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Sandecká V, Pour L, Špička I, Minařík J, Radocha J, Jelínek T, Heindorfer A, Pavlíček P, Sýkora M, Jungová A, Kessler P, Wróbel M, Starostka D, Ullrychová J, Stejskal L, Štork M, Straub J, Pika T, Brožová L, Ševčíková S, Maisnar V, Hájek R. Bortezomib-based therapy for newly diagnosed multiple myeloma patients ineligible for autologous stem cell transplantation: Czech Registry Data. Eur J Haematol 2021; 107:466-474. [PMID: 34272773 DOI: 10.1111/ejh.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study compared the use of bortezomib in different combination regimens in newly diagnosed multiple myeloma (NDMM) patients who were transplant ineligible. PATIENTS AND METHODS We analyzed data from the Registry of Monoclonal Gammopathies (RMG) of the Czech Myeloma Group (CMG) to provide real-world evidence of outcome for 794 newly diagnosed MM transplant ineligible patients. The most frequently used regimen was VCd (bortezomib-cyclophosphamide-dexamethasone) (47.5%) over VMP (bortezomib-melphalan-prednisone) (21.7%), BDd (bortezomib-doxorubicin-dexamethasone) (9.8%), and VTd (bortezomib-thalidomide-dexamethasone) (2.9%). RESULTS The overall response rate (ORR) was 69.2% (478/691), including 12.6% (≥ CR); 34.7% very good partial responses (VGPR); and 21.9% partial responses (PR). Among triplet regimens, VMP was the most effective regimen compared to VCd, BDd, and VTd. Median PFS was 22.3 vs. 18.5 vs. 13.7 vs. 13.8 mo, (P = .275), respectively, and median OS was 49 vs. 41.7 vs. 37.9 vs. 32.2 mo (P = .004), respectively. The most common grade 3-4 toxicities were anemia in 17.4% and infections in 18% of patients. CONCLUSION Our study confirmed that bortezomib-based treatment is effective and safe in NDMM transplant ineligible patients, especially VMP, which was identified as superior between bortezomib-based induction regimens not only in clinical trials, but also in real clinical practice.
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Affiliation(s)
- Viera Sandecká
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Ivan Špička
- 1st Department of Medicine, Department of Hematology, Charles University and General Hospital, Prague, Czech Republic
| | - Jiří Minařík
- Department of Hemato-Oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jakub Radocha
- 4th Department of Internal Medicine, Hematology, University Hospital and Charles University in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Tomáš Jelínek
- Department of Hematooncology, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | | | - Petr Pavlíček
- Department of Internal Medicine and Hematology, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michal Sýkora
- Department of Clinical Hematology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Alexandra Jungová
- Hematology and Oncology Department, Charles University Hospital Pilsen, Pilsen, Czech Republic
| | - Petr Kessler
- Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Czech Republic
| | - Marek Wróbel
- Department of Clinical Hematology, Hospital Novy Jicin, Czech Republic
| | - David Starostka
- Department of Clinical Hematology, Hospital Havirov, Czech Republic
| | - Jana Ullrychová
- Department of Clinical Hematology, Regional Health Corporation, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - Lukáš Stejskal
- Department of Hematology, Silesian Hospital in Opava, Opava, Czech Republic
| | - Martin Štork
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Jan Straub
- 1st Department of Medicine, Department of Hematology, Charles University and General Hospital, Prague, Czech Republic
| | - Tomáš Pika
- Department of Hemato-Oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Lucie Brožová
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Sabina Ševčíková
- Babak Myeloma Group, Department of Pathophysiology, Masaryk University, Brno, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Internal Medicine, Hematology, University Hospital and Charles University in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Roman Hájek
- Department of Hematooncology, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
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2
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Hájek R, Sandecka V, Špička I, Raab M, Goldschmidt H, Beck S, Minařík J, Pavlíček P, Radocha J, Heindorfer A, Jelínek T, Stejskal L, Brožová L, Ševčíková S, Straub J, Pika T, Pour L, Maisnar V, Seckinger A, Hose D. Identification of patients with smouldering multiple myeloma at ultra-high risk of progression using serum parameters: the Czech Myeloma Group model. Br J Haematol 2020; 190:189-197. [PMID: 32163180 DOI: 10.1111/bjh.16572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/18/2020] [Indexed: 12/31/2022]
Abstract
