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Jaccard A, Bridoux F, Roeloffzen W, Minnema MC, Bergantim R, Hájek R, João C, Cibeira MT, Palladini G, Schönland S, Merlini G, Milani P, Dimopoulos MA, Ravichandran S, Hegenbart U, Agis H, Gros B, Asra A, Magarotto V, Cheliotis G, Psarros G, Sonneveld P, Wechalekar A, Kastritis E. Healthcare Resource Utilization and Cost-of-Illness in Systemic Light Chain (AL) Amyloidosis in Europe: Results From the Real-World, Retrospective EMN23 Study. Clin Lymphoma Myeloma Leuk 2024:S2152-2650(24)00057-0. [PMID: 38453615 DOI: 10.1016/j.clml.2024.01.013] [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] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To report healthcare resource utilization (HCRU) and safety outcomes in systemic light chain (AL) amyloidosis from the EMN23 study. MATERIALS AND METHODS The retrospective, observational, multinational EMN23 study included 4,480 patients initiating first-line treatment for AL amyloidosis in 2004-2018 and assessed, among other objectives, HCRU and safety outcomes. HCRU included hospitalizations, examinations, and dialysis; safety included serious adverse events (SAEs) and adverse events of special interest (AESIs). Data were descriptively analyzed by select prognostic factors (e.g., cardiac staging by Mayo2004/European) for 2004-2010 and 2011-2018. A cost-of-illness analysis was conducted for the UK and Spain. RESULTS HCRU/safety and dialysis data were extracted for 674 and 774 patients, respectively. Of patients with assessed cardiac stage (2004-2010: 159; 2011-2018: 387), 67.9% and 61.0% had ≥ 1 hospitalization, 56.0% and 51.4% had ≥ 1 SAE, and 31.4% and 28.9% had ≥ 1 AESI across all cardiac stages in 2004-2010 and 2011-2018, respectively. The per-patient-per-year length of hospitalization increased with disease severity (cardiac stage). Of patients with dialysis data (2004-2010: 176; 2011-2018: 453), 23.9% and 14.8% had ≥ 1 dialysis session across all cardiac stages in 2004-2010 and 2011-2018, respectively. The annual cost-of-illness was estimated at €40,961,066 and €31,904,386 for the UK and Spain, respectively; dialysis accounted for ∼28% (UK) and ∼35% (Spain) of the total AL amyloidosis costs. CONCLUSIONS EMN23 showed that the burden of AL amyloidosis is substantial, highlighting the need for early disease diagnosis and effective treatments targeting the underlying pathology.
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Affiliation(s)
- Arnaud Jaccard
- CHU Limoges, National Amyloidosis Center and Hematology Unit, Limoges, France
| | | | - Wilfried Roeloffzen
- Amyloidosis Centre of Expertise Department of Internal Medicine, Faculty of Medical Sciences, University Medical Center Groningen, Groningen, Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rui Bergantim
- Department of Hematology, Hospital São João, Porto, Portugal
| | - Roman Hájek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Cristina João
- Department of Hematology, Hospital Clinic, IDIBAPS, Champalimaud Center for the Unknown, Lisbon, Portugal
| | - M Teresa Cibeira
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Giovanni Palladini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefan Schönland
- Medical Department V, Amyloidosis Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Giampaolo Merlini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Milani
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sriram Ravichandran
- National Amyloidosis Centre, University College London, London, United Kingdom
| | | | - Hermine Agis
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University Vienna, Vienna, Austria
| | | | | | | | | | | | | | - Ashutosh Wechalekar
