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Jelinek T, Zihala D, Sevcikova T, Anilkumar Sithara A, Kapustova V, Sahinbegovic H, Venglar O, Muronova L, Broskevicova L, Nenarokov S, Bilek D, Popkova T, Plonkova H, Vrana J, Zidlik V, Hurnik P, Havel M, Hrdinka M, Chyra Z, Stracquadanio G, Simicek M, Hajek R. Beyond the marrow: insights from comprehensive next-generation sequencing of extramedullary multiple myeloma tumors. Leukemia 2024:10.1038/s41375-024-02206-w. [PMID: 38493239 DOI: 10.1038/s41375-024-02206-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 03/18/2024]
Abstract
Extramedullary multiple myeloma (EMM) is an aggressive form of multiple myeloma (MM). This study represents the most comprehensive next-generation sequencing analysis of EMM tumors (N = 14) to date, uncovering key molecular features and describing the tumor microenvironment. We observed the co-occurrence of 1q21 gain/amplification and MAPK pathway mutations in 79% of EMM samples, suggesting that these are crucial mutational events in EMM development. We also demonstrated that patients with mutated KRAS and 1q21 gain/amplification at the time of diagnosis have a significantly higher risk of EMM development (HR = 2.4, p = 0.011) using data from a large CoMMpass dataset. We identified downregulation of CXCR4 and enhanced cell proliferation, along with reduced expression of therapeutic targets (CD38, SLAMF7, GPRC5D, FCRH5), potentially explaining diminished efficacy of immunotherapy. Conversely, we identified significantly upregulated EZH2 and CD70 as potential future therapeutic options. For the first time, we report on the tumor microenvironment of EMM, revealing CD8+ T cells and NK cells as predominant immune effector cells using single-cell sequencing. Finally, this is the first longitudinal study in EMM revealing the molecular changes from the time of diagnosis to EMM relapse.
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Affiliation(s)
- T Jelinek
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - D Zihala
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - T Sevcikova
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - A Anilkumar Sithara
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - V Kapustova
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - H Sahinbegovic
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - O Venglar
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - L Muronova
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - L Broskevicova
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - S Nenarokov
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - D Bilek
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - T Popkova
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - H Plonkova
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - J Vrana
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - V Zidlik
- Department of Pathology, University Hospital Ostrava, Ostrava, Czech Republic
| | - P Hurnik
- Department of Pathology, University Hospital Ostrava, Ostrava, Czech Republic
| | - M Havel
- Department of Nuclear Medicine, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Imaging Methods, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - M Hrdinka
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Z Chyra
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - G Stracquadanio
- School of Biological Sciences, The University of Edinburgh, Edinburgh, EH9 3BF, UK
| | - M Simicek
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - R Hajek
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic.
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Buske C, Dreyling M, Alvarez-Larrán A, Apperley J, Arcaini L, Besson C, Bullinger L, Corradini P, Giovanni Della Porta M, Dimopoulos M, D'Sa S, Eich HT, Foà R, Ghia P, da Silva MG, Gribben J, Hajek R, Harrison C, Heuser M, Kiesewetter B, Kiladjian JJ, Kröger N, Moreau P, Passweg JR, Peyvandi F, Rea D, Ribera JM, Robak T, San-Miguel JF, Santini V, Sanz G, Sonneveld P, von Lilienfeld-Toal M, Wendtner C, Pentheroudakis G, Passamonti F. Managing hematological cancer patients during the COVID-19 pandemic: an ESMO-EHA Interdisciplinary Expert Consensus. ESMO Open 2022; 7:100403. [PMID: 35272130 PMCID: PMC8795783 DOI: 10.1016/j.esmoop.2022.100403] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has created enormous challenges for the clinical management of patients with hematological malignancies (HMs), raising questions about the optimal care of this patient group. METHODS This consensus manuscript aims at discussing clinical evidence and providing expert advice on statements related to the management of HMs in the COVID-19 pandemic. For this purpose, an international consortium was established including a steering committee, which prepared six working packages addressing significant clinical questions from the COVID-19 diagnosis, treatment, and mitigation strategies to specific HMs management in the pandemic. During a virtual consensus meeting, including global experts and lead by the European Society for Medical Oncology and the European Hematology Association, statements were discussed and voted upon. When a consensus could not be reached, the panel revised statements to develop consensual clinical guidance. RESULTS AND CONCLUSION The expert panel agreed on 33 statements, reflecting a consensus, which will guide clinical decision making for patients with hematological neoplasms during the COVID-19 pandemic.
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Affiliation(s)
- C Buske
- Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany.
| | - M Dreyling
- Department of Medicine III at LMU Hospital, Munich, Germany
| | - A Alvarez-Larrán
- Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - J Apperley
- Centre for Haematology, Imperial College London, Hammersmith Hospital, London, UK
| | - L Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - C Besson
- Service d'Hématologie Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France; UVSQ, Inserm, CESP, Villejuif, France
| | - L Bullinger
- Department of Hematology, Oncology, and Tumorimmunology, Campus Virchow Klinikum, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - P Corradini
- Hematology Division, University of Milan, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - M Giovanni Della Porta
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - M Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - S D'Sa
- UCLH Centre for Waldenström and Neurohaematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - H T Eich
- Department of Radiation Oncology, University of Muenster, Münster, Germany
| | - R Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - P Ghia
- Strategic Research Program on Chronic Lymphocytic Leukemia and Laboratory of B Cell Neoplasia, Division of Molecular Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - M G da Silva
- Department Of Hematology, Portuguese Institute of Oncology, Lisbon, Portugal
| | - J Gribben
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - R Hajek
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - C Harrison
- Clinical Director - Haematology, Haemostasis, Palliative Care, Cellular Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hanover, Germany
| | - B Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - J J Kiladjian
- Université de Paris, APHP, Hôpital Saint-Louis, Centre d'Investigations Cliniques, Paris, France
| | - N Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - P Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | - J R Passweg
- Hematology Division, Basel University Hospital, Basel, Switzerland
| | - F Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - D Rea
- University Medical Department of Hematology and Immunology, France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Hôpital Saint-Louis, Paris, France
| | - J-M Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - T Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - J F San-Miguel
- Clínica Universidad de Navarra (CUN), Centro de Investigación Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), CIBERONC, Pamplona, Spain
| | - V Santini
- MDS Unit, Hematology, DMSC, AOUC, University of Florence, Florence, Italy
| | - G Sanz
- Hematology Department, Hospital Univesitario y Politecnico La Fe, Valencia; CIBERONC, IS Carlos III, Madrid, Spain
| | - P Sonneveld
- Erasmus MC Cancer Institute, Department of Haematology, Rotterdam, The Netherlands
| | - M von Lilienfeld-Toal
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - C Wendtner
- Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilian University, Munich, Germany
| | - G Pentheroudakis
- Scientific and Medical Division, European Society for Medical Oncology, Lugano, Switzerland
| | - F Passamonti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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Maiolino A, Hajek R, Jelinek T, Moreau P, Martin T, Pour L, Mikala G, Symeonidis A, Bringhen S, Rawlings A, Risse ML, Vande-Velde H, Spicka I. ISATUXIMAB PLUS CARFILZOMIB AND DEXAMETHASONE IN PATIENTS WITH RELAPSED MULTIPLE MYELOMA AND SOFT-TISSUE PLASMACYTOMAS: IKEMA SUBGROUP ANALYSIS. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Campioni M, Agirrezabal I, Hajek R, Minarik J, Pour L, Spicka I, Gonzalez-McQuire S, Jandova P, Maisnar V. Methodology and results of real-world cost-effectiveness of carfilzomib in combination with lenalidomide and dexamethasone in relapsed multiple myeloma using registry data. Eur J Health Econ 2020; 21:219-233. [PMID: 31673898 PMCID: PMC7072050 DOI: 10.1007/s10198-019-01122-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/08/2019] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To predict the real-world (RW) cost-effectiveness of carfilzomib in combination with lenalidomide and dexamethasone (KRd) versus lenalidomide and dexamethasone (Rd) in relapsed multiple myeloma (MM) patients after one to three prior therapies. METHODS A partitioned survival model that included three health states (progression-free, progressed disease and death) was built. Progression-free survival (PFS), overall survival (OS) and time to discontinuation (TTD) data for the Rd arm were derived using the Registry of Monoclonal Gammopathies in the Czech Republic; the relative treatment effects of KRd versus Rd were estimated from the phase 3, randomised, ASPIRE trial, and were used to predict PFS, OS and TTD for KRd. The model was developed from the payer perspective and included drug costs, administration costs, monitoring costs, palliative care costs and adverse-event related costs collected from Czech sources. RESULTS The base case incremental cost effectiveness ratio for KRd compared with Rd was €73,156 per quality-adjusted life year (QALY) gained. Patients on KRd incurred costs of €117,534 over their lifetime compared with €53,165 for patients on Rd. The QALYs gained were 2.63 and 1.75 for patients on KRd and Rd, respectively. CONCLUSIONS Combining the strengths of randomised controlled trials and observational databases in cost-effectiveness models can generate policy-relevant results to allow well-informed decision-making. The current model showed that KRd is likely to be cost-effective versus Rd in the RW and, therefore, the reimbursement of KRd represents an efficient allocation of resources within the healthcare system.
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Affiliation(s)
- M Campioni
- Economic Modeling Center of Excellence, Global Health Economics, Amgen (Europe) GmbH, Zug, Switzerland.
| | - I Agirrezabal
- Economic Modeling Center of Excellence, Global Health Economics, Amgen (Europe) GmbH, Zug, Switzerland
| | - R Hajek
- Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, 17. listopadu 1790, 708 52, Ostrava, Czech Republic
| | - J Minarik
- Department of Hemato-Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 185/6, 779 00, Olomouc, Czech Republic
| | - L Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine Masaryk Universit, Jihlavská 340/20, 625 00, Brno, Czech Republic
| | - I Spicka
- Department of Internal Medicine, Charles University in Prague, First Faculty of Medicine and General Teaching Hospital, Katerinska 32, 121 08, Prague, Czech Republic
| | | | | | - V Maisnar
- Department of Internal Medicine, Charles University in Prague, First Faculty of Medicine and General Teaching Hospital, Katerinska 32, 121 08, Prague, Czech Republic
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Stork M, Sevcikova S, Brozova L, Spicka I, Maisnar V, Minarik J, Jungova A, Gregora E, Velichova R, Hajek R, Jelinek T, Pour L. Bortezomib retreatment is effective in relapsed multiple myeloma patients - real-life clinical practice data. Neoplasma 2019; 67:178-184. [PMID: 31829027 DOI: 10.4149/neo_2019_190430n383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/26/2019] [Indexed: 11/08/2022]
Abstract
Nowadays, bortezomib, a proteasome inhibitor, is widely used in treatment of newly diagnosed or relapsed multiple myeloma. The aim of this study was to analyze efficiency of bortezomib retreatment in patients with relapsed or refractory multiple myeloma. From 2004 to 2016, 283 patients were retrospectively evaluated at all hematological centers in the Czech Republic. Bortezomib was administered at the standard dosing and in combined therapy with corticosteroids, chemotherapy or thalidomide. Before bortezomib retreatment, 61% of patients received previous lenalidomide treatment, 40.6% autologous transplantation, and median number of prior lines of therapy was three. In total, 21% of patients were refractory to the first bortezomib treatment. In bortezomib retreatment, overall response rate was 34.5%, median progression-free survival was 7.8 months (95% CI: 6.7-8.9), median duration of response was 10.5 months (95% CI: 8.0-13.0) and median overall survival was 20.3 months (95% CI: 17.9-22.7). Grade 3-4 adverse events included thrombocytopenia, neutropenia, anemia and infection. Neuropathy grade 2 or higher occurred in 19.4% of patients. We conclude that bortezomib retreatment is an effective and safe therapeutic alternative for relapsed or refractory multiple myeloma patients.