Smouldering multiple myeloma (SMM) presents without MM defining symptoms. We aimed to identify patients with SMM with an 80% risk of progression within 2 years using only serum parameters. In total, 527 patients with SMM were included and divided into a training group (287 patients from the Czech Myeloma Group [CMG]) and an independent validation group (240 patients from Heidelberg). The median follow-up was 2·4 and 2·5 years, respectively. Progression to MM occurred in 51·9% of the CMG and 38·8% of the Heidelberg patients, respectively. The median risk of progression was 11·0% (CMG) and 9·7% (Heidelberg) per year, during the 5 years after diagnosis. A serum involved/uninvolved free light-chain ratio of >30, immunoparesis, and serum monoclonal (M) protein of ≥2·3 g/dl emerged as powerful predictors of 2-year progression rate with a hazard ratio (HR) of 2·49 (95% confidence interval [CI] 1·49-4·17), HR of 2·01 (95% CI 1·36-2·96) and HR of 2·00 (95% CI 1·44-2·79) (P < 0·001) in univariate Cox regression analysis, respectively. Based on this, the CMG model identified patients with SMM with a 2-year risk of progression of 78·7% (95% CI 53·1-95·7; HR 6·8; P < 0·001, CMG) and 81·3% (95% CI 47·1-98·8; HR 38·63; P < 0·001, Heidelberg). Serum parameters in the CMG model allow identification of patients with SMM with an 80% risk of progression to symptomatic MM within 2 years.
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Affiliation(s)
- Roman Hájek
- Department of Hemato-Oncology, University Hospital, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Viera Sandecka
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Ivan Špička
- 1st Department of Medicine, 1st Faculty of Medicine, Charles University and General Hospital in Prague, Praha, Czech Republic
| | - Marc Raab
- Internal Medicine V and National Center for Tumor Diseases (NCT), University Clinic Heidelberg, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Internal Medicine V and National Center for Tumor Diseases (NCT), University Clinic Heidelberg, Heidelberg, Germany
| | - Susanne Beck
- Labor für Myelomforschung, University Clinic Heidelberg, Heidelberg, Germany
| | - Jiří Minařík
- Department of Hemato-Oncology, University Hospital, Olomouc, Czech Republic
| | - Petr Pavlíček
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Praha, Czech Republic
| | - Jakub Radocha
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Adriana Heindorfer
- Department of Clinical Hematology, Hospital Liberec, Liberec, Czech Republic
| | - Tomáš Jelínek
- Department of Hemato-Oncology, University Hospital, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lukáš Stejskal
- Department of Hematology and Transfusion, Hospital Opava, Opava, Czech Republic
| | - Lucie Brožová
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Sabina Ševčíková
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Straub
- 1st Department of Medicine, 1st Faculty of Medicine, Charles University and General Hospital in Prague, Praha, Czech Republic
| | - Tomáš Pika
- Department of Hemato-Oncology, University Hospital, Olomouc, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Anja Seckinger
- Labor für Myelomforschung, University Clinic Heidelberg, Heidelberg, Germany
| | - Dirk Hose
- Labor für Myelomforschung, University Clinic Heidelberg, Heidelberg, Germany
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3
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Vrabel D, Sedlarikova L, Besse L, Rihova L, Bezdekova R, Almasi M, Kubaczkova V, Brožová L, Jarkovsky J, Plonkova H, Jelinek T, Sandecka V, Stork M, Pour L, Sevcikova S, Hajek R. Dynamics of tumor-specific cfDNA in response to therapy in multiple myeloma patients. Eur J Haematol 2019; 104:190-197. [PMID: 31763708 PMCID: PMC7065130 DOI: 10.1111/ejh.13358] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 12/14/2022]
Abstract
Objectives Progress in multiple myeloma treatment allows patients to achieve deeper responses, for which the assessment of minimal residual disease (MRD) is critical. Typically, bone marrow samples are used for this purpose; however, this approach is site‐limited. Liquid biopsy represents a minimally invasive and more comprehensive technique that is not site‐limited, but equally challenging. Methods While majority of current data comes from short‐term studies, we present a long‐term study on blood‐based MRD monitoring using tumor‐specific cell‐free DNA detection by ASO‐qPCR. One hundred and twelve patients were enrolled into the study, but long‐term sampling and analysis were feasible only in 45 patients. Results We found a significant correlation of quantity of tumor‐specific cell‐free DNA levels with clinically meaningful events [induction therapy (P = .004); ASCT (P = .012)]. Moreover, length of cfDNA fragments is associated with better treatment response of patients. Conclusions These results support the concept of tumor‐specific cell‐free DNA as a prognostic marker.
