assay was <0.002%. The proportion of patients without detectable PCR target was 22% of all autotransplanted patients. A threshold level of 0.01% in the qASO-PCR assay 3-6 months after SCT was found to be a useful cut-off limit to divide the patients into two prognostic groups: MRD low/negative vs. MRD high. Low/negative MRD after SCT was a significant predictive factor for the prolongation of progression free (70 vs. 19 months; P = 0.003) and suggestively also for overall survival. We conclude that not only CR but also its depth is important for the long-term outcome in MM.
Collapse
Affiliation(s)
- Mervi Putkonen
- Department of Medicine, Turku University Central Hospital, Vaasa, Finland.
| | | | | | | | | | | | | |
Collapse
|
27
|
Hämäläinen M, Juvonen V, Häikiö S, Lakkala T, Johansson J, Pelliniemi TT, Salmi TT, Remes K, Kairisto V. ETS-related gene ERG expression in AML patients is significantly associated with NPM1 mutation status. Eur J Haematol 2010; 85:361-2. [PMID: 20546020 DOI: 10.1111/j.1600-0609.2010.01483.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
28
|
Johnsen HE, Geisler C, Juvonen E, Remes K, Juliusson G, Hörnsten P, Kvaloy S, Kvalheim G, Jürgensen GW, Pedersen LM, Bergmann OJ, Schmitz A, Boegsted M. Priming with r-metHuSCF and filgrastim or chemotherapy and filgrastim in patients with malignant lymphomas: a randomized phase II pilot study of mobilization and engraftment. Bone Marrow Transplant 2010; 46:44-51. [PMID: 20436517 DOI: 10.1038/bmt.2010.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
SCF has been shown to synergize with G-CSF to mobilize CD34(+) PBPCs. In this study we report results from this combination after a phase II trial of 32 patients with malignant lymphoma randomized to receive recombinant methionyl human SCF (ancestim, r-metHuSCF) in combination with recombinant methionyl human G-CSF (filgrastim, r-metHuG-CSF) (experimental arm A) or routine chemotherapy plus filgrastim (conventional arm B). The primary objective was to evaluate the side effects and toxicity during priming and mobilization. The secondary objectives were efficacy by the level of blood-circulating PBPCs, the number of harvest days and the time to three-lineage engraftment after autografting. First, during priming 5 patients had 8 serious events, 4 in each arm. A summary of all adverse events revealed 30 (94%) patients suffering from 132 events of all grading. Second, neutropenia and thrombocytopenia was documented in arm B. Third, 9/14 (64%) patients in arm A reached the target of 5 million CD34(+) cells/kg body weight (bw) compared with 13/15 (87%) in arm B. The results represent the first randomized trial of growth factor plus chemotherapy priming and indicate that a formal phase III trial very unlikely may challenge chemotherapy plus r-metHuG-CSF priming in candidates for high-dose therapy.
Collapse
Affiliation(s)
- H E Johnsen
- Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Johnsen HE, Bøgsted M, Klausen TW, Gimsing P, Schmitz A, Kjaersgaard E, Damgaard T, Voss P, Knudsen LM, Mylin AK, Nielsen JL, Björkstrand B, Gruber A, Lenhoff S, Remes K, Dahl IM, Fogd K, Dybkaer K. Multiparametric flow cytometry profiling of neoplastic plasma cells in multiple myeloma. Cytometry 2010; 78:338-47. [DOI: 10.1002/cyto.b.20523] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Accepted: 03/14/2010] [Indexed: 11/11/2022]
|
30
|
Airas L, Päivärinta M, Röyttä M, Karhu J, Kauppila M, Itälä-Remes M, Remes K. Central nervous system immune reconstitution inflammatory syndrome (IRIS) after hematopoietic SCT. Bone Marrow Transplant 2009; 45:593-6. [PMID: 19684631 DOI: 10.1038/bmt.2009.186] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
31
|
Koskela K, Pelliniemi TT, Pulkki K, Remes K. Treatment of Multiple Myeloma with All-Trans Retinoic Acid Alone and in Combination with Chemotherapy: a Phase I/II Trial. Leuk Lymphoma 2009; 45:749-54. [PMID: 15160951 DOI: 10.1080/10428190310001628158] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
All-trans retinoic acid (ATRA) is a derivative of vitamin A. ATRA inhibits the growth of human myeloma cell lines and freshly isolated myeloma cells in vitro mainly by down-regulating interleukin-6 receptor. Clinically, however, ATRA alone has not been efficacious and adverse events, notably hypercalcemia, have been common. In the present study 10 patients with stable multiple myeloma after conventional chemotherapy received ATRA alone for 2 months, followed by a combination of ATRA and the chemotherapy regimen during which no further reduction of the paraprotein had occurred. The purpose of the combination therapy was to sensitize the myeloma cells with ATRA to chemotherapy by blocking the growth-promoting effect of IL-6. Although ATRA was well tolerated, ATRA alone lacked clinical efficacy. The combination therapy resulted minimal responses in 4 patients and relatively long progression-free survival in 4 patients was achieved. In 3 of these responding patients serum concentrations of interleukin-6 and/or soluble interleukin-6 receptor were elevated prior to the study. The bone marrow cells of responding patients were sensitive to ATRA in vitro. These results show that ATRA alone is not effective to treat multiple myeloma. There may be some beneficial effect of ATRA in combination chemotherapy in selected patients who have activated IL-6 signaling.
