1
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Zanwar S, Gertz MA, Muchtar E, Buadi FK, Kourelis T, Gonsalves W, Go RS, Hayman S, Kapoor P, Binder M, Cook J, Dingli D, Leung N, Lin Y, Warsame R, Fonder A, Hobbs M, Hwa YL, Kyle RA, Rajkumar SV, Kumar S, Dispenzieri A. Treatment patterns for AL amyloidosis after frontline daratumumab, bortezomib, cyclophosphamide, and dexamethasone treatment failures. Leukemia 2024:10.1038/s41375-024-02243-5. [PMID: 38594348 DOI: 10.1038/s41375-024-02243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Affiliation(s)
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | | | | | | | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | | | | | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Joselle Cook
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, US
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2
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Rajkumar SV, Bergsagel PL, Kumar S. Smoldering Multiple Myeloma: Observation Versus Control Versus Cure. Hematol Oncol Clin North Am 2024; 38:293-303. [PMID: 38158241 DOI: 10.1016/j.hoc.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Smoldering multiple myeloma (SMM) is an intermediate clinical stage in the spectrum of monoclonal plasma cell disorders. It represents a heterogeneous clinically defined condition in which some patients (approximately 50%) have monoclonal gammopathy of undetermined significance (premalignancy), and some (approximately 50%) have multiple myeloma (biologic malignancy). Using specific prognostic factors, patients with SMM, in whom malignant transformation has already likely occurred, can be identified. These patients are considered to have high-risk SMM. Patients with newly diagnosed high-risk SMM are candidates for early intervention with lenalidomide or lenalidomide plus dexamethasone for 2 years, or enrollment in clinical trials.
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Affiliation(s)
- S Vincent Rajkumar
- Division of Hematology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| | - P Leif Bergsagel
- Division of Hematology Oncology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
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3
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Goel U, Charalampous C, Kapoor P, Binder M, Buadi FK, Dingli D, Dispenzieri A, Fonder A, Gertz MA, Gonsalves WI, Hayman SR, Hobbs MA, Hwa YL, Kourelis T, Lacy MQ, Leung N, Lin Y, Warsame RM, Kyle RA, Rajkumar SV, Kumar SK. Outcomes of patients with multiple myeloma refractory to standard dose vs low dose lenalidomide. Blood Cancer J 2024; 14:55. [PMID: 38531841 DOI: 10.1038/s41408-024-01039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/20/2023] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
Refractoriness to lenalidomide is an important factor determining the choice of therapy at first relapse in multiple myeloma (MM). It remains debatable if resistance to lenalidomide varies among MM refractory to standard doses vs low dose maintenance doses. In this study, we assessed the outcomes with subsequent therapies in patients with MM refractory to standard dose vs low dose lenalidomide. We retrospectively reviewed all patients with MM at our institution who received first line therapy with lenalidomide containing regimens, and assessed progression free survival (PFS) and overall survival for these patients for second line therapy, and with lenalidomide retreatment. For second line therapy, we found no difference in the PFS between standard dose refractory and low dose refractory groups (median PFS 14 months vs 14 months, p = 0.95), while the PFS for both these groups was inferior to the not refractory group (median PFS 30 months, p < 0.001 for both pairs). Similar trends were seen among these groups on lenalidomide retreatment, and on multivariable analysis. These data suggest that refractoriness to lenalidomide is not dose dependent, and definition of lenalidomide refractoriness should not depend on the dose of lenalidomide to which the disease was considered refractory.
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Affiliation(s)
- Utkarsh Goel
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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4
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Hoff FW, Banerjee R, Khan AM, McCaughan G, Wang B, Wang X, Roose J, Anderson LD, Cowan AJ, Rajkumar SV, Kaur G. Once-weekly versus twice-weekly bortezomib in newly diagnosed multiple myeloma: a real-world analysis. Blood Cancer J 2024; 14:52. [PMID: 38519476 PMCID: PMC10959949 DOI: 10.1038/s41408-024-01034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
Induction regimens for multiple myeloma (MM) commonly include bortezomib, which has typically been administered twice weekly despite studies demonstrating comparable efficacy and less peripheral neuropathy (PN) with once-weekly bortezomib. We aimed to analyze the real-world prevalence and efficacy of once-weekly versus twice-weekly bortezomib regimens in newly diagnosed MM. We analyzed 2497 US patients aged 18-70 years treated with commercial first-line bortezomib using nationwide Flatiron Health electronic health record-derived data, including 910 (36.4%) patients who received twice-weekly and 1522 (63.2%) who received once-weekly bortezomib. Once-weekly bortezomib use increased over time, from 57.7% in 2017 to 73.1% in 2022. Multivariate analysis identified worsened performance status and more recent year of diagnosis with higher odds of receiving once-weekly bortezomib. Real-world progression-free survival (median 37.2 months with once-weekly versus 39.6 months with twice-weekly, p = 0.906) and overall survival (medians not reached in either cohort, p = 0.800) were comparable. PN rates were higher in patients receiving twice-weekly bortezomib (34.7% versus 18.5%, p < 0.001). In conclusion, once-weekly bortezomib is clearly associated with similar efficacy and fewer toxicities compared to twice-weekly bortezomib. Our findings support once-weekly bortezomib as a standard-of-care regimen for newly diagnosed patients with MM.
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Affiliation(s)
- Fieke W Hoff
- Myeloma, Waldenstrom's, and Amyloidosis Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rahul Banerjee
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Adeel M Khan
- Myeloma, Waldenstrom's, and Amyloidosis Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Georgia McCaughan
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Bo Wang
- Willamette Valley Cancer Institute, Eugene, OR, USA
| | | | | | - Larry D Anderson
- Myeloma, Waldenstrom's, and Amyloidosis Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Andrew J Cowan
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Gurbakhash Kaur
- Myeloma, Waldenstrom's, and Amyloidosis Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
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5
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Goldman-Mazur S, Visram A, Rajkumar SV, Kapoor P, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Hayman SR, Dingli D, Kourelis T, Gonsalves W, Warsame R, Muchtar E, Leung N, Kyle RA, Kumar SK. Predictors and Impact of Timing of Disease Progression Following Primary Therapy in Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2024; 24:e104-e111.e1. [PMID: 38135634 DOI: 10.1016/j.clml.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
In multiple myeloma (MM) significant variation in progression-free survival (PFS) and overall survival (OS) is observed. We examined the outcomes of 1557 MM patients stratified into short (<2 years), medium (between 2 and 5 years) and long (>5 years) PFS. Short PFS occurred in 758 patients (48.7%), medium in 561 patients (36.2%), and long in 238 patients (15.3%). Median post-progression PFS was 9.2 months (95% CI: 8.1-11.0) in the short PFS and 33.1 months (95% CI: 29.0-42.1; P < .001) in the long PFS group. Median post-progression OS was 26.6 months (95% CI: 23.9-29.8) in the short PFS and 87.8 months (95% CI: 71.3- NR; P < .001) in the long PFS. Worse survival in the short PFS was irrespective of high risk (HR) fluorescence in situ hybridization (FISH) features, defined as deletion 17p and/or translocation t(4;14), t(14;16), t(14;20). In a multivariable analysis short PFS was associated with HR FISH, extramedullary plasmacytoma, plasma cell labeling index ≥2% at diagnosis, nonimmunoglobulin G isotype, treatment without autologous stem cell transplantation and achieving less than very good partial remission. In conclusion, the duration of the PFS significantly influences survival, regardless of HR cytogenetic features. Therefore, it should be considered an important parameter for risk stratification in patients experiencing a relapse.
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Affiliation(s)
| | - Alissa Visram
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN; Division of Hematology, Ottawa Hospital Research Institute, Ontario, Canada
| | | | - Prashant Kapoor
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Francis K Buadi
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | - David Dingli
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Nelson Leung
- Division of Nephrology, Mayo Clinic Rochester, Rochester, MN
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN.
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6
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Abdallah N, Witzig TE, Kumar SK, Lacy MQ, Hayman SR, Dispenzieri A, Roy V, Gertz MA, Bergsagel PL, Rajkumar SV. Phase III randomized trial of Thal+ZLD versus ZLD in patients with asymptomatic multiple myeloma - updated results after 18-year follow-up. Leukemia 2024:10.1038/s41375-024-02192-z. [PMID: 38418610 DOI: 10.1038/s41375-024-02192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Nadine Abdallah
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas E Witzig
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shaji K Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Suzanne R Hayman
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vivek Roy
- Division of Hematology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Morie A Gertz
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - P Leif Bergsagel
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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7
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Abdallah NH, Lakshman A, Kumar SK, Cook J, Binder M, Kapoor P, Dispenzieri A, Gertz MA, Lacy MQ, Hayman SR, Buadi FK, Dingli D, Lin Y, Kourelis T, Warsame R, Bergsagel L, Rajkumar SV. Mode of progression in smoldering multiple myeloma: a study of 406 patients. Blood Cancer J 2024; 14:9. [PMID: 38228628 PMCID: PMC10791688 DOI: 10.1038/s41408-024-00980-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/18/2024] Open
Abstract
The approach to patients with high-risk smoldering multiple myeloma (SMM) varies among clinicians; while some advocate early intervention, others reserve treatment at progression to multiple myeloma (MM). We aimed to describe the myeloma-defining events (MDEs) and clinical presentations leading to MM diagnosis among SMM patients seen at our institution. We included 406 patients diagnosed with SMM between 2013-2022, seen at Mayo Clinic, Rochester, MN. The 2018 Mayo 20/2/20 criteria were used for risk stratification. Median follow-up was 3.9 years. Among high-risk patients who did not receive treatment in the SMM phase (n = 71), 51 progressed by last follow-up; the MDEs included: bone lesions (37%), anemia (35%), hypercalcemia (8%), and renal failure (6%); 24% met MM criteria based on marrow plasmacytosis (≥60%) and/or free light chain ratio (>100); 45% had clinically significant MDEs (hypercalcemia, renal insufficiency, and/or bone lesions). MM diagnosis was made based on surveillance labs/imaging(45%), testing obtained due to provider suspicion for progression (14%), bone pain (20%), and hospitalization/ED presentations due to MM complications/symptoms (4%). The presentation was undocumented in 14%. A high proportion (45%) of patients with high-risk SMM on active surveillance develop end-organ damage at progression. About a quarter of patients who progress to MM are not diagnosed based on routine interval surveillance testing.
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Affiliation(s)
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Joselle Cook
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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8
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Gagnon MF, Midthun SM, Fangel JA, Schuh CM, Luoma IM, Pearce KE, Meyer RG, Ailawadhi S, Arribas MJ, Braggio E, Fonseca R, Rajkumar SV, Zepeda-Mendoza C, Xu X, Greipp PT, Timm MM, Otteson GE, Shi M, Jevremovic D, Olteanu H, Peterson JF, Ketterling RP, Kumar S, Baughn LB. Superior detection rate of plasma cell FISH using FACS-FISH. Am J Clin Pathol 2024; 161:60-70. [PMID: 37658775 DOI: 10.1093/ajcp/aqad108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES Fluorescence in situ hybridization (FISH) for plasma cell neoplasms (PCNs) requires plasma cell (PC) identification or purification strategies to optimize results. We compared the efficacy of cytoplasmic immunoglobulin FISH (cIg-FISH) and fluorescence-activated cell sorting FISH (FACS-FISH) in a clinical laboratory setting. METHODS The FISH analysis results of 14,855 samples from individuals with a suspected PCN subjected to cytogenetic evaluation between 2019 and 2022 with cIg-FISH (n = 6917) or FACS-FISH (n = 7938) testing were analyzed. RESULTS Fluorescence-activated cell sorting-FISH increased the detection rate of abnormalities in comparison with cIg-FISH, with abnormal results documented in 54% vs 50% of cases, respectively (P < .001). It improved the detection of IGH::CCND1 (P < .001), IGH::MAF (P < .001), IGH::MAFB (P < .001), other IGH rearrangements (P < .001), and gains/amplifications of 1q (P < .001), whereas the detection rates of IGH::FGFR3 fusions (P = .3), loss of 17p (P = .3), and other abnormalities, including hyperdiploidy (P = .5), were similar. Insufficient PC yield for FISH analysis was decreased between cIg-FISH and FACS-FISH (22% and 3% respectively, P < .001). Flow cytometry allowed establishment of ploidy status in 91% of cases. In addition, FACS-FISH decreased analysis times, workload efforts, and operating costs. CONCLUSIONS Fluorescence-activated cell sorting-FISH is an efficient PC purification strategy that affords significant improvement in diagnostic yield and decreases workflow requirements in comparison with cIg-FISH.