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Affiliation(s)
- David Vrabel
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Lenka Sedlarikova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Lenka Besse
- Laboratory of Experimental Oncology, Department of Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Lucie Rihova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Renata Bezdekova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Martina Almasi
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Veronika Kubaczkova
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucie Brožová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Hana Plonkova
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Tomas Jelinek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Viera Sandecka
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Martin Stork
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Sabina Sevcikova
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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4
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Radocha J, Hájek R, Brožová L, Pour L, Špička I, Minařík J, Gregora E, Jungová A, Jelínek T, Heindorfer A, Sýkora M, Maisnar V. Simplified novel prognostic score for real-life older adults with multiple myeloma-registry-based analysis. Ann Hematol 2018; 98:951-962. [PMID: 30539278 DOI: 10.1007/s00277-018-3568-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/26/2018] [Indexed: 11/24/2022]
Abstract
The main goal was to find a simple prognostic to evaluate overall survival of patients older than 65 years of age with myeloma. Retrospective registry-based analysis from the Registry of Monoclonal Gammopathies was conducted. Patients over 65 years with symptomatic myeloma were included. The four major parameters with impact on survival were identified: male gender, age > 75, creatinine > 152 μmol/L, and ECOG performance status 2-4. The patients were scored as good (0 points), intermediate good (1 point), intermediate poor (2 points), poor (3-4 points). Patients (1410 MM) were included. Median OS (months) was 65.7 (95% CI 49.8-81.7) for good, 51.0 (44.1-57.8) for intermediate good, 32.2 (26.2-38.2) for intermediate poor, and 18.9 (15.1-22.7) for poor. The differences in OS were statistically significant (p < 0.0001). Good score was used as reference for hazard ratios, which for each other score were 1.43 (1.09-1.84) for intermediate good, 2.58 (2.00-3.33) for intermediate poor, and 3.88 (2.94-5.10) for poor. Time to progression showed medians (months) 20.5 (17.4-62.4) for good, 19.3 (17.0-21.7) for intermediate good, 19.6 (16.2-23.0) for intermediate poor, and 13.0 (10.8-15.2) for poor. The suggested scoring system provides readily available information about the prognosis of MM patients above 65 years.
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Affiliation(s)
- J Radocha
- 4th Department of Internal Medicine - Hematology, Faculty Hospital, Charles University, Hradec Králové, Czech Republic. .,Czech Myeloma Group, Brno, Czech Republic.