Collapse
Affiliation(s)
- Kari Koskela
- Department of Medicine, Turku University Central Hospital, Turku, Finland.
| | | | | | | |
Collapse
|
32
|
|
33
|
Johnsen HE, Björkstrand B, Klausen TW, Remes K, Gruber A, Knudsen LM, Bergmann OJ, Lenhoff S. Double vs. single high dose melphalan 200 mg/m2 and autologous stem cell transplantation for multiple myeloma: a region-based study in 484 patients from the Nordic area. Hematol Rep 2009. [PMCID: PMC3222243 DOI: 10.4081/hr.2009.e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Autologous stem cell transplantation is still considered the standard of care in young patients with multiple myeloma (MM). This disease is the most common indication for high-dose therapy (HDT) supported by hematopoietic stem cell transplantation and much data support the benefit of this procedure. Results of randomized studies are in favor of tandem autologous transplantation although the effect on overall survival is unclear. Based on sequential registration trials in the Nordic area, we aimed to evaluate the outcome of conventional single or double HDT. During 1994–2000 we registered a total of 484 previously untreated patients under the age of 60 years at diagnosis who on a regional basis initially were treated with single [Trial NMSG #5/94 and #7/98 (N=383)] or double [Trial Huddinge Karolinska Turku Herlev (N=101)] high-dose melphalan (200 mg/m2) therapy supported by autologous stem cell transplantation. A complete or very good partial response was achieved by 40% of patients in the single transplant group and 60% of patients in the double transplant group (p=0.0006). The probability of surviving progression free for five years after the diagnosis was 25% (95% CL 18–32%) in the singletransplant group and 46% (95% CL 33–55%) in the double transplant group (p=0.0014). The estimated overall five-year survival rate was 60% in the single transplant group and 64% in the doubletransplant (p=0.9). In a multivariate analysis of variables, including single versus double transplantation, β2 microglobulin level, age, sex and disease stage, only β2 microglobulin level was predictive for overall survival (p>0.0001) and progression free survival (p=0.001). In accordance with these results, a 1:1 case-control matched comparison between double and single transplantation did not identify significant differences in overall and progression free survival. In this retrospective analysis up front double transplantation with melphalan (200 mg/m2) as compared to single transplantation did not seem to improve the final outcome among patients in the Nordic area. These data are in accordance with recent publications from the Bologna 96 trial indicating that a second transplant should not be recommended up front as standard care.
Collapse
|
34
|
Itälä M, Huhtinen AR, Juvonen V, Kairisto V, Pelliniemi TT, Penttilä TL, Rauhala A, Tienhaara A, Remes K. Stem cell transplantation in poor-risk chronic lymphocytic leukemia: assessment of post-transplant minimal residual disease using four- and six-color flow cytometry and allele-specific RQ-PCR. Eur J Haematol 2008; 81:100-6. [PMID: 18410542 DOI: 10.1111/j.1600-0609.2008.01082.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A total of 178 bone marrow samples were taken for minimal residual disease (MRD) analysis after 34 stem cell transplantations for poor-risk chronic lymphocytic leukemia, and 86 of them were analyzed in parallel by flow cytometry and allele-specific oligonucleotide-PCR (ASO-PCR). ASO primer was successfully designed for all patients whose frozen diagnosis samples were available. Flow cytometry and ASO-PCR were concordant, i.e. both either positive or both negative, in 78% of the analyses. Flow cytometry did not detect MRD in any of the samples that were PCR-negative cases. In contrast, ASO-PCR detected MRD in samples that were negative for MRD by flow cytometry in 22% of the analyses. In one patient, the immunophenotype but not the IgV(H) gene sequence had changed during a course of the disease, and MRD could not be followed by flow cytometry. In the remaining cases, the discrepancy was due to a higher sensitivity of ASO-PCR. Autologous stem cell transplantation resulted in clinical complete response in 87% (20/23) of the patients. By flow cytometry, 35% (8/23) of autotransplanted patients became MRD-negative, but only 12.5% (2/16) PCR-negative (sensitivity of ASO-PCR <0.001 and <0.01, respectively). All allotransplanted patients achieved or maintained hematological CR, and five out of nine patients (56%) became PCR-negative (sensitivity of PCR between <0.001 and <0.003), two of them having non-myeloablative conditioning. None of the patients who became PCR-negative after allogeneic transplantation have relapsed.