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Affiliation(s)
- Marie-France Gagnon
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
| | - Sally M Midthun
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
| | - James A Fangel
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
| | - Cynthia M Schuh
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
| | - Ivy M Luoma
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
| | - Kathryn E Pearce
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
| | - Reid G Meyer
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
| | - Sikander Ailawadhi
- Department of Medicine, Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, US
| | - Mariano J Arribas
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Scottsdale, AZ, US
| | - Esteban Braggio
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Scottsdale, AZ, US
| | - Rafael Fonseca
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Scottsdale, AZ, US
| | - S Vincent Rajkumar
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Cinthya Zepeda-Mendoza
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
| | - Xinjie Xu
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
| | - Patricia T Greipp
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
| | - Michael M Timm
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
| | - Gregory E Otteson
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
| | - Min Shi
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
| | - Dragan Jevremovic
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
| | - Horatiu Olteanu
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
| | - Jess F Peterson
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
| | - Rhett P Ketterling
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
| | - Shaji Kumar
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Jacksonville, FL, US
| | - Linda B Baughn
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, US
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, US
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9
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Abdallah NH, Nagayama H, Takahashi N, Gonsalves W, Fonder A, Dispenzieri A, Dingli D, Buadi FK, Lacy MQ, Hobbs M, Gertz MA, Binder M, Kapoor P, Warsame R, Hayman SR, Kourelis T, Hwa YL, Lin Y, Kyle RA, Rajkumar SV, Broski SM, Kumar SK. Muscle and fat composition in patients with newly diagnosed multiple myeloma. Blood Cancer J 2023; 13:185. [PMID: 38086801 PMCID: PMC10716405 DOI: 10.1038/s41408-023-00934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/13/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
Measures of muscle and adipose tissue mass have been associated with outcomes in several malignancies, but studies in multiple myeloma (MM) are inconsistent. The aim of this study was to evaluate the association between muscle and fat areas and radiodensity, and overall survival (OS) in patients with newly diagnosed MM. We included 341 patients diagnosed with MM from 2010-2019 who had an 18F-fluorodeoxyglucose positron emission tomography/computed tomography at diagnosis. A cross-sectional image at the third lumbar vertebrae was segmented into muscle and fat components. Median follow up was 5.7 years. There was no association between sarcopenia and baseline disease characteristics or OS. Low muscle radiodensity was associated with higher disease stage, anemia, and renal failure. OS was 5.6 vs. 9.0 years in patients with muscle radiodensity in the lower vs. middle/upper tertiles, respectively (P = 0.02). High subcutaneous adipose tissue (SAT) radiodensity was associated with higher stage, anemia, thrombocytopenia, hypercalcemia, renal failure, and high LDH. OS was 5.4 years vs. not reached in patients with SAT radiodensity in the upper vs. middle/lower tertiles, respectively (P = 0.001). In conclusion, sarcopenia was not associated with OS in MM patients. High SAT radiodensity and low muscle radiodensity were associated with advanced disease stage and adverse laboratory characteristics.
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Affiliation(s)
| | | | | | | | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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10
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Charalampous C, Goel U, Kapoor P, Binder M, Buadi FK, Cook J, Dingli D, Dispenzieri A, Fonder AL, Gertz MA, Gonsalves W, Hayman SR, Hobbs MA, Hwa YL, Kourelis T, Lacy MQ, Leung N, Lin Y, Warsame R, Kyle RA, Rajkumar SV, Kumar SK. Comparison of daratumumab-based regimens as second-line therapy in relapsed/refractory multiple myeloma. Blood Cancer J 2023; 13:183. [PMID: 38072941 PMCID: PMC10711005 DOI: 10.1038/s41408-023-00957-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
| | - Utkarsh Goel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Francis K Buadi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joselle Cook
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amie L Fonder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wilson Gonsalves
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Suzanne R Hayman
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Miriam A Hobbs
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yi L Hwa
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shaji K Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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Sandahl TB, Rajkumar SV. Discarded Treatments: When the Problem and the Solution Are More Than Meets the Eye. Mayo Clin Proc 2023; 98:1748-1750. [PMID: 38043989 DOI: 10.1016/j.mayocp.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 12/05/2023]
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12
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Yadav U, Kumar SK, Baughn LB, Dispenzieri A, Greipp P, Ketterling R, Jevremovic D, Buadi FK, Dingli D, Lacy MQ, Fonseca R, Bergsagel PL, Ailawadhi S, Roy V, Parrondo R, Sher T, Hayman SR, Kapoor P, Leung N, Cook J, Binder M, Muchtar E, Warsame R, Kourelis TV, Go RS, Lin Y, Seth A, Lester SC, Breen WG, Kyle RA, Gertz MA, Rajkumar SV, Gonsalves WI. Impact of cytogenetic abnormalities on the risk of disease progression in solitary bone plasmacytomas. Blood 2023; 142:1871-1878. [PMID: 37494698 PMCID: PMC10731916 DOI: 10.1182/blood.2023021187] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/07/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023] Open
Abstract
Most patients with solitary bone plasmacytomas (SBP) progress to multiple myeloma (MM) after definitive radiation therapy as their primary treatment. Whether the presence of high-risk (HR) cytogenetic abnormalities by fluorescence in situ hybridization (FISH) in the clonal plasma cells, obtained either directly from the diagnostic SBP tissue or the corresponding bone marrow examination at the time of diagnosis, is associated with a shorter time to progression (TTP) to MM is unknown. This study evaluated all patients diagnosed with SBP at the Mayo Clinic from January 2012 to July 2022. The presence of del(17p), t(14;16), t(4;14), or +1q (gain or amplification) by FISH in clonal plasma cells was defined as HR. A total of 114 patients were included in this cohort, and baseline FISH was available for 55 patients (48%), of which 22 were classified as HR (40%). The median TTP to MM for patients with SBP and HR FISH was 8 months (95% confidence interval [CI], 6.3-26) compared with 42 months (95% CI, 25-not reached [NR]) in patients with SBP without HR FISH (P < .001). In a multivariate analysis, only HR FISH was a significant predictor for shorter TTP to MM, independent of minimal marrow involvement and an abnormal serum free light chain ratio at diagnosis. Deletion (17p) and gain 1q abnormalities were the most common FISH abnormalities responsible for the short TTP to MM. Thus, assessing for HR FISH abnormalities in clonal plasma cells derived from either the diagnostic SBP tissue or the staging bone marrow examination of patients with newly diagnosed SBP is feasible and prognostic for a shorter TTP to MM.
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Affiliation(s)
- Udit Yadav
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Linda B. Baughn
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Patricia Greipp
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Rhett Ketterling
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Dragan Jevremovic
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Rafael Fonseca
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | | | | | - Vivek Roy
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Ricardo Parrondo
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Taimur Sher
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN
- Division of Nephrology, Mayo Clinic, Rochester, MN
| | - Joselle Cook
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Ronald S. Go
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Scott C. Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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13
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Banerjee R, Wang B, Anderson LD, McCaughan G, Mehra N, Cowan AJ, Rajkumar SV, Kaur G. Once-weekly bortezomib as the standard of care in multiple myeloma: results from an international survey of physicians. Blood Cancer J 2023; 13:162. [PMID: 37926718 PMCID: PMC10625982 DOI: 10.1038/s41408-023-00937-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Rahul Banerjee
- Department of Medicine, University of Washington, Seattle, WA, USA.
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Bo Wang
- Willamette Valley Cancer Institute, Eugene, OR, USA
| | - Larry D Anderson
- Myeloma, Waldenstrom's, and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Georgia McCaughan
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
- Garvan Institute of Medical Research, University of New South Wales, Sydney, NSW, Australia
| | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, India
| | - Andrew J Cowan
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Gurbakhash Kaur
- Myeloma, Waldenstrom's, and Amyloidosis Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
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14
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Richardson PG, Facon T, Venner CP, Bahlis NJ, Offner F, White D, Karlin L, Benboubker L, Voog E, Yoon S, Suzuki K, Shibayama H, Zhang X, Villarreal M, Twumasi‐Ankrah P, Labotka R, Rifkin RM, Lonial S, Kumar SK, Rajkumar SV, Moreau P. Late versus early response and depth of response are associated with improved outcomes in patients with newly diagnosed multiple myeloma enrolled in the TOURMALINE-MM2 trial. EJHaem 2023; 4:995-1005. [PMID: 38024593 PMCID: PMC10660432 DOI: 10.1002/jha2.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 12/01/2023]
Abstract
Deeper responses are associated with longer survival in multiple myeloma (MM); however, limited data exist on the impact of response kinetics on outcomes. We investigated progression-free survival (PFS) and duration of response (DOR) by response depth and in early (best confirmed response 0-4 months; n = 424) versus late responders (best confirmed response >4 months; n = 281). Newly diagnosed patients enrolled in TOURMALINE-MM2 receiving ixazomib-lenalidomide-dexamethasone (IRd) (n = 351) or placebo-Rd (n = 354) were evaluated post hoc. Deeper responses were associated with longer PFS (complete response [CR] not reached [NR], very good partial response [VGPR] 37.2 months, partial response [PR] 16.4 months) and DOR (CR NR, VGPR 42.6 months, PR 15.4 months). Among patients with a PFS (n = 511) or DOR (n = 484) of ≥6 months who achieved ≥PR, median PFS was prolonged among late versus early responders receiving IRd (59.7 vs. 17.9 months) or placebo-Rd (56.6 vs. 12.4 months), as was median DOR (IRd, NR vs. 20.9 months; placebo-Rd, 58.2 vs. 11.7 months). While the treatment paradigm for newly diagnosed MM is treatment to progression, our findings suggest slowness of response to a proteasome inhibitor-immunomodulatory drug-steroid combination is not a negative predictor of outcome.
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Affiliation(s)
- Paul G. Richardson
- Harvard Medical SchoolJerome Lipper Multiple Myeloma Center, Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Thierry Facon
- Centre Hospitalier Universitaire (CHU) LilleService des Maladies du Sang, University of LilleLilleFrance
| | - Christopher P. Venner
- Cross Cancer InstituteUniversity of AlbertaEdmontonAlbertaCanada
- BC Cancer Vancouver CentreUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Nizar J. Bahlis
- Arnie Charbonneau Cancer InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Darrell White
- QEII Health Sciences Center and Dalhousie UniversityHalifaxNova ScotiaCanada
| | | | | | | | - Sung‐Soo Yoon
- Department of Internal MedicineSeoul National University HospitalSeoulRepublic of Korea
| | | | | | - Xiaoquan Zhang
- Takeda Development Center Americas, Inc. (TDCA)LexingtonMassachusettsUSA
| | - Miguel Villarreal
- Takeda Development Center Americas, Inc. (TDCA)LexingtonMassachusettsUSA
| | | | - Richard Labotka
- Takeda Development Center Americas, Inc. (TDCA)LexingtonMassachusettsUSA
| | - Robert M. Rifkin
- US Oncology Research – Rocky Mountain Cancer CentersDenverColoradoUSA
| | - Sagar Lonial
- Department of Hematology and Medical OncologyWinship Cancer InstituteEmory University School of MedicineAtlantaGeorgiaUSA
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15
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Kapoor P, Rajkumar SV. Current approach to Waldenström macroglobulinemia. Blood Rev 2023; 62:101129. [PMID: 37659912 PMCID: PMC10841191 DOI: 10.1016/j.blre.2023.101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
Waldenström macroglobulinemia (WM) is a unique CD20+, B-cell non-Hodgkin lymphoma, characterized by lymphoplasmacytic infiltration of the bone marrow and circulating monoclonal immunoglobulin M. The clinical manifestations and outcomes of patients are highly variable. High-level evidence supports integration of monoclonal anti-CD20 antibody, rituximab, to the chemotherapy backbone to treat WM. However, its contemporary management has become more nuanced, with deeper understanding of the pathophysiology and incorporation of Bruton's tyrosine kinase (BTK) inhibitors to the treatment paradigm. Prior knowledge of the patients' MYD88L265P and CXCR4 mutation status may aid in the treatment decision-making. Currently, the two frequently utilized approaches include fixed-duration chemoimmunotherapy and BTK inhibitor-based continuous treatment until progression. Randomized trials comparing these two vastly divergent approaches are lacking. Recent studies demonstrating efficacy of B cell lymphoma-2 (BCL2) inhibitors and non-covalent BTK inhibitors in patients, previously exposed to a covalent BTK inhibitor, are a testament to the rapidly expanding options against WM.
