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Dimopoulos MA, Moreau P, Terpos E, Mateos MV, Zweegman S, Cook G, Delforge M, Hájek R, Schjesvold F, Cavo M, Goldschmidt H, Facon T, Einsele H, Boccadoro M, San-Miguel J, Sonneveld P, Mey U. Corrigendum to "Corrigendum to 'Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up'": [Ann Oncol Volume 33, Issue 1, January 2022, Page 117]. Ann Oncol 2022; 33:988. [PMID: 35810138 DOI: 10.1016/j.annonc.2022.05.004] [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: 11/25/2022] Open
Affiliation(s)
- M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - P Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M V Mateos
- University Hospital of Salamanca, IBSAL, Cancer Research Center, Salamanca, Spain
| | - S Zweegman
- Department of Hematology, Amsterdam, UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - G Cook
- Leeds Cancer Centre and University of Leeds, Leeds, UK
| | - M Delforge
- Department of Hematology, University Hospital Leuven, Leuven, Belgium
| | - R Hájek
- Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - F Schjesvold
- Oslo Myeloma Center, Oslo, University Hospital, Oslo; KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | - M Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - H Goldschmidt
- University Hospital Heidelberg, Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - T Facon
- Hôpital Claude Huriez, Lille University Hospital, Lille, France
| | - H Einsele
- Department of Internal Medicine II, University Hospital Wurzburg, Wurzburg, Germany
| | - M Boccadoro
- Division of Hematology, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - J San-Miguel
- Clinica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona, Spain
| | - P Sonneveld
- Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - U Mey
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
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Dimopoulos MA, Moreau P, Terpos E, Mateos MV, Zweegman S, Cook G, Delforge M, Hájek R, Schjesvold F, Cavo M, Goldschmidt H, Facon T, Einsele H, Boccadoro M, San-Miguel J, Sonneveld P, Mey U. Corrigendum to 'Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up': [Ann Oncol 2021; 32(3): 309-322]. Ann Oncol 2021; 33:117. [PMID: 34857439 DOI: 10.1016/j.annonc.2021.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - P Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M V Mateos
- University Hospital of Salamanca, IBSAL, Cancer Research Center, Salamanca, Spain
| | - S Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - G Cook
- Leeds Cancer Centre and University of Leeds, Leeds, UK
| | - M Delforge
- Department of Hematology, University Hospital Leuven, Leuven, Belgium
| | - R Hájek
- Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - F Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, Oslo; KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | - M Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - H Goldschmidt
- University Hospital Heidelberg, Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - T Facon
- Hôpital Claude Huriez, Lille University Hospital, Lille, France
| | - H Einsele
- Department of Internal Medicine II, University Hospital Wurzburg, Wurzburg, Germany
| | - M Boccadoro
- Division of Hematology, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - J San-Miguel
- Clinica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona, Spain
| | - P Sonneveld
- Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - U Mey
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
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Mateos MV, Gavriatopoulou M, Facon T, Auner HW, Leleu X, Hájek R, Dimopoulos MA, Delimpasi S, Simonova M, Špička I, Pour L, Kriachok I, Pylypenko H, Doronin V, Usenko G, Benjamin R, Dolai TK, Sinha DK, Venner CP, Garg M, Stevens DA, Quach H, Jagannath S, Moreau P, Levy M, Badros AZ, Anderson LD, Bahlis NJ, Cavo M, Chai Y, Jeha J, Arazy M, Shah J, Shacham S, Kauffman MG, Richardson PG, Grosicki S. Effect of prior treatments on selinexor, bortezomib, and dexamethasone in previously treated multiple myeloma. J Hematol Oncol 2021; 14:59. [PMID: 33849608 PMCID: PMC8045319 DOI: 10.1186/s13045-021-01071-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
Therapeutic regimens for previously treated multiple myeloma (MM) may not provide prolonged disease control and are often complicated by significant adverse events, including peripheral neuropathy. In patients with previously treated MM in the Phase 3 BOSTON study, once weekly selinexor, once weekly bortezomib, and 40 mg dexamethasone (XVd) demonstrated a significantly longer median progression-free survival (PFS), higher response rates, deeper responses, a trend to improved survival, and reduced incidence and severity of bortezomib-induced peripheral neuropathy when compared with standard twice weekly bortezomib and 80 mg dexamethasone (Vd). The pre-specified analyses described here evaluated the influence of the number of prior lines of therapy, prior treatment with lenalidomide, prior proteasome inhibitor (PI) therapy, prior immunomodulatory drug therapy, and prior autologous stem cell transplant (ASCT) on the efficacy and safety of XVd compared with Vd. In this 1:1 randomized study, enrolled patients were assigned to receive once weekly oral selinexor (100 mg) with once weekly subcutaneous bortezomib (1.3 mg/m2) and 40 mg per week dexamethasone (XVd) versus standard twice weekly bortezomib and 80 mg per week dexamethasone (Vd). XVd significantly improved PFS, overall response rate, time-to-next-treatment, and showed reduced all grade and grade ≥ 2 peripheral neuropathy compared with Vd regardless of prior treatments, but the benefits of XVd over Vd were more pronounced in patients treated earlier in their disease course who had either received only one prior therapy, had never been treated with a PI, or had prior ASCT. Treatment with XVd improved outcomes as compared to Vd regardless of prior therapies as well as manageable and generally reversible adverse events. XVd was associated with clinical benefit and reduced peripheral neuropathy compared to standard Vd in previously treated MM. These results suggest that the once weekly XVd regimen may be optimally administered to patients earlier in their course of disease, as their first bortezomib-containing regimen, and in those relapsing after ASCT.Trial registration: ClinicalTrials.gov (NCT03110562). Registered 12 April 2017. https://clinicaltrials.gov/ct2/show/NCT03110562 .
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Affiliation(s)
| | - Maria Gavriatopoulou
- Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Thierry Facon
- CHU Lille Service Des Maladies du Sang, 59000, Lille, France
| | | | - Xavier Leleu
- Department of Hematology, CHU La Miletrie and Inserm CIC 1402, Poitiers, France
| | - Roman Hájek
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | | | | | - Maryana Simonova
- Institute of Blood Pathology and Transfusion Medicine of NAMS of Ukraine, Lviv, Ukraine
| | - Ivan Špička
- Charles University and General Hospital, Prague, Czech Republic
| | - Ludĕk Pour
- University Hospital Brno, Brno, Czech Republic
| | | | | | - Vadim Doronin
- City Clinical Hospital #40, Moscow, Russian Federation
| | - Ganna Usenko
- City Clinical Hospital No. 4 of Dnipro City Council, Dnipro, Ukraine
| | | | - Tuphan K Dolai
- Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Dinesh K Sinha
- State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, India
| | | | - Mamta Garg
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Don A Stevens
- Norton Cancer Institute, St. Matthews Campus, Louisville, KY, USA
| | - Hang Quach
- St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Sundar Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Moshe Levy
- Baylor University Medical Center, Dallas, TX, USA
| | - Ashraf Z Badros
- Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Larry D Anderson
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nizar J Bahlis
- Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, USA
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Yi Chai
- Karyopharm Therapeutics Inc, Newton, MA, USA
| | | | | | - Jatin Shah
- Karyopharm Therapeutics Inc, Newton, MA, USA
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Rosiñol L, Beksac M, Zamagni E, Van de Donk NWCJ, Anderson KC, Badros A, Caers J, Cavo M, Dimopoulos MA, Dispenzieri A, Einsele H, Engelhardt M, Fernández de Larrea C, Gahrton G, Gay F, Hájek R, Hungria V, Jurczyszyn A, Kröger N, Kyle RA, Leal da Costa F, Leleu X, Lentzsch S, Mateos MV, Merlini G, Mohty M, Moreau P, Rasche L, Reece D, Sezer O, Sonneveld P, Usmani SZ, Vanderkerken K, Vesole DH, Waage A, Zweegman S, Richardson PG, Bladé J. Expert review on soft-tissue plasmacytomas in multiple myeloma: definition, disease assessment and treatment considerations. Br J Haematol 2021; 194:496-507. [PMID: 33724461 DOI: 10.1111/bjh.17338] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In this review, two types of soft-tissue involvement in multiple myeloma are defined: (i) extramedullary (EMD) with haematogenous spread involving only soft tissues and (ii) paraskeletal (PS) with tumour masses arising from skeletal lesions. The incidence of EMD and PS plasmacytomas at diagnosis ranges from 1·7% to 4·5% and 7% to 34·4% respectively. EMD disease is often associated with high-risk cytogenetics, resistance to therapy and worse prognosis than in PS involvement. In patients with PS involvement a proteasome inhibitor-based regimen may be the best option followed by autologous stem cell transplantation (ASCT) in transplant eligible patients. In patients with EMD disease who are not eligible for ASCT, a proteasome inhibitor-based regimen such as lenalidomide-bortezomib-dexamethasone (RVD) may be the best option, while for those eligible for high-dose therapy a myeloma/lymphoma-like regimen such as bortezomib, thalidomide and dexamethasone (VTD)-RVD/cisplatin, doxorubicin, cyclophosphamide and etoposide (PACE) followed by SCT should be considered. In both EMD and PS disease at relapse many strategies have been tried, but this remains a high-unmet need population.
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Affiliation(s)
- Laura Rosiñol
- Department of Hematology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Meral Beksac
- Department of Hematology, Ankara University, Ankara, Turkey
| | - Elena Zamagni
- Istituto di Ematologia "Seràgnoli", Dipartamento di Medicina Specialistica Diagnostica e Sperimentale, Università degli Studi, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | - Ashraf Badros
- University of Maryland at Baltimore, Baltimore, MD, USA
| | - Jo Caers
- Department of Clinical Hematology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Michele Cavo
- Istituto di Ematologia "Seràgnoli", Dipartamento di Medicina Specialistica Diagnostica e Sperimentale, Università degli Studi, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Meletios-Athanasios Dimopoulos
- Hematology and Medical Oncology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | | | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Monika Engelhardt
- Interdisciplinary Tumor Center, University of Freiburg, Freiburg, Germany
| | | | - Gösta Gahrton
- Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Francesca Gay
- Myeloma Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Roman Hájek
- Department of Haematooncology, University of Ostrava, Ostrava, Czech Republic
| | | | - Artur Jurczyszyn
- Medical College Department of Hematology, Jagiellanian University, Krakow, Poland
| | - Nicolaus Kröger
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert A Kyle
- Division of Hematology, Mayo Clínic, Rochester, MN, USA
| | | | | | - Suzanne Lentzsch
- Multiple Myeloma and Amyloidosis Service, Columbia University, New York, NY, USA
| | - Maria V Mateos
- IBSAL, Cancer Research Center, University Hospital of Salamanca, Salamanca, Spain
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Department of molecular Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Hospital Saint-Antoine, Sorbonne University, París, France
| | - Philippe Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | - Leo Rasche
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Donna Reece
- Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | | | - Pieter Sonneveld
- Erasmus MC Cancer Institute, Erasmus University of Rotterdam, Rotterdam, the Netherlands
| | - Saad Z Usmani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer institute/Atrium Health, Charlotte, NC, USA
| | - Karin Vanderkerken
- Department Hematology and Immunology, Vriji Universiteit Brussel, Brussels, Belgium
| | - David H Vesole
- John Theurer Cancer, Hackensack Meridian School of Medicine, Hackensat, NJ, USA
| | - Anders Waage
- Department of Clinical Molecular Medicine, St. Olavs Hospital, NTNU Trondheim, Trondheim, Norway
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Paul G Richardson
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Joan Bladé
- Department of Hematology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Dimopoulos MA, Moreau P, Terpos E, Mateos MV, Zweegman S, Cook G, Delforge M, Hájek R, Schjesvold F, Cavo M, Goldschmidt H, Facon T, Einsele H, Boccadoro M, San-Miguel J, Sonneveld P, Mey U. Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up †. Ann Oncol 2021; 32:309-322. [PMID: 33549387 DOI: 10.1016/j.annonc.2020.11.014] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - P Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M V Mateos
- University Hospital of Salamanca, IBSAL, Cancer Research Center, Salamanca, Spain
| | - S Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - G Cook
- Leeds Cancer Centre and University of Leeds, Leeds, UK
| | - M Delforge
- Department of Hematology, University Hospital Leuven, Leuven, Belgium
| | - R Hájek
- Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - F Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, Oslo; KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | - M Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - H Goldschmidt
- University Hospital Heidelberg, Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - T Facon
- Hôpital Claude Huriez, Lille University Hospital, Lille, France
| | - H Einsele
- Department of Internal Medicine II, University Hospital Wurzburg, Wurzburg, Germany
| | - M Boccadoro
- Division of Hematology, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - J San-Miguel
- Clinica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona, Spain
| | - P Sonneveld
- Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - U Mey
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
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Grosicki S, Simonova M, Spicka I, Pour L, Kriachok I, Gavriatopoulou M, Pylypenko H, Auner HW, Leleu X, Doronin V, Usenko G, Bahlis NJ, Hajek R, Benjamin R, Dolai TK, Sinha DK, Venner CP, Garg M, Gironella M, Jurczyszyn A, Robak P, Galli M, Wallington-Beddoe C, Radinoff A, Salogub G, Stevens DA, Basu S, Liberati AM, Quach H, Goranova-Marinova VS, Bila J, Katodritou E, Oliynyk H, Korenkova S, Kumar J, Jagannath S, Moreau P, Levy M, White D, Gatt ME, Facon T, Mateos MV, Cavo M, Reece D, Anderson LD, Saint-Martin JR, Jeha J, Joshi AA, Chai Y, Li L, Peddagali V, Arazy M, Shah J, Shacham S, Kauffman MG, Dimopoulos MA, Richardson PG, Delimpasi S. Once-per-week selinexor, bortezomib, and dexamethasone versus twice-per-week bortezomib and dexamethasone in patients with multiple myeloma (BOSTON): a randomised, open-label, phase 3 trial. Lancet 2020; 396:1563-1573. [PMID: 33189178 DOI: 10.1016/s0140-6736(20)32292-3] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/25/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Selinexor combined with dexamethasone has shown activity in patients with heavily pre-treated multiple myeloma. In a phase 1b/2 study, the combination of oral selinexor with bortezomib (a proteasome inhibitor) and dexamethasone induced high response rates with low rates of peripheral neuropathy, the main dose-limiting toxicity of bortezomib. We aimed to evaluate the clinical benefit of weekly selinexor, bortezomib, and dexamethasone versus standard bortezomib and dexamethasone in patients with previously treated multiple myeloma. METHODS This phase 3, randomised, open-label trial was done at 123 sites in 21 countries. Patients aged 18 years or older, who had multiple myeloma, and who had previously been treated with one to three lines of therapy, including proteasome inhibitors, were randomly allocated (1:1) to receive selinexor (100 mg once per week), bortezomib (1·3 mg/m2 once per week), and dexamethasone (20 mg twice per week), or bortezomib (1·3 mg/m2 twice per week for the first 24 weeks and once per week thereafter) and dexamethasone (20 mg four times per week for the first 24 weeks and twice per week thereafter). Randomisation was done using interactive response technology and stratified by previous proteasome inhibitor therapy, lines of treatment, and multiple myeloma stage. The primary endpoint was progression-free survival in the intention-to-treat population. Patients who received at least one dose of study treatment were included in the safety population. This trial is registered at ClinicalTrials.gov, NCT03110562. The trial is ongoing, with 55 patients remaining on randomised therapy as of Feb 20, 2020. FINDINGS Of 457 patients screened for eligibility, 402 were randomly allocated-195 (49%) to the selinexor, bortezomib, and dexamethasone group and 207 (51%) to the bortezomib and dexamethasone group-and the first dose of study medication was given between June 6, 2017, and Feb 5, 2019. Median follow-up durations were 13·2 months [IQR 6·2-19·8] for the selinexor, bortezomib, and dexamethasone group and 16·5 months [9·4-19·8] for the bortezomib and dexamethasone group. Median progression-free survival was 13·93 months (95% CI 11·73-not evaluable) with selinexor, bortezomib, and dexamethasone and 9·46 months (8·11-10·78) with bortezomib and dexamethasone (hazard ratio 0·70 [95% CI 0·53-0·93], p=0·0075). The most frequent grade 3-4 adverse events were thrombocytopenia (77 [39%] of 195 patients in the selinexor, bortezomib, and dexamethasone group vs 35 [17%] of 204 in the bortezomib and dexamethasone group), fatigue (26 [13%] vs two [1%]), anaemia (31 [16%] vs 20 [10%]), and pneumonia (22 [11%] vs 22 [11%]). Peripheral neuropathy of grade 2 or above was less frequent with selinexor, bortezomib, and dexamethasone (41 [21%] patients) than with bortezomib and dexamethasone (70 [34%] patients; odds ratio 0·50 [95% CI 0·32-0·79], p=0·0013). 47 (24%) patients in the selinexor, bortezomib, and dexamethasone group and 62 (30%) in the bortezomib and dexamethasone group died. INTERPRETATION A once-per-week regimen of selinexor, bortezomib, and dexamethasone is a novel, effective, and convenient treatment option for patients with multiple myeloma who have received one to three previous lines of therapy. FUNDING Karyopharm Therapeutics.