Collapse
Affiliation(s)
- Maija Itälä
- Department of Medicine, Turku University Central Hospital, Turku, Finland.
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Hämäläinen MM, Kairisto V, Juvonen V, Johansson J, Aurén J, Kohonen K, Remes K, Salmi TT, Helenius H, Pelliniemi TT. Wilms tumour gene 1 overexpression in bone marrow as a marker for minimal residual disease in acute myeloid leukaemia. Eur J Haematol 2007; 80:201-7. [PMID: 18081724 DOI: 10.1111/j.1600-0609.2007.01009.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Wilms tumour gene 1 (WT1) is overexpressed in leucocytes of most acute myeloid leukaemia (AML) patients. However, the clinical relevance of WT1 gene expression as minimal residual disease (MRD) marker in AML has been questioned. METHODS We determined the expression of WT1 gene in bone marrow (BM) mononuclear cells of 100 AML patients at diagnosis and compared it with other MRD markers during follow up in 16 patients using quantitative reverse transcription-polymerase chain reaction. RESULTS The median WT1 gene expression was 9.7% of K562 cell line WT1 expression (lower quartile 1.5%, upper quartile 29.9%, n = 100) at diagnosis and, 0.053% (lower quartile 0.022%, upper quartile 0.125%, n = 87) in molecular or immunophenotypic remission. Median WT1 expression in control BM was 0.029% (lower quartile 0.013%, upper quartile 0.061%, n = 22). The upper 99% percentile of remission samples was 0.3%, which was regarded as the cut-off of increased WT1 gene expression in AML and was exceeded in 87% of all AML patients at diagnosis. WT1 and the other MRD markers showed only minor differences in profiles during follow-up. WT1 expression at diagnosis with median value 9.7% as the cut-off level or as a continuous variable had no prognostic significance for 2-yr survival. CONCLUSIONS The sensitivity of WT1 as a MRD marker was low due to the relatively high background WT1 gene expression in BM cells at remission and in subjects without haematological malignancies. Therefore, WT1 gene expression analysis would be beneficial only in those patients who do not have a more specific and sensitive MRD marker.
Collapse
|
36
|
Koistinen P, Räty R, Itälä M, Jantunen E, Koivunen E, Nousiainen T, Pelliniemi TT, Remes K, Ruutu T, Savolainen ER, Siitonen T, Silvennoinen R, Volin L, Elonen E. Long-term outcome of intensive chemotherapy for adults with de novo acute myeloid leukaemia (AML): the nationwide AML-92 study by the Finnish Leukaemia Group. Eur J Haematol 2007; 78:477-86. [PMID: 17391337 DOI: 10.1111/j.1600-0609.2007.00846.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the long-term outcome of idarubicin- and cytarabine-based intensive chemotherapy in adult acute myeloid leukaemia (AML). PATIENTS AND METHODS A total of 327 consecutive patients with de novo AML (promyelocytic leukaemia excluded) aged 16-65 yr were recruited into the study between September 1992 and December 2001. The latest follow-up data were collected in October 2006. After remission achievement with the first (conventional cytarabine) or second (high-dose cytarabine) chemotherapy cycle, three intensive consolidation courses each containing high- or intermediate-dose cytarabine were given. RESULTS A total of 268 patients (82%) achieved complete remission (CR). CR rate was 82% and 84% for patients <60 and > or =60 yr of age, respectively. CR rates in patients with favourable (93%) and intermediate/normal karyotypes (87%) were significantly (P < 0.01) higher than CR rate in patients with adverse karyotype (61%). Median relapse-free survival (RFS) for the patients not transplanted in the first CR (n = 195) was 1.7 yr (95% CI: 0.81-2.60). At 4 yr, a plateau of 70% in RFS was reached for patients with favourable karyotypes. The 5-yr survival was 71%, 47% and 37% for the non-transplanted patients (n = 202) with favourable, intermediate/normal and intermediate/abnormal karyotypes, respectively, while only 8% of the patients having adverse karyotype were alive at 5 yr (P < 0.01). Of the patients with favourable, intermediate/normal or intermediate/abnormal karyotypes, respectively, 58%, 41% and 31% were expected to be alive at 10 yr. CONCLUSIONS Idarubicin- and cytarabine-based intensive chemotherapy regimen is very effective in de novo AML for adult patients up to 65 yr of age. New treatment strategies are needed, however, to improve the outcome of the patients with intermediate and adverse karyotypes.