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16
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Macauda A, Briem K, Clay-Gilmour A, Cozen W, Försti A, Giaccherini M, Corradi C, Sainz J, Niazi Y, Ter Horst R, Li Y, Netea MG, Vogel U, Hemminki K, Slager SL, Varkonyi J, Andersen V, Iskierka-Jazdzewska E, Mártinez-Lopez J, Zaucha J, Camp NJ, Rajkumar SV, Druzd-Sitek A, Bhatti P, Chanock SJ, Kumar SK, Subocz E, Mazur G, Landi S, Machiela MJ, Jerez A, Norman AD, Hildebrandt MAT, Kadar K, Berndt SI, Ziv E, Buda G, Nagler A, Dumontet C, Raźny M, Watek M, Butrym A, Grzasko N, Dudzinski M, Rybicka-Ramos M, Matera EL, García-Sanz R, Goldschmidt H, Jamroziak K, Jurczyszyn A, Clavero E, Giles GG, Pelosini M, Zawirska D, Kruszewski M, Marques H, Haastrup E, Sánchez-Maldonado JM, Bertsch U, Rymko M, Raab MS, Brown EE, Hofmann JN, Vachon C, Campa D, Canzian F. Identification of novel genetic loci for risk of multiple myeloma by functional annotation. Leukemia 2023; 37:2326-2329. [PMID: 37723249 PMCID: PMC10624610 DOI: 10.1038/s41375-023-02022-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/08/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Angelica Macauda
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Klara Briem
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alyssa Clay-Gilmour
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Wendy Cozen
- Division of Hematology/Oncology, Division of Hematology/Oncology, Department of Medicine, School of Medicine, Department of Pathology, School of Medicine, Susan and Henry Samueli College of Health Sciences, Chao Family Comprehensive Cancer Center, University of California at Irvine, Irvine, CA, USA
| | - Asta Försti
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | | | | | - Juan Sainz
- Genomic Oncology Area, GENYO. Centre for Genomics and Oncological Research: Pfizer / University of Granada / Andalusian Regional Government, PTS, Granada, Spain
- Instituto de Investigación Biosanitaria IBs.Granada, Granada, Spain
- Department of Biochemistry and Molecular Biology I, University of Granada, Granada, Spain
| | - Yasmeen Niazi
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Rob Ter Horst
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Yang Li
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Centre for Individualised Infection Medicine (CiiM) & TWINCORE, joint ventures between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), Hannover, Germany
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Department for Immunology & Metabolism, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Ulla Vogel
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Kari Hemminki
- Biomedical Center, Faculty of Medicine, Charles University Pilsen, Pilsen, Czech Republic
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Susan L Slager
- Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Judit Varkonyi
- Department of Hematology, Semmelweis University, Budapest, Hungary
| | - Vibeke Andersen
- Molecular Diagnostics and Clinical Research Unit, Institute of Regional Health Research, University Hospital of Southern Denmark, Odense, Denmark
- Institute of Regional Research, University of Southern Denmark, Odense, Denmark
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Joaquin Mártinez-Lopez
- Hospital Universitario 12 de Octubre, Instituto de Investigación del Hospital Universitario 12 de Octubre, 28041, Madrid, Spain
| | - Jan Zaucha
- Department of Haematology & Transplantology, Medical University of Gdańsk, Gdańsk, Poland
| | - Nicola J Camp
- Division of Hematology and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Agnieszka Druzd-Sitek
- Department of Lymphoproliferative Diseases, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- Program in Epidemiology, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shaji K Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Edyta Subocz
- Department of Hematology, Warmian-Masurian Cancer Center of The Ministry Of The Interior And Administration's Hospital, Olsztyn, Poland
| | | | - Stefano Landi
- Department of Biology, University of Pisa, Pisa, Italy
| | - Mitchell J Machiela
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrés Jerez
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, IMIB, Murcia, Spain
| | - Aaron D Norman
- Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Michelle A T Hildebrandt
- Department of Lymphoma - Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elad Ziv
- Department of Medicine, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Gabriele Buda
- Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Arnon Nagler
- Hematology Division Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Malgorzata Raźny
- Department of Hematology, Rydygier Specialistic Hospital, Cracow, Poland
| | - Marzena Watek
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
- Department of Hematology, Holycross Cancer Center, Kielce, Poland
| | - Aleksandra Butrym
- Wroclaw Medical University, Wroclaw, Poland
- Alfred Sokolowski Specialist Hospital in Walbrzych Oncology Support Centre for Clinical Trials, Wałbrzych, Poland
| | - Norbert Grzasko
- Department of Experimental Hematooncology, Medical University of Lublin, Lublin, Poland
| | - Marek Dudzinski
- Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, Rzeszow, Poland
| | - Malwina Rybicka-Ramos
- Department of Hematology, Specialist Hospital No.1 in Bytom, Academy of Silesia, Faculty of Medicine, Katowice, Poland
| | | | - Ramón García-Sanz
- University Hospital of Salamanca, Diagnostic Laboratory Unit in Hematology, University Hospital of Salamanca, IBSAL, CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
- National Centre for Tumour Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
- National Centre for Tumour Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany. GMMG Study Group at University Hospital Heidelberg, Heidelberg, Germany
| | - Krzysztof Jamroziak
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Artur Jurczyszyn
- Hematology Department, Jagiellonian University Medical College, Cracow, Poland
| | - Esther Clavero
- Hematology Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Matteo Pelosini
- U.O. Dipartimento di Ematologia, Azienda USL Toscana Nord Ovest, Livorno, Italy
| | - Daria Zawirska
- Department of Hematology, University Hospital, Crakow, Poland
| | - Marcin Kruszewski
- Department of Hematology, University Hospital No. 2 in Bydgoszcz, Bydgoszcz, Poland
| | - Herlander Marques
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Eva Haastrup
- Department of Clinical Immunology, the Bloodbank, Rigshospitalet, Copenhagen University Hospital, København, Denmark
| | - José Manuel Sánchez-Maldonado
- Genomic Oncology Area, GENYO. Centre for Genomics and Oncological Research: Pfizer / University of Granada / Andalusian Regional Government, PTS, Granada, Spain
- Instituto de Investigación Biosanitaria IBs.Granada, Granada, Spain
| | - Uta Bertsch
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
- National Centre for Tumour Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Marcin Rymko
- Department of Hematology, Provincial Polyclinical Hospital in Torun, Torun, Poland
| | - Marc-Steffen Raab
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Elizabeth E Brown
- Department of Pathology, School of Medicine at the University of Alabama, Birmingham, AL, USA
| | - Jonathan N Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Celine Vachon
- Division of Biomedical Statistics & Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Daniele Campa
- Department of Biology, University of Pisa, Pisa, Italy
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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17
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Zanwar S, Ho M, Lin Y, Kapoor P, Binder M, Buadi FK, Dispenzieri A, Dingli D, Fonder A, Gertz MA, Gonsalves W, Hayman SR, Hwa Y, Hobbs M, Kourelis T, Lacy MQ, Leung N, Muchtar E, Warsame R, Jevremovic D, Kyle RA, Rajkumar SV, Kumar S. Natural history, predictors of development of extramedullary disease, and treatment outcomes for patients with extramedullary multiple myeloma. Am J Hematol 2023; 98:1540-1549. [PMID: 37421603 DOI: 10.1002/ajh.27023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
Extramedullary multiple myeloma (EMM) can present either at initial diagnosis (de novo) or at disease relapse (secondary) and confers an aggressive clinical course. Limited data exist for choosing the optimal therapy for EMM and this remains an area of unmet clinical need. After excluding paraskeletal multiple myeloma and primary plasma cell leukemia, we identified 204 (68%) patients with secondary EMM and 95 (32%) with de novo EMM between January 01, 2000 and 31 December, 2021. The median overall survival (OS) was 0.7 (95% CI: 0.6-0.9) years for secondary EMM and 3.6 (95%CI: 2.4-5.6) years for de novo EMM. The median progression-free survival (PFS) with initial therapy was 2.9 months (95% CI: 2.4-3.2 months) for secondary EMM and 12.9 months (95% CI: 6.7-18 months) for de novo EMM. Patients with secondary EMM treated with CAR-T therapy (n = 20) achieved a partial response (PR) or better in 75% with a median PFS of 4.9 months (3.1 months-not reached; NR). Patients with EMM treated with bispecific antibodies (n = 12) achieved a ≥ PR in 33%, with a median PFS of 2.9 months (95%CI: 2.2 months-NR). In a matched cohort, multivariate logistic regression analysis demonstrated younger age at diagnosis, 1q duplication, and t(4;14) at diagnosis of MM to be independent predictors of development of secondary EMM. Presence of EMM was independently associated with inferior OS in the matched cohorts for both de novo (HR 2.9 [95% CI: 1.6-5.4], p = .0007) and secondary EMM (HR 1.5 [95% CI: 1.1-2], p = .001).
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Affiliation(s)
- Saurabh Zanwar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew Ho
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashant Kapoor
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Francis K Buadi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Yi Hwa
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Nephrology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dragan Jevremovic
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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18
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Chowdhury RB, Kastritis E, Rajkumar SV, Leung N. The nephrotoxicity of bortezomib: did we miss a complication after 20 years of use and multiple landmark trials? Nephrol Dial Transplant 2023; 38:2099-2104. [PMID: 37002539 DOI: 10.1093/ndt/gfad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
- Raad B Chowdhury
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - S Vincent Rajkumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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19
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Abdallah N, Dispenzieri A, Muchtar E, Buadi FK, Kapoor P, Lacy MQ, Hwa YL, Fonder A, Hobbs MA, Hayman SR, Leung N, Dingli D, Go RS, Lin Y, Gonsalves WI, Binder M, Kourelis T, Warsame R, Kyle RA, Rajkumar SV, Gertz MA, Kumar SK. The impact of Post-Transplant doxycycline in AL amyloidosis - updated results after Long-Term follow up. Amyloid 2023; 30:261-267. [PMID: 36533960 DOI: 10.1080/13506129.2022.2155809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/14/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The current treatment paradigm of AL amyloidosis lacks effective fibril-directed therapies. Doxycycline has been shown to have anti-fibril properties in preclinical models. In 2012, we reported that posttransplant prophylaxis with doxycycline was associated with improved survival compared to penicillin in patients with haematologic response. We provide here updated results after long-term follow up. METHODS We included 553 patients who underwent transplant between July 24th, 1996, and June 24th, 2014. Doxycycline 100 mg daily was used for prophylaxis in patients with penicillin allergy; since 2013, doxycycline was used as the standard for prophylaxis. Prophylaxis was typically continued for a year after transplant. RESULTS The median follow-up from transplant was 12.7 years. Doxycycline was used for prophylaxis in 33% of patients; the rest received penicillin. The median time to next treatment was 6.0 (95%CI; 4.4-8.8) years and 6.0 (95%CI; 4.9-7.1) years in the doxycycline and penicillin groups, respectively (p = .89). The median overall survival was 12.0 (95%CI: 11.0-19.6) years and 11.0 (95%CI: 9.6-12.7) years in the 2 groups, respectively (p = .17). There was a minimal trend towards improved survival with doxycycline among patients with ≥ very good partial response and among patients with organ response that was not statistically significant. CONCLUSION After long-term follow-up, there is no clear evidence to support benefit of doxycycline in the post-transplant setting.
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Affiliation(s)
| | | | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology, Mayo Clinic, Rochester, MN, USA
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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20
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Alaggio R, Amador C, Anagnostopoulos I, Attygalle AD, de Oliveira Araujo IB, Berti E, Bhagat G, Borges AM, Boyer D, Calaminici M, Chadburn A, Chan JKC, Cheuk W, Chng WJ, Choi JK, Chuang SS, Coupland SE, Czader M, Dave SS, de Jong D, Di Napoli A, Du MQ, Elenitoba-Johnson KS, Ferry J, Geyer J, Gratzinger D, Guitart J, Gujral S, Harris M, Harrison CJ, Hartmann S, Hochhaus A, Jansen PM, Karube K, Kempf W, Khoury J, Kimura H, Klapper W, Kovach AE, Kumar S, Lazar AJ, Lazzi S, Leoncini L, Leung N, Leventaki V, Li XQ, Lim MS, Liu WP, Louissaint A, Marcogliese A, Medeiros LJ, Michal M, Miranda RN, Mitteldorf C, Montes-Moreno S, Morice W, Nardi V, Naresh KN, Natkunam Y, Ng SB, Oschlies I, Ott G, Parrens M, Pulitzer M, Rajkumar SV, Rawstron AC, Rech K, Rosenwald A, Said J, Sarkozy C, Sayed S, Saygin C, Schuh A, Sewell W, Siebert R, Sohani AR, Suzuki R, Tooze R, Traverse-Glehen A, Vega F, Vergier B, Wechalekar AD, Wood B, Xerri L, Xiao W. Correction: "The 5th edition of The World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms" Leukemia. 2022 Jul;36(7):1720-1748. Leukemia 2023; 37:1944-1951. [PMID: 37468552 PMCID: PMC10457187 DOI: 10.1038/s41375-023-01962-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
| | - Catalina Amador
- Department of Pathology, University of Miami, Miami, FL, USA
| | | | | | | | - Emilio Berti
- University of Milan, Fondazione Cà Granda, IRCCS, Ospedale Maggiore Policlinico, Milan, Italy
| | - Govind Bhagat
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Daniel Boyer
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Mariarita Calaminici
- Centre for Haemato-Oncology, Barts Cancer Institute, QMUL and SIHMDS Barts Health NHS Trust, London, UK
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Wah Cheuk
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Wee-Joo Chng
- National University Cancer Institute, Singapore, Singapore
| | - John K Choi
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Sarah E Coupland
- Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Magdalena Czader
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, USA
| | - Sandeep S Dave
- Center for Genomic and Computational Biology and Department of Medicine, Duke University, Durham, NC, USA
| | - Daphne de Jong
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Pathology, Amsterdam, The Netherlands
| | - Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Sapienza University, School of Medicine and Psychology, Sant' Andrea Hospital, Rome, Italy
| | - Ming-Qing Du
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK.
