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Sherbenou D, Stalker M, Forsberg P, Mark TM. Sustained Response to Selinexor-Based Therapy for Triple-Class Refractory Multiple Myeloma with Early Relapse After Allogeneic Stem Cell Transplantation. Clin Lymphoma Myeloma Leuk 2021; 21:e630-e634. [PMID: 33863694 DOI: 10.1016/j.clml.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/14/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Daniel Sherbenou
- University of Colorado Denver-Anschutz Medical Campus, Aurora, CO
| | - Margaret Stalker
- University of Colorado Denver-Anschutz Medical Campus, Aurora, CO
| | - Peter Forsberg
- University of Colorado Denver-Anschutz Medical Campus, Aurora, CO
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Kilari D, Hari P, Qayed M, Fraser R, Davila O, Kumar S, Mark TM, Nieto Y, D'Souza A. Tandem high-dose chemotherapy and autologous hematopoietic stem cell transplantation (SCT) compared to single SCT for relapsed/refractory germ cell tumors (GCT). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.572] [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: 11/20/2022] Open
Abstract
572 Background: Single-center observational studies have established the use of single or tandem SCT to salvage relapsed GCT but randomized trials are lacking. We analyzed outcomes and prognostic factors in 2,395 male SCT recipients for relapsed GCT between 1990 and 2015. Methods: Recipients of single or tandem SCT reported to the Center for International Blood and Marrow Transplant Research were identified. Outcomes were compared by SCT year: 1990-94 (N = 288), 1995-99 (N = 351), 2000-04 (N = 376), 2005-09 (N = 509) and 2010-15 (N = 871). A recent subset (n = 267, 2000-2015) with detailed disease- and transplant-related data was further analyzed with a multivariate (MVA) Cox proportional hazards model. Results: Median age at SCT was 31 (11-76) years and 49% received SCT within 12 months of diagnosis consistent with early relapse/primary refractory GCT. 26% had primary extragonadal GCT; 1,167 (49%) had intent to tandem transplant (TT). The median follow up was 51 (3-313) months. Day 100 non-relapse mortality was statistically similar at 8% in 1990-94 (vs. 4% in 2010-15) but 3-year progression-free survival (PFS) improved from 24 (18-31)% in 1990-94 to 47 (43-50)% in 2010-15 (p < 0.0001) and 3-year survival (OS) from 35 (29-40)% to 54 (50-57)% in 2010-15 (p < 0.0001). Compared with single SCT, TT recipients were younger 31 (16-62) vs 34 (13-76), with lower Hematopoietic Cell Transplantation-Comorbidity Index, more likely to undergo SCT after 1 line of chemotherapy (28% vs 9%), and within 1 year of diagnosis (51% vs 38%). TT was preferred over single SCT over time (48% of SCT were TT in 2000-04 vs. 81% in 2010-15). In MVA, non-seminoma histology, residual tumor at SCT, receipt of > 1 line of pre-SCT chemotherapy and single SCT (vs. TT), were associated with worse PFS and OS. Year of SCT was not significant when adjusted for these covariates. Conclusions: In this large longitudinal cohort, improvements in PFS and OS were observed in recent years. SCT earlier in disease course and tandem SCT were associated with superior outcomes. These data involving a large cohort reported from 225 centers confirm specialized centers’ date in a real-world setting.