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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Jaccard A, Bridoux F, Roeloffzen W, Minnema MC, Bergantim R, Hájek R, João C, Cibeira MT, Palladini G, Schönland S, Merlini G, Milani P, Dimopoulos MA, Ravichandran S, Hegenbart U, Agis H, Gros B, Asra A, Dergarabetian E, Magarotto V, Leonidakis A, Cheliotis G, Sonneveld P, Wechalekar A, Kastritis E. P1714: HEALTHCARE RESOURCE UTILIZATION IN PATIENTS WITH LIGHT CHAIN AMYLOIDOSIS IN EUROPE. Hemasphere 2022. [PMCID: PMC9429565 DOI: 10.1097/01.hs9.0000849712.10352.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gentile M, Magarotto V, Offidani M, Musto P, Bringhen S, Teresa Petrucci M, Gay F, Larocca A, Uccello G, Petrungaro A, Vigna E, Greco R, Grazia Recchia A, Tripepi G, Ria R, Di Raimondo F, Palumbo A, Morabito F. Lenalidomide and low-dose dexamethasone (Rd) versus bortezomib, melphalan, prednisone (VMP) in elderly newly diagnosed multiple myeloma patients: A comparison of two prospective trials. Am J Hematol 2017; 92:244-250. [PMID: 28006855 DOI: 10.1002/ajh.24621] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 11/30/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022]
Abstract
There are currently no direct head-to-head clinical trials evaluating bortezomib-melphalan-prednisone (VMP) versus lenalidomide and low-dose dexamethasone (Rd). VMP (257 cases) and Rd (222 cases) arms of two randomized phase III trials were employed to assess the treatment influence on outcome in untreated elderly MM patients. Progression free survival (PFS) and overall survival (OS) were the primary and secondary end-points, respectively, and were investigated according to treatments administered over a 60-months follow-up period. While VMP significantly reduced the disease progression rate between enrolment and 12 months of follow-up, no difference between the two schedules was found between 12 and 32 months. After 32 months, Rd-treated patients had a lower incidence of disease progression. A statistically significant higher OS rate was seen in the VMP arm, which was maintained after data adjustment for potential confounders. Both approaches showed acceptable toxicity profiles. The profound tumor reduction by VMP over Rd justifies the initial higher PFS rate in favor of the bortezomib schedule, while the Rd regimen overcomes this evident initial drawback in reducing the tumor burden by long-term drug administration, gaining a subsequent improved disease control. VMP is associated with a significant reduced risk of death. This study may help physicians make a more informed therapy choice.
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Affiliation(s)
- Massimo Gentile
- Department of Onco‐hematologyHematology UnitA.O. of Cosenza Italy
| | - Valeria Magarotto
- Myeloma Unit, Division of HematologyUniversity of Torino, Azienda Ospedaliero‐Universitaria Città della Salute e della Scienza di Torino Italy
| | | | - Pellegrino Musto
- Scientific Direction, IRCCS‐CROB, Referral Cancer Center of BasilicataRionero in Vulture Potenza Italy
| | - Sara Bringhen
- Myeloma Unit, Division of HematologyUniversity of Torino, Azienda Ospedaliero‐Universitaria Città della Salute e della Scienza di Torino Italy
| | - Maria Teresa Petrucci
- HematologyDepartment of Cellular Biotechnologies and Hematology, La Sapienza UniversityRome Italy
| | - Francesca Gay
- Myeloma Unit, Division of HematologyUniversity of Torino, Azienda Ospedaliero‐Universitaria Città della Salute e della Scienza di Torino Italy
| | - Alessandra Larocca
- Myeloma Unit, Division of HematologyUniversity of Torino, Azienda Ospedaliero‐Universitaria Città della Salute e della Scienza di Torino Italy
| | | | | | - Ernesto Vigna
- Department of Onco‐hematologyHematology UnitA.O. of Cosenza Italy
| | - Rosa Greco
- Department of Onco‐hematologyHematology UnitA.O. of Cosenza Italy
| | - Anna Grazia Recchia
- Biotechnology Research Unit, Azienda Sanitaria Provinciale di CosenzaAprigliano CS Italy
| | - Giovanni Tripepi
- Consiglio Nazionale delle Ricerche, Istituto di Fisiologia ClinicaReggio Calabria Italy
| | - Roberto Ria
- Internal MedicineDepartment of Biomedical Science, G Baccelli Policlinico, Bari, University of Bari Aldo Moro Medical School Italy
| | | | - Antonio Palumbo
- Myeloma Unit, Division of HematologyUniversity of Torino, Azienda Ospedaliero‐Universitaria Città della Salute e della Scienza di Torino Italy
| | - Fortunato Morabito
- Department of Onco‐hematologyHematology UnitA.O. of Cosenza Italy
- Biotechnology Research Unit, Azienda Sanitaria Provinciale di CosenzaAprigliano CS Italy