| | - Kojo S Elenitoba-Johnson
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Judith Ferry
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Julia Geyer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg Medical School, Chicago, IL, USA
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Marian Harris
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - Christine J Harrison
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Patty M Jansen
- Leiden University Medical Center, Department of Pathology, Leiden, The Netherlands
| | | | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik Zurich, and Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Joseph Khoury
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hiroshi Kimura
- Department of Virology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wolfram Klapper
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Alexandra E Kovach
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Alexander J Lazar
- Departments of Pathology & Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stefano Lazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Nelson Leung
- Division of Nephrology and Hypertension, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Vasiliki Leventaki
- Department of Pathology, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA
| | - Xiao-Qiu Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, PR China
| | - Megan S Lim
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wei-Ping Liu
- Department of Pathology, West-China Hospital, Sichuan University, Chengdu, PR China
| | - Abner Louissaint
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Marcogliese
- Department of Pathology & Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Michal
- Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Roberto N Miranda
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina Mitteldorf
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Santiago Montes-Moreno
- Anatomic Pathology Department and Translational Hematopathology Lab, Valdecilla/IDIVAL University Hospital, Santander, Spain
| | - William Morice
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kikkeri N Naresh
- Section of Pathology, Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Yasodha Natkunam
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ilske Oschlies
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.
| | - Marie Parrens
- Department of Pathology, Bordeaux University Hospital, Bordeaux, France
| | - Melissa Pulitzer
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Vincent Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, Rochester, MN, USA
| | - Andrew C Rawstron
- HMDS, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Karen Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Andreas Rosenwald
- Institute of Pathology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Jonathan Said
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Shahin Sayed
- Department of Pathology-Aga Khan University Hospital-Nairobi, Nairobi, Kenya
| | - Caner Saygin
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK
| | - William Sewell
- Immunology Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany.
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ritsuro Suzuki
- Department of Hematology & Oncology, Shimane University School of Medicine, Shimane, Japan
| | - Reuben Tooze
- Division of Haematology and Immunology, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Alexandra Traverse-Glehen
- Hospices Civils de Lyon/Department of Pathology/Université Lyon 1/Centre International de Recherche en Infectiologie (CIRI) INSERM U1111-CNRS UMR5308, Lyon, France
| | - Francisco Vega
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beatrice Vergier
- Department of Pathology, Hopital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | - Brent Wood
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Luc Xerri
- Department of Pathology, Institut Paoli-Calmettes and Aix-Marseille University, Marseille, France
| | - Wenbin Xiao
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Charalampous C, Goel U, Kapoor P, Binder M, Buadi FK, Cook J, Dingli D, Dispenzieri A, Fonder AL, Gertz MA, Gonsalves W, Hayman SR, Hobbs MA, Hwa YL, Kourelis T, Lacy MQ, Leung N, Lin Y, Warsame R, Kyle RA, Rajkumar SV, Kumar SK. Outcomes of patients with primary refractory multiple myeloma in the era of triplet and quadruplet induction therapy. Blood Adv 2023; 7:4371-4380. [PMID: 37603349 PMCID: PMC10432608 DOI: 10.1182/bloodadvances.2023009681] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
Patients with multiple myeloma (MM) who do not respond to initial therapy have worse outcomes than primary responders, and effective treatments are lacking in this population. However, the outcomes of primary refractory disease in the modern treatment era have not yet been studied. We reviewed patients with MM treated with triplet/quadruplet therapy at our institution to assess the incidence of primary refractory disease and the impact of salvage therapies in this population. We identified 1127 patients, of whom 1086 were evaluated for hematologic responses after 4 to 6 cycles. Of these, 93.3% (1013) had evidence of response, whereas 6.7% (73) had primary refractory disease. With a median overall survival (OS) of 51.3 months, patients with primary refractory disease had an increased risk of shorter survival in univariable and multivariable analyses (hazard ratio [HR], 3.5 [95% confidence interval (CI), 2.5-4.9]; HR, 4.3 [95% CI, 2.6-6.9], respectively). In the subgroup analysis of patients with primary refractory disease, those who received second-line autologous stem cell transplantation (ASCT) had increased second progression-free survival (20.9 vs 8.1 months; P < .01) and second OS (74.7 vs 31.3 months; P = .02) compared with patients who did not. We conclude that early progression remains a significant factor for shorter OS in the current era, and salvage ASCT could be the most beneficial option for this population.
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Affiliation(s)
| | - Utkarsh Goel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Moritz Binder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Francis K. Buadi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Joselle Cook
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Amie L. Fonder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Morie A. Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Wilson Gonsalves
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Suzanne R. Hayman
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Miriam A. Hobbs
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Yi L. Hwa
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Martha Q. Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Robert A. Kyle
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - S. Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Shaji K. Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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22
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Dimopoulos MA, Merlini G, Bridoux F, Leung N, Mikhael J, Harrison SJ, Kastritis E, Garderet L, Gozzetti A, van de Donk NWCJ, Weisel KC, Badros AZ, Beksac M, Hillengass J, Mohty M, Ho PJ, Ntanasis-Stathopoulos I, Mateos MV, Richardson P, Blade J, Moreau P, San-Miguel J, Munshi N, Rajkumar SV, Durie BGM, Ludwig H, Terpos E. Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group. Lancet Oncol 2023; 24:e293-e311. [PMID: 37414019 DOI: 10.1016/s1470-2045(23)00223-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 07/08/2023]
Abstract
Here, the International Myeloma Working Group (IMWG) updates its clinical practice recommendations for the management of multiple myeloma-related renal impairment on the basis of data published until Dec 31, 2022. All patients with multiple myeloma and renal impairment should have serum creatinine, estimated glomerular filtration rate, and free light chains (FLCs) measurements together with 24-h urine total protein, electrophoresis, and immunofixation. If non-selective proteinuria (mainly albuminuria) or involved serum FLCs value less than 500 mg/L is detected, then a renal biopsy is needed. The IMWG criteria for the definition of renal response should be used. Supportive care and high-dose dexamethasone are required for all patients with myeloma-induced renal impairment. Mechanical approaches do not increase overall survival. Bortezomib-based regimens are the cornerstone of the management of patients with multiple myeloma and renal impairment at diagnosis. New quadruplet and triplet combinations, including proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies, improve renal and survival outcomes in both newly diagnosed patients and those with relapsed or refractory disease. Conjugated antibodies, chimeric antigen receptor T-cells, and T-cell engagers are well tolerated and effective in patients with moderate renal impairment.
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Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Frank Bridoux
- Department of Nephrology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Nelson Leung
- Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
| | - Simon J Harrison
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Alessandro Gozzetti
- Department of Hematology, University of Siena, Policlinico S Maria alle Scotte, Siena, Italy
| | - Niels W C J van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Katja C Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ashraf Z Badros
- Department of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Meral Beksac
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | | | - Mohamad Mohty
- Department of Hematology, Hôpital Saint-Antoine, Sorbonne University and INSERM UMRs 938, Paris, France
| | - P Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | | | - Paul Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Joan Blade
- Department of Hematology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Philippe Moreau
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Jesus San-Miguel
- Cancer Center Clinica Universidad de Navarra, CCUN, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Spain
| | - Nikhil Munshi
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Brian G M Durie
- Department of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, First Department of Medicine, Clinic Ottakring, Vienna, Austria
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece.
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23
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Visram A, Hayman SR, Dispenzieri A, Kapoor P, Lacy MQ, Gertz MA, Buadi FK, Dingli D, Warsame R, Kourelis T, Cook J, Binder M, Gonsalves W, Muchtar E, Leung N, Roy V, Rajkumar SV, Kumar S. A phase 1/2 of carfilzomib and melphalan conditioning for autologous stem cell transplantation for multiple myeloma (CARAMEL). Am J Hematol 2023. [PMID: 37334773 DOI: 10.1002/ajh.26990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/17/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023]
Abstract
In this phase 1/2 study, carfilzomib was added to high-dose melphalan conditioning prior to autologous stem cell transplantation (ASCT) in patients with multiple myeloma that had been treated with ≤2 prior lines of therapy. Carfilzomib was escalated at doses of 27, 36, 45, and 56 mg/m2 on days -6, -5, -2, and -1 before ASCT in the phase 1 component of the study. In addition, all the patients received melphalan 100 mg/m2 on days -4 and -3. The primary endpoint of the phase 1 component was to identify the maximum tolerated dose, and the primary endpoint of the phase 2 component was the rates of complete response (≥CR) at 1 year after ASCT. The phase 1 dose escalation cohort included 14 patients, and 35 patients were included in the phase 2 cohort. The maximum tested dose was 56 mg/m2 (MTD). The median time from diagnosis to study enrollment was 5.8 (range 3.4-88.4) months, and 16% of patients had obtained a ≥CR prior to ASCT. The best response within 1 year after ASCT was a ≥ CR rate in 22% for the entire cohort, and 22% for patients treated at the MTD. The ≥VGPR rates improved from 41% before ASCT to 77% by 1 year after ASCT. One patient had a grade 3 renal adverse event, and renal function returned to baseline with supportive care. The rate of grade 3-4 cardiovascular toxicity was 16%. The addition of carfilzomib to melphalan conditioning was safe and resulted in deep responses after ASCT.
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Affiliation(s)
- Alissa Visram
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Suzanne R Hayman
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Angela Dispenzieri
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Prashant Kapoor
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Francis K Buadi
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - David Dingli
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Rahma Warsame
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Joselle Cook
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Wilson Gonsalves
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Nelson Leung
- Division of Nephrology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Vivek Roy
- Division of Hematology, Mayo Clinic, Jacksonville, Florida, USA
| | - S Vincent Rajkumar
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic Rochester, Rochester, Minnesota, USA
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24
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Rajkumar SV, Kostakoglu L. Defining Myeloma and Advancing Treatment Options: A Conversation Between S. Vincent Rajkumar and Lale Kostakoglu. J Nucl Med 2023; 64:831-834. [PMID: 37263762 DOI: 10.2967/jnumed.123.265877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/14/2023] [Indexed: 06/03/2023] Open
Affiliation(s)
| | - Lale Kostakoglu
- University of Virginia Health System, Charlottesville, Virginia
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25
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Vaxman I, Kumar SK, Buadi F, Lacy MQ, Dingli D, Hayman S, Kourelis T, Warsame R, Hwa Y, Fonder A, Hobbs M, Muchtar E, Leung N, Kapoor P, Go R, Lin Y, Gonsalves W, Siddiqui M, Kyle RA, Rajkumar SV, Gertz MA, Dispenzieri A. Daratumumab, carfilzomib, and pomalidomide for the treatment of POEMS syndrome: The Mayo Clinic Experience. Blood Cancer J 2023; 13:91. [PMID: 37253713 DOI: 10.1038/s41408-023-00859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/20/2023] [Accepted: 05/12/2023] [Indexed: 06/01/2023] Open
Affiliation(s)
- I Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah- Tikvah, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Hayman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T Kourelis
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - E Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Siddiqui
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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26
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Rozenova K, Willrich M, Snyder M, Dasari S, Kourelis T, Rajkumar SV, Kumar S, Dispenzieri A, Murray DL. Kappa Free Light Chain Drift Prompts the Need for a New Upper Limit of Normal Free Light Chain Ratio to Avoid an Epidemic of Kappa Light Chain Monoclonal Gammopathy of Undermined Significance. J Appl Lab Med 2023:7180091. [PMID: 37232112 DOI: 10.1093/jalm/jfad027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/08/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Multiple laboratory tests are employed for detection of monoclonal proteins in patients and include serum protein electrophoresis (SPEP), immunofixation electrophoresis, free light chain (FLC) immunoassay, and mass spectrometry (Mass-Fix). Recently, reports on a drift in FLC quantitation results have been brought to light. METHODS We studied a cohort of 16 887 patients whose sera were tested for a monoclonal protein by a FLC assay, serum protein electrophoresis, and Mass-Fix. This is a retrospective study designed to assess the impact of a drift on the performance of FLC ratio (rFLC) in groups of patients with and without detectable plasma cell disorders (PCDs). RESULTS The results demonstrated that 63% of patients with monoclonal protein equal or higher than 2 g/L (by SPEP) had an abnormal rFLC (reference range 0.26-1.65). Conversely, 16% of patients with undetectable monoclonal protein by other methods (i.e., SPEP and Mass-Fix) who also had no record of treated PCD had an abnormal rFLC. In these cases, there was an imbalance in the number of kappa high rFLCs to lambda low rFLCs of 201 to 1. CONCLUSIONS The results of this study suggest decreased specificity of rFLC for a monoclonal kappa FLC in the 1.65 to 3.0 range.