Collapse
Affiliation(s)
- Pirjo Koistinen
- Department of Medicine, Oulu University Hospital, Oulu, Finland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Putkonen M, Rauhala A, Pelliniemi TT, Remes K. Sepsis, low platelet nadir at mobilization and previous IFN use predict stem cell mobilization failure in patients with multiple myeloma. Cytotherapy 2007; 9:548-54. [PMID: 17882719 DOI: 10.1080/14653240701508429] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Successful stem cell mobilization is a prerequisite for autologous blood cell transplantation. We analyzed factors that may predict the success of stem cell mobilization in patients with multiple myeloma (MM). METHODS We analyzed 124 consecutive patients and compared those who failed to mobilize a sufficient amount of CD34(+) cells (peak blood CD34(+) cell count <20x10(6)/L) (n=20) with those with successful mobilization (n=104). The peak blood CD34(+) cell count after mobilization was used as the marker of mobilization success against which the various predictive factors were tested. RESULTS In univariate analysis the best predictive factors for mobilization failure were the number of different chemotherapy regimens (P<0.001), number of chemotherapy cycles (P<0.001), time from diagnosis to mobilization (P<0.001) and previous use of IFN (P<0.001). The distributions of treatment responses at mobilization were similar in the groups with successful and unsuccessful mobilization, and were CR or VGPR in 10% of all patients, PR in 54% and stable or progressive disease in 36%. Regarding the mobilization-related factors, lower leukocyte nadir (P<0.001), longer duration of leukocyte counts <1x10(9)/L (P<0.001), lower platelet nadir (P=0.001), longer duration of platelet counts <20x10(9)/L (P<0.001) and the occurrence of sepsis after the mobilization therapy (P=0.001) were significantly associated with mobilization failure. In multivariate analysis, the amount of earlier chemotherapy cycles (P=0.002), low platelet nadir (P=0.020), occurrence of sepsis at mobilization (P=0.040) and previous use of IFN (P=0.052) remained as significant predictive factors for mobilization failure. DISCUSSION Predicting the success of stem cell mobilization beforehand may have important practical consequences. By identifying those patients who will fail to mobilize stem cells, unnecessary mobilization and collection attempts can be avoided.
Collapse
Affiliation(s)
- M Putkonen
- Deptartment of Medicine, Turku University Central Hospital, Turku, Finland.
| | | | | | | |
Collapse
|
38
|
Jantunen E, Itälä M, Siitonen T, Koivunen E, Leppä S, Juvonen E, Kuittinen O, Lehtinen T, Koistinen P, Nyman H, Nousiainen T, Volin L, Remes K. Late non-relapse mortality among adult autologous stem cell transplant recipients: a nation-wide analysis of 1482 patients transplanted in 1990–2003. Eur J Haematol 2006; 77:114-9. [PMID: 16856906 DOI: 10.1111/j.1600-0609.2006.00685.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Data on the incidence and causes of late (>100 d) non-relapse mortality (NRM) in autologous stem cell transplant (ASCT) recipients is limited. We have analysed NRM in a cohort of 1,482 adult patients who received ASCT in 1990-2003 in six Finnish transplant centres. The most common diagnoses included non-Hodgkin's lymphoma (NHL) (n = 542), multiple myeloma (MM) (n = 528), breast cancer (n = 132); Hodgkin's lymphoma (HL) (n = 86) and chronic lymphocytic leukaemia (CLL) (n = 63). Until September 2005, 646 patients (44%) have died. Late NRM was observed in 68 patients (4.6% of ASCT recipients; 11% of all deaths). There were 38 males and 30 females with a median age of 58 yr (20-69) at the time of ASCT. The median time to NRM was 27 months from ASCT (3-112). The risk of NRM was highest in patients with CLL (9.5%) and those with HL (8.1%) followed by MM and NHL (4.9% and 4.8%, respectively). The risk of late NRM was comparable in patients who received total body irradiation (TBI) and those who received chemotherapy-only regimens (6.7% vs. 4.3%). Another malignancy was the most common cause of late NRM (24 patients, 35% of late NRM). Twelve patients (0.8% of ASCT recipients) have died due to secondary haematological malignancy. Altogether 22 patients (32% of late NRM) died from infectious causes. Malignancies and late infections are important causes of NRM after ASCT. These facts point out the importance of prolonged follow-up in ASCT recipients.