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Affiliation(s)
| | - Maryana Simonova
- Institute of Blood Pathology and Transfusion Medicine, National Academy of Medical Sciences of Ukraine, Lviv, Ukraine
| | - Ivan Spicka
- Charles University and General Hospital, Prague, Czech Republic
| | - Ludek Pour
- Clinic of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Maria Gavriatopoulou
- Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Halyna Pylypenko
- Department of Hematology, Cherkassy Regional Oncological Center, Cherkassy, Ukraine
| | | | - Xavier Leleu
- Department of Hematology, CHU la Miletrie and Inserm CIC 1402, Poitiers, France
| | | | - Ganna Usenko
- City Clinical Hospital 4 of Dnipro City Council, City Hematology Center, Dnipro, Ukraine
| | - Nizar J Bahlis
- Charbonneau Cancer Research Institute, University of Calgary, Calgary, AB, Canada
| | - Roman Hajek
- Department of Hemato-oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Reuben Benjamin
- Kings College NHS Foundation Trust, Kings College London, London, UK
| | - Tuphan K Dolai
- Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Dinesh K Sinha
- State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, India
| | | | - Mamta Garg
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kraków, Poland
| | - Pawel Robak
- Department of Hematology, Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Monica Galli
- Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | | | - Galina Salogub
- Chemotherapy of Oncology Diseases-Bone Marrow Transplantation Department 1, Almazov National Medical Research Centre, Ministry of Health of Russia, St Petersburg, Russia
| | - Don A Stevens
- Norton Cancer Institute, St Matthews Campus, Louisville, KY, USA
| | - Supratik Basu
- New Cross Hospital, Royal Wolverhampton NHS Trust and University of Wolverhampton, Wolverhampton, UK
| | - Anna M Liberati
- Oncohematology Hospital S Maria Terni, University of Perugia, Terni, Italy
| | - Hang Quach
- University of Melbourne, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Vesselina S Goranova-Marinova
- University Hospital "Sv Georgi" EAD, Clinic of Clinical Hematology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jelena Bila
- Clinic for Hematology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Eirini Katodritou
- Hematology Department, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - Hanna Oliynyk
- Department of Hematology, Vinnytsia M I Pyrohov Regional Clinical Hospital, Vinnytsia, Ukraine
| | - Sybiryna Korenkova
- Bone Marrow Transplantation Department, Kyiv Bone Marrow Transplantation Center, Kyiv, Ukraine
| | | | - Sundar Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Moshe Levy
- Baylor University Medical Center, Dallas, TX, USA
| | - Darrell White
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Moshe E Gatt
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Thierry Facon
- CHU Lille Service des Maladies du Sang F-59000, Lille, France
| | | | - Michele Cavo
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italy
| | - Donna Reece
- University Health Network-Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Larry D Anderson
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Yi Chai
- Karyopharm Therapeutics, Newton, MA, USA
| | | | | | | | - Jatin Shah
- Karyopharm Therapeutics, Newton, MA, USA
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7
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Suska A, Vesole DH, Castillo JJ, Kumar SK, Parameswaran H, Mateos MV, Facon T, Gozzetti A, Mikala G, Szostek M, Mikhael J, Hajek R, Terpos E, Jurczyszyn A. Plasma Cell Leukemia - Facts and Controversies: More Questions than Answers? Clin Hematol Int 2020; 2:133-142. [PMID: 34595454 PMCID: PMC8432408 DOI: 10.2991/chi.k.200706.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/07/2020] [Accepted: 06/01/2020] [Indexed: 11/18/2022] Open
Abstract
Plasma cell leukemia (PCL) is an aggressive hematological malignancy characterized by an uncontrolled clonal proliferation of plasma cells (PCs) in the bone marrow and peripheral blood. PCL has been defined by an absolute number of circulating PCs exceeding 2.0 × 109/L and/or >20% PCs in the total leucocyte count. It is classified as primary PCL, which develops de novo, and secondary PCL, occurring at the late and advanced stages of multiple myeloma (MM). Primary and secondary PCL are clinically and biologically two distinct entities. After the diagnosis, treatment should be immediate and should include a proteasome inhibitor and immunomodulator-based combination regimens as induction, followed by stem cell transplantation (SCT) in transplant-eligible individuals who have cleared the peripheral blood of circulating PCs. Due to the rarity of the condition, there have been very few clinical trials. Furthermore, virtually all of the myeloma trials exclude patients with active PCL. The evaluation of response has been defined by the International Myeloma Working Group and consists of both acute leukemia and MM criteria. With conventional chemotherapy, the prognosis of primary PCL has been ominous, with reported overall survival (OS) ranging from 6.8 to 12.6 months. The use of novel agents and autologous SCT appears to be associated with deeper response and an improved survival, although it still remains low. The PCL prognostic index provides a simple score to risk-stratify PCL. The prognosis of secondary PCL is extremely poor, with OS of only 1 month.
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Affiliation(s)
- Anna Suska
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - David H Vesole
- The John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ, USA
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Maria V Mateos
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | - Gabor Mikala
- Department of Hematology and Stem Cell Transplantation, South-Pest Central Hospital, Natl. Inst. Hematol. Infectol, Budapest, Hungary
| | - Marta Szostek
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, Arizona, USA
| | - Roman Hajek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
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8
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Goldman‐Mazur S, Jurczyszyn A, Castillo JJ, Waszczuk‐Gajda A, Grząśko N, Radocha J, Bittrich M, Kortüm KM, Gozzetti A, Usnarska‐Zubkiewicz L, Davila Valls J, Jayabalan DS, Niesvizky R, Kelman J, Coriu D, Rosiñol L, Szukalski Ł, González‐Calle V, Mateos MV, Jamroziak K, Hus I, Avivi I, Cohen Y, Suska A, Chappell A, Madduri D, Chhabra S, Kleman A, Hari P, Delforge M, Robak P, Gentile M, Kozłowska I, Goldberg SL, Czepiel J, Silbermann R, Olszewski AJ, Barth P, Mikala G, Chim CS, Długosz‐Danecka M, Grosicki S, Vesole DH. A multicenter retrospective study of 223 patients with t(14;16) in multiple myeloma. Am J Hematol 2020; 95:503-509. [PMID: 32072687 DOI: 10.1002/ajh.25758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/01/2020] [Accepted: 02/05/2020] [Indexed: 12/20/2022]
Abstract
The t(14;16) translocation, found in 3%-5% of newly diagnosed (ND) multiple myeloma (MM), has been associated with adverse outcomes. However, the studies establishing the characteristics of t(14;16) included solely small cohorts. The goal of the current international, multicenter (n = 25 centers), retrospective study was to describe the characteristics and outcomes of t(14;16) patients in a large, real-world cohort (n = 223). A substantial fraction of patients had renal impairment (24%) and hemoglobin <10 g/dL (56%) on initial presentation. Combined therapy of both immunomodulatory drug and proteasome inhibitor (PI) in the first line was used in 35% of patients. Autologous stem cell transplantation was performed in 42% of patients. With a median follow up of 4.1 years (95% CI 3.7-18.7), the median progression-free survival (PFS) and overall survival (OS) from first line therapy were 2.1 years (95% CI 1.5-2.4) and 4.1 years (95% CI 3.3-5.5), respectively. Worse OS was predicted by age > 60 years (HR = 1.65, 95% CI [1.05-2.58]), as well as revised International Scoring System (R-ISS) 3 (vs R-ISS 2; HR = 2.59, 95% CI [1.59-4.24]). In conclusion, based on the largest reported cohort of t(14;16) patients, quarter of this subset of MM patients initially presents with renal failure, while older age and the R-ISS 3 predict poor survival.
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Affiliation(s)
- Sarah Goldman‐Mazur
- Department of HematologyJagiellonian University Medical College Cracow Poland
| | - Artur Jurczyszyn
- Department of HematologyJagiellonian University Medical College Cracow Poland
| | - Jorge J. Castillo
- Division of Hematological MalignanciesDana‐Farber Cancer Institute, Harvard Medical School Boston Massachusetts
| | - Anna Waszczuk‐Gajda
- Department of Hematology, Oncology and Internal DiseasesWarsaw Medical University Warsaw Poland
| | - Norbert Grząśko
- Department of Experimental HematologyMedical University of Lublin Lublin Poland
- Department of HematologySt. Johnʼs Cancer Center Lublin Poland
| | - Jakub Radocha
- 4th Department of Internal Medicine– HematologyUniversity Hospital and Faculty of Medicine in Hradec Kralove, Charles University Hradec Kralove Czech Republic
| | - Max Bittrich
- Department of Internal Medicine IIUniversity Hospital Würzburg Würzburg Germany
| | - K. Martin Kortüm
- Department of Internal Medicine IIUniversity Hospital Würzburg Würzburg Germany
| | - Alessandro Gozzetti
- Hematology, Department of Medical Science, Surgery and NeuroscienceUniversity of Siena Siena Italy
| | - Lidia Usnarska‐Zubkiewicz
- Department of HematologyBlood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University Wroclaw Poland
| | | | | | | | | | - Daniel Coriu
- Department of HematologyFundeni Clinical Institute, University of Medicine and Pharmacy “Carol Davila” Bucharest Romania
| | - Laura Rosiñol
- Department of HematologyAmyloidosis and Myeloma Unit, Hospital Clínic, IDIBAPS, University of Barcelona Barcelona Spain
| | - Łukasz Szukalski
- Department of HematologyCollegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń Bydgoszcz Poland
| | - Veronica González‐Calle
- Hospital Universitario de Salamanca/ Instituto Biosanitario de Salamanca (IBSAL) Salamanca Spain
| | - Maria V. Mateos
- Hospital Universitario de Salamanca/ Instituto Biosanitario de Salamanca (IBSAL) Salamanca Spain
| | | | - Iwona Hus
- Department of Experimental HematologyMedical University of Lublin Lublin Poland
- Institute of Hematology and Transfusion Medicine Warsaw Poland
| | - Irit Avivi
- Tel Aviv Sourasky Medical Center Tel Aviv Israel
- The Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Yael Cohen
- Tel Aviv Sourasky Medical Center Tel Aviv Israel
- The Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Anna Suska
- Department of HematologyJagiellonian University Medical College Cracow Poland
| | - Aimee Chappell
- Department of Hematology/OncologyMedstar Georgetown University Hospital Washington DC
| | - Deepu Madduri
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai New York New York
| | - Saurabh Chhabra
- Division of Hematology/Oncology Department of Medicine Medical College of Wisconsin Milwaukee Wisconsin
| | - Ariel Kleman
- Division of Hematology/Oncology Department of Medicine Medical College of Wisconsin Milwaukee Wisconsin
| | - Parameswaran Hari
- Division of Hematology/Oncology Department of Medicine Medical College of Wisconsin Milwaukee Wisconsin
| | | | | | | | | | - Stuart L. Goldberg
- John Theurer Cancer CenterHackensack University Medical Center Hackensack New Jersey
- Cota Inc. New York New York
| | - Jacek Czepiel
- Department of Infectious and Tropical DiseasesJagiellonian University Medical College Cracow Poland
| | - Rebecca Silbermann
- Division of Hematology and Medical OncologyKnight Cancer Institute, Oregon Health and Science University Portland Oregon
| | - Adam J. Olszewski
- Department of MedicineWarren Alpert Medical School, Brown University Providence Rhode Island
| | - Peter Barth
- Department of MedicineWarren Alpert Medical School, Brown University Providence Rhode Island
| | - Gabor Mikala
- Department of Hematology and Stem Cell TransplantationSouth‐Pest Central Hospital, National Institute of Hematology and Infectology Budapest Hungary
| | - Chor S. Chim
- Department of MedicineQueen Mary Hospital, University of Hong Kong Pokfulam, Hong Kong
| | - Monika Długosz‐Danecka
- Department of Clinical OncologyMaria Sklodowska‐Curie National Institute of Oncology Cracow Poland
| | - Sebastian Grosicki
- Department of Cancer PreventionMedical University of Silesia Katowice Poland
| | - David H. Vesole
- John Theurer Cancer CenterHackensack University Medical Center Hackensack New Jersey
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9
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Caballero-Velázquez T, Calderón-Cabrera C, López-Corral L, Puig N, Marquez-Malaver F, Pérez-López E, García-Calderón C, Rosso-Fernández CM, Caballero Barrigón D, Martín J, Mateos MV, San Miguel J, Pérez-Simón JA. Efficacy of bortezomib to intensify the conditioning regimen and the graft-versus-host disease prophylaxis for high-risk myeloma patients undergoing transplantation. Bone Marrow Transplant 2019; 55:419-430. [PMID: 31551517 DOI: 10.1038/s41409-019-0670-6] [Citation(s) in RCA: 6] [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] [Received: 01/09/2019] [Revised: 06/15/2019] [Accepted: 07/22/2019] [Indexed: 11/09/2022]
Abstract
This multicenter phase I trial was designed to evaluate the safety and efficacy of bortezomib (Bz) as part of both the conditioning regimen and the graft-versus-host disease (GvHD) prophylaxis. Patients received fludarabine, melphalan and Bz (days -9 and -2). GVHD prophylaxis consisted of Bz (days +1, +4, and +7), sirolimus (Siro) from day -5 and tacrolimus (Tk) from -3 (except the first five patients that did not receive Tk). Twenty-five patients with poor prognostic multiple myeloma were included. Eleven out of the 19 patients had high-risk features. Out of the 21 patients evaluable at day +100, 14 were in CR (67%) and 7 (33%) in PR. Cumulative incidence (CI) of nonrelapse mortality at 1 year was 24%. CI of grades 2-4 and 3-4 acute GvHD was 35% and 10%, respectively; CI of chronic GvHD was 35% and 55% at 1 and 2 years, respectively. Overall and event free survival at 2 years were 64% and 31%, respectively. Bz as part of the conditioning regimen and in the combination with Siro/tacrolimus for GvHD prophylaxis is safe and effective allowing an optimal disease control early after transplant and reducing the risk of GvHD.