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Affiliation(s)
| | | | | | - Raphael Fraser
- Center for International Blood and Marrow Transplant Research/ Medical College of Wisconsin, Milwaukee, WI
| | - Omar Davila
- Center for International Blood and Marrow Transplant Research/ Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Yago Nieto
- UT MD Anderson Cancer Center, Houston, TX
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research/ Medical College of Wisconsin, Milwaukee, WI
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Palumbo A, Chanan-Khan AAA, Weisel K, Nooka AK, Masszi T, Beksac M, Spicka I, Hungria VT, Mateos MV, Mark TM, Qi M, Schecter JM, Amin H, Qin X, Deraedt W, Ahmadi T, Spencer A, Sonneveld P. Phase III randomized controlled study of daratumumab, bortezomib, and dexamethasone (DVd) versus bortezomib and dexamethasone (Vd) in patients (pts) with relapsed or refractory multiple myeloma (RRMM): CASTOR study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.18_suppl.lba4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA4 Background: Daratumumab (D), a human anti-CD38 IgGκ mAb, induces deep and durable responses with a favorable safety profile in RRMM pts. We report a pre-specified interim analysis of the first randomized controlled study of D (CASTOR; NCT02136134). Methods: Pts with ≥1 prior line of therapy were randomized (1:1) to 8 cycles (q3w) of bortezomib (V)/dexamethasone (d) (V: 1.3 mg/m2sc on Days 1, 4, 8, 11; d: 20 mg po on Days 1, 2, 4, 5, 8, 9, 11, 12) ± D (16 mg/kg iv qw in Cycles 1-3, Day 1 of Cycles 4-8, then q4w until progression). Primary endpoint was PFS. Results: 498 pts (DVd, 251; Vd, 247) were randomized. Baseline demographics and disease characteristics were well balanced. Pts received a median of 2 prior lines of therapy (range 1-10). 66% received prior V; 76% received prior IMiD; 48% received prior PI and IMiD; 33% were IMiD-refractory; 32% were refractory to last line of prior therapy. With median follow-up of 7.4 months, D significantly improved median PFS (61% reduction in risk of progression) and TTP for DVd vs Vd (Table). D significantly increased ORR (83% vs 63%, P <0.0001), and doubled rates of ≥VGPR (59% vs 29%, P <0.0001), and ≥CR (19% vs 9%, P= 0.0012) for DVd vs Vd, respectively; median duration of response was NR vs 7.9 months, respectively. Most common (>25%) AEs (DVd/Vd) were thrombocytopenia (59%/44%), peripheral sensory neuropathy (47%/ 38%), diarrhea (32%/22%) and anemia (26%/31%). Most common grade 3/4 AEs (>10%) were thrombocytopenia (45%/33%), anemia (14%/16%), neutropenia (13%/4%). 7%/9% of pts discontinued due to a TEAE. D-associated infusion-related reactions (45% of pts) mostly occurred during the first infusion; most were grade 1/2 (grade 3/4, 9%/0%). Conclusions: D significantly improved PFS, TTP, and ORR in combination with Vd vs Vd alone. DVd doubled both VGPR and sCR/CR rates vs Vd alone. Safety of DVd is consistent with the known safety profile of D and Vd. The addition of D to Vd should be considered a new standard of care for RRMM pts currently receiving Vd alone. Clinical trial information: NCT02136134. [Table: see text]
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Affiliation(s)
| | | | - Katja Weisel
- Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Tubingen, Germany
| | | | - Tamas Masszi
- Fovarosi Onkormanyzat Szent Laszlo Korhaza, Hematologia, Budapest, Hungary
| | - Meral Beksac
- Ankara Universitesi Tip Fakultesi, Ankara, Turkey
| | - Ivan Spicka
- Vseobecna Fakultni Nemocnice V Praze, Prague, Czech Republic
| | - Vania T.M. Hungria
- Irmandade da Santa Casa de Misericordia de São Paulo, Sao Paulo, Brazil
| | | | | | - Ming Qi
- Janssen Research and Development, LLC, Raritan, NJ
| | | | - Himal Amin
- Janssen Research & Development LLC, Raritan, NJ
| | - Xiang Qin
- Janssen Research & Development LLC, Raritan, NJ