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Affiliation(s)
- Krasimira Rozenova
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Maria Willrich
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Melissa Snyder
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Surendra Dasari
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | | | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Angela Dispenzieri
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - David L Murray
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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27
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Abdallah NH, Smith AN, Geyer S, Binder M, Greipp PT, Kapoor P, Dispenzieri A, Gertz MA, Baughn LB, Lacy MQ, Hayman SR, Buadi FK, Dingli D, Hwa YL, Lin Y, Kourelis T, Warsame R, Kyle RA, Rajkumar SV, Kumar SK. Conditional survival in multiple myeloma and impact of prognostic factors over time. Blood Cancer J 2023; 13:78. [PMID: 37188699 DOI: 10.1038/s41408-023-00852-4] [Citation(s) in RCA: 2] [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] [Received: 02/20/2023] [Revised: 04/22/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
Overall survival estimates from diagnosis are valuable for guiding treatment, but do not consider the years already survived. Conditional survival (CS) provides dynamic survival predictions over time. This study was conducted to estimate CS at 1-8 years from diagnosis and the impact of baseline prognostic factors on CS in multiple myeloma (MM) patients. This is a retrospective study including 2556 MM patients diagnosed between 2004 and 2019. CS (t | s) was defined as the probability of surviving t years given survival of s years. Median age was 64 years. Median follow-up was 6.2 years and median overall survival from diagnosis was 7.5 years. The 5-year CS estimates at s = 0, 1, 2, 3, and 5 years were 0.64, 0.61, 0.61, 0.61, and 0.58, respectively. On multivariate analysis, age ≥ 65 and proteasome inhibitor+immunomodulatory-based induction were associated with decreased survival and increased survival, respectively, retained at 5 years. The adverse impact of 1q gain/amplification, high-risk IgH translocation, and ISS-3 was significant at 1 and 3 years but not 5 years. Chromosome 17 abnormality was associated with decreased survival only at 1 year. Among MM patients, 5-year CS was stable at 1-5 years from diagnosis. The prognostic impact of high-risk cytogenetic factors decreased with additional years survived.
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Affiliation(s)
| | | | - Susan Geyer
- Department of biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Patricia T Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Linda B Baughn
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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28
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Panakkal V, Lakshman A, Shi M, Olteanu H, Horna P, Timm MM, Otteson GE, Baughn LB, Greipp PT, Gonsalves WI, Kapoor P, Gertz MA, Binder M, Buadi FK, Dispenzieri A, Rajkumar SV, Kumar SK, Jevremovic D. Utility of flow cytometry screening before MRD testing in multiple myeloma. Blood Cancer J 2023; 13:55. [PMID: 37080968 PMCID: PMC10119092 DOI: 10.1038/s41408-023-00832-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Vandana Panakkal
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arjun Lakshman
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Michael M Timm
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | | | - Linda B Baughn
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Patricia T Greipp
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Wilson I Gonsalves
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Prashant Kapoor
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Francis K Buadi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shaji K Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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29
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Leung N, Rajkumar SV. Multiple myeloma with acute light chain cast nephropathy. Blood Cancer J 2023; 13:46. [PMID: 36990996 PMCID: PMC10060259 DOI: 10.1038/s41408-023-00806-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/31/2023] Open
Abstract
Light chain cast nephropathy (LCCN) is a leading cause of acute kidney injury (AKI) in patients with multiple myeloma (MM) and is now defined as a myeloma defining event. While the long-term prognosis has improved with novel agents, short-term mortality remains significantly higher in patients with LCCN especially if the renal failure is not reversed. Recovery of renal function requires a rapid and significant reduction of the involved serum free light chain. Therefore, proper treatment of these patients is of the utmost importance. In this paper, we provide an algorithm for treatment of MM patients who present with biopsy-proven LCCN or in those where other causes of AKI have been ruled out. The algorithm is based on data from randomized trial whenever possible. When trial data is not available, our recommendations is based on non-randomized data and expert opinions on best practices. We recommend that all patients should enroll in a clinical trial if available prior to resorting to the treatment algorithm we outlined.
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Affiliation(s)
- Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
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30
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Goldman-Mazur S, Visram A, Kapoor P, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Hayman SR, Dingli D, Kourelis T, Gonsalves W, Warsame R, Muchtar E, Leung N, Binder M, Fonder A, Hobbs M, Hwa YL, Kyle RA, Rajkumar SV, Kumar SK. Outcomes after biochemical or clinical progression in patients with multiple myeloma. Blood Adv 2023; 7:909-917. [PMID: 35413102 PMCID: PMC10025108 DOI: 10.1182/bloodadvances.2022007082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/20/2022] Open
Abstract
Almost all patients with multiple myeloma (MM) eventually relapse, either asymptomatically or with end-organ damage. However, it remains unclear whether initiating therapy at the time of biochemical progression (BP) improves the outcomes compared with initiating therapy at the clinical progression (CP) stage. Here, we retrospectively assessed 1347 patients with relapsed MM. Most progressions were BP (60.4%); 39.6% had CP. The most prevalent symptoms at relapse were new or evolving bone disease (80.9%), anemia (38.0%), and renal failure (12.7%). Patients with BP had longer median time from second-line treatment to the next treatment compared with patients who had CP (17.0 vs 9.6 months; P < .001) as well as longer median overall survival from first relapse (59.4 vs 26.2 months; P < .001). Male sex (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.02-2.18; P = .04), plasma cell labeling index ≥2% (OR, 1.58; 95% CI, 1.02-2.45; P = .04), and extramedullary disease at diagnosis (OR, 1.84; 95% CI, 1.08-3.13; P = .03) were associated with higher risk of CP, whereas very good partial remission or better had decreased risk of CP (OR, 0.62; 95% CI, 0.43-0.91; P = .02). To conclude, patients with CP have inferior postprogression outcomes compared with patients who have BP. Patients with deeper response to first-line therapy are less likely to develop CP. The presence of a specific CRAB (C, hypercalcemia; R, renal failure; A, anemia; B, bone disease) symptom at diagnosis predicts for the development of similar CRAB symptoms at relapse.
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Affiliation(s)
| | - Alissa Visram
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
- Division of Hematology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Prashant Kapoor
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | - Martha Q. Lacy
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Morie A. Gertz
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | | | - David Dingli
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Nelson Leung
- Division of Nephrology, Mayo Clinic Rochester, Rochester, MN
| | - Moritz Binder
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Amie Fonder
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | - Robert A. Kyle
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
| | | | - Shaji K. Kumar
- Division of Hematology, Mayo Clinic Rochester, Rochester, MN
- Correspondence: Shaji K. Kumar, Division of Hematology, Mayo Clinic Rochester, 200 First St SW, Rochester, MN 55905;
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31
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Chohan KL, Paludo J, Vallumsetla N, Larson D, King RL, He R, Gonsalves W, Inwards D, Witzig TE, Swaika A, Jain T, Leung N, Ailawadhi S, Reeder CB, Lacy MQ, Rajkumar SV, Kumar S, Kyle RA, Gertz MA, Ansell SM, Kapoor P. Survival trends in young patients with Waldenström macroglobulinemia: Over five decades of experience. Am J Hematol 2023; 98:432-439. [PMID: 36588384 DOI: 10.1002/ajh.26807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/25/2022] [Accepted: 12/06/2022] [Indexed: 01/03/2023]
Abstract
Waldenström macroglobulinemia (WM) is a rare, indolent lymphoma, that predominately affects the elderly. We report the outcomes of young WM patients, evaluated over five decades, compared to their older counterparts, matched for the time of diagnosis. Between January 1, 1960 and October 31, 2013, 140 (11.8%) WM patients were ≤50 years of age at diagnosis in our database, and their estimated 10-year overall survival (OS) was 74%, with death attributable to WM in a higher proportion of patients compared to their older (≥65 years) counterparts (91% vs. 58%, p = .0001). Young patients were grouped into three cohorts based on the timing of the initiation of therapy: Group 1 (1960-1977, n = 12), Group 2 (1978-1995, n = 48), and Group 3 (1996-2013, n = 74). Among young patients, there was no disease-specific survival (DSS) difference across the three periods, [median DSS at 13 years (95% CI 5-23), 16 years (95% CI 14-22), and 15 years (95% CI 10-NR; p = .41), respectively]. However, DSS for the older cohort incrementally improved (Group 1, median 5.2 years, Group 2: 9.6 years, Group 3: 12 years; p = .05) over these periods. The estimated average years-of-life lost for the young cohort was 11.2 years from diagnosis, based on the expected survival for a normal age- and sex-matched population. Despite a protracted disease course, nearly all young patients succumb to their disease. In contrast to the improved survival of the elderly patient population, the evolving treatment strategies in WM have not impacted the outcome of young patients; however, the impact of Bruton tyrosine kinase inhibitors on this unique patient population remains to be determined.
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Affiliation(s)
- Karan L Chohan
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonas Paludo
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dirk Larson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rong He
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Wilson Gonsalves
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - David Inwards
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas E Witzig
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhisek Swaika
- Division of Medical Oncology and Hematology, Queens Medical Associates, Northwell Health Physician Partners, Queens, New York, USA
| | - Tania Jain
- Division of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland, USA
| | - Nelson Leung
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sikander Ailawadhi
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Craig B Reeder
- Division of Hematology-Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Martha Q Lacy
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - S Vincent Rajkumar
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shaji Kumar
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert A Kyle
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Morie A Gertz
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen M Ansell
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashant Kapoor
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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32
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Charalampous C, Goel U, Kapoor P, Binder M, Buadi FK, Dingli D, Dispenzieri A, Fonder AL, Gertz MA, Gonsalves W, Hayman SR, Hobbs MA, Hwa YL, Kourelis T, Lacy MQ, Leung N, Lin Y, Warsame R, Kyle RA, Rajkumar SV, Kumar S. Thrombosis in multiple myeloma: Risk estimation by induction regimen and association with overall survival. Am J Hematol 2023; 98:413-420. [PMID: 36588396 DOI: 10.1002/ajh.26806] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/27/2022] [Accepted: 11/28/2022] [Indexed: 01/03/2023]
Abstract
Lenalidomide-containing (R) triplet and quadruplet regimens are the standard of care for multiple myeloma (MM) and have been shown to increase the risk of thrombosis. The association between thromboembolism (TE) and survival in the novel multidrug era is not yet delineated. In this study, we evaluated the incidence of TE during the first year of MM diagnosis, its association with the type of induction regimen, and its impact on overall survival. We studied 672 newly diagnosed MM (NDMM) patients who received a triplet or quadruplet lenalidomide-based induction at the Mayo Clinic, Rochester. TE was diagnosed in 83 patients (12.4%). Of these, 56 (8.3%) had a deep venous thrombosis (DVT), 23 (3.4%) had a pulmonary embolism (PE) with or without the DVT, and 4 (0.6%) patients had a stroke. Carfilzomib-Rd (KRd) had the highest risk of TE (21.1%, 18/85), followed by quadruplets (11.1%, 5/45), bortezomib-Rd (9.6%, 51/531), and 0/11 (0%), treated with other lenalidomide-containing regimens. The difference in TE risk between KRd and the other regimens was statistically significant (OR = 2.6, p < .01). Nine patients developed a TE before being exposed to any treatment. Survival was significantly lower among patients that developed a TE (66 vs. 133 months, p < .01). The association of TE with reduced survival demonstrated in univariate analysis (HR = 2.2, 95% CI = 1.6-3.3) was maintained in the multivariable analysis adjusted for high-risk interphase fluorescence in situ hybridization (FISH), sex, age, receipt of an upfront transplant, the response at induction, and the International Staging System (ISS) (HR = 2.61, CI = 1.74-3.9). We conclude that TE is an important aspect of MM management, and effective management is especially relevant in the novel treatment era.