| | - R Hájek
- Czech Myeloma Group, Brno, Czech Republic.,Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - L Brožová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - L Pour
- Czech Myeloma Group, Brno, Czech Republic.,Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine Masaryk Universtiy, University Hospital Brno, Brno, Czech Republic
| | - I Špička
- Czech Myeloma Group, Brno, Czech Republic.,1st Medical Department - Clinical Department of Haematology of the First Faculty of Medicine and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - J Minařík
- Czech Myeloma Group, Brno, Czech Republic.,Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, Olomouc, Czech Republic
| | - E Gregora
- Czech Myeloma Group, Brno, Czech Republic.,Department of Internal Medicine and Hematology, 3rd Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - A Jungová
- Czech Myeloma Group, Brno, Czech Republic.,Hematology and Oncology Department, Charles University Hospital Pilsen, Prague, Czech Republic
| | - T Jelínek
- Czech Myeloma Group, Brno, Czech Republic.,Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - A Heindorfer
- Czech Myeloma Group, Brno, Czech Republic.,Department of Clinical Hematology, Hospital Liberec, Liberec, Czech Republic
| | - M Sýkora
- Czech Myeloma Group, Brno, Czech Republic.,Department of Clinical Hematology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - V Maisnar
- 4th Department of Internal Medicine - Hematology, Faculty Hospital, Charles University, Hradec Králové, Czech Republic.,Czech Myeloma Group, Brno, Czech Republic
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5
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Radocha J, Maisnar V, Pour L, Špička I, Minařík J, Szeligová L, Pavlíček P, Jungová A, Krejčí M, Pika T, Straub J, Brožová L, Stejskal L, Heindorfer A, Jindra P, Kessler P, Mikula P, Sýkora M, Wróbel M, Jarkovský J, Hájek R. Validation of multiple myeloma risk stratification indices in routine clinical practice: Analysis of data from the Czech Myeloma Group Registry of Monoclonal Gammopathies. Cancer Med 2018; 7:4132-4145. [PMID: 29931775 PMCID: PMC6089168 DOI: 10.1002/cam4.1620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/15/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022] Open
Abstract
This study used data from the Czech Myeloma Group Registry of Monoclonal Gammopathies to validate the International Myeloma Working Group (IMWG) and revised International Staging System (R-ISS) indices for risk stratification in patients with multiple myeloma (MM) in clinical practice. Patients were included if they had symptomatic MM, complete data allowing R-ISS and IMWG staging (including cytogenetic information regarding t(4;14), t(14;16), and del(17p)), and key parameters for treatment evaluation. Median overall survival (OS) in included patients (n = 550) was 47.7 (95% CI: 39.5-55.9) and 46.2 (95% CI: 38.9-53.5) months from diagnosis and initiation of first-line therapy, respectively. Patients categorized as higher vs lower risk had reduced survival; median OS from diagnosis was 35.4 (95% CI: 30.5-40.3) vs 58.3 (95% CI: 53.8-62.9) months in high-risk vs other patients (IMWG; P = .001) and 34.1 (95% CI: 30.2-38.0) vs 47.2 (95% CI: 43.4-51.0) months in Stage III vs Stage II patients (R-ISS; P < .001). In conclusion, IMWG and R-ISS risk stratification indices are applicable to patients with MM in a real-world setting.