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Affiliation(s)
- M Stork
- Department of Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - S Sevcikova
- Babak Myeloma Group, Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - L Brozova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - I Spicka
- 1st Medical Department, Clinical Department of Hematology of the First Faculty of Medicine and General Teaching Hospital Charles University, Prague, Czech Republic
| | - V Maisnar
- 4th Department of Internal Medicine - Hematology, Faculty Hospital and Charles University in Hradec Kralove, Hradec Kralove, Czech Republic
| | - J Minarik
- Department of Hemato-Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - A Jungova
- Hematology and Oncology Department , Charles University Hospital Pilsen, Pilsen, Czech Republic
| | - E Gregora
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - R Velichova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - R Hajek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - T Jelinek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - L Pour
- Department of Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
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Maisnar V, Stefanikova Z, Spicka I, Pour L, Minarik J, Flochova E, Radocha J, Gregora E, Stecova N, Jelinek T, Jungova A, Kralikova E, Brozova L, Hajek R. Lenalidomide and dexamethasone in treatment of patients with relapsed and refractory multiple myeloma - analysis of data from the Czech Myeloma Group Registry of Monoclonal Gammopathies. Neoplasma 2019; 66:499-505. [PMID: 30784289 DOI: 10.4149/neo_2018_180824n644] [Citation(s) in RCA: 4] [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: 08/24/2018] [Accepted: 12/05/2018] [Indexed: 11/08/2022]
Abstract
Lenalidomide (LEN) is an immunomodulator with clinical activity against myeloma cells. Based on the pivotal phase 3 trials MM-009 and MM010, the combination of lenalidomide and dexamethasone(DEX) was approved for patients with multiple myeloma who received at least one prior therapy. Here, we evaluated LEN/DEX therapy in unselected population and subsequently in selected sub-groups of patients with relapsed/refractory multiple myeloma followed in the Registry of Monoclonal Gammopathies of the Czech Myeloma Group. Altogether 858 patients were treated with LEN/DEX in the Czech Republic and Slovakia until end of 2017. The analyzed sub-groups were defined as patients with high risk cytogenetic aberrations and patients with relapsed and refractory MM. The overall response rate (ORR; partial remission or better response, PR) in the whole group of patients was 46.3% for all lines of therapy, 26.4% for high-risk group and 32.1% for relapsed and refractory group. Medians of overall survival (OS) in the same cohorts were as follows: 25.6, 15.7 and 18.5 months, progression free survival (PFS) was: 11.2, 6.4 and 9.0 months respectively. The most common adverse events were hematologic and infectious. In conclusion we found that our results correlated with those found in other studies in terms of response rates, survival measures, and also of treatment toxicity.
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Affiliation(s)
- V Maisnar
- 4th Department of Medicine - Hematology, Faculty Hospital and Charles University, Hradec Kralove, Czech Republic
| | - Z Stefanikova
- Department of Clinical Hematology, University Hospital and Comenius University, Bratislava, Slovakia
| | - I Spicka
- 1st Department of Medicine - Clinical Department of Hematology, First Faculty of Medicine and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - L Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - J Minarik
- Department of Hemato-Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - E Flochova
- Department of Hematology and Transfusiology, University Hospital and Comenius University, Martin, Slovakia
| | - J Radocha
- 4th Department of Medicine - Hematology, Faculty Hospital and Charles University, Hradec Kralove, Czech Republic
| | - E Gregora
- Department of Internal Medicine and Hematology, 3rd Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - N Stecova
- Department of Hematology and Transfusiology, Luis Pasteur University Hospital, Kosice, Slovakia
| | - T Jelinek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - A Jungova
- Hematology and Oncology Department, Charles University Hospital Pilsen, Plzen, Czech Republic
| | - E Kralikova
- Department of Hematology and Transfusiology, F. D. Roosevelt Faculty Hospital, Banska Bystrica, Slovakia
| | - L Brozova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - R Hajek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
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Steiner N, Hajek R, Nachbaur D, Borjan B, Sevcikova S, Göbel G, Gunsilius E. Levels of CEACAM6 in Peripheral Blood Are Elevated in Patients with Plasma Cell Disorders: A Potential New Diagnostic Marker and a New Therapeutic Target? Dis Markers 2019; 2019:1806034. [PMID: 30809317 PMCID: PMC6369456 DOI: 10.1155/2019/1806034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/07/2018] [Accepted: 11/25/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The prognosis of multiple myeloma is still unfavorable due to inherent characteristics of the disease and the often-delayed diagnosis due to widespread and unspecific symptoms such as back pain and fatigue. Therefore, a simple diagnostic blood test would be helpful to speed up the diagnostic procedure in such patients (pts.). Here, we evaluated the diagnostic value of plasma levels of carcinoembryonic antigen-related cell adhesion molecule 6 (CEACAM6) in the peripheral blood and bone marrow of pts. with plasma cell disorders and in healthy controls. MATERIALS AND METHODS Immunoreactive CEACAM6 was determined in the peripheral blood and bone marrow (n = 95/100) of pts. with monoclonal gammopathy of unknown significance (MGUS: 28/37), newly diagnosed multiple myeloma (NDMM: 42/40), and relapsed/refractory multiple myeloma (RRMM: 25/23) by sandwich ELISA. RESULTS Median CEACAM6 levels in the peripheral blood of pts. with plasma cell disorders were significantly higher than those of healthy controls (healthy controls: 15.2 pg/ml (12.1-17.1); MGUS: 19.0 pg/ml (16.4-22.5); NDMM: 18.0 pg/ml (13.4-21.2); and RRMM: 18.9 pg/ml (15.2-21.5); p < 0.001). Plasma levels of CEACAM6 discriminated healthy subjects from MGUS/NDMM pts. (AUC = 0.71, 95% CI: 0.6-0.8); i.e., a CEACAM6 level > 17.3 pg/ml has an 82% (95% CI: 70-90) predictive probability for the identification of MGUS or NDMM. Moreover, CEACAM6 levels in the bone marrow were significantly higher in RRMM pts. than in NDMM pts. (p = 0.04), suggesting a role of this molecule in disease progression. CONCLUSION CEACAM6 plasma levels can noninvasively identify pts. with a plasma cell disorder and should be evaluated prospectively as a potential diagnostic marker. Moreover, due to high CEACAM6 levels in the bone marrow in RRMM pts., this adhesion molecule might be a therapeutic target in multiple myeloma pts.
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Affiliation(s)
- N. Steiner
- Laboratory for Tumor Biology & Angiogenesis, Department of Internal Medicine V (Hematology and Medical Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - R. Hajek
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - D. Nachbaur
- Department of Internal Medicine V (Hematology and Medical Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - B. Borjan
- Department of Internal Medicine V (Hematology and Medical Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - S. Sevcikova
- Babak Myeloma Group, Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - G. Göbel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - E. Gunsilius
- Laboratory for Tumor Biology & Angiogenesis, Department of Internal Medicine V (Hematology and Medical Oncology), Medical University of Innsbruck, Innsbruck, Austria
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8
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Ludwig H, Delforge M, Facon T, Einsele H, Gay F, Moreau P, Avet-Loiseau H, Boccadoro M, Hajek R, Mohty M, Cavo M, Dimopoulos MA, San-Miguel JF, Terpos E, Zweegman S, Garderet L, Mateos MV, Cook G, Leleu X, Goldschmidt H, Jackson G, Kaiser M, Weisel K, van de Donk NWCJ, Waage A, Beksac M, Mellqvist UH, Engelhardt M, Caers J, Driessen C, Sonneveld P. Prevention and management of adverse events of Novel agents in multiple myeloma: A consensus of the european myeloma network. Leukemia 2017:leu2017353. [PMID: 29251284 DOI: 10.1038/leu.2017.353] [Citation(s) in RCA: 9] [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: 10/10/2017] [Revised: 11/23/2017] [Accepted: 11/30/2017] [Indexed: 11/08/2022]
Abstract
During the last few years, several new drugs have been introduced for treatment of patients with multiple myeloma, which have significantly improved treatment outcome. All of these novel substances differ at least in part in their mode of action from similar drugs of the same drug class, or are representatives of new drugs classes, and as such present with very specific side effect profiles. In this review, we summarize these adverse events, provide information on their prevention, and give practical guidance for monitoring of patients and for management of adverse events.Leukemia accepted article preview online, 18 December 2017. doi:10.1038/leu.2017.353.