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Affiliation(s)
- T Caballero-Velázquez
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - C Calderón-Cabrera
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - L López-Corral
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - N Puig
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - F Marquez-Malaver
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - E Pérez-López
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - C García-Calderón
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - C M Rosso-Fernández
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - D Caballero Barrigón
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - J Martín
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - M V Mateos
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - J San Miguel
- Clínica Universidad de Navarra, Centro Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - J A Pérez-Simón
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain.
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10
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Chim CS, Kumar SK, Orlowski RZ, Cook G, Richardson PG, Gertz MA, Giralt S, Mateos MV, Leleu X, Anderson KC. Correction: Management of relapsed and refractory multiple myeloma: novel agents, antibodies, immunotherapies and beyond. Leukemia 2019; 33:1058-1059. [PMID: 30842604 PMCID: PMC7608453 DOI: 10.1038/s41375-019-0410-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C S Chim
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.
| | - S K Kumar
- Department of Medicine, Mayo Clinic at Rochester, Rochester, MN, USA
| | - R Z Orlowski
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Cook
- Haematology & Myeloma Studies, Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - P G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M A Gertz
- Department of Medicine, Mayo Clinic at Rochester, Rochester, MN, USA
| | - S Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M V Mateos
- Department of Haematology, University Hospital of Salamanca, Salamanca, Spain
| | - X Leleu
- Hopital La Mileterie, part of the Academic Hospital of Poitiers (CHU), Poitiers, France
| | - K C Anderson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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11
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Sanoja-Flores L, Flores-Montero J, Garcés JJ, Paiva B, Puig N, García-Mateo A, García-Sánchez O, Corral-Mateos A, Burgos L, Blanco E, Hernández-Martín J, Pontes R, Díez-Campelo M, Millacoy P, Rodríguez-Otero P, Prosper F, Merino J, Vidriales MB, García-Sanz R, Romero A, Palomera L, Ríos-Tamayo R, Pérez-Andrés M, Blanco JF, González M, van Dongen JJM, Durie B, Mateos MV, San-Miguel J, Orfao A. Next generation flow for minimally-invasive blood characterization of MGUS and multiple myeloma at diagnosis based on circulating tumor plasma cells (CTPC). Blood Cancer J 2018; 8:117. [PMID: 30455467 PMCID: PMC6242818 DOI: 10.1038/s41408-018-0153-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 12/26/2022] Open
Abstract
Here, we investigated for the first time the frequency and number of circulating tumor plasma cells (CTPC) in peripheral blood (PB) of newly diagnosed patients with localized and systemic plasma cell neoplasms (PCN) using next-generation flow cytometry (NGF) and correlated our findings with the distinct diagnostic and prognostic categories of the disease. Overall, 508 samples from 264 newly diagnosed PCN patients, were studied. CTPC were detected in PB of all active multiple myeloma (MM; 100%), and smoldering MM (SMM) patients (100%), and in more than half (59%) monoclonal gammopathy of undetermined significance (MGUS) cases (p <0.0001); in contrast, CTPC were present in a small fraction of solitary plasmacytoma patients (18%). Higher numbers of CTPC in PB were associated with higher levels of BM infiltration and more adverse prognostic features, together with shorter time to progression from MGUS to MM (p <0.0001) and a shorter survival in MM patients with active disease requiring treatment (p ≤ 0.03). In summary, the presence of CTPC in PB as assessed by NGF at diagnosis, emerges as a hallmark of disseminated PCN, higher numbers of PB CTPC being strongly associated with a malignant disease behavior and a poorer outcome of both MGUS and MM.
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Affiliation(s)
- L Sanoja-Flores
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J Flores-Montero
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J J Garcés
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - B Paiva
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - N Puig
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - A García-Mateo
- Department of Hematology, Health Care Center of Segovia (CAS), Segovia, Spain
| | - O García-Sánchez
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - A Corral-Mateos
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - L Burgos
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - E Blanco
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J Hernández-Martín
- Department of Hematology, Health Care Center of Segovia (CAS), Segovia, Spain
| | - R Pontes
- Faculty of Medicine, Federal University of Rio de Janeiro and Institute of Pediatrics and Childhood Care, Rio de Janeiro, Brazil
| | - M Díez-Campelo
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - P Millacoy
- Department of Hematology, Hospital Center of Navarra (CHN), Pamplona, Spain
| | - P Rodríguez-Otero
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - F Prosper
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - J Merino
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - M B Vidriales
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - R García-Sanz
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - A Romero
- Primary Care Center Miguel Armijo, Sanidad de Castilla y León (SACYL), Salamanca, Spain
| | - L Palomera
- Department of Hematology, University Hospital Lozano Blesa (HULB), Zaragoza, Spain
| | - R Ríos-Tamayo
- Department of Hematology, Virgen de las Nieves Hospital (HVN), Granada, Spain
| | - M Pérez-Andrés
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain
| | - J F Blanco
- Department of Orthopedics, University Hospital of Salamanca, IBSAL; IBMCC (USAL-CSIC), Salamanca, Spain
| | - M González
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - J J M van Dongen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - B Durie
- Cedars-Sinai Samuel Oschin Cancer Center, Los Angeles, CA, USA
| | - M V Mateos
- Department of Hematology, University Hospital of Salamanca (HUSA), IBSAL; IBMCC (USAL-CSIC). CIBER-ONC number CB16/12/00233, Salamanca, Spain
| | - J San-Miguel
- Clinica Universidad de Navarra (UNAV), Applied Medical Research Center (CIMA), IDISNA. CIBER-ONC number CB16/12/00369 and CB16/12/00489, Pamplona, Spain
| | - A Orfao
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca (USAL), Salamanca, Spain.
- Centro de Investigación Biomédica en Red de Cáncer: CIBER-ONC number CB16/12/00400, Instituto Carlos III, Madrid, Spain.
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12
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Chim CS, Kumar SK, Orlowski RZ, Cook G, Richardson PG, Gertz MA, Giralt S, Mateos MV, Leleu X, Anderson KC. Management of relapsed and refractory multiple myeloma: novel agents, antibodies, immunotherapies and beyond. Leukemia 2018; 32:252-262. [PMID: 29257139 PMCID: PMC5808071 DOI: 10.1038/leu.2017.329] [Citation(s) in RCA: 212] [Impact Index Per Article: 35.3] [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: 08/02/2017] [Revised: 10/09/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023]
Abstract
Despite enormous advances, management of multiple myeloma (MM) remains challenging. Multiple factors impact the decision to treat or which regimen to use at MM relapse/progression. Recent major randomized controlled trials (RCTs) showed widely varying progression-free survivals (PFS), ranging from a median of 4 months (MM-003) to 23.6 months (ASPIRE). Based on these RCTs, next-generation proteasome inhibitors (carfilzomib and ixazomib), next-generation immunomodulatory agent (pomalidomide), and monoclonal antibodies (elotuzumab and daratumumab) were approved for relapsed and refractory MM. Daratumumab, targeting CD38, has multiple mechanisms of action including modulation of the immunosuppressive bone marrow micro-environment. In addition to the remarkable single agent activity in refractory MM, daratumumab produced deep responses and superior PFS in MM when combined with lenalidomide/dexamethasone, or bortezomib/dexamethasone. Other anti-CD38 antibodies, such as isatuximab and MOR202, are undergoing assessment. Elotuzumab, targeting SLAMF7, yielded superior response rates and PFS when combined with lenalidomide/dexamethasone. New combinations of these next generation novel agents and/or antibodies are undergoing clinical trials. Venetoclax, an oral BH3 mimetic inhibiting BCL2, showed single agent activity in MM with t(11;14), and is being studied in combination with bortezomib/dexamethasone. Selinexor, an Exportin-1 inhibitor, yielded promising results in quad- or penta-refractory MM including patients resistant to daratumumab. Pembrolizumab, an anti-PD1 check-point inhibitor, is being tested in combination with lenalidomide/dexamethasone or pomalidomide/dexamethasone. Chimeric antigen receptor-T cells targeting B-cell maturation antigen have yielded deep responses in RRMM. Finally, salvage autologous stem cell transplantation (ASCT) remains an important treatment in MM relapsing/progressing after a first ASCT. Herein, the clinical trial data of these agents are summarized, cautious interpretation of RCTs highlighted, and algorithm for salvage treatment of relapse/refractory MM proposed.
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Affiliation(s)
- C S Chim
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - S K Kumar
- Department of Medicine, Mayo Clinic at Rochester, Rochester, MN, USA
| | - R Z Orlowski
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Cook
- Haematology & Myeloma Studies, Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - P G Richardson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M A Gertz
- Department of Medicine, Mayo Clinic at Rochester, Rochester, MN, USA
| | - S Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M V Mateos
- Department of Haematology, University Hospital of Salamanca, Salamanca, Spain
| | - X Leleu
- Hopital La Mileterie, part of the Academic Hospital of Poitiers (CHU), France
| | - K C Anderson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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13
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Moreau P, San Miguel J, Sonneveld P, Mateos MV, Zamagni E, Avet-Loiseau H, Hajek R, Dimopoulos MA, Ludwig H, Einsele H, Zweegman S, Facon T, Cavo M, Terpos E, Goldschmidt H, Attal M, Buske C. Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28:iv52-iv61. [PMID: 28453614 DOI: 10.1093/annonc/mdx096] [Citation(s) in RCA: 455] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P Moreau
- Haematology Department, University Hospital Hôtel-Dieu, Nantes, France
| | - J San Miguel
- Clinica Universidad de Navarra, CIMA, IDISNA, Pamplona, Spain
| | - P Sonneveld
- Erasmus Medical Center Institute, Rotterdam, The Netherlands
| | - M V Mateos
- University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - E Zamagni
- Seragnoli Institute of Hematology, School of Medicine, Bologna University, Bologna, Italy
| | - H Avet-Loiseau
- The Cancer Research Center of Toulouse, CRCT, INSERM U 1037, Toulouse, France
| | - R Hajek
- Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, University of Athens, Athens, Greece
| | - H Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - H Einsele
- Department of Internal Medicine II, University Hospital Wuerzburg, Wuerzburg, Germany
| | - S Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - T Facon
- University Hospital Huriez, Lille, France
| | - M Cavo
- Seragnoli Institute of Hematology, School of Medicine, Bologna University, Bologna, Italy
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, University of Athens, Athens, Greece
| | - H Goldschmidt
- Department of Medicine, University of Heidelberg, Heidelberg
| | - M Attal
- The Cancer Research Center of Toulouse, CRCT, INSERM U 1037, Toulouse, France
| | - C Buske
- Comprehensive Cancer Center Ulm and Department of Internal Medicine III, Institute of Experimental Cancer Research, University Hospital, Ulm, Germany
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14
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Fernández de Larrea C, Dávila J, Isola I, Ocio EM, Rosiñol L, García-Sanz R, Cibeira MT, Tovar N, Rovira M, Mateos MV, Miguel JS, Bladé J. Absence of spontaneous response improvement beyond day +100 after autologous stem cell transplantation in multiple myeloma. Bone Marrow Transplant 2016; 52:567-569. [PMID: 27869809 DOI: 10.1038/bmt.2016.299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 01/18/2023]
Abstract
The response evaluation after autologous stem-cell transplantation (ASCT) is usually performed at day +100 in patients with multiple myeloma (MM). A recent report suggests that improvement in the response can be observed beyond day +100. The aim of the present study has been to evaluate the rate of improved response and outcome beyond day +100 after ASCT, with and without maintenance therapy. One hundred and forty-four patients who underwent single ASCT with chemosensitive disease and achieved less than CR at day 100 post ASCT were evaluated. Seventy-four patients (51.4%) did not receive any maintenance with only one of them showing an upgrade in the response. The remaining 70 patients (48.6%) received maintenance therapy; eleven of them (15.7%) improved their response beyond day +100. The outcome of these patients was better than those who did not upgrade their response in both progression-free survival and overall survival (P=0.019 and P=0.031, respectively). In conclusion, the improvement in response beyond day +100 after ASCT in patients not receiving any therapy is exceedingly rare. A minority of patients receiving maintenance therapy after ASCT upgrades their response and this finding is associated with better outcome.