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Affiliation(s)
- Jakub Radocha
- 4th Department of Medicine - Haematology, Faculty of Medicine, Charles University Hospital, Hradec Králové, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Medicine - Haematology, Faculty of Medicine, Charles University Hospital, Hradec Králové, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Ivan Špička
- 1st Medical Department - Clinical Department of Haematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jiři Minařík
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czech Republic
| | - Lenka Szeligová
- Department of Haemato-Oncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Petr Pavlíček
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Alexandra Jungová
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Marta Krejčí
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Tomáš Pika
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czech Republic
| | - Jan Straub
- 1st Medical Department - Clinical Department of Haematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Lucie Brožová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lukáš Stejskal
- Department of Hematology, Hospital Opava, Opava, Czech Republic
| | | | - Pavel Jindra
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Petr Kessler
- Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Pelhrimov, Czech Republic
| | - Peter Mikula
- Department of Clinical Haematology, Hospital in Havirov, Havirov, Czech Republic
| | - Michal Sýkora
- Department of Clinical Hematology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Marek Wróbel
- Department of Hematology, Hospital Novy Jicin, Novy Jicin, Czech Republic
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Hájek
- Department of Haemato-Oncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
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6
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Jelínek T, Maisnar V, Pour L, Špička I, Minařík J, Gregora E, Kessler P, Sýkora M, Fraňková H, Adamová D, Wróbel M, Mikula P, Jarkovský J, Diels J, Gatopoulou X, Veselá Š, Besson H, Brožová L, Ito T, Hájek R. Adjusted comparison of daratumumab monotherapy versus real-world historical control data from the Czech Republic in heavily pretreated and highly refractory multiple myeloma patients. Curr Med Res Opin 2018; 34:775-783. [PMID: 29172760 DOI: 10.1080/03007995.2017.1410121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We conducted an adjusted comparison of progression-free survival (PFS) and overall survival (OS) for daratumumab monotherapy versus standard of care, as observed in a real-world historical cohort of heavily pretreated multiple myeloma patients from Czech Republic. METHODS Using longitudinal chart data from the Registry of Monoclonal Gammopathies (RMG) of the Czech Myeloma Group, patient-level data from the RMG was pooled with pivotal daratumumab monotherapy studies (GEN501 and SIRIUS; 16 mg/kg). RESULTS From the RMG database, we identified 972 treatment lines in 463 patients previously treated with both a proteasome inhibitor and an immunomodulatory drug. Treatment initiation dates for RMG patients were between March 2006 and March 2015. The most frequently used treatment regimens were lenalidomide-based regimens (33.4%), chemotherapy (18.1%), bortezomib-based regimens (13.6%), thalidomide-based regimens (8.0%), and bortezomib plus thalidomide (5.3%). Few patients were treated with carfilzomib-based regimens (2.5%) and pomalidomide-based regimens (2.4%). Median observed PFS for daratumumab and the RMG cohort was 4.0 and 5.8 months (unadjusted hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.94-1.39), respectively, and unadjusted median OS was 20.1 and 11.9 months (unadjusted HR, 0.61; 95% CI, 0.48-0.78), respectively. Statistical adjustments for differences in baseline characteristics were made using patient-level data. The adjusted HRs (95% CI) for PFS and OS for daratumumab versus the RMG cohort were 0.79 (0.56-1.12; p = .192) and 0.33 (0.21-0.52; p < .001), respectively. CONCLUSIONS Adjusted comparisons between trial data and historical cohorts can provide useful insights to clinicians and reimbursement decision makers on relative treatment efficacies in the absence of head-to-head comparison studies for daratumumab monotherapy.
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Affiliation(s)
- Tomáš Jelínek
- a Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine and Faculty of Science , University of Ostrava , Poruba , Czech Republic