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Affiliation(s)
- H Ludwig
- Wilhelminen Cancer Research Institute, Vienna, Austria
| | - M Delforge
- Stem Cell Biology and Embryology Unit, Department of Development and Regeneration, Catholic University Leuven, Leuven, Belgium
| | - T Facon
- Department of Hematology, Lille University Hospital, Lille, France
| | - H Einsele
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - F Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - P Moreau
- Department of Hematology, University Hospital, University of Nantes, Nantes, France
| | - H Avet-Loiseau
- Centre de Recherches en Cancerologie de Toulouse CRCT, Institut National de la Sante et de la Recherche Medicale, Université Toulouse, Toulouse, France
| | - M Boccadoro
- Division of Hematology, Citta della Salute e della Scienza, University of Torino, Torino, Italy
| | - R Hajek
- Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - M Mohty
- Department of Haematology, Saint Antoine Hospital, University Pierre and Marie Curie, and INSERM UMRs 938, Paris, France
| | - M Cavo
- a 'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - J F San-Miguel
- Department of Hematology, Clinica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - S Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - L Garderet
- Department of Haematology, Saint Antoine Hospital, University Pierre and Marie Curie, and INSERM UMRs 938, Paris, France
| | - M-V Mateos
- Hospital Universitario de Salamanca, Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
| | - G Cook
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - X Leleu
- Service d'Hématologie et Thérapie Cellulaire, PRC, and Inserm CIC1402, Hospital de la Miléterie, Poitiers, France
| | - H Goldschmidt
- National Center for Tumor Diseases, Heidelberg Medical University, Heidelberg, Germany
| | - G Jackson
- Department of Hematology, Newcastle University, Newcastle, UK
| | - M Kaiser
- Myeloma Group, The Institute of Cancer Research ICR, London, UK
| | - K Weisel
- Department of Hematology and Oncology, University of Tuebingen, Tuebingen, Germany
| | - N W C J van de Donk
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - A Waage
- Department of Hematology, St Olavs Hospital, and IKOM, NTNU, Trondheim, Norway
| | - M Beksac
- Department of Medicine, Ankara University, Ankara, Turkey
| | - U H Mellqvist
- Department of Hematology Sahlgrenska Hospital, Gothenburg, Sweden
| | - M Engelhardt
- Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany
| | - J Caers
- Department of Hematology, University Hospital of Liège, Liège, Belgium
| | - C Driessen
- Department of Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - P Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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9
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Hari P, Mateos MV, Abonour R, Knop S, Bensinger W, Ludwig H, Song K, Hajek R, Moreau P, Siegel DS, Feng S, Obreja M, Aggarwal SK, Iskander K, Goldschmidt H. Efficacy and safety of carfilzomib regimens in multiple myeloma patients relapsing after autologous stem cell transplant: ASPIRE and ENDEAVOR outcomes. Leukemia 2017; 31:2630-2641. [PMID: 28439109 PMCID: PMC5729352 DOI: 10.1038/leu.2017.122] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/29/2016] [Revised: 03/09/2017] [Accepted: 04/03/2017] [Indexed: 01/12/2023]
Abstract
Autologous stem cell transplantation (ASCT) is a standard treatment for eligible multiple myeloma (MM) patients, but many patients will relapse after ASCT and require subsequent therapy. The proteasome inhibitor carfilzomib is approved for relapsed or refractory MM (RRMM). In phase 3 trials, carfilzomib-based regimens (ASPIRE, carfilzomib-lenalidomide-dexamethasone; ENDEAVOR, carfilzomib-dexamethasone) demonstrated superior progression-free survival (PFS) compared with standard therapies for RRMM (ASPIRE: lenalidomide-dexamethasone; ENDEAVOR, bortezomib-dexamethasone). This subgroup analysis of ASPIRE and ENDEAVOR evaluated outcomes according to prior ASCT status. In total, 446 patients in ASPIRE and 538 in ENDEAVOR had prior ASCT. Median PFS was longer for carfilzomib-based regimens vs non-carfilzomib-based regimens for patients with prior ASCT (ASPIRE: 26.3 vs 17.8 months (hazard ratio (HR)=0.68); ENDEAVOR: not estimable vs 10.2 months (HR=0.61)), those with one prior line of therapy that included ASCT (ASPIRE: 29.7 vs 17.8 months (HR=0.70); ENDEAVOR: not estimable vs 11.2 months (HR=0.46)), and those without prior ASCT (ASPIRE: 26.4 vs 16.6 months (HR=0.76); ENDEAVOR: 17.7 vs 8.5 months (HR=0.43)). Overall response rates also favored the carfilzomib-based regimens. No new safety signals were detected. This analysis suggests that carfilzomib-based treatment may lead to improvement in PFS and response rates regardless of prior transplant status. Further evaluation is warranted.
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Affiliation(s)
- P Hari
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - M-V Mateos
- Hematology, Hospital Clinico Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - R Abonour
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - S Knop
- Medizinische Klinik der Universitat Wurzburg, Wurzburg, Germany
| | - W Bensinger
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - H Ludwig
- Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver, British Columbia, Canada
| | - K Song
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - R Hajek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - P Moreau
- Department of Hematology, University of Nantes, Nantes, France
| | - D S Siegel
- John Theurer Cancer Center at Hackensack University, Hackensack, NJ, USA
| | - S Feng
- Amgen Inc., Thousand Oaks, CA, USA
| | - M Obreja
- Amgen Inc., Thousand Oaks, CA, USA
| | | | | | - H Goldschmidt
- Universitatsklinikum Heidelberg, Heidelberg, Germany
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10
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Jelinek T, Bezdekova R, Zatopkova M, Burgos L, Simicek M, Sevcikova T, Paiva B, Hajek R. Current applications of multiparameter flow cytometry in plasma cell disorders. Blood Cancer J 2017; 7:e617. [PMID: 29053157 PMCID: PMC5678219 DOI: 10.1038/bcj.2017.90] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 06/11/2017] [Revised: 07/30/2017] [Accepted: 08/07/2017] [Indexed: 12/12/2022] Open
Abstract
Multiparameter flow cytometry (MFC) has become standard in the management of patients with plasma cell (PC) dyscrasias, and could be considered mandatory in specific areas of routine clinical practice. It plays a significant role during the differential diagnostic work-up because of its fast and conclusive readout of PC clonality, and simultaneously provides prognostic information in most monoclonal gammopathies. Recent advances in the treatment and outcomes of multiple myeloma led to the implementation of new response criteria, including minimal residual disease (MRD) status as one of the most relevant clinical endpoints with the potential to act as surrogate for survival. Recent technical progress led to the development of next-generation flow (NGF) cytometry that represents a validated, highly sensitive, cost-effective and widely available technique for standardized MRD evaluation, which also could be used for the detection of circulating tumor cells. Here we review current applications of MFC and NGF in most PC disorders including the less frequent solitary plasmocytoma, light-chain amyloidosis or Waldenström macroglobulinemia.
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Affiliation(s)
- T Jelinek
- Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Faculty of Science, University of Ostrava, Ostrava, Czech Republic.,Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), IDISNA, Pamplona, Spain
| | - R Bezdekova
- Department of Clinical Haematology, University Hospital Brno, Brno, Czech Republic
| | - M Zatopkova
- Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - L Burgos
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), IDISNA, Pamplona, Spain
| | - M Simicek
- Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - T Sevcikova
- Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - B Paiva
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), IDISNA, Pamplona, Spain
| | - R Hajek
- Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Faculty of Science, University of Ostrava, Ostrava, Czech Republic
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11
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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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12
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Gay F, Oliva S, Petrucci MT, Montefusco V, Conticello C, Musto P, Catalano L, Evangelista A, Spada S, Campbell P, Ria R, Salvini M, Offidani M, Carella AM, Omedé P, Liberati AM, Troia R, Cafro AM, Malfitano A, Falcone AP, Caravita T, Patriarca F, Nagler A, Spencer A, Hajek R, Palumbo A, Boccadoro M. Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: a pooled analysis. Leukemia 2016; 31:1727-1734. [PMID: 28008174 DOI: 10.1038/leu.2016.381] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 12/22/2022]
Abstract
In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.
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Affiliation(s)
- F Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - S Oliva
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M T Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Roma, Roma, Italy
| | - V Montefusco
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - C Conticello
- Division of Hematology, Azienda Policlinico 'Vittorio Emanuele', University of Catania, Catania, Italy
| | - P Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Potenza, Italy
| | - L Catalano
- Hematology, Department of Clinical Medicine and Surgery, AOU Federico II, Napoli, Italy
| | - A Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - S Spada
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - P Campbell
- Haematology Department, Cancer Services, Barwon Health, Geelong, Australia
| | - R Ria
- Department of Biomedical Science, University of Bari 'Aldo Moro' Medical School, Internal Medicine 'G. Baccelli' Policlinico, Bari, Italy
| | - M Salvini
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Offidani
- Hematology Department, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - A M Carella
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Martino-Ist, Genova, Italy
| | - P Omedé
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Liberati
- Department of Oncohematology, AO S.Maria di Terni, Terni, Italy
| | - R Troia
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Cafro
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - A Malfitano
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A P Falcone
- Division of Hematology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - T Caravita
- UOC Ematologia S. Eugenio ASL RM2 Roma, Roma, Italy
| | - F Patriarca
- Department of Hematology, Azienda Ospedaliera-Universitaria di Udine, DISM, Università di Udine, Udine, Italy
| | - A Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Spencer
- Department of Clinical Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - R Hajek
- Blood Cancer Research Group, Department of Haematooncology, Faculty Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - A Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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13
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Jelinek T, Hajek R. PD-1/PD-L1 inhibitors in multiple myeloma: The present and the future. Oncoimmunology 2016; 5:e1254856. [PMID: 28123899 DOI: 10.1080/2162402x.2016.1254856] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/22/2016] [Accepted: 10/24/2016] [Indexed: 01/05/2023] Open
Abstract
The introduction of PD-1/PD-L1 pathway inhibitors has marked a significant milestone in the treatment of various types of solid tumors. The current situation in multiple myeloma (MM) is rather unclear, as distinct research groups have reported discordant results. This discrepancy dominantly concerns the expression of PD-1/PD-L1 molecules as well as the identification of the responsible immune effector cell population. The results of monotherapy with PD-1/PD-L1 inhibitors have been unsatisfactory in MM, suggesting that a combination approach is needed. The most logical partners are immunomodulatory agents as they possess many synergistic effects. We are also proposing other rational and promising combinations (e.g., daratumumab, ibrutinib, anti-CD137) that warrant further investigation.
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Affiliation(s)
- T Jelinek
- Faculty of Science, University of Ostrava, Czech Republic; Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Czech Republic; Centro de Investigacion Medica Aplicada (CIMA), Clinica Universidad de Navarra, IDISNA, Pamplona, Spain
| | - R Hajek
- Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava , Czech Republic
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14
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Jelinek T, Kryukova E, Kufova Z, Kryukov F, Hajek R. Proteasome inhibitors in AL amyloidosis: focus on mechanism of action and clinical activity. Hematol Oncol 2016; 35:408-419. [PMID: 27647123 DOI: 10.1002/hon.2351] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 11/11/2022]
Abstract
Proteasome inhibitors are the backbone in the treatment of multiple myeloma with 3 of its representatives (bortezomib, carfilzomib, and ixazomib) having already been approved. There is a different situation altogether in the treatment of amyloid light chain (AL) amyloidosis where owing to the rarity of this entity neither of these drugs has currently gained approval. Amyloid light chain plasma cells are possibly more vulnerable to bortezomib than myeloma plasmocytes because of a slightly distinct mechanism of action, which is described in depth in this manuscript. Bortezomib is highly active and rapidly effective as a single agent and even more potent in combination with dexamethasone and alkylators. Bortezomib-based regimens have become a standard part of the initial treatment of AL amyloidosis in the majority of centers. We have reviewed all available data on bortezomib in various combinations and settings. Carfilzomib seems to be effective but also toxic in these fragile patients with a high rate of cardiac events. Oral ixazomib has shown a surprisingly high efficacy with manageable toxicity and has received the Food and Drug Administration Breakthrough Therapy designation in 2014 for relapsed AL amyloidosis patients. In this review we have comprehensively described the current available knowledge of these 3 proteasome inhibitors and their use in AL amyloidosis.
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Affiliation(s)
- T Jelinek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - E Kryukova
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Z Kufova
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - F Kryukov
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - R Hajek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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15
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Jelinek T, Kufova Z, Hajek R. Immunomodulatory drugs in AL amyloidosis. Crit Rev Oncol Hematol 2016; 99:249-60. [PMID: 26806146 DOI: 10.1016/j.critrevonc.2016.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 11/20/2015] [Accepted: 01/12/2016] [Indexed: 01/20/2023] Open
Abstract
Immunoglobulin light chain amyloidosis (AL amyloidosis) is indeed a rare plasma cell disorder, yet the most common of the systemic amyloidoses. The choice of adequate treatment modality is complicated and depends dominantly on the risk stratification of these fragile patients. Immunomodulatory drugs (IMiDs) are currently used in newly diagnosed patients as well as in salvage therapy in relapsed/refractory patients. IMiDs have a pleiotropic effect on malignant cells and the exact mechanism of their action has been described recently. Thalidomide is the most ancient representative, effective but toxic. Lenalidomide seems to be more effective, nevertheless the toxicity remains high, especially in patients with renal insufficiency. Pomalidomide is the newest IMiD used in this indication with a good balance between efficacy and tolerable toxicity and represents the most promising compound. This review is focused on the evaluation of all three representatives of IMiDs and their roles in the treatment of this malignant disorder.