Collapse
MESH Headings
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/surgery
- Cardiovascular Diseases/mortality
- Cause of Death
- Cohort Studies
- Combined Modality Therapy
- Female
- Finland/epidemiology
- Follow-Up Studies
- Hodgkin Disease/drug therapy
- Hodgkin Disease/surgery
- Humans
- Infections/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/surgery
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/surgery
- Male
- Middle Aged
- Multiple Myeloma/drug therapy
- Multiple Myeloma/surgery
- Neoplasms/mortality
- Neoplasms/surgery
- Neoplasms, Second Primary/mortality
- Peripheral Blood Stem Cell Transplantation/mortality
- Peripheral Blood Stem Cell Transplantation/statistics & numerical data
- Postoperative Complications/mortality
- Transplantation Conditioning/mortality
- Transplantation, Autologous/mortality
- Transplantation, Autologous/statistics & numerical data
- Whole-Body Irradiation/adverse effects
Collapse
Affiliation(s)
- E Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Jantunen E, Itälä M, Juvonen E, Leppä S, Keskinen L, Vasala K, Remes K, Wiklund T, Elonen E, Nousiainen T. Autologous stem cell transplantation in elderly (>60 years) patients with non-Hodgkin's lymphoma: a nation-wide analysis. Bone Marrow Transplant 2006; 37:367-72. [PMID: 16415893 DOI: 10.1038/sj.bmt.1705266] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Limited experience is available on the feasibility and efficacy of autologous stem cell transplantation (ASCT) in elderly patients with non-Hodgkin's lymphoma (NHL). In 1994-2004 altogether 88 NHL patients > 60 years old received ASCT in six Finnish transplant centres. There were 57 male and 31 female patients with a median age of 63 years (range 60-70 years); 17 patients were>65 years. The histology included diffuse large B cell (n = 29), mantle cell (n = 27), follicular (n = 15), peripheral T cell (n = 12) and other (n = 5). Disease status at ASCT was I complete remission/partial remission (CR/PR) in 53 patients, II CR/PR in 30 patients and other in five patients. The conditioning regimens included BEAC (n = 49), BEAM (n = 34), TBI-CY (n = 4) and other (n = 1). Eighty-four patients received PB grafts. The medians to reach neutrophils > 0.5 and platelets > 20 were 10 and 14 days, respectively. The early treatment-related mortality (TRM) (<100 days) was 11%. With a median follow-up of 21 months for all patients, 45 patients (51%) are alive. A relapse or progression after ASCT has been observed in 32 patients (36%). ASCT is feasible in selected elderly patients with NHL, but the early TRM seems to be higher than in younger patients.
Collapse
Affiliation(s)
- E Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Jantunen E, Itälä M, Siitonen T, Juvonen E, Koivunen E, Koistinen P, Volin L, Remes K, Nousiainen T. Autologous stem cell transplantation in patients with chronic lymphocytic leukaemia: the Finnish experience. Bone Marrow Transplant 2006; 37:1093-8. [PMID: 16699533 DOI: 10.1038/sj.bmt.1705375] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although autologous stem cell transplantation (ASCT) has gained some popularity as a treatment option in patients with chronic lymphocytic leukaemia (CLL), limited multicentre data are available on the feasibility and efficacy of this approach. Between January 1995 and June 2005, 72 patients with CLL received ASCT in five Finnish centres. There were 45 men and 27 women with a median age of 57 years (38-69). The median time from diagnosis to ASCT was 32 months (6-181) and the median number of prior regimens 1 (1-4). All patients received blood stem cell grafts and CD34+ selection had been performed in 44 patients (61%). The most common high-dose regimen was a total body irradiation plus cyclophosphamide (38 patients, 53%). No early treatment-related deaths were observed. With a median follow-up of 28 months from ASCT, a relapse or progression has been observed in 27 patients (37%). The projected progression-free survival is 48 months (confidence interval (CI) 30-66). The projected median overall survival is 95 months (CI 74-101) from ASCT and is not influenced by graft selection or conditioning regimen used. Autologous stem cell transplantation is a feasible treatment option for CLL. Randomized trials against alternative treatments are needed to assess the impact of ASCT on the clinical course of CLL.