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Affiliation(s)
- C Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J Dávila
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (IBMCC-USAL, CSIC), Salamanca, Spain
| | - I Isola
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - E M Ocio
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (IBMCC-USAL, CSIC), Salamanca, Spain
| | - L Rosiñol
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - R García-Sanz
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (IBMCC-USAL, CSIC), Salamanca, Spain
| | - M T Cibeira
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - N Tovar
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Rovira
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M V Mateos
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (IBMCC-USAL, CSIC), Salamanca, Spain
| | - J S Miguel
- Clínica Universitaria de Navarra, Centro de Investigación Médica Aplicada (CIMA), Pamplona, Spain
| | - J Bladé
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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15
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Palumbo A, Chanan-Khan A, Weisel K, Nooka AK, Masszi T, Beksac M, Spicka I, Hungria V, Munder M, Mateos MV, Mark TM, Qi M, Schecter J, Amin H, Qin X, Deraedt W, Ahmadi T, Spencer A, Sonneveld P. Daratumumab, Bortezomib, and Dexamethasone for Multiple Myeloma. N Engl J Med 2016; 375:754-66. [PMID: 27557302 DOI: 10.1056/nejmoa1606038] [Citation(s) in RCA: 1075] [Impact Index Per Article: 134.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Daratumumab, a human IgGκ monoclonal antibody that targets CD38, induces direct and indirect antimyeloma activity and has shown substantial efficacy as monotherapy in heavily pretreated patients with multiple myeloma, as well as in combination with bortezomib in patients with newly diagnosed multiple myeloma. METHODS In this phase 3 trial, we randomly assigned 498 patients with relapsed or relapsed and refractory multiple myeloma to receive bortezomib (1.3 mg per square meter of body-surface area) and dexamethasone (20 mg) alone (control group) or in combination with daratumumab (16 mg per kilogram of body weight) (daratumumab group). The primary end point was progression-free survival. RESULTS A prespecified interim analysis showed that the rate of progression-free survival was significantly higher in the daratumumab group than in the control group; the 12-month rate of progression-free survival was 60.7% in the daratumumab group versus 26.9% in the control group. After a median follow-up period of 7.4 months, the median progression-free survival was not reached in the daratumumab group and was 7.2 months in the control group (hazard ratio for progression or death with daratumumab vs. control, 0.39; 95% confidence interval, 0.28 to 0.53; P<0.001). The rate of overall response was higher in the daratumumab group than in the control group (82.9% vs. 63.2%, P<0.001), as were the rates of very good partial response or better (59.2% vs. 29.1%, P<0.001) and complete response or better (19.2% vs. 9.0%, P=0.001). Three of the most common grade 3 or 4 adverse events reported in the daratumumab group and the control group were thrombocytopenia (45.3% and 32.9%, respectively), anemia (14.4% and 16.0%, respectively), and neutropenia (12.8% and 4.2%, respectively). Infusion-related reactions that were associated with daratumumab treatment were reported in 45.3% of the patients in the daratumumab group; these reactions were mostly grade 1 or 2 (grade 3 in 8.6% of the patients), and in 98.2% of these patients, they occurred during the first infusion. CONCLUSIONS Among patients with relapsed or relapsed and refractory multiple myeloma, daratumumab in combination with bortezomib and dexamethasone resulted in significantly longer progression-free survival than bortezomib and dexamethasone alone and was associated with infusion-related reactions and higher rates of thrombocytopenia and neutropenia than bortezomib and dexamethasone alone. (Funded by Janssen Research and Development; ClinicalTrials.gov number, NCT02136134.).
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Affiliation(s)
- Antonio Palumbo
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Asher Chanan-Khan
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Katja Weisel
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Ajay K Nooka
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Tamas Masszi
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Meral Beksac
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Ivan Spicka
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Vania Hungria
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Markus Munder
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Maria V Mateos
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Tomer M Mark
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Ming Qi
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Jordan Schecter
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Himal Amin
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Xiang Qin
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - William Deraedt
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Tahamtan Ahmadi
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Andrew Spencer
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
| | - Pieter Sonneveld
- From the Department of Hematology, University of Turin, Turin, Italy (A.P.); the Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville (A.C.-K.); Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II, Tuebingen (K.W.), and University Medical Center of the Johannes Gutenberg-University, Third Department of Medicine, Mainz (M.M.) - both in Germany; Winship Cancer Institute, Emory University, Atlanta (A.K.N.); the Department of Hematology and Stem Cell Transplantation, St. László Hospital, Semmelweis University, Budapest, Hungary (T.M.); Ankara University, Department of Hematology, Ankara, Turkey (M.B.); Clinical Department of Hematology, 1st Medical Department, Charles University in Prague, Prague, Czech Republic (I.S.); Irmandade Da Santa Casa De Misericordia De São Paulo, São Paulo (V.H.); University Hospital of Salamanca-Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain (M.V.M.); Weill Cornell Medical College, New York (T.M.M.); Janssen Research and Development, Spring House, PA (M.Q., X.Q., T.A.); Janssen Research and Development, Raritan, NJ (J.S., H.A.); Janssen Research and Development, Beerse, Belgium (W.D.); Malignant Haematology and Stem Cell Transplantation Service, Alfred Health-Monash University, Melbourne, VIC, Australia (A.S.); and the Department of Hematology, Erasmus MC, Rotterdam, the Netherlands (P.S.)
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16
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González-Calle V, Dávila J, Escalante F, de Coca AG, Aguilera C, López R, Bárez A, Alonso JM, Hernández R, Hernández JM, de la Fuente P, Puig N, Ocio EM, Gutiérrez NC, García-Sanz R, Mateos MV. Bence Jones proteinuria in smoldering multiple myeloma as a predictor marker of progression to symptomatic multiple myeloma. Leukemia 2016; 30:2026-2031. [PMID: 27133826 DOI: 10.1038/leu.2016.123] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/07/2016] [Accepted: 04/12/2016] [Indexed: 12/11/2022]
Abstract
The diagnosis of smoldering multiple myeloma (SMM) includes patients with a heterogeneous risk of progression to active multiple myeloma (MM): some patients will never progress, whereas others will have a high risk of progression within the first 2 years. Therefore, it is important to improve risk assessment at diagnosis. We conducted a retrospective study in a large cohort of SMM patients, in order to investigate the role of Bence Jones (BJ) proteinuria at diagnosis in the progression to active MM. We found that SMM patients presenting with BJ proteinuria had a significantly shorter median time to progression (TTP) to MM compared with patients without BJ proteinuria (22 vs 88 months, respectively; hazard ratio=2.3, 95% confidence interval=1.4-3.9, P=0.002). We also identified risk subgroups based on the amount of BJ proteinuria: ⩾500 mg/24 h, <500 mg/24 h and without it, with a significantly different median TTP (13, 37 and 88 months, P<0.001). Thus, BJ proteinuria at diagnosis is an independent variable of progression to MM that identifies a subgroup of high-risk SMM patients (51% risk of progression at 2 years) and ⩾500 mg of BJ proteinuria may allow, if validated in another series, to reclassify these patients to MM requiring therapy before the end-organ damage development.
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Affiliation(s)
- V González-Calle
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - J Dávila
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - F Escalante
- Complejo Asistencial Universitario de León, León, Spain
| | - A G de Coca
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - R López
- Hospital Virgen Del Puerto, Plasencia, Spain
| | - A Bárez
- Hospital Nuestra Señora de Sonsoles, Ávila, Spain
| | - J M Alonso
- Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | - R Hernández
- Complejo Asistencial de Zamora, Zamora, Spain
| | | | - P de la Fuente
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - N Puig
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - E M Ocio
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - N C Gutiérrez
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - R García-Sanz
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - M V Mateos
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
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17
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Cabral R, Caballero JC, Alonso S, Dávila J, Cabrero M, Caballero D, Vázquez L, Sánchez-Guijo F, López L, Cañizo MC, Mateos MV, González M. Late differentiation syndrome in acute promyelocytic leukemia: a challenging diagnosis. Hematol Rep 2014; 6:5654. [PMID: 25568763 PMCID: PMC4274482 DOI: 10.4081/hr.2014.5654] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/22/2014] [Indexed: 11/23/2022] Open
Abstract
Detailed knowledge about differentiation syndrome (DS) has remained limited. There are 2 large studies conducted by the Spanish workgroup PETHEMA (Programa Español de Tratamientos en Hematología; Spanish Program on Hematology Treatments) and the European group trial (LPA 96-99 and APL 93) in which the incidence, characteristics, prognostic factors and outcome of patients developing DS are evaluated. Both have described the median time of DS development between 10 and 12 days. The severity of the DS has been evaluated in the study conducted by PETHEMA, and severe DS usually occurs at the beginning of the treatment (median of 6 days), as compared with moderate DS (median of 15 days). We report here in two cases of late severe DS, with late diagnosis due to both time and form of presentation. We discuss the physiopathology, clinical presentation, prophylaxis and treatment of DS.
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Affiliation(s)
- Renata Cabral
- Hematology Service, Hospital Santo António , Porto, Portugal
| | | | - Sara Alonso
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | - Julio Dávila
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | - Monica Cabrero
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | | | - Lourdes Vázquez
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | | | - Lucia López
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | - Maria C Cañizo
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | - Maria V Mateos
- Hematology Service, Hospital Universitário , Salamanca, Spain
| | - Marcos González
- Hematology Service, Hospital Universitário , Salamanca, Spain
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18
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Thilakarathne P, Palumbo A, Diels J, Delforge M, van Sanden S, Mateos MV, Chirita O, Dimopoulos MA, van de Velde H, San Miguel JF. Inverse Probability of Censoring Weighted Analysis to Adjust the Treatment Effect on Overall Survival for Subsequent Therapy: A Case Study in a Clinical Trial in Multiple Myeloma. Value Health 2014; 17:A546. [PMID: 27201769 DOI: 10.1016/j.jval.2014.08.1770] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - J Diels
- Janssen Pharmaceutica N. V., Beerse, Belgium
| | - M Delforge
- University Hospital Leuven, Leuven, Belgium
| | - S van Sanden
- EMEA HEMAR Analytics, Janssen EMEA, Beerse, Belgium
| | - M V Mateos
- Hospital Universitario de Salamanca, Salamanca, Spain
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19
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Ocio EM, Richardson PG, Rajkumar SV, Palumbo A, Mateos MV, Orlowski R, Kumar S, Usmani S, Roodman D, Niesvizky R, Einsele H, Anderson KC, Dimopoulos MA, Avet-Loiseau H, Mellqvist UH, Turesson I, Merlini G, Schots R, McCarthy P, Bergsagel L, Chim CS, Lahuerta JJ, Shah J, Reiman A, Mikhael J, Zweegman S, Lonial S, Comenzo R, Chng WJ, Moreau P, Sonneveld P, Ludwig H, Durie BGM, Miguel JFS. New drugs and novel mechanisms of action in multiple myeloma in 2013: a report from the International Myeloma Working Group (IMWG). Leukemia 2014; 28:525-42. [PMID: 24253022 PMCID: PMC4143389 DOI: 10.1038/leu.2013.350] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [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: 08/27/2013] [Revised: 10/23/2013] [Accepted: 11/07/2013] [Indexed: 01/08/2023]
Abstract
Treatment in medical oncology is gradually shifting from the use of nonspecific chemotherapeutic agents toward an era of novel targeted therapy in which drugs and their combinations target specific aspects of the biology of tumor cells. Multiple myeloma (MM) has become one of the best examples in this regard, reflected in the identification of new pathogenic mechanisms, together with the development of novel drugs that are being explored from the preclinical setting to the early phases of clinical development. We review the biological rationale for the use of the most important new agents for treating MM and summarize their clinical activity in an increasingly busy field. First, we discuss data from already approved and active agents (including second- and third-generation proteasome inhibitors (PIs), immunomodulatory agents and alkylators). Next, we focus on agents with novel mechanisms of action, such as monoclonal antibodies (MoAbs), cell cycle-specific drugs, deacetylase inhibitors, agents acting on the unfolded protein response, signaling transduction pathway inhibitors and kinase inhibitors. Among this plethora of new agents or mechanisms, some are specially promising: anti-CD38 MoAb, such as daratumumab, are the first antibodies with clinical activity as single agents in MM. Moreover, the kinesin spindle protein inhibitor Arry-520 is effective in monotherapy as well as in combination with dexamethasone in heavily pretreated patients. Immunotherapy against MM is also being explored, and probably the most attractive example of this approach is the combination of the anti-CS1 MoAb elotuzumab with lenalidomide and dexamethasone, which has produced exciting results in the relapsed/refractory setting.
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Affiliation(s)
- E M Ocio
- Department of Hematology, University Hospital and Cancer Research Center, University of Salamanca-IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain
| | - P G Richardson
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - S V Rajkumar
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Palumbo
- Department of Hematology, University of Torino, Torino, Italy
| | - M V Mateos
- Department of Hematology, University Hospital and Cancer Research Center, University of Salamanca-IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain
| | - R Orlowski
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - S Kumar
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Usmani
- M.I.R.T. UAMS, Little Rock, AR, USA
| | - D Roodman
- Director of Hematology/Oncology, Indiana University, Indianapolis, IN, USA
| | - R Niesvizky
- Department of Hematology, Weill Cornell Medical College, New York, NY, USA
| | - H Einsele
- Department of Internal Medicine, University of Wurzburg, Wurzburg, Germany
| | - K C Anderson
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M A Dimopoulos
- School of Medicine, University of Athens, Athens, Greece
| | - H Avet-Loiseau
- Department of Hematology, University of Toulouse, Toulouse, France
| | - U-H Mellqvist
- Department of Medicine, Section of Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I Turesson
- Department of Medicine, Section of Hematology, Skane University Hospital, Malmo, Sweden
| | - G Merlini
- Department of Molecular Medicine, Univeristy of Pavia, Pavia, Italy
| | - R Schots
- Department of Clinical Hematology and Stem Cell Laboratory, University Ziekenhuis, Brussels, Belgium
| | - P McCarthy
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - L Bergsagel
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - C S Chim
- Department of Hematology, Queen Mary Hospital, Hong Kong
| | - J J Lahuerta
- Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Shah
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - A Reiman
- Department of Oncology, University of New Brunswick, Saint John Regional Hospital, St John, NB, Canada
| | - J Mikhael
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - S Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Lonial
- Department of Hematology and Medical Oncology, Shanghai Chang Zheng Hospital, Atlanta, GA, USA
| | - R Comenzo
- Department of Hematology, Tufts Medical School, Boston, MA, USA
| | - W J Chng
- Department of Hematology Oncology, National University Cancer Institute, Singapore
| | - P Moreau
- Department of Hematology, University Hospital, Nantes, France
| | - P Sonneveld
- Department of Hematology, Erasmus MC, Rotterdam, The Netherlands
| | - H Ludwig
- Department of Medicine, Center for Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria
| | | | - J F S Miguel
- 1] Department of Hematology, University Hospital and Cancer Research Center, University of Salamanca-IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain [2] Department of Clinical and Translational Medicine, University of Navarra, Pamplona, Spain
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Dimopoulos MA, Leleu X, Palumbo A, Moreau P, Delforge M, Cavo M, Ludwig H, Morgan GJ, Davies FE, Sonneveld P, Schey SA, Zweegman S, Hansson M, Weisel K, Mateos MV, Facon T, Miguel JFS. Expert panel consensus statement on the optimal use of pomalidomide in relapsed and refractory multiple myeloma. Leukemia 2014; 28:1573-85. [PMID: 24496300 PMCID: PMC4131249 DOI: 10.1038/leu.2014.60] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/16/2014] [Accepted: 01/21/2014] [Indexed: 11/24/2022]
Abstract
In this report, a panel of European myeloma experts discuss the role of pomalidomide in the treatment of relapsed and refractory multiple myeloma (RRMM). Based on the available evidence, the combination of pomalidomide and low-dose dexamethasone is a well-tolerated and effective treatment option for patients with RRMM who have exhausted treatment with lenalidomide and bortezomib. The optimal starting dose of pomalidomide is 4 mg given on days 1–21 of each 28-day cycle, whereas dexamethasone is administered at a dose of 40 mg weekly (reduced to 20 mg for patients aged >75 years). The treatment should continue until evidence of disease progression or unacceptable toxicity. Dose-modification schemes have been established for patients who develop neutropenia, thrombocytopaenia and other grade 3–4 adverse events during pomalidomide therapy. Guidance on the prevention and management of infections and venous thromboembolism is provided, based on the available clinical evidence and the experience of panel members. The use of pomalidomide in special populations, such as patients with advanced age, renal impairment or unfavourable cytogenetic features, is also discussed.