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Affiliation(s)
- T Jelinek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic; Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
| | - Z Kufova
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - R Hajek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic; Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
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16
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Sevčíková S, Kubiczková L, Sedlaříková L, Ríhová L, Kryukov F, Szturz P, Hajek R, Pour L, Adam Z. Impact of anakinra treatment on cytokine and lymphocytes/ monocytes profile of an Erdheim-Chester patient. Klin Onkol 2014; 27:276-82. [PMID: 25115717 DOI: 10.14735/amko2014276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Erdheim-Chester disease (ECD) is a rare non-Langerhans cells histiocytosis associated with intense immune activation. In our clinical center, an ECD patient was treated with anakinra, IL1RA (interleukin1 receptor antagonist), resulting in clinical improvement and major decrease of pathological fatigue. The aim of the study was to evaluate changes in cytokine profile and shift of immune cells estimated by flow cytometric analysis of ECD patient before, during initial stages of anakinra treatment as well as after treatment ceased in comparison to healthy donors. METHODS Singleplex reactions of 19 individual cytokines from serum of ECD patient were measured by FACS array. Flow cytometric analyses were performed on peripheral blood cells. RESULTS The most striking result is substantial decrease of IL6 immediately after anakinra treatment started suggesting a major role of IL1 pathway in ECD pathophysiology. As for flow cytometric analysis, increased number of CD16+ monocytes before treatment is a new finding. CONCLUSION Our results suggest that IL6 may be a marker of early treatment response of ECD patients treated with anakinra.
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Smetana J, Dementyeva E, Kryukov F, Nemec P, Greslikova H, Kupska R, Mikulasova A, Ihnatova I, Hajek R, Kuglik P. Incidence of cytogenetic aberrations in two B lineage subpopulations in multiple myeloma patients analyzed by combination of whole-genome profiling and FISH. Neoplasma 2014; 61:48-55. [PMID: 24195508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Multiple myeloma (MM) is an incurable malignant disease of the terminal developmental stage of B-lymphocytes. While genetic heterogeneity of MM is widely described, little is known about its genetic basis as well as primary damage during plasma cells (PC) development. In this study, we focused on genome-wide screening of DNA copy number changes using oligonucleotide-based array-CGH together with I-FISH of the IgH locus rearrangements in pair samples of bone marrow B-cells (CD19+) and CD138+ PC from newly diagnosed MM patients. The IgH disruption was found in 8.9% (4/45) of CD19+ samples and in 57.8% (26/45) of CD138+ samples. The genomic profiling using array-CGH identified copy number alterations (CNAs) in 10% (2/20) of CD19+ samples in regions known to be important for MM pathogenesis. In contrast, we found CNAs in 100% (16/16) of CD138+ samples. Most common chromosomal abnormalities were trisomies of odd-numbered chromosomes (3, 5, 7, 9, 11, 15, 19 and 21), gain 1q, gain Xq and monosomy of chromosome 13. We did not find any correlation between incidence of CNAs in CD19+ and CD138+ cells. In conclusion, effective utilization of FISH and array-CGH can identify genetic lesions in premalignant stages leading to better understanding and characterization of MM.
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Smetana J, Dementyeva E, Kryukov F, Nemec P, Greslikova H, Kupska R, Mikulasova A, Ihnatova I, Hajek R, Kuglik P. Incidence of cytogenetic aberrations in two B lineage subpopulations in multiple myeloma patients analyzed by combination of whole-genome profiling and FISH. Neoplasma 2014. [DOI: 10.4149/neo_2014_008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Ludwig H, Miguel JS, Dimopoulos MA, Palumbo A, Garcia Sanz R, Powles R, Lentzsch S, Ming Chen W, Hou J, Jurczyszyn A, Romeril K, Hajek R, Terpos E, Shimizu K, Joshua D, Hungria V, Rodriguez Morales A, Ben-Yehuda D, Sondergeld P, Zamagni E, Durie B. International Myeloma Working Group recommendations for global myeloma care. Leukemia 2013; 28:981-92. [DOI: 10.1038/leu.2013.293] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/17/2013] [Accepted: 09/23/2013] [Indexed: 12/31/2022]
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20
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Fernández de Larrea C, Kyle RA, Durie BGM, Ludwig H, Usmani S, Vesole DH, Hajek R, San Miguel JF, Sezer O, Sonneveld P, Kumar SK, Mahindra A, Comenzo R, Palumbo A, Mazumber A, Anderson KC, Richardson PG, Badros AZ, Caers J, Cavo M, LeLeu X, Dimopoulos MA, Chim CS, Schots R, Noeul A, Fantl D, Mellqvist UH, Landgren O, Chanan-Khan A, Moreau P, Fonseca R, Merlini G, Lahuerta JJ, Bladé J, Orlowski RZ, Shah JJ. Plasma cell leukemia: consensus statement on diagnostic requirements, response criteria and treatment recommendations by the International Myeloma Working Group. Leukemia 2012; 27:780-91. [PMID: 23288300 DOI: 10.1038/leu.2012.336] [Citation(s) in RCA: 229] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive variant of myeloma characterized by the presence of circulating plasma cells. It is classified as either primary PCL occurring at diagnosis or as secondary PCL in patients with relapsed/refractory myeloma. Primary PCL is a distinct clinic-pathological entity with different cytogenetic and molecular findings. The clinical course is aggressive with short remissions and survival duration. The diagnosis is based upon the percentage (≥ 20%) and absolute number (≥ 2 × 10(9)/l) of plasma cells in the peripheral blood. It is proposed that the thresholds for diagnosis be re-examined and consensus recommendations are made for diagnosis, as well as, response and progression criteria. Induction therapy needs to begin promptly and have high clinical activity leading to rapid disease control in an effort to minimize the risk of early death. Intensive chemotherapy regimens and bortezomib-based regimens are recommended followed by high-dose therapy with autologous stem cell transplantation if feasible. Allogeneic transplantation can be considered in younger patients. Prospective multicenter studies are required to provide revised definitions and better understanding of the pathogenesis of PCL.
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Affiliation(s)
- C Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain.
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21
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Avet-Loiseau H, Durie BGM, Cavo M, Attal M, Gutierrez N, Haessler J, Goldschmidt H, Hajek R, Lee JH, Sezer O, Barlogie B, Crowley J, Fonseca R, Testoni N, Ross F, Rajkumar SV, Sonneveld P, Lahuerta J, Moreau P, Morgan G. Combining fluorescent in situ hybridization data with ISS staging improves risk assessment in myeloma: an International Myeloma Working Group collaborative project. Leukemia 2012; 27:711-7. [PMID: 23032723 DOI: 10.1038/leu.2012.282] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The combination of serum β2-microglobulin and albumin levels has been shown to be highly prognostic in myeloma as the International Staging System (ISS). The aim of this study was to assess the independent contributions of ISS stage and cytogenetic abnormalities in predicting outcomes. A retrospective analysis of international studies looking at both ISS and cytogenetic abnormalities was performed in order to assess the potential role of combining ISS stage and cytogenetics to predict survival. This international effort used the International Myeloma Working Group database of 12 137 patients treated worldwide for myeloma at diagnosis, of whom 2309 had cytogenetic studies and 5387 had analyses by fluorescent in situ hybridization (iFISH). Comprehensive analyses used 2642 patients with sufficient iFISH data available. Using the comprehensive iFISH data, combining both t(4;14) and deletion (17p), along with ISS stage, significantly improved the prognostic assessment in terms of progression-free survival and overall survival. The additional impact of patient age and use of high-dose therapy was also demonstrated. In conclusion, the combination of iFISH data with ISS staging significantly improves risk assessment in myeloma.
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Affiliation(s)
- H Avet-Loiseau
- Unité de Génomique du Myélome, Laboratoire UGM, University Hospital, CHU Rangueil, Toulouse, France
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22
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Zahradova L, Mollova K, Ocadlikova D, Kovarova L, Adam Z, Krejci M, Pour L, Krivanova A, Sandecka V, Hajek R. Efficacy and safety of Id-protein-loaded dendritic cell vaccine in patients with multiple myeloma--phase II study results. Neoplasma 2012; 59:440-9. [PMID: 22489700 DOI: 10.4149/neo_2012_057] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED In a phase II clinical study, pretreated multiple myeloma patients with relapsing or stable disease received autologous anticancer vaccine containing dendritic cells loaded with Id-protein. Patients received a total of 6 vaccine doses intradermally in monthly intervals. No clinical responses were observed. During the follow-up with a median of 33.1 months (range: 11-43 months), the disease remained stable in 7/11 (64%) of patients. Immune responses measured by ELISpot were noted in 3/11 (27%) and DTH skin test for Id-protein was positive in 8/11 (73%) of patients; out of those, 1/11 (9%) and 5/11 (46%), respectively, had preexisting immune response to Id-protein before the vaccination began. Outcomes were compared to those of a control group of 13 patients. A trend to lower cumulative incidence of progression in the vaccinated group was observed at 12 months from the first vaccination (p= 0.099). More patients from the control group compared to vaccinated patients required active anticancer therapy [4/11 (36%) vs. 8/13 (62%)]. Vaccines based on dendritic cells loaded with Id-protein are safe and induce specific immune response in multiple myeloma patients. Our results suggest that the vaccination could stabilize the disease in approximately two-thirds of patients. KEYWORDS dendritic cells, immunotherapy, anticancer vaccines, Id-protein, multiple myeloma.
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Affiliation(s)
- L Zahradova
- Department of Internal Medicine-Hematooncology, University Hospital Brno and Masaryk University Brno, Jihlavska 20, 625 00, Brno, Czech Republic.
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23
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Simek M, Hajek R, Fluger I, Molitor M, Grulichova J, Langova K, Tobbia P, Nemec P, Zalesak B, Lonsky V. Superiority of topical negative pressure over closed irrigation therapy of deep sternal wound infection in cardiac surgery. J Cardiovasc Surg (Torino) 2012; 53:113-120. [PMID: 22231537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM We sought to compare clinical outcomes, in-hospital mortality and 1-year survival of two different treatment modalities of deep sternal wound infection, topical negative pressure and the closed irrigation therapy. METHODS Retrospective analysis of 66 consecutive patients treated for deep sternal infection at our institution. A total of 28 patients (February 2002 through September 2004) underwent primarily closed irrigation therapy, and 34 patients (November 2004 through December 2007) had the application of topical negative pressure. Four patients (July 2004 through December 2004) who underwent a combination of both strategies were excluded from the study. Clinical and wound care outcomes were compared, focusing on therapeutic failure rate, in-hospital stay and the 1-year mortality of both treatment strategies. RESULTS Topical negative pressure was associated with a significantly lower failure rate of the primary therapy (P<0.05), shortening of the intensive care unit stay (P<0.001), a particular decrease in the in-hospital stay (P<0.05) and the 1-year mortality (P<0.05) in comparison with closed irrigation therapy. Comparable overall length of the therapy, in-hospital stay and the risk of wire-related fistulas after chest reconstruction were found. CONCLUSION Topical negative pressure is a superior method of treatment for deep sternal wound infection, which is based on lower therapeutic failure rate, significant decrease in-hospital stay, and the decrease of the 1-year mortality rate, compared with primarily applied closed irrigation.