Collapse
Affiliation(s)
- E Jantunen
- Department of Medicine, Kuopio University Hospital, 70211 Kuopio, Finland.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Jantunen E, Itälä M, Lehtinen T, Kuittinen O, Koivunen E, Leppä S, Juvonen E, Koistinen P, Wiklund T, Nousiainen T, Remes K, Volin L. Early treatment-related mortality in adult autologous stem cell transplant recipients: a nation-wide survey of 1482 transplanted patients. Eur J Haematol 2006; 76:245-50. [PMID: 16412136 DOI: 10.1111/j.1600-0609.2005.00605.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate early (<100 d) treatment-related mortality (TRM) in autologous stem cell transplant (ASCT) recipients. PATIENTS Altogether 1482 adult patients received ASCT in six Finnish centres 1990-2003. The most common diagnoses were non-Hodgkin's lymphoma (NHL) (n = 542), multiple myeloma (MM) (n = 528), breast cancer (BC) (n = 132), Hodgkin's lymphoma (n = 86) and chronic lymphocytic leukaemia (CLL) (n = 63). RESULTS Forty-two patients (2.8%) died from treatment-related reasons <100 d from ASCT. The median time to death was 38 d from ASCT (0-99). The risk of TRM varied according to the diagnoses. The highest risk was observed in patients with AL amyloidosis (24%) followed by NHL (4.4%) and MM (1.9%). No early TRM was observed in patients transplanted for BC or CLL. Infections were the cause of death in 16 patients (fungal 7, bacterial 6, viral 3). Organ toxicity was responsible for early death in 26 patients (heart 9, lungs 7, other 10). CONCLUSIONS This nation-wide survey indicated a low early TRM in ASCT recipients in general, but higher risks in patients with AL amyloidosis or NHL. In addition to patient selection, also optimization of transplant procedure may be needed in these patient groups to reduce early TRM.
Collapse
Affiliation(s)
- E Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Kuittinen T, Wiklund T, Remes K, Elonen E, Lehtinen T, Kuittinen O, Leppä S, Putkonen M, Räty R, Turpeenniemi-Hujanen T, Nousiainen T, Jantunen E. Outcome of progressive disease after autologous stem cell transplantation in patients with non-Hodgkin's lymphoma: a nation-wide survey. Eur J Haematol 2005; 75:199-205. [PMID: 16104875 DOI: 10.1111/j.1600-0609.2005.00481.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyse outcome and prognostic factors in non-Hodgkin's lymphoma (NHL) patients who progress after autologous stem cell transplantation (ASCT). PATIENTS Altogether 115 consecutive NHL patients transplanted in 1991-2000 were studied. Histology included diffuse large B cell (n = 52), follicular (n = 26), mantle cell (n = 15), T cell (n = 16) and other subtypes (n = 6). The median time from ASCT to the progression was 7 months. Ninety-six patients (83%) received salvage treatment. RESULTS Twenty-four patients (25%) achieved complete remission and 30 (31%) partial remission. The median overall survival was 8 months (range 0-98+) and the projected 4-year survival 21%. In multivariate analysis factors predicting treatment response after the progression included the use of rituximab (P = 0.036), histology other than diffuse large B cell (P = 0.001) and International Prognostic Index < or =2 at progression (P < 0.001). Normal lactate dehydrogenase (LDH) at progression (P = 0.002), response to salvage treatment (P < 0.001) and time from ASCT to progression > or =7 months (P = 0.022) were predictors for overall survival. CONCLUSIONS Although the prognosis of patients who progress after ASCT is generally poor, many patients will respond to current therapies, and some may experience prolonged survival. Normal LDH at time of disease progression and longer time to progression after ASCT were the most powerful predictors for a promising outcome.
Collapse
Affiliation(s)
- T Kuittinen
- Department of Medicine, Kuopio University Hospital, Finland.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Putkonen M, Rauhala A, Itälä M, Kauppila M, Pelliniemi TT, Remes K. Double versus single autotransplantation in multiple myeloma; a single center experience of 100 patients. Haematologica 2005; 90:562-3. [PMID: 15820960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
One hundred patients with newly diagnosed multiple myeloma (MM) were treated with high-dose chemotherapy followed by single or double autologous stem cell transplantation (ASCT). Up-front treatment with a double ASCT tended to prolong progression-free and overall survival.