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Palumbo A, Chanan-Khan AAA, Weisel K, Nooka AK, Masszi T, Beksac M, Spicka I, Hungria VT, Mateos MV, Mark TM, Qi M, Schecter JM, Amin H, Qin X, Deraedt W, Ahmadi T, Spencer A, Sonneveld P. Phase III randomized controlled study of daratumumab, bortezomib, and dexamethasone (DVd) versus bortezomib and dexamethasone (Vd) in patients (pts) with relapsed or refractory multiple myeloma (RRMM): CASTOR study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.lba4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Katja Weisel
- Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Tubingen, Germany
| | | | - Tamas Masszi
- Fovarosi Onkormanyzat Szent Laszlo Korhaza, Hematologia, Budapest, Hungary
| | - Meral Beksac
- Ankara Universitesi Tip Fakultesi, Ankara, Turkey
| | - Ivan Spicka
- Vseobecna Fakultni Nemocnice V Praze, Prague, Czech Republic
| | - Vania T.M. Hungria
- Irmandade da Santa Casa de Misericordia de São Paulo, Sao Paulo, Brazil
| | | | | | - Ming Qi
- Janssen Research and Development, LLC, Raritan, NJ
| | | | - Himal Amin
- Janssen Research & Development LLC, Raritan, NJ
| | - Xiang Qin
- Janssen Research & Development LLC, Raritan, NJ
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Ely S, Forsberg P, Niesvizky R, Mark TM. Plasma cell proliferation by SynKii multiplex immunohistochemistry (mIHC) for clinical use in multiple myeloma (MM). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.8056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Peter Forsberg
- New York Presbyterian Hospital - Weill Cornell Campus, New York, NY
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Rossi AC, Mark TM, Rodriguez M, Shah M, Quinn R, Pearse RN, Zafar F, Pekle K, Speaker S, Jayabalan D, Ely S, Coleman M, Chen-Kiang S, Niesvizky R. Clarithromycin, pomalidomide, and dexamethasone (ClaPD) in relapsed or refractory multiple myeloma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8036 Background: Clarithromycin has been shown to enhance anti-myeloma activity of lenalidomide+dexamethasone in the upfront treatment of multiple myeloma (MM). Pomalidomide is an immunomodulatory agent effective in relapsed/refractory MM (RRMM). We hypothesized that clarithromycin may similarly enhance pomalidomide + dexamethasone in RRMM. We now report updated results from a phase 2 trial of ClaPD in RRMM. Methods: 73 patients with RRMM were enrolled in a single-institution phase 2 study of ClaPD. All subjects had ≥ 3 prior lines of therapy, one of which must have included lenalidomide. ClaPD is clarithromycin 500mg twice daily; dexamethasone 40mg weekly; and pomalidomide 4mg for days 1-21 of a 28-day cycle. All patients had VTE prophylaxis with aspirin. Monthly disease response evaluation included immunoelectrophoresis and free light chain analysis; bone marrow biopsy with skeletal imaging was used to confirm MM responses. Treatment continued as tolerated until disease progression. Results: The 66 patients who completed ≥ 1 cycle of ClaPD are reported. Median number of cycles was 6 (range 1-17). Responses were progressive disease: 10%, stable disease: 21%, minimal response: 12%, partial response: 33%, very good partial response: 18%, stringent complete remission: 5%, for an overall response rate (ORR) of 56% and ≥VGPR rate of 23%. Median time to PR was 1.25 cycles (range 1-8). Median PFS was 5 months. Response and PFS were not different in patients refractory to lenalidomide (85%), bortezomib (82%), or double-refractory patients (76%). After a median follow up of 12 months,28 pts (42%) remain on study without progression and 56pts (85%) are alive. Two pts withdrew due to toxicity (1 Grade 3 fatigue, 1 Grade 4 muscular weakness). One patient withdrew consent. Conclusions: ClaPD is highly effective for heavily pre-treated RRMM, particularly in lenalidomide-refractory disesase and compares favorably to previously published Phase 2 data of Pom/Dex (ORR 56% vs 40% - Lacy et. al JCO 2009) without excess toxicity. Response to ClaPD is rapid, well tolerated, and sustained over 7 months in most subjects. These data support the clinical efficacy of pomalidomide based regimens in RRMM.