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Affiliation(s)
| | - X Leleu
- Service des Maladies du Sang, Hôpital Huriez, CHRU Lille, Lille, France
| | - A Palumbo
- Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S Giovanni Battista, Turin, Italy
| | - P Moreau
- Service d'Hematologie, CHU, Nantes, France
| | - M Delforge
- University Hospital Leuven, Leuven, Belgium
| | - M Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - H Ludwig
- 1st Department of Internal Medicine, Center for Oncology and Hematology, Wilhelminenhospital, Vienna, Austria
| | - G J Morgan
- Institute of Cancer Research, Royal Marsden Hospital, London, UK
| | - F E Davies
- Institute of Cancer Research, Royal Marsden Hospital, London, UK
| | - P Sonneveld
- Department of Hematology, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - S A Schey
- Department of Haemato-oncology, King's College Hospital and King's College London, London, UK
| | - S Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - M Hansson
- Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden
| | - K Weisel
- University of Tuebingen, Tuebingen, Germany
| | - M V Mateos
- Hospital Universitario de Salamanca, CIC, IBMCC (USAL-CSIC), Salamanca, Spain
| | - T Facon
- Service des Maladies du Sang, Hôpital Huriez, CHRU Lille, Lille, France
| | - J F S Miguel
- Clinica Universidad de Navarra, Centro Investigaciones Medicas Aplicada (CIMA), Pamplona, Spain
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Puig N, Sarasquete ME, Balanzategui A, Martínez J, Paiva B, García H, Fumero S, Jiménez C, Alcoceba M, Chillón MC, Sebastián E, Marín L, Montalbán MA, Mateos MV, Oriol A, Palomera L, de la Rubia J, Vidriales MB, Bladé J, Lahuerta JJ, González M, Miguel JFS, García-Sanz R. Critical evaluation of ASO RQ-PCR for minimal residual disease evaluation in multiple myeloma. A comparative analysis with flow cytometry. Leukemia 2013; 28:391-7. [DOI: 10.1038/leu.2013.217] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/14/2013] [Accepted: 07/10/2013] [Indexed: 11/09/2022]
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Rodríguez Diez G, Uranga RM, Mateos MV, Giusto NM, Salvador GA. Differential participation of phospholipase A2 isoforms during iron-induced retinal toxicity. Implications for age-related macular degeneration. Neurochem Int 2012; 61:749-58. [PMID: 22732705 DOI: 10.1016/j.neuint.2012.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 06/06/2012] [Accepted: 06/14/2012] [Indexed: 01/01/2023]
Abstract
Both elevated iron concentrations and the resulting oxidative stress condition are common signs in retinas of patients with age-related macular degeneration (AMD). The role of phospholipase A(2) (PLA(2)) during iron-induced retinal toxicity was investigated. To this end, isolated retinas were exposed to increasing Fe(2+) concentrations (25, 200 or 800 μM) or to the vehicle, and lipid peroxidation levels, mitochondrial function, and the activities of cytosolic PLA(2) (cPLA(2)) and calcium-independent PLA(2) (iPLA(2)) were studied. Incubation with Fe(2+) led to a time- and concentration-dependent increase in retinal lipid peroxidation levels whereas retinal cell viability was only affected after 60 min of oxidative injury. A differential release of arachidonic acid (AA) and palmitic acid (PAL) catalyzed by cPLA(2) and iPLA(2) activities, respectively, was also observed in microsomal and cytosolic fractions obtained from retinas incubated with iron. AA release diminished as the association of cyclooxygenase-2 increased in microsomes from retinas exposed to iron. Retinal lipid peroxidation and cell viability were also analyzed in the presence of cPLA(2) inhibitor, arachidonoyl trifluoromethyl ketone (ATK), and in the presence of iPLA(2) inhibitor, bromoenol lactone (BEL). ATK decreased lipid peroxidation levels and also ERK1/2 activation without affecting cell viability. BEL showed the opposite effect on lipid peroxidation. Our results demonstrate that iPLA(2) and cPLA(2) are differentially regulated and that they selectively participate in retinal signaling in an experimental model resembling AMD.
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Affiliation(s)
- G Rodríguez Diez
- Instituto de Investigaciones Bioquímicas de Bahía Blanca, Universidad Nacional del Sur and Consejo Nacional de Investigaciones Científicas y Técnicas, 8000 Bahía Blanca, Argentina
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23
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López-Corral L, Sarasquete ME, Beà S, García-Sanz R, Mateos MV, Corchete LA, Sayagués JM, García EM, Bladé J, Oriol A, Hernández-García MT, Giraldo P, Hernández J, González M, Hernández-Rivas JM, San Miguel JF, Gutiérrez NC. SNP-based mapping arrays reveal high genomic complexity in monoclonal gammopathies, from MGUS to myeloma status. Leukemia 2012; 26:2521-9. [PMID: 22565645 DOI: 10.1038/leu.2012.128] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Genetic events mediating transformation from premalignant monoclonal gammopathies (MG) to multiple myeloma (MM) are unknown. To obtain a comprehensive genomic profile of MG from the early to late stages, we performed high-resolution analysis of purified plasma cells from 20 MGUS, 20 smoldering MM (SMM) and 34 MM by high-density 6.0 SNP array. A progressive increase in the incidence of copy number abnormalities (CNA) from MGUS to SMM and to MM (median 5, 7.5 and 12 per case, respectively) was observed (P=0.006). Gains on 1q, 3p, 6p, 9p, 11q, 19p, 19q and 21q along with 1p, 16q and 22q deletions were significantly less frequent in MGUS than in MM. Although 11q and 21q gains together with 16q and 22q deletions were apparently exclusive of MM status, we observed that these abnormalities were also present in minor subclones in MGUS. Overall, a total of 65 copy number-neutral LOH (CNN-LOH) were detected. Their frequency was higher in active MM than in the asymptomatic entities (P=0.047). A strong association between genetic lesions and fragile sites was also detected. In summary, our study shows an increasing genomic complexity from MGUS to MM and identifies new chromosomal regions involved in CNA and CNN-LOH.
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Affiliation(s)
- L López-Corral
- Servicio de Hematología del Hospital Universitario de Salamanca, IBMCC (USAL-CSIC) e IBSAL, Salamanca, Spain
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24
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Spicka I, Mateos MV, Redman K, Dimopoulos MA, Richardson PG. An overview of the VISTA trial: newly diagnosed, untreated patients with multiple myeloma ineligible for stem cell transplantation. Immunotherapy 2011; 3:1033-40. [DOI: 10.2217/imt.11.104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Multiple myeloma, a plasma cell neoplasm, is the second most common hematologic malignancy after non-Hodgkins lymphoma and is responsible for 2% of cancer deaths. Melphalan and prednisone (MP) has been the standard treatment in elderly patients for many decades. The VISTA study evaluated the effect of this combination with or without the first-in-class proteasome inhibitor bortezomib in newly diagnosed myeloma patients who were not candidates for autologous stem cell transplantation. Altogether 682 patients were enrolled and prospectively randomized in this trial. All patients received nine 6-week cycles of oral melphalan (9 mg/m2) and prednisone (60 mg/m2) on days 1–4, either alone or with bortezomib administered intravenously (1.3 mg/m2 on days 1, 4, 8, 11, 22, 25, 29 and 32 during the first four cycles and on days 1, 8, 22, 29 during remaining course of therapy). Median time to progression (the primary end point of the trial) was 24 months in the bortezomib-containing group compared with 16.6 months in the control group (p < 0.001). Response was evaluated in 337 patients receiving bortezomib compared with 331 patients in the control group who received MP alone; the percentages of partial response or better was 71 vs 35% (p < 0.001), with complete response seen in 30 vs 4%, respectively (p < 0.001). Median response duration in both groups was 19.9 versus 13.1 months, respectively. Median overall survival has not been reached in VMP group compared with 43 months in the MP group (p < 0.001), and this benefit is maintained after long term follow-up and subsequent antimyeloma therapies. Hematological adverse events (AEs) were similar in both groups, although patients in the bortezomib group experienced more frequent peripheral sensory neuropathy (including 13% grade 3, with less than 1% grade 4). Overall, the occurrence of grade 3 AEs was higher in patients receiving bortezomib (53 vs 44%, p = 0.02), but the risk of grade 4 AEs was identical (28 vs 27%). These results confirm the superiority of MP plus bortezomib combination over MP therapy in treatment-naive patients with newly diagnosed multiple myeloma who are ineligible for autologous stem cell transplantation.
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Affiliation(s)
- Ivan Spicka
- First Medical Department – Clinical Department of Haematology of the First Faculty of Medicine & General Teaching Hospital, Charles University in Prague, First Faculty of Medicine, U nemocnice 2, Prague 2, 128 08, Czech Republic
| | - MV Mateos
- Hospital Universitario de Salamanca, Salamanca, Spain
| | - K Redman
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - MA Dimopoulos
- School of Medicine, University of Athens, Athens, Greece
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25
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Mateos MV, Salvador GA, Giusto NM. Selective localization of phosphatidylcholine-derived signaling in detergent-resistant membranes from synaptic endings. Biochim Biophys Acta 2009; 1798:624-36. [PMID: 20026046 DOI: 10.1016/j.bbamem.2009.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 11/19/2009] [Accepted: 12/14/2009] [Indexed: 01/21/2023]
Abstract
Detergent-resistant membranes (DRMs) are a class of specialized microdomains that compartmentalize several signal transduction processes. In this work, DRMs were isolated from cerebral cortex synaptic endings (Syn) on the basis of their relative insolubility in cold Triton X-100 (1%). The lipid composition and marker protein content were analyzed in DRMs obtained from adult and aged animals. Both DRM preparations were enriched in Caveolin, Flotillin-1 and c-Src and also presented significantly higher sphingomyelin (SM) and cholesterol content than purified Syn. Total phospholipid-fatty acid composition presented an increase in 16:0 (35%), and a decrease in 20:4n-6 (67%) and 22:6n-3 (68%) content in DRM from adults when compared to entire synaptic endings. A more dramatic decrease was observed in the 20:4n-6 and 22:6n-3 content in DRMs from aged animals (80%) with respect to the results found in adults. The coexistence of phosphatidylcholine-specific-phospholipase C (PC-PLC) and phospholipase D (PLD) in Syn was previously reported. The presence of these signaling pathways was also investigated in DRMs isolated from adult and aged rats. Both PC-PLC and PLD pathways generate the lipid messenger diacylglycerol (DAG) by catalyzing PC hydrolysis. PC-PLC and PLD1 localization were increased in the DRM fraction. The increase in DAG generation (60%) in the presence of ethanol, confirmed that PC-PLC was also activated when compartmentalized in DRMs. Conversely, PLD2 was excluded from the DRM fraction. Our results show an age-related differential fatty acid composition and a selective localization of PC-derived signaling in synaptic DRMs obtained from adult and aged rats.
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Affiliation(s)
- M V Mateos
- Instituto de Investigaciones Bioquímicas de Bahía Blanca, Universidad Nacional del Sur and Consejo Nacional de Investigaciones Científicas y Técnicas, CC 857, B8000FWB Bahía Blanca, Argentina
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26
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Pérez-Simón JA, Caballero D, Mateos MV, San Miguel JF. Graft vs. Host Disease and Graft vs. Myeloma Effect after Non-myeloablative Allogeneic Transplantation. Leuk Lymphoma 2009; 45:1725-9. [PMID: 15223629 DOI: 10.1080/10428190410001667686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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
For many years progress in event free and overall survival in patients diagnosed with multiple myeloma have been modest, however recently newer therapeutic options have become available and, for a small but increasing subset of patients, an "operational cure" can be offered. Although autologous transplantation is associated with a prolongation in event free and overall survival as compared to conventional chemotherapy, there is no plateau in the survival curves. By contrast, the use of allogeneic hematopoietic stem cells provides a tumor-free stem cell source and graft-vs.-myeloma activity leading to a higher frequency of long term survivors in molecular remission. Unfortunately, allogeneic transplantation has been associated with high transplant-related mortality (TRM). Non-myeloablative or reduced intensity conditioning (RIC) regimens, designed to be immunosuppressive rather than myeloablative, in an effort to reduce the toxicity and TRM associated with high dose chemotherapy, but maintaining the GVM effect, have been developed showing up to 90% overall response rate and low TRM. Interestingly, in a significant proportion of patients disease response is preceded by GVHD, suggesting a clear relationship between GVHD and graft vs. myeloma effect. Nevertheless these patients are at risk of developing life threatening complications and, on the contrary, some patients who reach disease control after GVHD and respond to GVHD therapy may finally relapse. Thus, efforts to separate GVM and GVHD are still required in order to improve the outcome of myeloma patients receiving allogeneic transplantation.