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Affiliation(s)
- M Simek
- Department of Cardiac Surgery, University Hospital and Palacky University, Faculty of Medicine, Olomouc, Czech Republic.
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Palumbo AP, Delforge M, Catalano J, Hajek R, Kropff M, Petrucci MT, Yu Z, Mei JM, Dimopoulos MA. Incidence of second primary malignancy (SPM) in melphalan-prednisone-lenalidomide combination followed by lenalidomide maintenance (MPR-R) in newly diagnosed multiple myeloma patients (pts) age 65 or older. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Maisnar V, Tichy M, Stulik J, Vavrova J, Friedecky B, Palicka V, Spirkova J, Zaloudkova L, Hernychova L, Spacilova J, Buchler T, Hajek R. The problems of proteinuria measurement in urine with presence of Bence Jones protein. Clin Biochem 2011; 44:403-5. [DOI: 10.1016/j.clinbiochem.2011.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 12/23/2010] [Accepted: 01/20/2011] [Indexed: 11/24/2022]
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Kessler P, Pour L, Gregora E, Zemanova M, Penka M, Brejcha M, Adam Z, Bacovsky J, Fenclova M, Frankova H, Hausdorf P, Walterova L, Heinzova V, Holikova M, Krejci M, Kubackova K, Langrova E, Maisnar V, Meluzinova I, Stavarova Y, Straub J, Scudla V, Gumulec J, Ullrychova J, Hajek R. Low molecular weight heparins for thromboprophylaxis during induction chemotherapy in patients with multiple myeloma. Klin Onkol 2011; 24:281-286. [PMID: 21905619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUNDS Patients with multiple myeloma have a high risk of venous thromboembolism (VTE), especially during the induction chemotherapy. The aim of our observational study was to determine the impact of prophylaxis with low molecular weight heparin (LMWH) on the incidence of thromboembolic complications. PATIENTS AND METHODS We analyzed the incidence of thromboembolic events in 258 patients treated with induction chemotherapy containing vincristin, doxorubicin or idarubicin, and dexamethasone, followed by stimulation chemotherapy with cyclophosphamide and G-CSF, and high-dose chemotherapy with melphalan. Two groups of these patients were compared based on the practice of thromboprophylaxis. Patients in the first group (Control, n = 140) were either not treated or treated with a short duration of anticoagulation therapy while the patients in the second group (Prophylactic, n = 118) underwent standard prophylaxis with LMWH throughout the entire period of induction chemotherapy. A total of 102 patients were selected for a close monitoring of the prophylactic effect of different LMWH doses and to be compared to patients without treatment. RESULTS Standard prophylaxis with LMWH significantly (p < 0.007) lowered a risk of VTE when compared to patients without such prophylaxis (3.4% versus 12.9%, respectively). Furthermore, analysis of the subgroup of 102 patients revealed that higher LMWH doses (> 70 IU/kg per day) achieved full prophylaxis in 28 patients while lower doses were less effective leading to DVT in 3 (7.7%) out of 39 patients. In contrast, VTE was diagnosed in 5 (14.3%) out of 35 patients without any LMWH prophylaxis. CONCLUSION Prophylaxis with LMWH leads to a significant reduction of the risk of thromboembolic complications during the induction chemotherapy in patients suffering from MM. The prophylactic effect of LMWH is dose-dependent.
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Affiliation(s)
- P Kessler
- Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Czech Republic
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27
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Legartova S, Harnicarova-Horakova A, Bartova E, Hajek R, Pour L, Kozubek S. Expression of RAN, ZHX-2, and CHC1L genes in multiple myeloma patients and in myeloma cell lines treated with HDAC and Dnmts inhibitors. Neoplasma 2010; 57:482-7. [PMID: 20568903 DOI: 10.4149/neo_2010_05_482] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Real time PCR is a powerful tool for studying the expression of genes involved in the pathophysiology of human diseases. Recent studies of the RAN (6p21), ZHX-2 (8q24.3), CHC1L (13q14.3) loci highlight the importance of these genes in multiple myeloma (MM) prognosis and therapeutic applications. Here, we described a detailed Real-Time PCR method for the detection of RAN, ZHX-2, and CHC1L expression, which could be applied in clinical situations. The expression profiles of these genes were studied in peripheral blood lymphocytes of healthy individuals, patients suffering from MM, and in the myeloma cell line, MOLP-8. Low expression levels of RAN, ZHX-2, and CHC1L were observed in myeloma patients, compared with peripheral blood lymphocytes and MOLP-8 cells. An inhibitor of histone deacetylases (TSA) had the ability to decrease expression of CHC1L and ZHX-2 in MOLP-8 cells, while expression of RAN was relatively stable in peripheral blood lymphocytes, control MOLP-8, and TSA- or 5-azacytidine treated MOLP-8 cells. In myeloma patients, we observed significant decreases in the expression of selected genes, but it was patient-specific. Our experiments illustrate new methodological approaches and troubleshooting for conducting gene expression studies in clinical laboratories.
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Affiliation(s)
- S Legartova
- Institute of Biophysics, Academy of Sciences of the Czech Republic, Brno, Czech Republic
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Ocadlikova D, Kryukov F, Mollova K, Kovarova L, Buresdova I, Matejkova E, Penka M, Buchler T, Hajek R, Michalek J. Generation of myeloma-specific T cells using dendritic cells loaded with MUC1- and hTERT- drived nonapeptides or myeloma cell apoptotic bodies. Neoplasma 2010; 57:455-64. [PMID: 20568900 DOI: 10.4149/neo_2010_05_455] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dendritic cells are able to induce anti-tumor immune responses by presenting tumor-specific antigens to T-lymphocytes. Various tumor-associated antigens have been studied in multiple myeloma in an effort to find a strong antigen capable of generating clinically meaningful responses in vaccinated patients. The aim of our study was to generate myeloma-specific cytotoxic T lymphocytes in vitro using dendritic cells loaded with peptide antigens or apoptotic bodies. Peripheral blood mononuclear cells from HLA-A2+ healthy donors were used for isolation and culture of dendritic cells (DCs) and T lymphocytes. DCs were loaded with hTERT- and MUC1-derived nonapeptides or apoptotic bodies from myeloma cells. Repeated stimulation of T lymphocytes led to their activation characterized by interferon-gamma production. Activated T lymphocytes were separated immunomagnetically and expanded in vitro. Specific cytotoxicity of the expanded T lymphocytes was tested against a myeloma cell line. There was evidence of cytotoxicity for all three types of antigens used for T lymphocyte priming and expansion. No statistically significant differences were observed in T lymphocyte cytotoxicity for any of the antigens. We present a method for the priming and expansion of myeloma-specific T lymphocytes using dendritic cells loaded with different types of tumor antigens. Cytotoxic T lymphocytes and/or activated dendritic cells generated by the described methods can be applied for cellular immunotherapy against multiple myeloma and other malignancies.
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Affiliation(s)
- D Ocadlikova
- University Cell Immunotherapy Center, Masaryk University, Brno, Czech Republic
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29
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Cumova J, Kovarova L, Potacova A, Buresova I, Kryukov F, Penka M, Michalek J, Hajek R. Optimization of immunomagnetic selection of myeloma cells from bone marrow using magnetic activated cell sorting. Int J Hematol 2010; 92:314-9. [DOI: 10.1007/s12185-010-0651-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 06/07/2010] [Accepted: 07/14/2010] [Indexed: 11/28/2022]
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Greslikova H, Zaoralova R, Filkova H, Nemec P, Oltova A, Kupska R, Rudolecka P, Smetana J, Pour L, Zahradova L, Krejci M, Buchler T, Adam Z, Hajek R, Kuglik P. Negative prognostic significance of two or more cytogenetic abnormalities in multiple myeloma patients treated with autologous stem cell transplantation. Neoplasma 2010; 57:111-7. [PMID: 20099973 DOI: 10.4149/neo_2010_02_111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Malignant plasma cells in multiple myeloma (MM) are frequently characterized by complex karyotypes and chromosome instability. These cytogenetic changes are considered important prognostic indicators in MM patients. We have studied samples from 68 patients with newly diagnosed MM who were treated with high-dose chemotherapy and autologous stem cell transplantation. G-banding revealed abnormal karyotypes in 14 of 55 patients (25%) who had informative conventional cytogenetics. The combination of cytoplasmic immunoglobulin light chain labeling and interphase fluorescent in situ hybridization (cIg-FISH) revealed the presence of genetic aberrations in 53 of 68 patients (78%). Chromosome 13 abnormalities were found in 33 patients (50%) and IgH rearrangements in 36 patients (56.25%). In IgH positive patients we performed subsequent examinations of IgH affecting translocations t(4;14) and t(11;14) and we found translocation t(11;14) in 8 patients (12.5%) and t(4;14) in 10 patients (15.5%). The occurrences of others chromosomal abnormalities with known prognostic impact in MM were as follows: del(17)(p13) was present in 5 patients (9.8%) and gain 1q21 in 14 patients (36%). Analysis of survival of patients with different cytogenetic abnormalities revealed shorter overall survival (OS) in patients with IgH rearrangements (p=0.020) and trend to shorter OS in patients with gain 1q21 (p=0.064), respectively. Remarkably, patients with two or more aberrations had significantly shorter overall survival (p=0.001), time to progression (p=0.036) and progression free survival (p=0.008). Our results show a high incidence of chromosomal abnormalities in MM patients and confirm the prognostic impact of selected chromosomal aberrations as well as cumulative effect of multiple cytogenetic changes occurring simultaneously.
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Affiliation(s)
- H Greslikova
- University Research Centre - Czech Myeloma Group, Masaryk University, Brno, Czech Republic.