Collapse
|
44
|
Itälä M, Aho H, Remes K. Reduced-intensity conditioning and blood stem cell transplantation from an HLA-identical sibling for severe aplastic anaemia: two patients with successful engraftment but a fatal post-transplant lymphoproliferative disorder in the other. ACTA ACUST UNITED AC 2005; 5:440-3. [PMID: 15448671 DOI: 10.1038/sj.thj.6200381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Allogeneic stem cell transplantation with reduced-intensity conditioning (RIC) can be offered to patients who are ineligible for high-dose conditioning because of their age or comorbidities. Malignant haematological diseases have so far been the most common indication of this new treatment modality; it has been less often used for nonmalignant diseases, and there are only a few reports of RIC and allotransplantation to treat acquired severe aplastic anaemia (SAA). We report two elderly patients (62 and 65 years of age) with SAA who underwent RIC (fludarabine + cyclophosphamide + ATG) and HLA-identical sibling allogeneic blood stem cell transplantation. Two important findings emerged. First, both of our patients who had failed standard immunological treatments and had a heavy transfusion history experienced successful engraftment after RIC and blood allografting, and one of them continues in full haematological remission 20+ months post-transplant. Secondly, the other patient died of Epstein-Barr virus-associated post-transplant lymphoproliferative disorder (PTLD) soon after engraftment, which implies that even if PTLD has been described in only few single cases after RIC, it may also complicate RIC allotransplants.
Collapse
Affiliation(s)
- Maija Itälä
- Department of Medicine, Turku University Central Hospital, PL 52, Turku, 20521 Finland.
| | | | | |
Collapse
|
45
|
Laaksonen S, Remes K, Koskela K, Voipio-Pulkki LM, Falck B. Thalidomide therapy and polyneuropathy in myeloma patients. Electromyogr Clin Neurophysiol 2005; 45:75-86. [PMID: 15861857] [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: 05/02/2023]
Abstract
Thalidomide is today an increasingly used therapy in advanced and refractory myeloma patients, especially in patients relapsing after high dose therapy. One important and well-known side effect of thalidomide is polyneuropathy (PNP). The purpose of this study was to investigate 1) how severe the thalidomide-induced PNP is in patients treated for myeloma 2) which neurophysiological tests and parameters are most sensitive in detecting the thalidomide-induced PNP and 3) how neuropathic symptoms correlate with neurophysiological changes. Twelve patients received thalidomide for treatment of relapsed multiple myeloma for at least 5 months. Prior to the thalidomide treatment, all patients had been treated with chemotherapy including vincristine, and seven patients had also received cisplatin. PNP symptoms, clinical findings and neurophysiological tests before and after the therapy were evaluated. Prior to thalidomide treatment, 7 patients had minimal and one patient slight PNP. After thalidomide treatment, 4 patients had minimal, 4 patients slight, and 3 patients moderate PNP. Thalidomide-induced PNP mainly affected sensory myelinated axons, but also alpha motor neuron axons were affected to some extent. Thermal thresholds were not altered, indicating that thin myelinated and unmyelinated axons are spared. The most sensitive parameter for detecting thalidomide-induced PNP was the sensory nerve compound action potential amplitude. The neuropathic symptoms deteriorated significantly during the therapy, but clinically, no patient developed a disabling PNP that would have required interrupting the therapy. The neuropathic side effects of thalidomide seem to be acceptable in myeloma patients.
Collapse
Affiliation(s)
- S Laaksonen
- Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland.
| | | | | | | | | |
Collapse
|
46
|
Remes K, Luoma S, Salmi TT, Tarja-Terttu P, Itälä M, Kauppila M, Nikoskelainen J, Putkonen M, Kairisto V, Rajamäki A, Tienhaara A, Pyrhönen S, Rauhala A. [Directions for allogenic stem cell transplants and how they reflect on the operation and results of the transfer center in Turku]. Duodecim 2005; 121:2085-97. [PMID: 16300297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
|
47
|
Remes K, Salmi TT. [Response to previous letter to editor]. Duodecim 2005; 121:2713. [PMID: 16454256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Kari Remes
- JACIE/ EBMT:n nimeämä tarkastaja, TYKS:n sisätautien klinikka
| | | |
Collapse
|
48
|
Korhonen K, Dunder T, Klaukka T, Reijonen TM, Issakoff K, Kiviharju M, Linna O, Remes K, Korppi M. Do inhaled steroids differ from cromones in terms of hospital admission rates for asthma in children? Acta Paediatr 2004; 93:1612-8. [PMID: 15841770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
AIM The aim of the present study was to investigate the characteristics of hospital admissions in two child populations receiving different types of drugs as their regular medication for steady-state asthma. METHODS Annual data on children aged under 16 y treated for asthma, including consumption of regular medication for asthma, numbers of hospital periods, lengths of hospitalizations and annual proportions of readmissions, were collected using patient-specific medical records from 1995 to 1999. In the Kuopio province, on average, 35.6-36.7/1000 children were on maintenance for asthma, of which 23% were receiving cromones, 51% were taking inhaled steroids and 26% were treated with cromones plus intermittent steroids. In the Oulu province, the respective prevalence was 32.7-34.9/1000, and the respective proportions were 5%, 93% and 2%. RESULTS Total and first admissions, as well as hospital days were clearly less in the Oulu province. In the children aged > or = 6y, the average annual total admissions were 0.3/1000 (Oulu) vs 1.2/1000 (Kuopio) (p < 0.001). Similarly, the first admissions were 0.2/1000 vs 1.0/1000 (p < 0.001), proportions of readmissions 6.3% vs 19.3% (p < 0.05), and numbers of hospital days 0.7/1000 vs 3.8/1000 (p < 0.001). The differences were in the same direction, though less prominent, also among children 2-5 y of age. CONCLUSION Our results suggest that inhaled steroids are better than cromones in preventing admissions for asthma when two provinces with different practices for maintenance medication of steady-state asthma were compared.