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Affiliation(s)
| | - Utkarsh Goel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Moritz Binder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Francis K Buadi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Amie L Fonder
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Morie A Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wilson Gonsalves
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suzanne R Hayman
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Miriam A Hobbs
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yi L Hwa
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Martha Q Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yi Lin
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert A Kyle
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shaji Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Bringhen S, Pour L, Benjamin R, Grosicki S, Min CK, de Farias DLC, Vorog A, Labotka RJ, Wang B, Cherepanov D, Cain LE, Manne S, Rajkumar SV, Dimopoulos MA. Ixazomib Versus Placebo as Post-Induction Maintenance Therapy in Newly Diagnosed Multiple Myeloma Patients: An Analysis by Age and Frailty Status of the TOURMALINE-MM4 Study. Clinical Lymphoma Myeloma and Leukemia 2023:S2152-2650(23)00093-9. [PMID: 37149398 DOI: 10.1016/j.clml.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND The TOURMALINE-MM4 trial demonstrated a significant and clinically meaningful progression-free survival (PFS) benefit with ixazomib versus placebo as postinduction maintenance in nontransplant, newly-diagnosed multiple myeloma patients, with a manageable and well-tolerated toxicity profile. MATERIALS AND METHODS In this subgroup analysis, efficacy and safety were assessed by age (< 65, 65-74, and ≥ 75 years) and frailty status (fit, intermediate-fit, and frail). RESULTS In this analysis, PFS benefit with ixazomib versus placebo was seen across age subgroups, including patients aged < 65 years (hazard ratio [HR], 0.576; 95% confidence interval [CI], 0.299-1.108; P = .095), 65-74 years (HR, 0.615; 95% CI, 0.467-0.810; P < .001), and ≥ 75 years (HR, 0.740; 95% CI, 0.537-1.019; P = .064). PFS benefit was also seen across frailty subgroups, including fit (HR, 0.530; 95% CI, 0.387-0.727; P < .001), intermediate-fit (HR, 0.746; 95% CI, 0.526-1.058; P = .098), and frail (HR, 0.733; 95% CI, 0.481-1.117; P = .147) patients. With ixazomib versus placebo, rates of grade ≥ 3 treatment-emergent adverse events (TEAEs; 28-44% vs. 10-36%), serious TEAEs (15-29% vs. 3-29%), and discontinuation due to TEAEs (7-19% vs. 5-11%) were higher or similar across age and frailty subgroups, and generally somewhat higher in older age groups and intermediate-fit/frail patients in both arms. Treatment with ixazomib versus placebo did not adversely affect patient-reported quality-of-life scores across age and frailty status subgroups. CONCLUSION Ixazomib is a feasible and effective maintenance option for prolonging PFS across this heterogeneous patient population.
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Ryu AJ, Kumar S, Dispenzieri A, Kyle RA, Rajkumar SV, Kingsley TC. Artificial intelligence-enabled screening strategy for drug repurposing in monoclonal gammopathy of undetermined significance. Blood Cancer J 2023; 13:28. [PMID: 36797276 PMCID: PMC9935510 DOI: 10.1038/s41408-023-00798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a benign hematological condition with the potential to progress to malignant conditions including multiple myeloma and Waldenstrom macroglobulinemia. Medications that modify progression risk have yet to be identified. To investigate, we leveraged machine-learning and electronic health record (EHR) data to screen for drug repurposing candidates. We extracted clinical and laboratory data from a manually curated MGUS database, containing 16,752 MGUS patients diagnosed from January 1, 2000 through December 31, 2021, prospectively maintained at Mayo Clinic. We merged this with comorbidity and medication data from the EHR. Medications were mapped to 21 drug classes of interest. The XGBoost module was then used to train a primary Cox survival model; sensitivity analyses were also performed limiting the study group to those with non-IgM MGUS and those with M-spikes >0.3 g/dl. The impact of explanatory features was quantified as hazard ratios after generating distributions using bootstrapping. Medication data were available for 12,253 patients; those without medications data were excluded. Our model achieved a good fit of the data with inverse probability of censoring weights concordance index of 0.883. The presence of multivitamins, immunosuppression, non-coronary NSAIDS, proton pump inhibitors, vitamin D supplementation, opioids, statins and beta-blockers were associated with significantly lower hazard ratio for MGUS progression in our primary model; multivitamins and non-coronary NSAIDs remained significant across both sensitivity analyses. This work could inform subsequent prospective studies, or similar studies in other disease states.
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Affiliation(s)
- Alexander J Ryu
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas C Kingsley
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Quantitative Health Sciences, Rochester, MN, USA
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35
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Nandakumar B, Baffour F, Abdallah NH, Kumar SK, Dispenzieri A, Buadi FK, Dingli D, Lacy MQ, Hayman SR, Kapoor P, Leung N, Fonder A, Hobbs M, Hwa YL, Muchtar E, Warsame R, Kourelis TV, Go RS, Kyle RA, Gertz MA, Rajkumar SV, Klug J, Korfiatis P, Gonsalves WI. Sarcopenia identified by computed tomography imaging using a deep learning-based segmentation approach impacts survival in patients with newly diagnosed multiple myeloma. Cancer 2023; 129:385-392. [PMID: 36413412 PMCID: PMC9822865 DOI: 10.1002/cncr.34545] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sarcopenia increases with age and is associated with poor survival outcomes in patients with cancer. By using a deep learning-based segmentation approach, clinical computed tomography (CT) images of the abdomen of patients with newly diagnosed multiple myeloma (NDMM) were reviewed to determine whether the presence of sarcopenia had any prognostic value. METHODS Sarcopenia was detected by accurate segmentation and measurement of the skeletal muscle components present at the level of the L3 vertebrae. These skeletal muscle measurements were further normalized by the height of the patient to obtain the skeletal muscle index for each patient to classify them as sarcopenic or not. RESULTS The study cohort consisted of 322 patients of which 67 (28%) were categorized as having high risk (HR) fluorescence in situ hybridization (FISH) cytogenetics. A total of 171 (53%) patients were sarcopenic based on their peri-diagnosis standard-dose CT scan. The median overall survival (OS) and 2-year mortality rate for sarcopenic patients was 44 months and 40% compared to 90 months and 18% for those not sarcopenic, respectively (p < .0001 for both comparisons). In a multivariable model, the adverse prognostic impact of sarcopenia was independent of International Staging System stage, age, and HR FISH cytogenetics. CONCLUSIONS Sarcopenia identified by a machine learning-based convolutional neural network algorithm significantly affects OS in patients with NDMM. Future studies using this machine learning-based methodology of assessing sarcopenia in larger prospective clinical trials are required to validate these findings.
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Affiliation(s)
| | | | | | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN
- Division of Nephrology, Mayo Clinic, Rochester, MN
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Ronald S. Go
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Jason Klug
- Department of Radiology, Mayo Clinic, Rochester, MN
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36
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Dicanio M, Giaccherini M, Clay‐Gilmour A, Macauda A, Sainz J, Machiela MJ, Rybicka‐Ramos M, Norman AD, Tyczyńska A, Chanock SJ, Barington T, Kumar SK, Bhatti P, Cozen W, Brown EE, Suska A, Haastrup EK, Orlowski RZ, Dudziński M, Garcia‐Sanz R, Kruszewski M, Martinez‐Lopez J, Beider K, Iskierka‐Jazdzewska E, Pelosini M, Berndt SI, Raźny M, Jamroziak K, Rajkumar SV, Jurczyszyn A, Vangsted AJ, Collado PG, Vogel U, Hofmann JN, Petrini M, Butrym A, Slager SL, Ziv E, Subocz E, Giles GG, Andersen NF, Mazur G, Watek M, Lesueur F, Hildebrandt MAT, Zawirska D, Ebbesen LH, Marques H, Gemignani F, Dumontet C, Várkonyi J, Buda G, Nagler A, Druzd‐Sitek A, Wu X, Kadar K, Camp NJ, Grzasko N, Waller RG, Vachon C, Canzian F, Campa D. A pleiotropic variant in DNAJB4 is associated with multiple myeloma risk. Int J Cancer 2023; 152:239-248. [PMID: 36082445 PMCID: PMC9828677 DOI: 10.1002/ijc.34278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 01/12/2023]
Abstract
Pleiotropy, which consists of a single gene or allelic variant affecting multiple unrelated traits, is common across cancers, with evidence for genome-wide significant loci shared across cancer and noncancer traits. This feature is particularly relevant in multiple myeloma (MM) because several susceptibility loci that have been identified to date are pleiotropic. Therefore, the aim of this study was to identify novel pleiotropic variants involved in MM risk using 28 684 independent single nucleotide polymorphisms (SNPs) from GWAS Catalog that reached a significant association (P < 5 × 10-8 ) with their respective trait. The selected SNPs were analyzed in 2434 MM cases and 3446 controls from the International Lymphoma Epidemiology Consortium (InterLymph). The 10 SNPs showing the strongest associations with MM risk in InterLymph were selected for replication in an independent set of 1955 MM cases and 1549 controls from the International Multiple Myeloma rESEarch (IMMEnSE) consortium and 418 MM cases and 147 282 controls from the FinnGen project. The combined analysis of the three studies identified an association between DNAJB4-rs34517439-A and an increased risk of developing MM (OR = 1.22, 95%CI 1.13-1.32, P = 4.81 × 10-7 ). rs34517439-A is associated with a modified expression of the FUBP1 gene, which encodes a multifunctional DNA and RNA-binding protein that it was observed to influence the regulation of various genes involved in cell cycle regulation, among which various oncogenes and oncosuppressors. In conclusion, with a pleiotropic scan approach we identified DNAJB4-rs34517439 as a potentially novel MM risk locus.
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Affiliation(s)
| | | | - Alyssa Clay‐Gilmour
- Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaGreenvilleSouth CarolinaUSA
| | - Angelica Macauda
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ)HeidelbergGermany
| | - Juan Sainz
- Genomic Oncology Area, GENYO. Center for Genomics and Oncological Research: PfizerUniversity of Granada/Andalusian Regional GovernmentGranadaSpain,Department of HematologyVirgen de las Nieves University HospitalGranadaSpain,Department of MedicineUniversity of GranadaGranadaSpain
| | - Mitchell J. Machiela
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteNational Institues of HealthBethesdaMarylandUSA
| | | | - Aaron D. Norman
- Division of Epidemiology, Department of Health Sciences ResearchMayo ClinicRochesterOntarioUSA,Division of Biomedical Statistics and Informatics, Department of Health Sciences ResearchMayo ClinicRochesterOntarioUSA
| | - Agata Tyczyńska
- Department of Hematology and TransplantologyMedical University of GdańskGdańskPoland
| | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteNational Institues of HealthBethesdaMarylandUSA
| | | | - Shaji K. Kumar
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterOntarioUSA
| | - Parveen Bhatti
- Cancer Control ResearchBC CancerVancouverCanada,Program in Epidemiology, Public Health Sciences DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Wendy Cozen
- Division of Hematology/Oncology, Department of Medicine, School of Medicine, Susan and Henry Samueli College of Health SciencesChao Family Comprehensive Cancer Center, University of CaliforniaIrvineCaliforniaUSA,Department of Pathology, School of Medicine, Susan and Henry Samueli College of Health SciencesChao Family Comprehensive Cancer Center, University of CaliforniaIrvineCaliforniaUSA
| | - Elizabeth E. Brown
- Department of Pathology, School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Anna Suska
- Plasma Cell Dyscrasia Center Department of Hematology Jagiellonian University Faculty of MedicineKrakówPoland
| | | | - Robert Z. Orlowski
- Department of Lymphoma ‐ Myeloma, Division of Cancer MedicineUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Marek Dudziński
- Department of Hematology, Institute of Medical Sciences, College of Medical SciencesUniversity of RzeszowRzeszowPoland
| | - Ramon Garcia‐Sanz
- Medina A. Department of Hematology, University Hospital of Salamanca (HUS/IBSAL)CIBERONC and Cancer Research Institute of Salamanca‐IBMCC (USAL‐CSIC)SalamancaSpain
| | - Marcin Kruszewski
- Department of HematologyUniversity Hospital No. 2 in BydgoszczBydgoszczPoland
| | | | - Katia Beider
- Hematology Division Chaim Sheba Medical CenterTel HashomerIsrael
| | | | - Matteo Pelosini
- U.O. Dipartimento di EmatologiaAzienda USL Toscana Nord OvestLivornoItaly,Present address:
Ospedale Santa ChiaraPisaItaly
| | - Sonja I. Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteNational Institues of HealthBethesdaMarylandUSA
| | | | - Krzysztof Jamroziak
- Department of HematologyInstitute of Hematology and Transfusion MedicineWarsawPoland
| | - S. Vincent Rajkumar
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterOntarioUSA
| | - Artur Jurczyszyn
- Plasma Cell Dyscrasia Center Department of Hematology Jagiellonian University Faculty of MedicineKrakówPoland
| | | | | | - Ulla Vogel
- National Research Center for the Working EnvironmentCopenhagenDenmark
| | - Jonathan N. Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteNational Institues of HealthBethesdaMarylandUSA
| | - Mario Petrini
- Hematology Unit, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Aleksandra Butrym
- Department of Cancer Prevention and TherapyWroclaw Medical UniversityWroclawPoland
| | - Susan L. Slager
- Division of Epidemiology, Department of Health Sciences ResearchMayo ClinicRochesterOntarioUSA
| | - Elad Ziv
- Department of MedicineUniversity of California San Francisco Helen Diller Family Comprehensive Cancer CenterSan FranciscoCaliforniaUSA
| | - Edyta Subocz
- Department of HematologyMilitary Institute of MedicineWarsawPoland
| | - Graham G. Giles
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia,Center for Epidemiology and Biostatistics, School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia,Precision Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
| | | | - Grzegorz Mazur
- Department of Internal Diseases, Occupational Medicine, Hypertension and Clinical OncologyWroclaw Medical UniversityWroclawPoland
| | - Marzena Watek
- Department of HematologyInstitute of Hematology and Transfusion MedicineWarsawPoland,Department of HematologyHolycross Cancer CenterKielcePoland
| | - Fabienne Lesueur