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31
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Pour L, Svachova H, Adam Z, Mikulkova Z, Buresova L, Kovarova L, Buchler T, Penka M, Vorlicek J, Hajek R. Pretreatment hepatocyte growth factor and thrombospondin-1 levels predict response to high-dose chemotherapy for multiple myeloma. Neoplasma 2010; 57:29-34. [PMID: 19895169 DOI: 10.4149/neo_2010_01_029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED Our aim was to establish whether the pretreatment levels of angiogenesis activators and inhibitors can be used to predict clinical responses to treatment that included high-dose chemotherapy with peripheral stem cell support.<br />We analyzed samples and treatment outcomes of 96 patients with MM enrolled in the CMG 2002 randomized clinical trial and treated with induction chemotherapy and high-dose chemotherapy with stem cell support. Concentrations of vascular endothelial growth factor (VEGF), hepatocytar growth factor (HGF), basic fibroblastic growth factor (bFGF), thrombospondin-1 (TSP-1), endostatin, and angiostatin were measured in the peripheral blood plasma and in the bone marrow plasma at diagnosis. <br />Pretreatment HGF concentrations in the peripheral blood plasma as well as in the bone marrow plasma of patients who achieved complete or very good partial response were significantly lower than those in patients who had partial or worse response. Patients with complete or very good partial response had higher TSP-1 levels in the bone marrow plasma than the partial or insufficient response subgroups. There were no correlations between the pretreatment levels of VEGF, bFGF, endostatin, or angiostatin and the treatment response. <br />Pretreatment concentrations of HGF and TSP-1 were predictive factors for treatment response. Patients with low angiogenesis rate as determined by the relative HGF and TSP-1 concentrations were more likely to achieve complete or very good partial response after high-dose chemotherapy. KEYWORDS Angiogenesis, cytokines, high-dose chemotherapy, multiple myeloma, therapeutic response.
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Affiliation(s)
- L Pour
- Department of Internal Medicine-Hematooncology, University Hospital Brno, Masaryk University Brno Czech Republic.
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Jagannath S, Siegel DS, Hajek R, Dimopoulos MA, Yoon S, Lonial S, Graef T, Lupinacci L, Reiser D, Anderson KC. Update on vantage program to assess combined vorinostat (V) and bortezomib (B) in patients (pts) with relapsed and/or refractory (RR) multiple myeloma (MM). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8133] [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: 11/20/2022] Open
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33
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Dementyeva E, Nemec P, Kryukov F, Muthu Raja KR, Smetana J, Zaoralova R, Greslikova H, Kupska R, Kuglik P, Hajek R. Centrosome amplification as a possible marker of mitotic disruptions and cellular carcinogenesis in multiple myeloma. Leuk Res 2010; 34:1007-11. [PMID: 20096458 DOI: 10.1016/j.leukres.2009.12.018] [Citation(s) in RCA: 11] [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: 10/04/2009] [Revised: 12/21/2009] [Accepted: 12/22/2009] [Indexed: 11/16/2022]
Abstract
Centrosome amplification (CA) as a potential marker of mitotic disruptions in multiple myeloma (MM) was investigated in two populations of B-cell lineage: B-cells and plasma cells (PCs). Using immunofluorescent staining, it was shown that CA in B-cells is present in 3.2+/-2.5% in healthy donors versus 9.9+/-7.9% in MM patients (p<0.0001). Based on the calculated threshold value of CA in B-cells, 37% (14/38) of MM patients were positive. There was no significant correlation between CA-positive MM cases (based on PC samples evaluation) and the occurrence of cytogenetic abnormalities in PCs, including del(13)(q14), del(17)(p13), gain(1)(q21) and hyperdiploidy.
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Affiliation(s)
- E Dementyeva
- University Research Centre, Czech Myeloma Group, Babak Research Institute, Masaryk University, Brno, Czech Republic
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Hajek R, Ruzickova J, Slavik L, Krcova V, Simek M, Fluger I. Endothelial protein C receptor expression after cardiopulmonary bypass in adult cardiac surgical patients. Crit Care 2010. [PMCID: PMC2934515 DOI: 10.1186/cc8367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kovarova L, Buresova I, Buchler T, Suska R, Pour L, Zahradova L, Penka M, Hajek R. Phenotype of plasma cells in multiple myeloma and monoclonal gammopathy of undetermined significance. Neoplasma 2009; 56:526-32. [PMID: 19728762 DOI: 10.4149/neo_2009_06_526] [Citation(s) in RCA: 12] [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] [Indexed: 11/08/2022]
Abstract
Flow cytometry is a useful tool for the analysis of plasma cells in monoclonal gammopathies. The aim of this study was to find possibilities and limits of multicolour flow cytometry in diagnostics of monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) and to identify parameters that could be used to differentiate between these two disorders. Surface markers CD38 and CD138 were used for identification of plasma cells, CD19 and CD56 further distinguished normal and abnormal plasma cells, respectively. The percentage of circulating plasma cells in peripheral blood was lower in MGUS patients then in MM (p<0,001) In bone marrow, the percentage of residual polyclonal CD19 plasma cell was higher (p<0,001) and the percentage of malignant monoclonal CD56 plasma cell was lower (p<0,001) in MGUS than in MM. In conclusion, flow cytometry is relatively quick and effective method for analysis of plasma cells thus immunophenotyping can significantly contribute to the differential diagnosis of plasma cell proliferations.
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Affiliation(s)
- L Kovarova
- Dept. of Clinical Heamatology, University Hospital, Czech Republic.
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Legartova S, Krejci J, Harnicarova A, Hajek R, Kozubek S, Bartova E. Nuclear topography of the 1q21 genomic region and Mcl-1 protein levels associated with pathophysiology of multiple myeloma. Neoplasma 2009; 56:404-13. [PMID: 19580342 DOI: 10.4149/neo_2009_05_404] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chromosomal rearrangements and copy number variation are frequently observed in cancer cells, including multiple myeloma (MM). Karyotypic abnormalities seen in MM cells correlate with the disease stage and drug responses. Here, we investigate the nuclear arrangement of the 1q21 region; amplification of this region is an important diagnostic and prognostic marker of MM. We examined the lymphoblastoid cell line CD138- ARH-77, multiple myeloma CD138+ MOLP-8 cells, and the CD138+ bone marrow fraction of patients diagnosed with MM. In this experimental system, we observed that gamma-radiation and selected cytostatic drugs such as melphalan and dexamethasone did not significantly alter the nuclear radial arrangement of the 1q21 region and other relevant regions of chromosome 1. Similarly, conserved nuclear radial positioning after cytostatic treatment was observed for the c-myc, TP53, CCND1, and IgH loci. When analyzed Mcl-1, a protein encoded by a gene mapped to the 1q21 region, we found that the variant Mcl1S is highly expressed in multiple myeloma MOLP-8 cells, but not in peripheral blood lymphocytes of healthy donors or lymphoblastoid ARH-77 cells; this is in contrast to the expression pattern of the Mcl-1L variant. On the basis of these observations we suggest that the 1q21 region is an important diagnostic marker of MM, particularly the gene encoding the Mcl-1S variant, which can be easily detected by western analysis.
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Affiliation(s)
- S Legartova
- Institute of Biophysics, Academy of Sciences of the Czech Republic, Brno, Czech Republic
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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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Simek M, Nemec P, Gwozdziewicz M, Langova K, Studentova H, Bruk V, Hajek R, Lonsky V. Endoscopic versus minimally invasive vein harvesting. Impact on leg-related morbidity in coronary artery bypass surgery: one-year follow-up of a prospective trial. J Cardiovasc Surg (Torino) 2008; 49:673-678. [PMID: 18670386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM We sought to compare the impact of endoscopic and minimally invasive great saphenous vein harvesting on leg-related patient morbidity after coronary artery bypass grafting. METHODS From February 2004 to July 2006, 120 patients underwent minimally invasive vein harvesting, and 180 patients underwent endoscopic vein harvesting for coronary artery bypass grafting. Patients were evaluated prospectively for wound-healing disturbances, residual leg edema, pain intensity and saphenous neuropathy at seven days, three months and one year after surgery. RESULTS Both harvesting techniques were associated with a low incidence of wound-healing disturbances; nevertheless, endoscopic vein harvesting was associated with a significantly lower incidence of residual edema (12% vs 28%, P<0.05 seven days postoperative; 6% vs 19%, P<0.001 three months postoperative), pain (9% vs 20%, P<0.05; 6% vs 10%, P<0.05) and saphenous neuropathy (6% vs 23%, P<0.001; 3% vs 14%, P<0.05) during follow-ups. Endoscopic vein harvesting was also associated with a significantly lower incidence of neurological disturbances at one-year follow-up (2% vs 8%, P<0.05). Mean harvesting time (43.9+/-10.2 vs 40.6+/-15.5 min, P=0.09), conversion rate (2% vs 3%, P=0.71) and injury per conduit (0.3+/-0.1 vs 0.3+/-0.2, P=0.91) were comparable for both groups. CONCLUSION EVH is superior to MIVH in terms of reduction in pain intensity, residual leg edema and saphenous neuropathy at seven days and again at three months postoperative. A significantly lower incidence of neurological disturbances is still presented one year after surgery.
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Affiliation(s)
- M Simek
- Department of Cardiac Surgery, University Hospital and Palacky University, Faculty of Medicine, Olomouc, Czech Republic.
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Blade J, Sonneveld P, San Miguel J, Sutherland H, Hajek R, Nagler A, Spencer A, Robak T, Harousseau JL, Orlowski RZ. The effect of pegylated liposomal doxorubicin plus bortezomib in multiple myeloma patients with renal insufficiency. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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40
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Tichy M, Palicka V, Budina M, Andrys C, Maisnar V, Vavrova J, Hajek R. The Czech National External Quality Assessment of monoclonal immunoglobulin in the period of 1996 - 2005. Neoplasma 2008; 55:61-64. [PMID: 18190243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The aim of the presented study was to evaluate the results of SEKK "Gammopathy" (GP) control cycle (Czech National External Quality Assessment) that assessed the success rate of monoclonal immunoglobulin determination by clinical laboratories for the 1996 - 2005 period. The study summarizes the results of 20 "Gammopathy" control cycles during the ten-year period. Control cycles were repeated every 6 months. Patients who provided samples for individual SEKK "Gammopathy" control cycles were selected during routine diagnostic process in the University Hospital Hradec Kralove. Correct paraprotein typing in both A and B control samples (plasma, serum or urine) is required prior to certification. Assessment of paraprotein concentration is optional. The number of participating laboratories was gradually increasing from 26 in 1996 to 79 in 2005 (including 6 Slovak laboratories). The majority of laboratories used immunofixation electrophoresis as the method of paraprotein typing. In 2005, only one laboratory was still using immunoelectrophoresis. Typing was successful in approximately 70% of cases during the first 3 cycles and the success rate gradually increased to almost 96% by 2005. The only exception was GP 1/02 cycle with a sample of relatively rare IgD-lambda paraprotein and the success rate of 38% only. A sample of plasma without paraprotein was distributed 4 times. Several laboratories falsely identified fibrinogen as paraprotein each time. Results of "Gammopathy" control cycle for the past 10 years confirmed the value and legitimacy of this control cycle in the system of external quality control of SEKK laboratories.
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Affiliation(s)
- M Tichy
- Institute of Clinical Biochemistry and Diagnostics, Charles University Teaching Hospital, Hradec Kralove, Czech Republic.