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Affiliation(s)
- J A Pérez-Simón
- Servicio de Hematología, Hospital Clínico Universitario, Salamanca, Spain
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27
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Giralt S, Stadtmauer EA, Harousseau JL, Palumbo A, Bensinger W, Comenzo RL, Kumar S, Munshi NC, Dispenzieri A, Kyle R, Merlini G, San Miguel J, Ludwig H, Hajek R, Jagannath S, Blade J, Lonial S, Dimopoulos MA, Einsele H, Barlogie B, Anderson KC, Gertz M, Attal M, Tosi P, Sonneveld P, Boccadoro M, Morgan G, Sezer O, Mateos MV, Cavo M, Joshua D, Turesson I, Chen W, Shimizu K, Powles R, Richardson PG, Niesvizky R, Rajkumar SV, Durie BGM. International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100). Leukemia 2009; 23:1904-12. [PMID: 19554029 DOI: 10.1038/leu.2009.127] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multiple myeloma is the most common indication for high-dose chemotherapy with autologous stem cell support (ASCT) in North America today. Stem cell procurement for ASCT has most commonly been performed with stem cell mobilization using colony-stimulating factors with or without prior chemotherapy. The target CD34+ cell dose to be collected as well as the number of apheresis performed varies throughout the country, but a minimum of 2 million CD34+ cells/kg has been traditionally used for the support of one cycle of high-dose therapy. With the advent of plerixafor (AMD3100) (a novel stem cell mobilization agent), it is pertinent to review the current status of stem cell mobilization for myeloma as well as the role of autologous stem cell transplantation in this disease. On June 1, 2008, a panel of experts was convened by the International Myeloma Foundation to address issues regarding stem cell mobilization and autologous transplantation in myeloma in the context of new therapies. The panel was asked to discuss a variety of issues regarding stem cell collection and transplantation in myeloma especially with the arrival of plerixafor. Herein, is a summary of their deliberations and conclusions.
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Affiliation(s)
- S Giralt
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
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Rosiñol L, Cibeira MT, Martinez J, Mateos MV, Terol MJ, de la Rubia J, Palomera L, de Arriba F, Oriol A, Amor AA, Besalduch J, de Paz R, Garcia-Larana J, Diaz-Mediavilla J, Sureda A, Lahuerta JJ, San Miguel J, Bladé J. A160 Thalidomide/Dexamethasone (TD) Versus Bortezomib (Velcade)/Thalidomide/Dexamethasone (VTD) Versus VB. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1557-9190(11)70484-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mateos MV, Richardson PG, Schlag R, Khuageva N, Dimopoulos MA, Shpilberg O, Kropff M, Spicka I, Palumbo A, Schots R, Liu K, Cakana A, van de Velde H, Miguel JS. A172 Peripheral Neuropathy with VMP Resolves in the Majority of Patients and Shows a Rate Plateau. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1557-9190(11)70492-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Delforge M, Kropff M, Spicka I, Petrucci M, Richardson PG, Schlag R, Khuageva N, Dimopoulos MA, Shpilberg O, Samoilova O, Mateos MV, Liu K, Deraedt W, van de Velde H, San Miguel J. A246 VMP Results in Fewer Bone Events and Greater ALP Increases Versus MP in the VISTA Study in Front-Line MM. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1557-9190(11)70521-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mateos MV, Martín ML, Gonzalez Y, Lahuerta JJ, Bladé J, Oriol A, Martinez J, Cibeira MT, de Paz R, Terol MJ, Garcia J, Bengoechea E, Martinez R, Martin A, de Arriba F, Palomera L, Hernandez JM, Bello JL, Miguel JS. A154 Bortezomib (Velcade)/Melphalan/Prednisone (VMP) Versus Velcade/Thalidomide/Prednisone (VTP) in Elderly. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1557-9190(11)70481-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sezer O, Siegel D, San Miguel J, Mateos MV, Prosser I, Guenther A, Bladé J, Cavo M, Jalaluddin M, Hazell K, Bourquelot PM, Anderson KC. A337 Panobinostat and Bortezomib Phase I Trial in Multiple Myeloma. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1557-9190(11)70547-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mateo G, Montalbán MA, Vidriales MB, Lahuerta JJ, Mateos MV, Gutiérrez N, Rosiñol L, Montejano L, Bladé J, Martínez R, de la Rubia J, Diaz-Mediavilla J, Sureda A, Ribera JM, Ojanguren JM, de Arriba F, Palomera L, Terol MJ, Orfao A, San Miguel JF. Prognostic Value of Immunophenotyping in Multiple Myeloma: A Study by the PETHEMA/GEM Cooperative Study Groups on Patients Uniformly Treated With High-Dose Therapy. J Clin Oncol 2008; 26:2737-44. [DOI: 10.1200/jco.2007.15.4120] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To analyze the prognostic impact of immunophenotyping in patients with multiple myeloma (MM). Patients and Methods We have prospectively analyzed the prognostic impact of antigenic markers, assessed by multiparametric flow cytometry, in a series of 685 newly diagnosed MM patients that were uniformly treated according to the GEM 2000 protocol. Results Our results show that expression of both CD19 and CD28 as well as the absence of CD117 were associated with a significantly shorter progression free-survival (PFS) and overall survival (OS). Interestingly, the CD28 expression correlated with t(14;16) and del(17p), while CD117-negative patients were associated with t(4;14) and del(13q). Simultaneous assessment of CD28 and CD117 antigens allowed stratification of patients with MM into three risk categories: poor risk (CD28 positive CD117 negative), intermediate (either both markers negative or both positive), and good risk (CD28 negative CD117 positive), with PFS rates of 30, 37, and 45 months, respectively (P = .01), and OS rates of 45, 68, and not reached, respectively (P = .0001). Conclusion To the best of our knowledge, this is the first prospective analysis in which the prognostic impact of a relatively high number of antigenic markers has been simultaneously analyzed in a large series of uniformly treated patients, showing that the expression of several antigens (particularly CD28 and CD117) on bone marrow plasma cells from patients with MM can help to identify patients at high risk of progression.
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Affiliation(s)
- Gema Mateo
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - M. Angeles Montalbán
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Maria-Belén Vidriales
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Juan J. Lahuerta
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Maria V. Mateos
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Norma Gutiérrez
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Laura Rosiñol
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Laura Montejano
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Joan Bladé
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Rafael Martínez
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Javier de la Rubia
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Joaquín Diaz-Mediavilla
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Anna Sureda
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - José M. Ribera
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - José M. Ojanguren
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Felipe de Arriba
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Luis Palomera
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Maria J. Terol
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Alberto Orfao
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
| | - Jesús F. San Miguel
- From the Hospital Universitario de Salamanca; Centro de Investigación del Cáncer (CIC, IBMCC USAL-CSIC); Servicio General de Citometría, Universidad de Salamanca; Hospital 12 de Octubre; Clínico San Carlos, Madrid; Clínic Universitari Barcelona; Hospital Sant Pau Barcelona; Hospital La Fé; Clínico Universitario, Valencia; Hospital Germans Trias i Pujol Badalona; Hospital de Galdakao; Hospital Morales Messeguer, Murcia; and the Hospital Lozano Blesa, Zaragoza, Spain
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Gonzalez-Porras JR, Martin-Herrero F, Garcia-Sanz R, Lopez ML, Balanzategui A, Mateos MV, Pavon P, Gonzalez M, Alberca I, San Miguel JF. Hyperhomocysteinemia is a risk factor of recurrent coronary event in young patients irrespective to the MTHFR C677T polymorphism. Thromb Res 2007; 119:691-8. [PMID: 17005242 DOI: 10.1016/j.thromres.2006.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Revised: 05/29/2006] [Accepted: 06/06/2006] [Indexed: 10/24/2022]
Abstract
Despite the well-known pro-coagulant effect of hyperhomocysteinemia, data is limited regarding the result on recurrent coronary event (RCE) in young people. One hundred and forty patients <55 years old with a first acute coronary syndrome (ACS) were prospectively followed for a mean (+/-S.D.) follow-up of 49+/-14 months in order to investigate the relationship between homocysteine levels (tHcy) at admission and the incidence of RCE. The tHcy values were divided into quartiles to examine their relationship with end points. Furthermore, we determined the effect of C677T methylene tetrahydrofolate reductase (MTHFR) polymorphism, as well as other risk factors for developing a RCE. The median plasma homocysteine concentration was 9.6 mumol/L (interquartile range, 3.7). In the screening of MTHFR C677T polymorphism in patients with ACS, the T allele frequency was 0.4 and the genotype frequency distributions were in Hardy-Weinberg equilibrium. At time of final evaluation, 49 (35%) of the 140 valuable patients had developed a RCE. Increasing numbers of RCE were observed for increasing quartiles of tHcy according to Kaplan-Meier survival (Log-rank test=0.0092). The MTHFR C677T polymorphism was not associated with an increased incidence of RCE. In multivariate analysis, the variables independently associated with a higher risk of RCE were age older than 45 years [HR=2.7; (95% CI, 1.3-6.1); p=0.030], body mass index more than 25 [HR=2.6; (95% CI, 1.1-5.9); p=0.034] and tHcy levels into quartile 4 (tHcy>12.37 mumol/L) [HR=2.5; (95% CI, 1.1-4.7); p=0.04]. Elevated plasma homocysteine level at admission is an independent risk factor for RCE after the first episode of ACS in young patients irrespective of the status of MTHFR C677T.
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Affiliation(s)
- J R Gonzalez-Porras
- Department of Hematology, University Hospital of Salamanca, Paseo de San Vicente, 58-182, Salamanca, 37007, Spain.
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35
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Gutiérrez NC, Castellanos MV, Martín ML, Mateos MV, Hernández JM, Fernández M, Carrera D, Rosiñol L, Ribera JM, Ojanguren JM, Palomera L, Gardella S, Escoda L, Hernández-Boluda JC, Bello JL, de la Rubia J, Lahuerta JJ, San Miguel JF. Prognostic and biological implications of genetic abnormalities in multiple myeloma undergoing autologous stem cell transplantation: t(4;14) is the most relevant adverse prognostic factor, whereas RB deletion as a unique abnormality is not associated with adverse prognosis. Leukemia 2006; 21:143-50. [PMID: 17024116 DOI: 10.1038/sj.leu.2404413] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.1] [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: 11/09/2022]
Abstract
Fluorescence in situ hybridization (FISH) has become a powerful technique for prognostic assessment in multiple myeloma (MM). However, the existence of associations between cytogenetic abnormalities compels us to re-assess the value of each abnormality. A total of 260 patients with MM at the time of diagnosis, enrolled in the GEM-2000 Spanish transplant protocol, have been analyzed by FISH in order to ascertain the independent influence on myeloma prognosis of IGH translocations, as well as RB and P53 deletions. Survival analyses showed that patients with t(4;14), RB or P53 deletions had a significantly shorter survival than patients without these abnormalities. However, patients with RB deletions without other abnormalities in FISH analysis, displayed a similar outcome to those patients without genetic changes by FISH (46 vs 54 months, P=0.3). In the multivariate analysis the presence of t(4;14), RB deletion associated with other abnormalities, age >60 years, high proportion of S-phase cells and advanced stage of the disease according to the International Staging System retained their independent prognostic influence. In summary, RB deletion as a sole abnormality does not lead to a shortening in the survival of MM patients, whereas t(4;14) confers the worst prognosis in MM patients treated with high-dose chemotherapy.
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Affiliation(s)
- N C Gutiérrez
- Servicios de Hematología: Hospital Universitario de Salamanca and Centro de Investigación del Cáncer (CIC), Universidad de Salamanca-CSIC, Spain
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36
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García-Sanz R, Hernández JM, Sureda A, García-Laraña J, Prósper F, Alegre A, Bárez A, Mateos MV, San Miguel JF. Pegylated liposomal doxorubicin, melphalan and prednisone therapy for elderly patients with multiple myeloma. Hematol Oncol 2006; 24:205-11. [PMID: 17006969 DOI: 10.1002/hon.790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/09/2022]
Abstract
Melphalan & Prednisone (MP) is considered as the standard therapy for Multiple Myeloma (MM) patients not eligible for high-dose therapy. Here, we report the results of a phase I-II study to evaluate the feasibility and efficacy of the association of PLD to the conventional MP regimen during the first six cycles of the front-line therapy for untreated MM patients older than 70. Thirty patients were included in the study with a median age of 77 years (71-84) and a M/F ratio of 17/13. The phase I of the study demonstrated that the maximum tolerable dose of PLD in this setting was 30 mg/m(2), so it was the final dose evaluated in the study. Twenty-nine patients were valuable for response, which was: complete in 4 (14%) partial in 15 (52%) minor/no changes in 7 (24%) and progressive in 3 (10%). The median progression free survival (PFS) was 24 months. The median overall survival (OS) has not been reached yet, with a 3-year probability for OS and PFS of 52 and 37%, respectively. Haematological toxicity was frequent but usually weak/moderate (grades 1 & 2 of the WHO scale) and it was resolved only with dose delays. Infection was a relatively frequent event (30% of patients), but only in 4 cases it was of grade 3. No cases of palmar-plantar erythrodysesthesia were observed. In conclusion, pegylated liposomal doxorubicin can be safely added to the other chemotherapeutic drugs in the treatment of elderly MM patients, which can be very useful for patients in whom novel agents are not tolerated or inefficient.
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Affiliation(s)
- R García-Sanz
- University Hospital of Salamanca, Grupo Español de Mieloma, Red Española de Mieloma, Salamanca, Spain.