| | - Vladimír Maisnar
- b 4th Department of Internal Medicine - Hematology, Charles University Faculty Hospital and Faculty of Medicine , Hradec Králové , Czech Republic
| | - Luděk Pour
- c Department of Internal Medicine, Hematology and Oncology , University Hospital Brno and Faculty of Medicine Masaryk University , Jihlavská 340/20, 625 00 Brno-Bohunice-Brno-Starý Lískovec , Czech Republic
| | - Ivan Špička
- d Department of Internal Medicine , Charles University in Prague, First Faculty of Medicine and General Teaching Hospital , Hradec Králové , Czech Republic
| | - Jiří Minařík
- e Department of Hemato-Oncology , University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc , Olomouc , Czech Republic
| | - Evžen Gregora
- f Department of Internal Medicine and Hematology , University Hospital Kralovske Vinohrady , Praha , Czech Republic
| | - Petr Kessler
- g Department of Hematology and Transfusion Medicine , Pelhrimov Hospital , Pelhřimov , Czech Republic
| | - Michal Sýkora
- h Department of Clinical Hematology , Hospital Ceske Budejovice , České Budějovice , Czech Republic
| | - Hana Fraňková
- i Department of Hematology , General Hospital Liberec , Liberec , Czech Republic
| | - Dagmar Adamová
- j Department of Clinical Hematology , Silesian Hospital Opava , Opava , Czech Republic
| | - Marek Wróbel
- k Department of Hematology , Hospital Novy Jicin , Nový Jičín , Czech Republic
| | - Peter Mikula
- l Department of Clinical Hematology , General Hospital Havirov , Havířov , Czech Republic
| | - Jiří Jarkovský
- m Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Science , Masaryk University , Brno , Czech Republic
| | - Joris Diels
- n Janssen Health Economics & Market Access EMEA Statistics & Modelling , Beerse , Belgium
| | - Xenia Gatopoulou
- o Janssen Health Economics & Market Access EMEA , Athens , Greece
| | - Šárka Veselá
- p Janssen - Cilag s.r.o. , Smíchov-Anděl , Czech Republic
| | - Hervé Besson
- n Janssen Health Economics & Market Access EMEA Statistics & Modelling , Beerse , Belgium
| | - Lucie Brožová
- m Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Science , Masaryk University , Brno , Czech Republic
| | - Tetsuro Ito
- q Janssen Health Economics & Market Access EMEA , High Wycombe , UK
| | - Roman Hájek
- r Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine , University of Ostrava , Ostrava , Czech Republic
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Brožová L, Schwarz D, Šnábl I, Kalina J, Pavlíčková B, Komenda M, Jarkovský J, Němec P, Hořínek D, Štefániková Z, Pour L, Hájek R, Maisnar V. Czech Registry of Monoclonal Gammopathies – Technical Solution, Data Collection and Visualisation. Klin Onkol 2017; 30:43-50. [DOI: 10.14735/amko20172s43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sandecká V, Hájek R, Pour L, Špička I, Ščudla V, Gregora E, Radocha J, Walterová L, Kessler P, Zahradová L, Adamová D, Valentova K, Vonke I, Obernauerová J, Starostka D, Wróbel M, Brožová L, Jarkovský J, Mikulášová A, Říhová L, Ševčíková S, Straub J, Minařík J, Adam Z, Krejčí M, Král Z, Maisnar V. A first Czech analysis of 1887 cases with monoclonal gammopathy of undetermined significance. Eur J Haematol 2017; 99:80-90. [PMID: 28384387 DOI: 10.1111/ejh.12894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant condition with a risk of malignant conversion. PATIENTS AND METHODS With the aim to estimate the cumulative risk MGUS progression to hematologic malignancies, we analyzed a nationwide population-based cohort of 1887 MGUS patients from the Czech Registry of Monoclonal Gammopathies (RMG) between 2007 and 2013. RESULTS During the follow-up period (median 4 years; range 0.6-34.8), progression to hematologic malignancies was observed in 8.6% (162 of 1887) of patients. Factors associated with progression were as follows: M-protein concentration ≥1.5 g/dL, pathological sFLC (<0.26 or >1.65) ratio, bone marrow plasma cells (BMPCs) in cytology >5%, immunoparesis, age ≥69 years, and the level of serum hemoglobin at baseline <12.0 g/dL. Combining these factors, we propose a new risk model (CMG model). The risk of progression at 10 years was 1.6%, 16.9%, 22.9%, 39.4%, and 52.3%, respectively, if 0 (reference group), one, two, three, or four to five risk factors are present (P<.001) with HR 63 times higher compared to the reference MGUS group. CONCLUSION The new CMG model was established with an advantage for better identification of MGUS patients at low risk.