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Maisnar V, Tichy M, Stulik J, Urban P, Adam Z, Kadlckova E, Vavrova J, Palicka V, Jebavy L, Kodet R, Buchler T, Hajek R. Capillary immunotyping electrophoresis and high resolution two-dimensional electrophoresis for the detection of mu-heavy chain disease. Clin Chim Acta 2007; 389:171-3. [PMID: 18036562 DOI: 10.1016/j.cca.2007.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 10/30/2007] [Accepted: 10/30/2007] [Indexed: 10/22/2022]
Abstract
Heavy chain disease with monoclonal incomplete mu-heavy chains (mu-HCD) is a rare disorder usually associated with an underlying lymphoproliferative malignancy. Laboratory diagnosis of patients with mu-HCD is usually challenging and the monoclonal protein is not detected by electrophoresis in up to 75% of mu-HCD cases. We describe a patient with multiple malignancies in whom we detected and characterized monoclonal mu-heavy chains using immunofixation electrophoresis, capillary zone electrophoresis with immunotyping, and high resolution two-dimensional electrophoresis. The high resolution 2D electrophoresis enabled us to determine the molecular weight of the mu-heavy chains. The abnormal protein concentration in the serum was unusually high, 38 g/l measured in our patient is the highest reported value in the literature so far.
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Affiliation(s)
- V Maisnar
- 2nd Department of Internal Medicine, Division of Clinical Haematology, Charles University Hospital, Hradec Králové, Czech Republic.
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Simek M, Nemec P, Zalesak B, Hajek R, Kalab M, Jecminkova L. Negative pressure therapy as a treatment modality for surgical site infection in cardiac surgery. Acta Chir Belg 2007; 107:653-7. [PMID: 18274179 DOI: 10.1080/00015458.2007.11680141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Negative pressure therapy (NPT), primarily introduced for the treatment of pressure ulcers or chronic debilitating wounds, has recently emerged as a novel treatment strategy in the field of cardiac surgery, providing superior results to the conventional therapeutic strategies. PATIENTS AND METHODS From November 2004 to October 2005, 25 patients underwent NPT (negative pressure therapy). Four patients (16%) were treated for extensive leg-wound infections, 10 (40%) were treated for superficial sternal wound infections and 11 (44%) for deep sternal wound infections. The median age was 67.9 years (range 48 to 79) and the median BMI was 34.2 kg/m2 (range 28 to 41). Because of wound infection complications, 11 patients (44%) were re-admitted to the department. In 13 patients (52%), NPT was employed after the failure of the conventional treatment strategy. RESULTS All 25 patients were successfully healed. In-hospital mortality was 0% and 30-day survival was 100%. The overall length of hospitalization reached 36.4 days (range 11 to 62). The median number of dressing changes was 4.9 (range 3 to 9). The median NPT treatment time until the surgical closure was 9.7 days (range 6 to 24 days). In 17 patients (68%), the excessive residual sternal defect required a local advancement flap transfer. One patient (4%) with a chronic wire-related fistula was re-admitted 6 months after NPT therapy. CONCLUSION NPT therapy can be considered as an effective treatment strategy associated with a low risk of procedure failure and wound infection recurrence, particularly in the management of sternal wound infection after cardiac surgery.
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Affiliation(s)
- M. Simek
- Department of Cardiac Surgery, University Hospital and Palacky University Faculty of Medicine, Olomouc, Czech Republic
| | - P. Nemec
- Department of Cardiac Surgery, University Hospital and Palacky University Faculty of Medicine, Olomouc, Czech Republic
| | - B. Zalesak
- Department of Plastic and Aesthetic Surgery, University Hospital and Palacky University Faculty of Medicine, Olomouc, Czech Republic
| | - R. Hajek
- Department of Cardiac Surgery, University Hospital and Palacky University Faculty of Medicine, Olomouc, Czech Republic
| | - M. Kalab
- Department of Cardiac Surgery, University Hospital and Palacky University Faculty of Medicine, Olomouc, Czech Republic
| | - L. Jecminkova
- Department of Cardiac Surgery, University Hospital and Palacky University Faculty of Medicine, Olomouc, Czech Republic
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Nemec P, Kuglik P, Vranova V, Zaoralova R, Greslikova H, Oltova A, Filkova H, Vidlakova P, Smejkalova J, Hajek R. P140 Prognostic impact of 1q21 amplification in patients with multiple myeloma treated by velcade, thalidomide and any conventional chemotherapy. Blood Rev 2007. [DOI: 10.1016/s0268-960x(07)70218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dudova S, Kovarova L, Horvath R, Penka M, Hajek R, Michalek J. P134 Amino acid sequences of T cell receptor reacting against multiple myeloma. Blood Rev 2007. [DOI: 10.1016/s0268-960x(07)70212-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zaoralova R, Greslikova H, Filkova H, Nemec P, Kuglik P, Oltova A, Pour L, Adam Z, Smejkalova J, Krivanova A, Krejci M, Hajek R. P141 Do the “new drugs” antagonize the impact of unfavourable cytogenetic markers in multiple myeloma? Blood Rev 2007. [DOI: 10.1016/s0268-960x(07)70219-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Greslikova H, Kuglik P, Filkova H, Oltova A, Adam Z, Krivanova A, Pour L, Smejkalova J, Krejci M, Hajek R. O58 Correlation between chromosomal aberrations and standard prognostic factors in patients with multiple myeloma undergoing autologous stem cell transplantation. Blood Rev 2007. [DOI: 10.1016/s0268-960x(07)70073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Harousseau JL, Nagler A, Sonneveld P, Bladé J, Hajek R, Spencer A, Robak T, Xiu L, Zhuang SH, Orlowski RZ. Effect of the combination of pegylated liposomal doxorubicin and bortezomib on time to progression (TTP) and overall survival of patients with relapsed/refractory multiple myeloma compared with bortezomib alone. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8002 Background: Proteasome inhibition with bortezomib is a standard of care for patients with relapsed/refractory multiple myeloma (MM). Recently, we reported the results of an interim analysis for the DOXIL-MMY-3001 study, a large multi-national, phase III, randomized study of patients with previously treated MM demonstrating that the combination of pegylated liposomal doxorubicin (PLD) and bortezomib resulted in a 45% risk reduction of experiencing disease progression over bortezomib alone (Orlowski et al, 2006 ASH Meeting, Abstract #404). The improvement in TTP was associated with an overall survival (OS) trend favoring the combination therapy (P=0.113; hazard ratio[HR], 1.48, 95% Confidence Interval [CI], 0.91 to 2.41). We now present an updated survival analysis with a median follow up of 11 months. Methods: 646 patients at 123 centers in 18 countries received either intravenous bortezomib, 1.3 mg/m2, on days 1, 4, 8, and 11 of every 21-day cycle, or the same bortezomib regimen with PLD, 30 mg/m2, on day 4. Results: As previously reported, median TTP was improved from 6.5 months for bortezomib alone to 9.3 months for the PLD+bortezomib combination (P=0.000004; HR, 1.82; 95% CI, 1.41 to 2.35). The complete+partial response rate was 43% for bortezomib and 48% for PLD+bortezomib (P=0.251). Median duration of response was increased from 7.0 months (95% CI, 5.9 to 8.3) to 10.2 months (95% CI, 10.2 to 12.9) with combination therapy (p=0.0008). Updated OS analysis showed PLD+bortezomib significantly improved OS (p<0.05; HR, 1.41, 95% CI, 1.002 to1.97). Both groups received a median of 5 cycles of treatment. The safety profile of the combination was consistent with the known toxicities of the two agents. Grade 3/4 adverse events were more frequent in the combination group primarily due to increase in myelosuppression and GI toxicities. Conclusions: PLD with bortezomib is superior to bortezomib monotherapy for the treatment of patients with relapsed/refractory MM. [Table: see text]
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Affiliation(s)
- J. L. Harousseau
- Hoteldieu Hospital, Nantes, France; Chaim Sheba Medical Center, Tel Hashomer, Israel; Erasmus Medical Center, Rotterdam, The Netherlands; Hospital Clinic I Provincial, Barcelona, Spain; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Alfred Hospital, Melbourne, Australia; Medical University of Lodz, Lodz, Poland; Johnson & Johnson PRD, Raritan, NJ; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A. Nagler
- Hoteldieu Hospital, Nantes, France; Chaim Sheba Medical Center, Tel Hashomer, Israel; Erasmus Medical Center, Rotterdam, The Netherlands; Hospital Clinic I Provincial, Barcelona, Spain; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Alfred Hospital, Melbourne, Australia; Medical University of Lodz, Lodz, Poland; Johnson & Johnson PRD, Raritan, NJ; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - P. Sonneveld
- Hoteldieu Hospital, Nantes, France; Chaim Sheba Medical Center, Tel Hashomer, Israel; Erasmus Medical Center, Rotterdam, The Netherlands; Hospital Clinic I Provincial, Barcelona, Spain; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Alfred Hospital, Melbourne, Australia; Medical University of Lodz, Lodz, Poland; Johnson & Johnson PRD, Raritan, NJ; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J. Bladé
- Hoteldieu Hospital, Nantes, France; Chaim Sheba Medical Center, Tel Hashomer, Israel; Erasmus Medical Center, Rotterdam, The Netherlands; Hospital Clinic I Provincial, Barcelona, Spain; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Alfred Hospital, Melbourne, Australia; Medical University of Lodz, Lodz, Poland; Johnson & Johnson PRD, Raritan, NJ; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - R. Hajek
- Hoteldieu Hospital, Nantes, France; Chaim Sheba Medical Center, Tel Hashomer, Israel; Erasmus Medical Center, Rotterdam, The Netherlands; Hospital Clinic I Provincial, Barcelona, Spain; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Alfred Hospital, Melbourne, Australia; Medical University of Lodz, Lodz, Poland; Johnson & Johnson PRD, Raritan, NJ; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A. Spencer
- Hoteldieu Hospital, Nantes, France; Chaim Sheba Medical Center, Tel Hashomer, Israel; Erasmus Medical Center, Rotterdam, The Netherlands; Hospital Clinic I Provincial, Barcelona, Spain; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Alfred Hospital, Melbourne, Australia; Medical University of Lodz, Lodz, Poland; Johnson & Johnson PRD, Raritan, NJ; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - T. Robak
- Hoteldieu Hospital, Nantes, France; Chaim Sheba Medical Center, Tel Hashomer, Israel; Erasmus Medical Center, Rotterdam, The Netherlands; Hospital Clinic I Provincial, Barcelona, Spain; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Alfred Hospital, Melbourne, Australia; Medical University of Lodz, Lodz, Poland; Johnson & Johnson PRD, Raritan, NJ; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - L. Xiu
- Hoteldieu Hospital, Nantes, France; Chaim Sheba Medical Center, Tel Hashomer, Israel; Erasmus Medical Center, Rotterdam, The Netherlands; Hospital Clinic I Provincial, Barcelona, Spain; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Alfred Hospital, Melbourne, Australia; Medical University of Lodz, Lodz, Poland; Johnson & Johnson PRD, Raritan, NJ; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - S. H. Zhuang