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Sureda A, Constans M, Iriondo A, Arranz R, Caballero MD, Vidal MJ, Petit J, López A, Lahuerta JJ, Carreras E, García-Conde J, García-Laraña J, Cabrera R, Jarque I, Carrera D, García-Ruiz JC, Pascual MJ, Rifón J, Moraleda JM, Pérez-Equiza K, Albó C, Díaz-Mediavilla J, Torres A, Torres P, Besalduch J, Marín J, Mateos MV, Fernández-Rañada JM, Sierra J, Conde E. Prognostic factors affecting long-term outcome after stem cell transplantation in Hodgkin's lymphoma autografted after a first relapse. Ann Oncol 2005; 16:625-33. [PMID: 15737986 DOI: 10.1093/annonc/mdi119] [Citation(s) in RCA: 165] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To analyse outcome and prognostic factors for overall survival (OS) and time to treatment failure (TTF) in 357 patients with Hodgkin's lymphoma (HL) undergoing an autologous stem cell transplantation (ASCT) after a first relapse and reported to the The Grupo Espanol de Linfomas/Trasplante Autologo de Medula Osea (GEL/TAMO) Cooperative Group. METHODS Two hundred and twenty males and 137 females with a median age of 29 years were autografted in second remission (n=181), first sensitive relapse (n=148) and first resistant relapse (n=28). RESULTS Five-year actuarial TTF and OS were of 49% +/- 3% and 57% +/- 3%. Advanced stage at diagnosis, complementary radiotherapy before ASCT, a short first complete response (CR) and detectable disease at ASCT adversely influenced TTF. Year of transplant < or =1995, bulky disease at diagnosis, a short first CR, detectable disease at ASCT and > or =1 extranodal areas involved at ASCT were adverse factors for OS. CONCLUSIONS ASCT constitutes a therapeutic option for HL patients after a first relapse. Promising results are observed in patients with low tumour burden at diagnosis, autografted after a long CR and without detectable disease at ASCT. Innovative approaches should be pursued for patients with risk factors at relapse.
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Affiliation(s)
- A Sureda
- Clinical Hematology Division, Hospital de la Santa Creu i Sant Pau, Antoni Maria i Claret, 167, 08025 Barcelona, Spain.
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Gómez-Núñez M, Martino R, Caballero MD, Pérez-Simón JA, Canals C, Mateos MV, Sarrá J, León A, Solano C, Moraleda JM, Urbano-Ispizua A, Besalduch J, Miguel JS, Sierra J. Elderly age and prior autologous transplantation have a deleterious effect on survival following allogeneic peripheral blood stem cell transplantation with reduced-intensity conditioning: results from the Spanish multicenter prospective trial. Bone Marrow Transplant 2004; 33:477-82. [PMID: 14730333 DOI: 10.1038/sj.bmt.1704379] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [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
Over a 3-year period, 145 patients ineligible for myeloablative conditioning underwent reduced-intensity conditioning (RIC) hematopoietic stem cell transplantation (SCT) from an HLA-identical sibling in a prospective study. The median age was 54 years, 88 patients were male and 61 patients were beyond the early-intermediate phase of their disease. The 100-day probability of developing grade II-IV acute graft-versus-host disease (GVHD) was 34%, and the 1-year probability of developing chronic extensive GVHD was 41%. The 1-year probabilities of transplant-related mortality (TRM), overall (OS) and progression-free survival were 20, 60 and 52%, respectively. Multivariate analyses found a better OS in: (i) patients <60 years; and (ii) recipients of a first SCT; and a higher TRM in: (i) age >60 years, (ii) recipients of a prior autologous SCT, and (iii) an ECOG performance status >1. The 1-year TRM in patients with 0 or 1 and >2 of the above-mentioned adverse prognostic factors were 17 vs 53%, respectively (P<0.001). In summary, our study shows that elderly patients have a higher TRM following an RIC protocol. However, age by itself should not preclude these RIC transplants, since TRM appears to be unacceptably high only in the presence of additional adverse factors.
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Affiliation(s)
- M Gómez-Núñez
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Martín A, Caballero MD, Pérez-Simón JA, López-Holgado N, Mateos MV, Cañizo MC, Miguel JFS. Results of autologous transplantation in lymphoma are not improved by increasing the dose of etoposide in the BEAM regimen: a single-centre sequential-cohort study. Bone Marrow Transplant 2004; 34:675-82. [PMID: 15334049 DOI: 10.1038/sj.bmt.1704595] [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: 11/08/2022]
Abstract
We have undertaken a retrospective sequential-cohort analysis of 131 lymphoma patients treated with the BEAM regimen and autologous stem cell transplantation, to compare BEAM at standard doses (sBEAM; n = 67 from May 1990 to April 1995) and BEAM with escalated etoposide dose from 800 to 1600 mg/m(2) (eBEAM; n = 64 from May 1995 to June 1999). Transplant-related mortality and incidence of secondary malignancies were similar in both groups. Disease progression was significantly lower in indolent lymphoma (IL) patients receiving eBEAM (7 vs 43%), although survival was comparable due to a higher toxic mortality in the eBEAM group. The 5-year event-free survival and overall survival were better in Hodgkin's disease (HD) patients treated with eBEAM (70 and 77%, respectively) compared to sBEAM (58 and 69%, respectively), but the difference was not statistically significant. In aggressive lymphomas, no difference was detected between groups. Our results indicate that while escalation of the etoposide doses in the BEAM conditioning regimen does not appear to improve outcome, encouraging results in IL and HD may warrant further studies.
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Affiliation(s)
- A Martín
- Servicio de Hematología, Hospital Clínico Universitario de Salamanca, Paseo de San Vicente 58-182, Salamanca, Spain
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Pérez-Simón JA, García-Escobar I, Martinez J, Vazquez L, Caballero D, Cañizo C, Mateos MV, San Miguel JF. Antibiotic prophylaxis with meropenem after allogeneic stem cell transplantation. Bone Marrow Transplant 2003; 33:183-7. [PMID: 14647255 DOI: 10.1038/sj.bmt.1704335] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the present study, we analyze the efficacy of prophylaxis with meropenem in patients receiving a matched related donor allogeneic transplant. In total, 38 patients were sequentially treated with meropenem starting on the day of the first febrile episode (n=17, group A) vs prophylactic meropenem starting on the first day with <500/mm(3) granulocytes (n=21, group B), and maintained until resolution of fever or after granulocyte count >500/mm(3). Of these, 16 (94%) patients in group A developed fever as compared to 16 (76%) in group B (P=0.02). While only one patient in group A did not require first-line antibiotherapy, there were seven (33%) in group B who did not require it (P=0.01) since fever lasted less than 72 h. In addition, 52% patients in group B did not require second-line antibiotics as compared to 11% among patients in group A (P=0.04). In multivariate analysis prophylaxis with meropenem (HR=2.83, 95% CI (1-8.02); P=0.04) and disease status at transplant (HR for early stage=0.15, 95% CI (0.04-0.62); P=0.04) significantly influenced the development of fever. In conclusion, the current pilot study suggests that the use of prophylaxis with meropenem during the period of neutropenia in patients undergoing allogeneic transplantation favorably affects the morbidity of the procedure by reducing febrile episodes.
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Affiliation(s)
- J A Pérez-Simón
- Servicio de Hematología, Hospital Universitario de Salamanca, Paseo de San Vicente, s.n 37007 Salamanca, Spain.
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del Cañizo MC, Martínez C, Conde E, Vallejo C, Brunet S, Sanz G, Mateos MV. Peripheral blood is safer than bone marrow as a source of hematopoietic progenitors in patients with myelodysplastic syndromes who receive an allogeneic transplantation. Results from the Spanish registry. Bone Marrow Transplant 2003; 32:987-92. [PMID: 14595386 DOI: 10.1038/sj.bmt.1704246] [Citation(s) in RCA: 23] [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: 11/09/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative therapy for patients with myelodysplastic syndromes (MDSs). We have analyzed the outcome of 81 patients who underwent an allogeneic transplant from an HLA-identical sibling donor. The overall survival (OS) was 31% and disease-free survival was 30% at 5.8 years. Transplant-related complications were the cause of death in 44% and disease progression in 16% of patients. Acute graft-versus-host disease (aGVHD) grades II-IV occurred in 32 cases (39%). Extensive chronic GVHD (cGVHD) was observed in 27% of patients. When the log-rank test was performed, we observed that patients transplanted more than 6 months after diagnosis, and those transplanted with bone marrow (BM) displayed a shorter survival (P=0.009 and 0.005, respectively). Patients who developed cGVHD showed a trend towards better OS (P=0.07). Patients receiving BM had a higher incidence of aGVHD (65 vs 50%) and less cGVHD (52 vs 30%), although the differences did not reach statistical significance. Moreover, patients who received PB-HSC displayed a faster engraftment (P=0.000) and showed a significantly lower early transplant-related mortality (14 vs 42%; P=0.006) and longer OS (P=0.005). In summary, our results show that hematopoietic transplantation should be performed as soon as possible in MDS patients and that PB is preferable to BM as a source of HSC.
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Affiliation(s)
- M C del Cañizo
- Servicio de Hematologia, Hospital Universitario de Salamanca, Po San Vicente 58-182, Salamanca 37007, Spain.
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Constans M, Sureda A, Terol MJ, Arranz R, Caballero MD, Iriondo A, Jarque I, Carreras E, Moraleda JM, Carrera D, León A, López A, Albó C, Díaz-Mediavilla J, Fernández-Abellán P, García-Ruiz JC, Hernández-Navarro F, Mataix R, Petit J, Pascual MJ, Rifón J, García-Conde J, Fernández-Rañada JM, Mateos MV, Sierra J, Conde E. Autologous stem cell transplantation for primary refractory Hodgkin's disease: results and clinical variables affecting outcome. Ann Oncol 2003; 14:745-51. [PMID: 12702529 DOI: 10.1093/annonc/mdg206] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [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: 11/12/2022] Open
Abstract
BACKGROUND Patients with primary refractory Hodgkin's disease (PR-HD) have a dismal prognosis when treated with conventional salvage chemotherapy. We analyzed time to treatment failure (TTF), overall survival (OS) and clinical variables influencing the outcome in patients undergoing autologous stem cell transplantation (ASCT) for PR-HD and reported to the Grupo Español de Linfomas/Trasplante Autólogo de Médula Osea (GEL/TAMO). PATIENTS AND METHODS Sixty-two patients, 41 males and 21 females with a median age of 27 years (range 13-55) were analyzed. Forty-two patients (68%) had advanced stage at diagnosis, 47 (76%) presented with B symptoms and 29 (47%) with a bulky mediastinal mass. Seventy-five percent of the patients had received more than one line of therapy before ASCT. Thirty-three patients received bone marrow as a source of hematopoietic progenitors, and 29 peripheral blood. Six patients were conditioned with high-dose chemotherapy plus total-body irradiation and 56 received chemotherapy-based protocols. RESULTS One-year transplantation-related mortality was 14% [95% confidence interval (CI) 6% to 23%]. Response rate at 3 months after ASCT was 52% [complete remission in 21 patients (34%), partial remission in 11 patients (18%)]. Actuarial 5-year TTF and OS were 15% (95% CI 5% to 24%) and 26% (95% CI 13% to 39%), respectively. The presence of B symptoms at ASCT was the only adverse prognostic factor significantly influencing TTF [relative risk (RR) 1.75, 95% CI 0.92-3.35, P = 0.08]. The presence of B symptoms at diagnosis (RR 2.08, 95% CI 0.90-4.79, P = 0.08), MOPP-like regimens as first-line therapy (RR 3.84, 95% CI 1.69-9.09, P = 0.001), bulky disease at ASCT (RR 2.79, 95% CI 0.29-6.03, P = 0.009) and two or more lines of therapy before ASCT (RR 2.24, 95% CI 0.95-5.27, P = 0.06) adversely influenced OS. CONCLUSIONS In our experience, although overall results of ASCT in PR-HD patients are poor, one-quarter of the patients remain alive at 5 years. Despite this, other therapeutic strategies should be investigated in this group of patients to improve the outcome.
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Affiliation(s)
- M Constans
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Valcárcel D, Martino R, Caballero D, Mateos MV, Pérez-Simón JA, Canals C, Fernández F, Bargay J, Muñiz-Díaz E, Gonzalez M, San Miguel JF, Sierra J. Chimerism analysis following allogeneic peripheral blood stem cell transplantation with reduced-intensity conditioning. Bone Marrow Transplant 2003; 31:387-92. [PMID: 12634730 DOI: 10.1038/sj.bmt.1703846] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We have performed a prospective study to evaluate early chimerism and its kinetics after allogeneic peripheral blood stem cell transplantation among 68 patients who received a reduced-intensity conditioning (RIC) regimen with fludarabine plus melphalan (n=40) or busulphan (n=28). Chimerism was analyzed by polymerase chain reaction amplification of short tandem repeats in unfractionated (UF) and/or fractionated nucleated cells from bone marrow and peripheral blood (PB). All of the patients showed initial donor engraftment and no patient presented primary or secondary graft failure. In UF samples, the probability of achieving stable complete donor chimerism (CDC) in PB within the first 6 months was 70% on day +30, 85% on day +100 and 95% on day +180. CDC in granulocytes was observed in nearly all cases from day +30 onwards. CDC in T cells, however, differed among melphalan and busulphan recipients during the first 3 months (100 vs 0% on day +30 and 93 vs 20% on day +90, respectively). In multivariate analysis, the only significant variable associated with the achievement of early CDC was having received more than two lines of chemotherapy pretransplant (P<0.02). No correlation was found between the rate of achieving early CDC and the occurrence of acute graft-versus-host disease (GVHD) or disease progression post-transplant. In multivariate analysis, the only variable that influenced the incidence of disease progression post-transplant was the development of chronic extensive GVHD (P<0.05). In conclusion, a state of CDC is readily obtained within the first 6 months after our RIC protocols. Donor myeloid engraftment occurs rapidly in all cases, while early T-cell CDC is more common in more immunosuppressed hosts and, perhaps, in melphalan recipients.
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Affiliation(s)
- D Valcárcel
- Division of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Menéndez P, Pérez-Simón JA, Mateos MV, Caballero MD, González M, San-Miguel JF, Orfao A. Influence of the different CD34+ and CD34- cell subsets infused on clinical outcome after non-myeloablative allogeneic peripheral blood transplantation from human leucocyte antigen-identical sibling donors. Br J Haematol 2002; 119:135-43. [PMID: 12358918 DOI: 10.1046/j.1365-2141.2002.03794.x] [Citation(s) in RCA: 25] [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: 11/20/2022]
Abstract
Currently, no information is available regarding the influence of the different CD34+ cell subsets infused on the haematopoietic recovery, following non-myeloablative allogeneic peripheral blood stem cell transplantation (allo-PBSCT). We have explored, in a group of 13 patients receiving non-myeloablative allo-PBSCT from human leucocyte antigen-identical sibling donors, the influence of the total dose of CD34+ haematopoietic progenitor cells (HPC) infused, compared with that of the different CD34+ HPC and CD34- leucocyte subsets in the leukapheresis samples, on both engraftment and clinical outcome. The overall numbers of total CD34+ HPC (P = 0.002) and myelomonocytic-committed CD34+ HPC infused (P = 0.0002) were strongly associated with neutrophil recovery (> 1 x 109 neutrophils/l), the latter being the only independent parameter influencing neutrophil recovery. Regarding long-term engraftment, only the number of immature CD34+ HPC infused/kg correlated with the duration of hospitalization in the first 2 years after discharge (r = -0.75, P = 0.005). Both the overall amount of CD34+ HPC and the number of myelomonocytic CD34+ HPC infused showed a significant influence on the risk of graft-versus-host disease (GVHD). Thus, the overall probability of GVHD was 100%vs 25% for patients receiving >/= 5 x 106 CD34+ HPC or >/= 3.5 x 106 of myelomonocytic-committed CD34+ HPC vs lower doses (P = 0.013). None of the other CD34+ and CD34- cell subsets analysed correlated with development of GVHD. In summary, our results suggest that in non-myeloablative allo-PBSCT, high numbers of CD34+ HPC, especially the myelomonocytic-committed CD34+ progenitors, lead to rapid neutrophil engraftment. However, they also strongly impair clinical outcome by increasing the incidence of GVHD.