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Affiliation(s)
- Adriana C. Rossi
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | | | | | | | | | | | - Faiza Zafar
- New York-Presbyterian Hospital, New York, NY
| | - Karen Pekle
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | | | | | | | | | - Selina Chen-Kiang
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Ruben Niesvizky
- Center of Excellence for Lymphoma and Myeloma, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY
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Kostakoglu L, Dingli D, Beksac M, Zamagni E, Mark TM, Chari A, Elliott BM, Lowe VJ, Ozkan E, Nanni C, Kucuk O, Fanti S, Coleman M, Jagannath S. Prognostic value of post-induction PET/CT in untreated multiple myeloma (MM) patients undergoing autologous stem cell transplant (ASCT). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e21006] [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: 11/20/2022] Open
Abstract
e21006 Background: Induction with novel biological agents has significantly improved progression free survival (PFS) of MM pts. However, role and timing of ASCT is unclear and there remains a need for a practical means to predict post-ASCT outcome. Our goal was to determine the prognostic value of FDG PET/CT (PET) after induction therapy (IT) in comparison with other prognostic factors and International Myeloma Working Group (IMWG) response criteria. Methods: Prospective, multicenter study of 113 newly diagnosed MM pts undergoing IT+ASCT. IT was not controlled and consisted of 2 or 3 novel agent combinations. The tested variables to predict PFS are shown in table. Two PET scoring systems were used: Score1, positive>marrow uptake; Score2, positive>liver uptake. ROC analysis determined the SUV cut-off. Results: With a median follow-up of 29.5 mo 56 (49.6%) pts relapsed (median PFS: 24.3 mo). Results are displayed in table. Post-IT, when a "+" PET (Score2) was associated with less than a VGPR response, relapses occurred in 83% of pts vs. in only 30% when PET was "-" and pts were in CR or VGPR. Multivariate analysis revealed only ISS to be an independent predictor of PFS (p=0.014). Conclusions: Post-IT a "-" PET associated with CR+VGPR suggests a durable response. Qualitative PET evaluation using a more liberal threshold (liver) to define positivity can be used to accurately assess response in MM. These data failed to prove the post-IT IMWG and PET response to be independent prognosticators while ISS was a superior predictor. This may be attributed to inadequate sample size, nonuniform pre- and post-ASCT treatments, varying follow-up times. Further analyses with stratifying various prognostic indicators and therapy schemes in a larger population are underway to determine a definitive role for PET as a predictor of post-ASCT outcome. [Table: see text]
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Affiliation(s)
| | | | - Meral Beksac
- Ankara University School of Medicine, Ankara, Turkey
| | - Elena Zamagni
- Bologna University School of Medicine, Bologna, Italy
| | | | - Ajai Chari
- Mount Sinai School of Medicine, New York, NY
| | | | | | - Elgin Ozkan
- Ankara University School of Medicine, Ankara, Turkey
| | | | - Ozlem Kucuk
- Ankara University School of Medicine, Ankara, Turkey
| | - Stefano Fanti
- Bologna University School of Medicine, Bologna, Italy
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Anderson PA, Greig A, Mark TM, Malouf NN, Oakeley AE, Ungerleider RM, Allen PD, Kay BK. Molecular basis of human cardiac troponin T isoforms expressed in the developing, adult, and failing heart. Circ Res 1995; 76:681-6. [PMID: 7534662 DOI: 10.1161/01.res.76.4.681] [Citation(s) in RCA: 145] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiac troponin T (cTnT), a protein essential for calcium-regulated myofibrillar ATPase activity, is expressed in the human heart as four isoforms (cTnT1 through cTnT4, numbered in the order of decreasing molecular size). The expression of these isoforms at the protein level has previously been found by us to differ in the normal and failing adult and fetal human heart. In the present study, we have cloned and sequenced four full-length cDNAs corresponding to the four native cTnT protein isoforms and have expressed these cDNAs in an in vitro transcription and translation system. The cDNAs differ by the variable inclusion of a 15- and a 30-nt exon in the 5' half of the coding region. These cDNAs yielded proteins that comigrate with the native isoforms, cTnT1 through cTnT4. Polyclonal antisera, raised against a synthetic peptide corresponding to the 10-residue peptide encoded by the 30-nt exon, reacted with the two human isoforms largest in molecular size (cTnT1 and cTnT2) and the two largest cTnT isoforms of the rabbit and rat. The isoforms cTnT1 and cTnT2, containing either both peptides encoded by the 30- and 15-nt exons or the peptide encoded by the 30-nt exon alone, are expressed in the fetal heart, with cTnT2 being expressed at a very low level. cTnT4, lacking both of these sequences, is expressed in the fetal heart and is reexpressed in the failing adult heart, whereas cTnT3, containing the 5-residue peptide, is the dominant isoform in the adult heart.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P A Anderson
- Department of Biology, University of North Carolina, Chapel Hill
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Lubin J, Mark TM, Wirtschafter AR. Papillomas of prostatic urethra with prostatic-type epithelium: report of eight cases. Mt Sinai J Med 1984; 51:218-21. [PMID: 6374438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Mark TM, Rywlin AM, Unger H. Cystic adventitial degeneration of the popliteal artery. Its occurrence in a patient with the nail-patella syndrome. Arch Pathol Lab Med 1983; 107:186-8. [PMID: 6687538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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