- Hoteldieu Hospital, Nantes, France; Chaim Sheba Medical Center, Tel Hashomer, Israel; Erasmus Medical Center, Rotterdam, The Netherlands; Hospital Clinic I Provincial, Barcelona, Spain; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Alfred Hospital, Melbourne, Australia; Medical University of Lodz, Lodz, Poland; Johnson & Johnson PRD, Raritan, NJ; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - R. Z. Orlowski
- Hoteldieu Hospital, Nantes, France; Chaim Sheba Medical Center, Tel Hashomer, Israel; Erasmus Medical Center, Rotterdam, The Netherlands; Hospital Clinic I Provincial, Barcelona, Spain; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Alfred Hospital, Melbourne, Australia; Medical University of Lodz, Lodz, Poland; Johnson & Johnson PRD, Raritan, NJ; University of North Carolina at Chapel Hill, Chapel Hill, NC
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Sonneveld P, Hajek R, Nagler A, Spencer A, Bladé J, Robak T, Zhuang SH, Harousseau JL, Fruchtman S, Orlowski RZ. Impact of prior thalidomide (T) therapy on the efficacy of pegylated liposomal doxorubicin (PLD) and bortezomib (B) in relapsed/refractory multiple myeloma (RRMM). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8023 Background: IMIDs and proteasome inhibitors offer novel therapeutic options for patients with RRMM. T+Dex is approved for the treatment of newly diagnosed MM (Rajkumar JCO 2006). Wang et al (ASCO 2006, ASH 2006) suggested prior T exposure resulted in partial cross resistance to subsequent treatment with lenalidomide (L). Our objectives were to determine 1) whether resistance also existed to PLD+B in patients receiving prior T vs no prior T and 2) if the efficacy and safety profile of PLD+B was comparable to that previously reported with L+Dex in T failures. Methods: We performed a post hoc analysis of a previously reported phase III trial comparing PLD+B vs B alone (Orlowski ASH 2006). RRMM patients receiving ≥1 prior therapy and randomized to receive PLD at 30 mg/m2 given on D4 of each cycle along with B at 1.3 mg/m2 on D1, 4, 8, and 11 of every 21-day cycle were analyzed based on prior T exposure or no prior T. Treatment was continued for up to 8 cycles or for at least 2 cycles beyond a CR unless disease progression was observed or unacceptable toxicity occurred. Results: 324 patients were randomized to PLD+B (n=194 [T naïve], n=130 [T exposed]) and included in this analysis. Baseline albumin was 3.8 g/dL, 3.8 g/dL and 4.8 g/dL for the PLD+B (T naïve), PLD+B (T exposed) and L+Dex (T exposed), respectively. Baseline β2 microglobulin was 5.2 g/dL, 5.4 g/dL and 3.7 g/dL for these groups, respectively. Conclusions: These results demonstrate that PLD+B provide a consistent efficacy benefit in both T exposed and T naïve patients with no evidence of cross resistance to prior T. Compared to L+Dex in a similar patient population with prior T exposure, PLD+B has comparable response rates and time to progression, but the risk of TVE is substantially reduced. These results should be considered when choosing treatment options for RRMM who have failed prior T treatment and confirmed in a prospective randomized study. [Table: see text] [Table: see text]
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Affiliation(s)
- P. Sonneveld
- Erasmus Medical Center, Rotterdam, The Netherlands; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Chaim Sheba Medical Center, Tel Hashomer, Israel; Alfred Hospital, Melbourne, Australia; Hospital Clinic I Provincial, Barcelona, Spain; Medical University of Lodz, Lodz, Poland; J&J Pharmaceutical Research & Development LLC, Raritan, NJ; University Hospital Hotel-Dieu, Nantes, France; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; University of North Carolina at Chapel Hill,
| | - R. Hajek
- Erasmus Medical Center, Rotterdam, The Netherlands; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Chaim Sheba Medical Center, Tel Hashomer, Israel; Alfred Hospital, Melbourne, Australia; Hospital Clinic I Provincial, Barcelona, Spain; Medical University of Lodz, Lodz, Poland; J&J Pharmaceutical Research & Development LLC, Raritan, NJ; University Hospital Hotel-Dieu, Nantes, France; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; University of North Carolina at Chapel Hill,
| | - A. Nagler
- Erasmus Medical Center, Rotterdam, The Netherlands; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Chaim Sheba Medical Center, Tel Hashomer, Israel; Alfred Hospital, Melbourne, Australia; Hospital Clinic I Provincial, Barcelona, Spain; Medical University of Lodz, Lodz, Poland; J&J Pharmaceutical Research & Development LLC, Raritan, NJ; University Hospital Hotel-Dieu, Nantes, France; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; University of North Carolina at Chapel Hill,
| | - A. Spencer
- Erasmus Medical Center, Rotterdam, The Netherlands; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Chaim Sheba Medical Center, Tel Hashomer, Israel; Alfred Hospital, Melbourne, Australia; Hospital Clinic I Provincial, Barcelona, Spain; Medical University of Lodz, Lodz, Poland; J&J Pharmaceutical Research & Development LLC, Raritan, NJ; University Hospital Hotel-Dieu, Nantes, France; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; University of North Carolina at Chapel Hill,
| | - J. Bladé
- Erasmus Medical Center, Rotterdam, The Netherlands; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Chaim Sheba Medical Center, Tel Hashomer, Israel; Alfred Hospital, Melbourne, Australia; Hospital Clinic I Provincial, Barcelona, Spain; Medical University of Lodz, Lodz, Poland; J&J Pharmaceutical Research & Development LLC, Raritan, NJ; University Hospital Hotel-Dieu, Nantes, France; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; University of North Carolina at Chapel Hill,
| | - T. Robak
- Erasmus Medical Center, Rotterdam, The Netherlands; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Chaim Sheba Medical Center, Tel Hashomer, Israel; Alfred Hospital, Melbourne, Australia; Hospital Clinic I Provincial, Barcelona, Spain; Medical University of Lodz, Lodz, Poland; J&J Pharmaceutical Research & Development LLC, Raritan, NJ; University Hospital Hotel-Dieu, Nantes, France; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; University of North Carolina at Chapel Hill,
| | - S. H. Zhuang
- Erasmus Medical Center, Rotterdam, The Netherlands; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Chaim Sheba Medical Center, Tel Hashomer, Israel; Alfred Hospital, Melbourne, Australia; Hospital Clinic I Provincial, Barcelona, Spain; Medical University of Lodz, Lodz, Poland; J&J Pharmaceutical Research & Development LLC, Raritan, NJ; University Hospital Hotel-Dieu, Nantes, France; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; University of North Carolina at Chapel Hill,
| | - J. L. Harousseau
- Erasmus Medical Center, Rotterdam, The Netherlands; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Chaim Sheba Medical Center, Tel Hashomer, Israel; Alfred Hospital, Melbourne, Australia; Hospital Clinic I Provincial, Barcelona, Spain; Medical University of Lodz, Lodz, Poland; J&J Pharmaceutical Research & Development LLC, Raritan, NJ; University Hospital Hotel-Dieu, Nantes, France; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; University of North Carolina at Chapel Hill,
| | - S. Fruchtman
- Erasmus Medical Center, Rotterdam, The Netherlands; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Chaim Sheba Medical Center, Tel Hashomer, Israel; Alfred Hospital, Melbourne, Australia; Hospital Clinic I Provincial, Barcelona, Spain; Medical University of Lodz, Lodz, Poland; J&J Pharmaceutical Research & Development LLC, Raritan, NJ; University Hospital Hotel-Dieu, Nantes, France; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; University of North Carolina at Chapel Hill,
| | - R. Z. Orlowski
- Erasmus Medical Center, Rotterdam, The Netherlands; Interní Hematoonkologická klinika Fakultní Brno, Brno, Czech Republic; Chaim Sheba Medical Center, Tel Hashomer, Israel; Alfred Hospital, Melbourne, Australia; Hospital Clinic I Provincial, Barcelona, Spain; Medical University of Lodz, Lodz, Poland; J&J Pharmaceutical Research & Development LLC, Raritan, NJ; University Hospital Hotel-Dieu, Nantes, France; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; University of North Carolina at Chapel Hill,
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Cocks K, Cohen D, Wisløff F, Sezer O, Lee S, Hippe E, Gimsing P, Turesson I, Hajek R, Smith A, Graham L, Phillips A, Stead M, Velikova G, Brown J. An international field study of the reliability and validity of a disease-specific questionnaire module (the QLQ-MY20) in assessing the quality of life of patients with multiple myeloma. Eur J Cancer 2007; 43:1670-8. [PMID: 17574838 DOI: 10.1016/j.ejca.2007.04.022] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 04/20/2007] [Accepted: 04/23/2007] [Indexed: 11/28/2022]
Abstract
AIM To test the reliability, validity and sensitivity of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-MY24 questionnaire, designed to assess the quality of life of myeloma patients with the QLQ-C30. METHODS The study was carried out through the EORTC Quality of Life Group using clinical trials in seven countries. All trials used the QLQ-C30 and QLQ-MY24 at baseline and a follow-up timepoint. RESULTS Two hundred and forty patients participated. The questionnaires were acceptable to patients. The hypothesised scale structure (disease symptoms, side-effects, body image and future perspective) was confirmed by multi-trait scaling, internal consistency and correlation analysis. Most scales demonstrated sensitivity to change and discriminated between clinically different patients. The social support scale (4 items) was removed due to observed ceiling effects. CONCLUSION The final questionnaire contains 20 items, QLQ-MY20, and is a reliable and valid instrument recommended for use with the QLQ-C30 in myeloma patients.
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Affiliation(s)
- K Cocks
- Clinical Trials Research Unit, University of Leeds, 17 Springfield Mount, Leeds LS2 9NG, UK.
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50
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Adam Z, Bolcak K, Stanicek J, Buchler T, Pour L, Krejci M, Prasek J, Neubauer J, Vorlicek J, Hajek R. Fluorodeoxyglucose positron emission tomography in multiple myeloma, solitary plasmocytoma and monoclonal gammapathy of unknown significance. Neoplasma 2007; 54:536-540. [PMID: 17949238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The aim of our study was to evaluate the role of fluorine-18 fluorodeoxyglucose positron emission tomography (FDGPET) in 49 patients with plasma cell malignancies. FDG-PET results were verified by conventional imaging methods, including plain radiographs, magnetic resonance imaging (MRI) and computer tomography (CT). Focally increased FDG uptake was observed in three (23 %) of 11 newly diagnosed myeloma patients with negative bone radiographs. Focally increased tracer uptake was found in five of 26 patients with MM in remission but with suspected relapse. Of the 20 patients who had negative FDG-PET scans, only one relapsed 12 months after FDG-PET examination.. FDG-PET was positive in two of six patients with MGUS and with suspected progression to MM or with suspected other malignancy. In one case a thyroid carcinoma was later detected, in the other an intestinal tumor was found. We conclude that FDG PET might contribute to initial staging of MM patients with negative bone radiographs and is useful for the follow-up of patients in remission especially in non-secretory MM and in patients with large plasmocytoma (>5 cm) after radiochemotherapy.
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Affiliation(s)
- Z Adam
- Departmenr of Internal Medicine- Hematooncology, University Hospital, Brno, Czech Republic.
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