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Affiliation(s)
- Pablo Menéndez
- Servicio General de Citometría, Departamento de Medicina and Centro de Investigaciones del Cáncer, Universidad de Salamanca, Spain
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Mateos MV, García-Sanz R, López-Pérez R, Moro MJ, Ocio E, Hernández J, Megido M, Caballero MD, Fernández-Calvo J, Bárez A, Almeida J, Orfão A, González M, San Miguel JF. Methylation is an inactivating mechanism of the p16 gene in multiple myeloma associated with high plasma cell proliferation and short survival. Br J Haematol 2002; 118:1034-40. [PMID: 12199782 DOI: 10.1046/j.1365-2141.2002.03749.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [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: 11/20/2022]
Abstract
In order to gain further insights into the role of the p16 gene in cell cycle regulation and the prognostic implications of its inactivation, we investigated the methylation status of the p16 gene in 98 untreated patients using a polymerase chain reaction assay based on the inability of some restriction enzymes to digest methylated sequences. Forty-one patients showed a p16 methylated gene (42%). The percentage of S-phase plasma cells (PC) in these patients was almost three times higher than in those with an unmethylated p16 gene (4.16% +/- 3.37%vs 1.5% +/- 1.41%, P < 0.001). The presence of p16 methylation also correlated with both elevated beta2-microglobulin serum levels and high C-reactive protein values. Patients with a p16 methylated gene had shorter overall and progression-free survival than those patients without p16 methylation. However, this feature did not retain independent prognostic influence on multivariate analysis, probably due to its association with the S-phase PC, which had more potent statistical significance in the Cox model. These findings showed methylation of the p16 gene was a frequent event inMM patients at diagnosis, and was associated with an increased proliferative rate of plasma cells and a poor prognosis, indicating an important role for p16 gene in the cell cycle regulation of multiple myeloma tumour cells, and thus in the clinical outcome of the disease.
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Affiliation(s)
- Maria V Mateos
- Servicio de Hematología, Hospital Universitario de Salamanca, Spain
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Menéndez P, Caballero MD, Prosper F, Del Cañizo MC, Pérez-Simón JA, Mateos MV, Nieto MJ, Corral M, Romero M, García-Conde J, Montalbán MA, San Miguel JF, Orfao A. The composition of leukapheresis products impacts on the hematopoietic recovery after autologous transplantation independently of the mobilization regimen. Transfusion 2002; 42:1159-72. [PMID: 12430673 DOI: 10.1046/j.1537-2995.2002.00190.x] [Citation(s) in RCA: 37] [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: 11/20/2022]
Abstract
BACKGROUND Effects of mobilization regimen on the composition of leukapheresis products (LPs) and on hematopoietic reconstitution after autologous peripheral blood progenitor cell transplantation (PBPCT) are not well known. STUDY DESIGN AND METHODS The effects of three different mobilization regimens--stem cell factor (SCF) plus granulocyte colony stimulating factor (G-CSF) plus cyclophosphamide (CCP), G-CSF alone, and G-CSF plus CCP--on the composition of LPs from patients with nonhematologic PBPC malignancies compared to LPs from G-CSF-mobilized healthy donors and normal marrow (BM) samples were analyzed. The impact of LP composition on both short- and long-term engraftment after autologous PBPCT was also evaluated. RESULTS The most effective regimen for mobilization of CD34+ hematopoietic progenitor cells (HPCs) into peripheral blood was SCF, G-CSF, and CCP, providing the highest numbers of all CD34+ HPCs subsets analyzed. Patients mobilized with SCF plus G-CSF plus CCP showed the highest numbers of neutrophils and monocytes, whereas the highest numbers of lymphocytes and NK cells were observed in LPs from G-CSF-mobilized patients. The overall number of CD34+ HPCs was the strongest factor for predicting recovery of platelets, whereas the number of myelomonocytic-committed CD34+ precursors was the most powerful independent prognostic factor for WBC and neutrophil recovery. The overall number of CD4+ T cells returned showed an independent prognostic value for predicting the occurrence of infections, during the first year after transplant. CONCLUSIONS The use of different mobilization regimens modifies the overall number of CD34+ HPCs obtained during leukapheresis procedures, and also affects both the absolute and the relative composition of the LPs in different CD34+ and CD34- cell subsets.
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Affiliation(s)
- Pablo Menéndez
- Department of Medicine, and the Cancer Investigation Center, University of Salamanca, Spain
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Pérez-Simón JA, Caballero D, Diez-Campelo M, Lopez-Pérez R, Mateos G, Cañizo C, Vazquez L, Vidriales B, Mateos MV, Gonzalez M, San Miguel JF. Chimerism and minimal residual disease monitoring after reduced intensity conditioning (RIC) allogeneic transplantation. Leukemia 2002; 16:1423-31. [PMID: 12145680 DOI: 10.1038/sj.leu.2402550] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2001] [Accepted: 10/22/2001] [Indexed: 11/09/2022]
Abstract
Since graft-versus-leukemia (GVL) is the main weapon for disease eradication after reduced intensity conditioning (RIC) allogeneic SCT, the availability of sensitive and specific techniques to monitor changes in tumor load after transplant are especially helpful. These minimal residual disease techniques would allow an early intervention in the event of low tumor burden, for which immunotherapy is highly effective. Some authors have found an association between persistence of MRD, mixed chimerism and risk of relapse. Nevertheless, data from the literature remain contradictory and further correlations should be established, especially in RIC transplants. In this study we have analyzed the impact of MRD and chimerism monitoring on the outcome of 34 patients undergoing RIC allogeneic SCT who were considered poor candidates for conventional transplantation due to advanced age or other concurrent medical conditions. At day +100 25 (75%) patients reached complete remission (CR), there were five (15%) partial responses and three patients progressed. Incidence of grade 2-4 aGVHD and extensive cGVHD were 35% and 58%, respectively. Sixteen percent of patients developing aGVHD relapsed as compared to 47% in those without aGVHD (P = 0.03) and also 10% of patients developing cGVHD relapsed as compared to 50% relapses in those without cGHVD (P = 0.03). Four patients (12%) died due to early (n = 1) and late (n = 3) transplant-related mortality. After a median follow-up of 15 months, 24 out of the 34 patients remain alive. Projected overall survival and disease-free survival at 3 years are 68% and 63%, respectively. Early chimerism analysis showed 67% of patients with complete chimerism (CC) in bone marrow (BM), 86% in peripheral blood (PB), 89% in granulocytes and 68% in T lymphocytes. On day +100, these figures were 68%, 79%, 90% and 73%, respectively, and on day +180 there were 83% patients with CC in BM, 100% in PB, 100% in granulocytes and 100% in T lymphocytes. We observed a trend to a higher incidence of relapse in patients with mixed chimerism (MC) as compared to patients with CC. MRD monitoring by flow cytometry and/or RT-PCR analysis was performed in 23 patients. MRD assessment on days +21 to +56 after transplant allowed identification of patients at risk of relapse. In this sense, seven out of 12 patients (58.3%) who had positive MRD on days +21 to +56 relapsed as compared to none out of 11 patients who had negative MRD (P = 0.002). Of the seven patients with criteria to monitor MRD who relapsed after transplant, all but one remained MRD positive until relapse. By contrast, 10 patients remained MRD negative and all of them are in continuous CR. In nine additional patients, persistence of MRD or mixed chimerism was observed after transplant and withdrawal of cyclosporin with or without DLI was performed. Only two out of these nine patients relapsed. MRD clearance was preceded by CC and GVHD. In conclusion, in our study we found that RIC allogeneic transplantation can be used in patients considered poor candidates for conventional transplantation due to advanced age or other concurrent medical conditions with both low toxicity and low transplant-related mortality. Simultaneous studies of both chimerism and MRD are a useful tool in order to predict risk of relapse in patients undergoing RIC transplants and so can be helpful for individualizing treatment strategies after transplant.
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Affiliation(s)
- J A Pérez-Simón
- Servicio de Hematología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
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González-Fraile MI, García-Sanz R, Mateos MV, Balanzategui A, González M, Váquez L, San Miguel JF. Methylenetetrahydrofolate reductase genotype does not play a role in multiple myeloma pathogenesis. Br J Haematol 2002; 117:890-2. [PMID: 12060127 DOI: 10.1046/j.1365-2141.2002.03502.x] [Citation(s) in RCA: 24] [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: 11/20/2022]
Abstract
Methylenetetrahydrofolate reductase (MTHFR) plays an important role in carcinogenesis. A decreased incidence of cancer has been reported in the presence of MTHFR 677TT, 1298AC and 1298CC polymorphic variants. We have analysed the MTHFR genotype in 107 multiple myeloma (MM) patients and 86 controls. The MM and control polymorphisms frequencies were: 34% and 48% for 677CC, 53% and 41% for 677CT, 12% and 11% for 677TT; 36% and 43% for 1298AA, 51% and 44% for 1298AC; and 12% and 13% for 1298CC respectively. No statistically significant differences were observed. In addition, no differences were seen according to MM stage, presence of p16 gene hypermethylation or response to treatment.
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Affiliation(s)
- Maria I González-Fraile
- Servicio de Hematología, Hospital Clínico Universitario de Salamanca, Centro de Investigación del Cáncer (CIC), Paseo de San Vicente 58-182, 37007 Salamanca, Spain
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Mateos MV, Garcia-Sanz R, López-Pérez R, Balanzategui A, González MI, Fernández-Calvo J, Moro MJ, Hernández J, Caballero MD, González M, San Miguel JF. p16/INK4a gene inactivation by hypermethylation is associated with aggressive variants of monoclonal gammopathies. Hematol J 2002; 2:146-9. [PMID: 11920239 DOI: 10.1038/sj.thj.6200084] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2000] [Accepted: 09/25/2000] [Indexed: 11/09/2022]
Abstract
INTRODUCTION A model of a stepwise malignant transformation has been proposed for the pathogenesis of monoclonal gammopathies. In this model, cell cycle regulators play a central role as a source of genetic events; particularly, p16/INK4a gene acts as a tumoral suppressor gene and, recently, inactivation of this gene through a methylation mechanism, has been observed in multiple myeloma patients. Under the diagnosis of monoclonal gammopathies there is a broad spectrum of disorders with very different outcomes, ranging from indolent courses, such as those of monoclonal gammopathy of undetermined significance, Waldeströn macroglobulinemia and smoldering multiple myeloma, to aggressive diseases such as symptomatic MM and primary plasma cell leukemia. To the best of our knowledge, the activity of p16 gene has not been evaluated and compared in these different subtypes of monoclonal gammopathies. MATERIALS AND METHODS The methylation status of the p16 gene was analysed in a group of 159 patients with monoclonal gammopathies (40 monoclonal gammopathy of uncertain significance, eight Waldenström Macroglobulinemia, eight smoldering multiple myeloma, 98 symptomatic multiple myeloma and five primary plasma cell leukemia) using three different assays (restriction enzymes and PCR or S-B and modification by sodium bisulphite). RESULTS Forty-one of 98 MM patients (41.8%) as well as four of the five (80%) primary PCL patients showed methylation of the p16 gene, while none of the patients with monoclonal gammopathy of undetermined significance, Waldenström Macroglobulinemia or smoldering multiple myeloma displayed a methylation status. CONCLUSION These findings suggest that the methylation of the p16 gene could be a relevant oncogenic event in the monoclonal gammopathies evolution being associated with the most aggressive forms.
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Affiliation(s)
- M V Mateos
- Hematology Service, University Hospital of Salamanca, Spain
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López-Pérez R, García-Sanz R, González D, Balanzategui A, Chillón MC, Alaejos I, Mateos MV, Caballero MD, Corral M, Orfão A, González M, San Miguel JF. Gene scanning of VDJH-amplified segments is a clinically relevant technique to detect contaminating tumor cells in the apheresis products of multiple myeloma patients undergoing autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 2001; 28:665-72. [PMID: 11704789 DOI: 10.1038/sj.bmt.1703219] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2001] [Accepted: 07/30/2001] [Indexed: 11/09/2022]
Abstract
Contaminating tumour cells in apheresis products have proved to influence the outcome of patients with multiple myeloma (MM) undergoing autologous stem cell transplantation (APBSCT). The gene scanning of clonally rearranged VDJ segments of the heavy chain immunoglobulin gene (VDJH) is a reproducible and easy to perform technique that can be optimised for clinical laboratories. We used it to analyse the aphereses of 27 MM patients undergoing APBSCT with clonally detectable VDJH segments, and 14 of them yielded monoclonal peaks in at least one apheresis product. The presence of positive results was not related to any pre-transplant characteristics, except the age at diagnosis (lower in patients with negative products, P = 0.04). Moreover, a better pre-transplant response trended to associate with a negative result (P = 0.069). Patients with clonally free products were more likely to obtain a better response to transplant (complete remission, 54% vs 28%; >90% reduction in the M-component, 93% vs 43% P = 0.028). In addition, patients transplanted with polyclonal products had longer progression-free survival, (39 vs 19 months, P = 0.037) and overall survival (81% vs 28% at 5 years, P = 0.045) than those transplanted with monoclonal apheresis. In summary, the gene scanning of apheresis products is a useful and clinically relevant technique in MM transplanted patients.
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Affiliation(s)
- R López-Pérez
- Haematology Service, University Hospital of Salamanca and Centre for Cancer Research of Salamanca, Paseo de San Vicente, 58-182, Salamanca, 37007, Spain
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