- Inserm, U900, Institut Curie, PSL Research University, Mines ParisTechParisFrance
| | - Michelle A. T. Hildebrandt
- Department of Lymphoma ‐ Myeloma, Division of Cancer MedicineUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Daria Zawirska
- Department of HematologyUniversity Hospital in CracowCracowPoland
| | | | - Herlander Marques
- Life and Health Sciences Research Institute (ICVS), School of Health SciencesUniversity of Minho, Braga, Portugal and ICVS/3B's – PT Government Associate LaboratoryBraga/GuimarãesPortugal
| | | | | | - Judit Várkonyi
- Department of Hematology and Internal MedicineSemmelweis UniversityBudapestHungary
| | - Gabriele Buda
- Hematology Unit, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Arnon Nagler
- Hematology Division Chaim Sheba Medical CenterTel HashomerIsrael
| | - Agnieszka Druzd‐Sitek
- Department of Lymphoproliferative DiseasesMaria Skłodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Xifeng Wu
- Department of Epidemiology, Division of Cancer Prevention and Population SciencesUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Katalin Kadar
- Department of Hematology and Internal MedicineSemmelweis UniversityBudapestHungary
| | - Nicola J. Camp
- Division of Hematology and Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Norbert Grzasko
- Department of Experimental HematooncologyMedical University of LublinLublinPoland
| | - Rosalie G. Waller
- Division of Biomedical Statistics and Informatics, Department of Health Sciences ResearchMayo ClinicRochesterOntarioUSA
| | - Celine Vachon
- Division of Epidemiology, Department of Health Sciences ResearchMayo ClinicRochesterOntarioUSA
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ)HeidelbergGermany
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37
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Goel U, Charalampous C, Kapoor P, Binder M, Buadi FK, Dingli D, Dispenzieri A, Fonder A, Gertz MA, Gonsalves WI, Hayman SR, Hobbs MA, Hwa YL, Kourelis T, Lacy MQ, Leung N, Lin Y, Warsame RM, Kyle RA, Rajkumar SV, Kumar SK. Defining drug/drug class refractoriness vs lines of therapy in relapsed/refractory multiple myeloma. Blood Cancer J 2023; 13:11. [PMID: 36631454 PMCID: PMC9834217 DOI: 10.1038/s41408-023-00785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Affiliation(s)
- Utkarsh Goel
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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38
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Ho M, Zanwar S, Buadi FK, Ailawadhi S, Larsen J, Bergsagel L, Binder M, Chanan‐Khan A, Dingli D, Dispenzieri A, Fonseca R, Gertz MA, Gonsalves W, Go RS, Hayman S, Kapoor P, Kourelis T, Lacy MQ, Leung N, Lin Y, Muchtar E, Roy V, Sher T, Warsame R, Fonder A, Hobbs M, Hwa YL, Kyle RA, Rajkumar SV, Kumar S. Risk factors for severe infection and mortality In patients with COVID-19 in patients with multiple myeloma and AL amyloidosis. Am J Hematol 2023; 98:49-55. [PMID: 36226510 PMCID: PMC9874728 DOI: 10.1002/ajh.26762] [Citation(s) in RCA: 13] [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] [Received: 08/12/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Abstract
Patients with multiple myeloma (MM) have a lower efficacy from COVID-19 vaccination and a high rate of mortality from COVID-19 in hospitalized patients. However, the overall rate and severity of COVID-19 infection in all settings (including non-hospitalized patients) and the independent impact of plasma cell-directed therapies on outcomes needs further study. We reviewed the medical records of 9225 patients with MM or AL amyloidosis (AL) seen at Mayo Clinic Rochester, Arizona, and Florida between 12/01/2019 and 8/31/2021 and identified 187 patients with a COVID-19 infection (n = 174 MM, n = 13 AL). The infection rate in our cohort was relatively low at 2% but one-fourth of the COVID-19 infections were severe. Nineteen (10%) patients required intensive care unit (ICU) admission and 5 (3%) patients required mechanical ventilation. The mortality rate among hospitalized patients with COVID-19 was 22% (16/72 patients). Among patients that were fully vaccinated at the time of infection (n = 12), two (17%) developed severe COVID-19 infection, without any COVID-related death. On multivariable analysis, treatment with CD38 antibody within 6 months of COVID-19 infection [Risk ratio (RR) 3.6 (95% CI: 1.2, 10.5), p = .02], cardiac [RR 4.1 (95% CI: 1.3, 12.4), p = .014] or pulmonary comorbidities [RR 3.6 (95% CI 1.1, 11.6); p = .029] were independent predictors for ICU admission. Cardiac comorbidity [RR 2.6 (95% CI: 1.1, 6.5), p = .038] was an independent predictor of mortality whereas MM/AL in remission was associated with lower mortality [RR 0.4 (95% CI: 0.2-0.8); p = .008].
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Affiliation(s)
- Matthew Ho
- Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Saurabh Zanwar
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Francis K. Buadi
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - Jeremy Larsen
- Division of HematologyMayo ClinicScottsdaleArizonaUSA
| | | | - Moritz Binder
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - David Dingli
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - Morie A. Gertz
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Wilson Gonsalves
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Ronald S. Go
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Suzanne Hayman
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Prashant Kapoor
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Martha Q. Lacy
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Nelson Leung
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Yi Lin
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Eli Muchtar
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Vivek Roy
- Division of HematologyMayo ClinicJacksonvilleFloridaUSA
| | - Taimur Sher
- Division of HematologyMayo ClinicJacksonvilleFloridaUSA
| | - Rahma Warsame
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Amie Fonder
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Miriam Hobbs
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Yi L. Hwa
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Robert A. Kyle
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - S. Vincent Rajkumar
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
| | - Shaji Kumar
- Division of Hematology, Department of Internal MedicineMayo ClinicRochesterMinnesotaUSA
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Goldman-Mazur S, Visram A, Rajkumar SV, Kapoor P, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Hayman SR, Dingli D, Kourelis T, Gonsalves W, Warsame R, Muchtar E, Leung N, Kyle RA, Kumar SK. Second- and third-line treatment strategies in multiple myeloma: a referral-center experience. Blood Cancer J 2022; 12:164. [PMID: 36473843 PMCID: PMC9723783 DOI: 10.1038/s41408-022-00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/02/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
The treatment landscape for relapsed multiple myeloma (MM) has increased. In this study, we aimed to characterize 2nd (n = 1439) and 3rd (n = 1104) line regimens and compare the results between subgroups based on the year of treatment initiation (2nd line: 2003-2008, 2009-2015, 2016-2021; 3rd line: 2004-2009, 2010-2015, and 2016-2021). In both the second- and third- lines, we observed increasing use of novel agents (from 78 to 95% and from 77 to 95%, respectively) and triplet regimens (from 15 to 69% and from 21 to 71%, respectively). The most frequently used regimens in the last studied periods included lenalidomide-dexamethasone (RD; 14%), carfilzomib-RD (12%), and daratumumab-RD (10%) for the second-line, and daratumumab-pomalidomide-dexamethasone (11%) and daratumumab-RD (10%) for the third-line. The median time to the next treatment from second-line therapy has improved from 10.4 months (95% CI: 8.4-12.4) to 16.6 months (95% CI: 13.3-20.3; p < 0.001). The median overall survival from the first relapse increased from 30.9 months (95% CI: 26.8-183.0) to 65.8 months (95% CI: 50.7-72.8; p < 0.001). Over the last two decades, more patients were treated with newer agents and triplets for relapsed MM. The landscape of regimens has become more diverse, and survival after the first relapse is continually improving.
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Affiliation(s)
- Sarah Goldman-Mazur
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Alissa Visram
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA ,grid.412687.e0000 0000 9606 5108Division of Hematology, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - S. Vincent Rajkumar
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Prashant Kapoor
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Angela Dispenzieri
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Martha Q. Lacy
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Morie A. Gertz
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Francis K. Buadi
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Suzanne R. Hayman
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - David Dingli
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Taxiarchis Kourelis
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Wilson Gonsalves
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Rahma Warsame
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Eli Muchtar
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Nelson Leung
- grid.66875.3a0000 0004 0459 167XDivision of Nephrology, Mayo Clinic Rochester, Rochester, MN USA
| | - Robert A. Kyle
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Shaji K. Kumar
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic Rochester, Rochester, MN USA
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Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is of considerable clinical importance to primary care physicians given its high prevalence in the general population. MGUS has a variable but lifelong risk for progression to hematologic cancer, such as multiple myeloma, Waldenström macroglobulinemia, or light-chain amyloidosis. In addition, MGUS has been associated with several nonmalignant yet symptomatic disorders that require therapy directed toward eliminating the monoclonal gammopathy. Thus, it is important not only to understand the essentials of diagnosing and monitoring patients with MGUS but also to recognize when to refer patients with MGUS to a specialist.
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Affiliation(s)
- Wilson I Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, Minnesota (W.I.G., S.V.R.)
| | - S Vincent Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota (W.I.G., S.V.R.)
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Scheckel CJ, Desai A, Rajkumar SV. Failure to Launch: Why Some Generics Don't Take. Mayo Clin Proc 2022; 97:1975-1980. [PMID: 36333013 DOI: 10.1016/j.mayocp.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/26/2022] [Accepted: 07/27/2022] [Indexed: 03/21/2023]
Affiliation(s)
- Caleb J Scheckel
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Aakash Desai
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - S Vincent Rajkumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
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Willrich MAV, Murray DL, Rajkumar SV, Bryant SC, Larson D, Pazdernik V, Snyder MR, Kyle RA, Dispenzieri A. Comparison of two free light chain assays: performance of the involved free light chain ratio and implications for diagnosis of multiple myeloma. Blood Cancer J 2022; 12:127. [PMID: 36055996 PMCID: PMC9440004 DOI: 10.1038/s41408-022-00722-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - David L Murray
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | | | - Sandra C Bryant
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, US
| | - Dirk Larson
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, US
| | - Vanessa Pazdernik
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, US
| | - Melissa R Snyder
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, US
| | - Angela Dispenzieri
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US. .,Division of Hematology, Mayo Clinic, Rochester, MN, US.
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Affiliation(s)
| | - S. Vincent Rajkumar
- Address for correspondence: Dr S. Vincent Rajkumar, Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. @VincentRK
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44
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Rajkumar SV. The Path Forward in Multiple Myeloma: 2021 Jan Waldenstrom Award Lecture. Clin Lymphoma Myeloma Leuk 2022; 22:666-669. [PMID: 35614010 DOI: 10.1016/j.clml.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
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Sidana S, Dueck AC, Thanarajasingam G, Griffin JM, Thompson C, Durani U, Burtis M, Warsame R, Paludo J, Gertz MA, Dispenzieri A, Ansell SM, Vincent Rajkumar S, Yost K, Bennani N, Lin Y, Kumar S. Longitudinal Patient Reported Outcomes with CAR-T Cell Therapy Versus Autologous and Allogeneic Stem Cell Transplant. Transplant Cell Ther 2022; 28:473-482. [PMID: 35550440 PMCID: PMC9357185 DOI: 10.1016/j.jtct.2022.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 12/14/2022]
Abstract
There are limited data on patient experience after chimeric antigen receptor (CAR) T-cell therapy, especially in comparison to autologous and allogeneic transplantation, which are more established forms of cellular therapy. We prospectively evaluated longitudinal patient-reported quality of life (QoL), symptom burden and cognition after CAR-T cell therapy and compared it with prospective cohorts of patients undergoing autologous stem cell transplantation (autoSCT) and allogeneic SCT (alloSCT). This was a single center study. The primary endpoint was change in QoL. Secondary endpoints were patient-reported adverse events (PRO-AEs) measured by Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) and cognitive function (NeuroQOLv2 questionnaire). Time profile of PRO-AEs was evaluated using longitudinal analysis, Toxicity over Time (ToxT). Patients completed questionnaires at baseline, week 2 and monthly for 6 months. One hundred four patients were evaluable (CAR-T: 34, autoSCT: 33, alloSCT: 37). Baseline QoL was similar across groups. We observed a short-term decline in QoL in all groups that gradually returned to baseline. The nadir in QoL was at week 2 and coincided with peak in symptom burden. The decline in overall QoL, physical and functional well-being was significantly less with CAR-T versus SCT groups and returned to baseline faster. Patients in the alloSCT group experienced the greatest symptom burden, greater decrease in performance status, largest short-term decline in QoL and slowest recovery. This study provides comprehensive data comparing QoL, PRO-AEs and cognition following CAR-T cell therapy versus autoSCT and alloSCT, and the first application of ToxT to PRO-CTCAE data. Short-term QOL, including physical and functional domains was better in the CAR-T group versus SCT groups, although all groups experienced an initial decline coinciding with peak symptoms. These data can serve as a guide for patient education, symptom management, and future studies in CAR-T cell therapy.