Collapse
Affiliation(s)
- K Korhonen
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Jantunen E, Wiklund T, Juvonen E, Putkonen M, Lehtinen T, Kuittinen O, Franssila K, Söderström KO, Leppä S, Elonen E, Remes K, Nousiainen T. Autologous stem cell transplantation in adult patients with peripheral T-cell lymphoma: a nation-wide survey. Bone Marrow Transplant 2004; 33:405-10. [PMID: 14676776 DOI: 10.1038/sj.bmt.1704367] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Limited experience is available on the feasibility and efficacy of high-dose therapy (HDT) supported by autologous stem cell transplantation (ASCT) in patients with peripheral T-cell lymphoma (PTCL). Therefore, a nation-wide survey was conducted in adult patients transplanted for PTCL in Finland during 1990-2001. After histopathology review, 37 patients were identified. The median age was 46 years (16-68) at the time of ASCT. Histology included PTCL not otherwise specified in 14 patients, anaplastic large cell lymphoma (ALCL) in 14 patients, and other in nine patients. Disease status at the time of ASCT was CR/PR1 in 18 patients; CR/PR2 in 14 patients, and other in five patients. HDT consisted of either BEAC (N=22) or BEAM (N=15), supported by blood stem cells in 34 patients (92%). Early transplant-related mortality was 11%. With a median follow-up of 24 months from HDT, 16 patients (43%) have relapsed or progressed. The estimated 5-year overall survival (OS) was 54%. Patients with ALCL had superior OS when compared with other subtypes (85 vs 35%, P=0.007). OS at 5 years was 63% in patients transplanted in CR/PR1 vs 45% in those transplanted in other disease status (P=NS). Prospective studies are needed to define the role of ASCT in this lymphoma type.
Collapse
Affiliation(s)
- E Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Jantunen E, Salonen J, Juvonen E, Koivunen E, Siitonen T, Lehtinen T, Kuittinen O, Leppä S, Anttila VJ, Itälä M, Wiklund T, Remes K, Nousiainen T. Invasive fungal infections in autologous stem cell transplant recipients: a nation-wide study of 1188 transplanted patients. Eur J Haematol 2004; 73:174-8. [PMID: 15287914 DOI: 10.1111/j.1600-0609.2004.00273.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Based on small single-centre series, the risk of invasive fungal infections (IFI) has been considered small in autologous stem cell transplant (ASCT) recipients. PURPOSE To analyse epidemiological and clinical features of (IFI) among ASCT recipients in Finland 1990-2001. PATIENTS During the study period, 1188 adult patients received high-dose therapy supported by ASCT in six centres. Altogether, 1112 patients (94%) received blood progenitor cells. The graft was CD34+ selected in 261 patients (22%). The major diagnostic groups were non-Hodgkin's lymphoma (n = 417), multiple myeloma (n = 395), breast cancer (n = 132) and Hodgkin's lymphoma (n = 53). RESULTS Eighteen patients (1.5%) with IFI were identified. The incidence of proven or probable invasive aspergillosis was 0.8%, followed by candidaemia with an incidence of 0.3%. The median time to the diagnosis of IFI was 35 d (6-162) from the progenitor cell infusion. In fourteen patients (78%) IFI was diagnosed during lifetime and they were treated with antifungal therapy for a median of 50 d. Nine patients (64%) were cured. CONCLUSIONS IFI appears to be a rare event after ASCT and Aspergillus infections seem to be predominant. These epidemiological features have an impact in planning prophylactic and empirical antifungal strategies in ASCT recipients.
Collapse
Affiliation(s)
- E Jantunen
- Department of Medicine, Kuopio University Hospital, Finland.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|