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Affiliation(s)
- Viera Sandecká
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Roman Hájek
- Department of Clinical Hematology, University Hospital, Ostrava, Czech Republic.,Babak Myeloma Group, Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Ivan Špička
- Department of Internal Medicine, University Hospital, Praha, Czech Republic
| | - Vlastimil Ščudla
- Department of Hemato-Oncology, University Hospital, Olomouc, Czech Republic
| | - Evžen Gregora
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Praha, Czech Republic
| | - Jakub Radocha
- Department of Medicine - Hematology, University Hospital, Hradec Kralove, Czech Republic
| | - Lenka Walterová
- Department of Clinical Hematology, Hospital Liberec, Czech Republic
| | - Petr Kessler
- Department of Hematology and Transfusion Medicine, Hospital Pelhřimov, Czech Republic
| | - Lenka Zahradová
- Department of Clinical Hematology, University Hospital, Ostrava, Czech Republic
| | - Dagmar Adamová
- Department of Hematology and Transfusion, Hospital Opava, Czech Republic
| | - Kamila Valentova
- Department of Clinical Hematology, Thomayer Hospital, Praha, Czech Republic
| | - Ivan Vonke
- Department of Clinical Hematology, Hospital České Budejovice, Czech Republic
| | - Jarmila Obernauerová
- Department of Hematology and Transfusion, Hospital Mlada Boleslav, Czech Republic
| | - David Starostka
- Department of Clinical Hematology, Hospital Havířov, Czech Republic
| | - Marek Wróbel
- Department of Clinical Hematology, Hospital Nový Jičín, Czech Republic
| | - Lucie Brožová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Aneta Mikulášová
- Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic.,Laboratory of Molecular Cytogenetics, Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Lucie Říhová
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Sabina Ševčíková
- Babak Myeloma Group, Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Ján Straub
- Department of Internal Medicine, University Hospital, Praha, Czech Republic
| | - Jiří Minařík
- Department of Hemato-Oncology, University Hospital, Olomouc, Czech Republic
| | - Zdeněk Adam
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Marta Krejčí
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Zdeněk Král
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Vladimír Maisnar
- Department of Medicine - Hematology, University Hospital, Hradec Kralove, Czech Republic
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Hovorka Š, Randová A, Borbášová T, Sysel P, Vychodilová H, Červenková-Šťastná L, Brožová L, Žitka J, Storch J, Kačírková M, Drašar P, Izák P. Permeability and diffusion coefficients of single methyl lactate enantiomers in Nafion® and cellophane membranes measured in diffusion cell. Sep Purif Technol 2016. [DOI: 10.1016/j.seppur.2015.12.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kuricová K, Tanhäuserová V, Pácal L, Bartáková V, Brožová L, Jarkovský J, Kaňková K. NOS3 894G>T polymorphism is associated with progression of kidney disease and cardiovascular morbidity in type 2 diabetic patients: NOS3 as a modifier gene for diabetic nephropathy? Kidney Blood Press Res 2014; 38:92-8. [PMID: 24603156 DOI: 10.1159/000355757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS We have previously associated SNP 894G>T in the NOS3 gene with diabetic nephropathy (DN) using multi-locus analysis. Variant 894G>T has been widely studied as a DN susceptibility factor with contradictory results. In the present study we genotyped 894G>T in the cohort of prospectively followed type 2 diabetics with the aim to investigate its possible role in the progression of DN and development of morbidity and mortality associated with diabetes. METHODS 311 subjects with defined stage of DN were enrolled in the study and followed up for a median of 38 months. We considered three end-points: progression of DN, major cardiovascular event and all-cause mortality. RESULTS Considering baseline GFR, age at enrolment and diabetes duration as confounders, Cox regression analysis identified 894GT genotype as a risk factor for DN progression (HR = 1.843 [95% CI 1.088 - 3.119], P = 0.023) and 894TT genotype as a risk factor for major cardiovascular event (HR = 2.515 [95% CI 1.060 - 5.965], P = 0.036). CONCLUSION We ascertained the significant effect of the NOS3 894G>T variant on DN progression and occurrence of major cardiovascular event in T2DM subjects. Based on these results NOS3 can be considered a modifier gene for DN.
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Affiliation(s)
- Katarína Kuricová
- Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Hradil J, Sysel P, Brožová L, Kovářová J, Kotek J. Heterogeneous membranes based on a composite of a hypercrosslinked microparticle adsorbent and polyimide binder. REACT FUNCT POLYM 2007. [DOI: 10.1016/j.reactfunctpolym.2007.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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