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Affiliation(s)
- Surbhi Sidana
- Division of BMT and Cellular Therapy, Stanford University School of Medicine, Stanford, CA,Division of Hematology, Mayo Clinic, Rochester, MN
| | - Amylou C. Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale Arizona
| | | | - Joan M. Griffin
- Division of Health Care Delivery Research and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Kathleen Yost
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Nora Bennani
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN
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Sidana S, Allmer C, Larson MC, Dueck A, Yost K, Warsame R, Thanarajasingam G, Cerhan JR, Paludo J, Rajkumar SV, Habermann TM, Nowakowski GS, Lin Y, Gertz MA, Witzig T, Dispenzieri A, Gonsalves WI, Ansell SM, Thompson CA, Kumar SK. Patient Experience in Clinical Trials: Quality of Life, Financial Burden, and Perception of Care in Patients With Multiple Myeloma or Lymphoma Enrolled on Clinical Trials Compared With Standard Care. JCO Oncol Pract 2022; 18:e1320-e1333. [PMID: 35580285 PMCID: PMC9377715 DOI: 10.1200/op.21.00789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Patients' concerns regarding clinical trial (CT) participation include apprehension about side effects, quality of life (QoL), financial burden, and quality of care. METHODS We prospectively evaluated the experience of patients with multiple myeloma or lymphoma who were treated on CTs (CT group, n = 35) versus patients treated with standard approaches (non-CT group, n = 88) focusing on QoL, financial burden of care, and patients' perception of quality of care over a 1-year period. RESULTS There were no significant differences in any of the patient-reported outcomes in CT versus non-CT groups. We observed an initial decline in overall QoL in the first 3 months across both groups, driven primarily by physical and functional well-being. QoL gradually improved and was above baseline by month 12. Patients reported highest improvement in the functional well-being subdomain. Patients in both groups reported high satisfaction with the quality of care received, and there were no differences in overall satisfaction, communication with team, or access to care. At baseline, 16%-19% of patients reported financial burden, which increased to a peak of 33% in the CT group and to 49% in the non-CT group over the course of 1 year. There was no significant difference in financial burden in the two groups overall. Most of the patients reported getting all the care that was deemed medically necessary in both groups. However, a significant proportion of patients reported having to make other kinds of financial sacrifices because of their cancer (CT group: 33% of patients at baseline and 21%-40% over 1 year; non-CT group: 19% at baseline and 25%-36% over 1 year). CONCLUSION Patients treated on CTs reported comparable QoL and quality of care with the non-CT group. A high proportion of patients reported financial burden over time in both groups. Our findings can serve as a guide to educate patients regarding CT participation and highlight the need to address the significant financial burden experienced by patients with cancer.
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Affiliation(s)
- Surbhi Sidana
- Division of BMT and Cellular Therapy, Stanford University School of Medicine, Stanford, CA,Division of Hematology, Mayo Clinic, Rochester, MN
| | - Cristine Allmer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Melissa C. Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Amylou Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | - James R. Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | - Shaji K. Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN,Shaji K. Kumar, MD, Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail:
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47
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Ebraheem M, Kumar SK, Dispenzieri A, Jevremovic D, Buadi FK, Dingli D, Cook J, Lacy MQ, Hayman SR, Kapoor P, Leung N, Fonder A, Hobbs M, Hwa YL, Muchtar E, Warsame R, Kourelis TV, Russell S, Binder M, Lin Y, Go RS, Siddiqui MA, Kyle RA, Rajkumar SV, Gonsalves WI, Gertz MA. Deepening Responses after Upfront Autologous Stem Cell Transplantation in Patients with Newly Diagnosed Multiple Myeloma in the Era of Novel Agent Induction Therapy. Transplant Cell Ther 2022; 28:760.e1-760.e5. [DOI: 10.1016/j.jtct.2022.07.030] [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] [Received: 06/14/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022]
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48
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Gagnon MF, Tian S, Geyer S, Sharma N, Vachon CM, Kusne Y, Bergsagel PL, Stewart AK, Rajkumar SV, Kumar S, Ailawadhi S, Baughn LB. Distribution of clonal hematopoiesis of indeterminate potential (CHIP) is not associated with race in patients with plasma cell neoplasms. Blood Cancer J 2022; 12:112. [PMID: 35882836 PMCID: PMC9325693 DOI: 10.1038/s41408-022-00706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/04/2022] [Accepted: 07/08/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marie-France Gagnon
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Shulan Tian
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Susan Geyer
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Neeraj Sharma
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Celine M Vachon
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Yael Kusne
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - P Leif Bergsagel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - S Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shaji Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sikander Ailawadhi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Linda B Baughn
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA. .,Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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49
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Macauda A, Clay-Gilmour A, Hielscher T, Hildebrandt MAT, Kruszewski M, Orlowski RZ, Kumar SK, Ziv E, Orciuolo E, Brown EE, Försti A, Waller RG, Machiela MJ, Chanock SJ, Camp NJ, Rymko M, Raźny M, Cozen W, Várkonyi J, Piredda C, Pelosini M, Belachew AA, Subocz E, Hemminki K, Rybicka-Ramos M, Giles GG, Milne RL, Hofmann JN, Zaucha JM, Vangsted AJ, Goldschmidt H, Rajkumar SV, Tomczak W, Sainz J, Butrym A, Watek M, Iskierka-Jazdzewska E, Buda G, Robinson DP, Jurczyszyn A, Dudziński M, Martinez-Lopez J, Sinnwell JP, Slager SL, Jamroziak K, Reis RMV, Weinhold N, Bhatti P, Carvajal-Carmona LG, Zawirska D, Norman AD, Mazur G, Berndt SI, Campa D, Vachon CM, Canzian F. Does a Multiple Myeloma Polygenic Risk Score Predict Overall Survival of Myeloma Patients? Cancer Epidemiol Biomarkers Prev 2022; 31:1863-1866. [PMID: 35700034 DOI: 10.1158/1055-9965.epi-22-0043] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/18/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Genome-wide association studies (GWAS) of multiple myeloma (MM) in populations of European ancestry (EA) identified and confirmed 24 susceptibility loci. For other cancers (e.g. colorectum and melanoma), risk loci have also been associated with patient survival. METHODS We explored the possible association of all the known risk variants and their polygenic risk score (PRS) with MM overall survival (OS) in multiple populations of EA (IMMEnSE consortium, InterLymph consortium, CoMMpass and the German GWAS) for a total of 3748 MM cases. Cox proportional hazards regression was used to assess the association between each risk SNP with OS under the allelic and codominant models of inheritance. All analyses were adjusted for age, sex, country of origin (for IMMEnSE) or principal components (for the others) and disease stage (ISS). SNP associations were meta-analyzed. RESULTS SNP associations were meta-analyzed. From the meta-analysis, two MM risk SNPs were associated with OS (p<0.05), specifically POT1-AS1-rs2170352 (HR=1.37, 95% C.I.=1.09-1.73, p=0.007) and TNFRSF13B-rs4273077 (HR=1.19, 95% C.I.=1.01-1.41, p=0.04). The association between the combined 24 SNP MM-PRS and OS, however, was not significant. CONCLUSIONS Overall, our results did not support an association between the majority of MM risk SNPs and OS. IMPACT This is the first study to investigate the association between MM PRS and OS in MM.
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Affiliation(s)
- Angelica Macauda
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Biology, University of Pisa, Pisa, Italy
| | - Alyssa Clay-Gilmour
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Greenville, South Carolina
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Michelle A T Hildebrandt
- Department of Lymphoma - Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marcin Kruszewski
- Department of Hematology University Hospital Bydgoszcz, Bydgoszcz, Poland
| | - Robert Z Orlowski
- Department of Lymphoma - Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shaji K Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Elad Ziv
- Department of Medicine, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Enrico Orciuolo
- Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Elizabeth E Brown
- Department of Pathology, School of Medicine, University of Alabama, Birmingham, Alabama
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Rosalie G Waller
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | | | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Bethesda, Maryland
| | - Nicola J Camp
- Division of Hematology and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Marcin Rymko
- Department of Haematology and Bone Marrow Transplantation, SSM im. M. Kopernika, Torun, Poland
| | | | - Wendy Cozen
- Division of Hematology/Oncology, Department of Medicine, School of Medicine, Department of Pathology, School of Medicine, Susan and Henry Samueli College of Health Sciences, Chao Family Comprehensive Cancer Center, University of California at Irvine, California
| | - Judit Várkonyi
- Department of Hematology and Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Chiara Piredda
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matteo Pelosini
- Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Alem A Belachew
- Department of Lymphoma - Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edyta Subocz
- Department of Hematology, Military Institute of Medicine, Warsaw, Poland
| | - Kari Hemminki
- Biomedical Center, Faculty of Medicine, Charles University in Pilsen, Pilsen, Czech Republic
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Jonathan N Hofmann
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Bethesda, Maryland
| | - Jan Maciej Zaucha
- Department of Hematology and Transplantology, Medical Univeristy of Gdańsk, Gdańsk, Poland
| | - Annette Juul Vangsted
- Department of Haematology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - S Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Waldemar Tomczak
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, Poland
| | - Juan Sainz
- Genomic Oncology Area, GENYO. Centre for Genomics and Oncological Research: Pfizer, University of Granada/Andalusian Regional Government, Granada, Spain
- Hematology department, Virgen de las Nieves University Hospital, Granada, Spain
| | - Aleksandra Butrym
- Department of Internal and Occupational Diseases, Medical University Wroclaw, Wroclaw, Poland
| | - Marzena Watek
- Hematology Clinic, Holycross Cancer Center, Kielce, Poland
| | | | - Gabriele Buda
- Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Dennis P Robinson
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Artur Jurczyszyn
- Plasma Cell Dyscrasias Center, Department of Hematology, Faculty of Medicine, Jagiellonian University, Kraków, Poland
| | - Marek Dudziński
- Department of Hematology, Institute of Medical Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | | | - Jason P Sinnwell
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Susan L Slager
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Krzysztof Jamroziak
- Department of Hematology, Transplantation and Internal Disease, Medical University of Warsaw, Warsaw, Poland
| | - Rui Manuel Vieira Reis
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal and ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | - Niels Weinhold
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
- CCU Molecular Hematology/Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Parveen Bhatti
- Division of Population Oncology Cancer Control Research, BC Cancer, Vancouver, Bristish Columbia, Canada
- Program in Epidemiology, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Luis G Carvajal-Carmona
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, California
- Latinos United for Cancer Health Advancement Initiative, University of California Davis Comprehensive Cancer Center, Sacramento, California
- Community Engagement Program, Clinical and Translational Science Center, University of California Davis, Sacramento, California
| | - Daria Zawirska
- Department of Hematology, University Hospital of Cracow, Cracow, Poland
| | - Aaron D Norman
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Grzegorz Mazur
- Department of Internal and Occupational Diseases, Medical University Wroclaw, Wroclaw, Poland
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Bethesda, Maryland
| | - Daniele Campa
- Department of Biology, University of Pisa, Pisa, Italy
| | - Celine M Vachon
- Division of Epidemiology, Department of Quantitative Sciences, Mayo Clinic, Rochester, Minnesota
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
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50
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Abeykoon JP, Vaxman J, Patel SV, Kumar S, Malave GC, Young KS, Ailawadhi S, Larsen JT, Dispenzieri A, Muchtar E, Gonsalves WI, Kourelis T, Leung N, Warsame R, Go RS, Bergsagel L, Lacy MQ, Rajkumar SV, Gertz MA, Kapoor P. Impact of belantamab mafodotin-induced ocular toxicity on outcomes of patients with advanced multiple myeloma. Br J Haematol 2022; 199:95-99. [PMID: 35694818 DOI: 10.1111/bjh.18298] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022]
Abstract
Belantamab mafodotin (BLMF) is a B-cell maturation antigen-directed antibody-drug conjugate, recently approved for advanced multiple myeloma (MM). The impact of BLMF-induced ocular toxicity on patient outcomes is unknown. We studied a cohort of 38 consecutively seen patients treated with BLMF outside of trials. Of those, 75% experienced ocular toxicity, with 69% developing keratopathy. Among patients requiring ocular toxicity-related permanent BLMF discontinuation (14%) or dose reduction (11%), 70% had progression of MM within a median of 3 months (95% confidence interval: 0.2-not reached) following BLMF interruption or dose reduction. Ocular toxicity is a major deterrent to the continuous use of BLMF in routine clinical practice. Measures to successfully prevent and mitigate ocular toxicity should be developed to achieve the full potential of this agent.
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Affiliation(s)
- Jithma P Abeykoon
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Julia Vaxman
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjay V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shaji Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabriella C Malave
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kimberly S Young
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sikander Ailawadhi
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jeremy T Larsen
- Division of Hematology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eli Muchtar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wilson I Gonsalves
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nelson Leung
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronald S Go
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Leif Bergsagel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Martha Q Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Morie A Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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