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Attal M, Palumbo A, Holstein SA, Lauwers-Cances V, Petrucci MT, Richardson PG, Hulin C, Tosi P, Anderson KC, Caillot D, Magarotto V, Moreau P, Marit G, Yu Z, McCarthy PL. Lenalidomide (LEN) maintenance (MNTC) after high-dose melphalan and autologous stem cell transplant (ASCT) in multiple myeloma (MM): A meta-analysis (MA) of overall survival (OS). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.8001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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)
| | - Antonio Palumbo
- Department of Hematology, University of Torino, Torino, Italy
| | | | | | | | | | - Cyrille Hulin
- Hematology Department, University Hospital, Nancy, France
| | - Patrizia Tosi
- Seràgnoli Institute of Hematology and Medical Oncology, Bologna University, Bologna, Italy
| | | | | | - Valeria Magarotto
- Myeloma Unit, Division of Hematology, University of Torino, AOU S. Giovanni Battista, Torino, Italy
| | | | - Gerald Marit
- Service d'Hématologie Clinique, Hôpital du Haut Leveque CHU de Bordeaux, Bordeaux, France
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Klepin HD, Rizzieri D, Palumbo A, Magarotto V, Eichhorst B. Individualizing treatment decisions for older adults with hematologic malignancies. Am Soc Clin Oncol Educ Book 2016:208-19. [PMID: 23714504 DOI: 10.14694/edbook_am.2013.33.208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hematologic malignancies are a common cause of morbidity and mortality among older adults, who represent the majority of patients diagnosed with these diseases. Treatment options and disease outcomes have improved in recent years because of the development of novel treatment strategies and the design of elderly-specific clinical trials. Despite this, extrapolation of clinical trial data to patients routinely seen in practice is challenging because of the presence of multimorbidity and functional impairments. Individualized treatment decision making requires not only an understanding of underlying tumor biology but also careful estimation of an older patient's anticipated ability to withstand the stresses of therapy. This article will discuss approaches to standardizing patient assessment strategies and tailoring therapeutic decisions for older adults with hematologic malignancies with a focus on acute myeloid leukemia (AML), allogeneic bone marrow transplantation, multiple myeloma (MM), and chronic lymphocytic leukemia (CLL).
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Affiliation(s)
- Heidi D Klepin
- From the Comprehensive Cancer Center of Wake Forest University, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC; Department of Medicine, Division of Hematologic Malignancies and Cell Therapy, Duke University Medical Center, Durham, NC; Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy; Department I of Internal Medicine and Center of Integrated Oncology Köln Bonn, University of Cologne, Köln, Germany
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Amorim S, Stathis A, Gleeson M, Iyengar S, Magarotto V, Leleu X, Morschhauser F, Karlin L, Broussais F, Rezai K, Herait P, Kahatt C, Lokiec F, Salles G, Facon T, Palumbo A, Cunningham D, Zucca E, Thieblemont C. Bromodomain inhibitor OTX015 in patients with lymphoma or multiple myeloma: a dose-escalation, open-label, pharmacokinetic, phase 1 study. The Lancet Haematology 2016; 3:e196-204. [DOI: 10.1016/s2352-3026(16)00021-1] [Citation(s) in RCA: 297] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 12/22/2022]
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Magarotto V, Salvini M, Bonello F, Bringhen S, Palumbo A. Strategy for the treatment of multiple myeloma utilizing monoclonal antibodies: A new era begins. Leuk Lymphoma 2015; 57:537-56. [DOI: 10.3109/10428194.2015.1102245] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Valeria Magarotto
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Salvini
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Bonello
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Sara Bringhen
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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Gay F, Oliva S, Petrucci MT, Conticello C, Catalano L, Corradini P, Siniscalchi A, Magarotto V, Pour L, Carella A, Malfitano A, Petrò D, Evangelista A, Spada S, Pescosta N, Omedè P, Campbell P, Liberati AM, Offidani M, Ria R, Pulini S, Patriarca F, Hajek R, Spencer A, Boccadoro M, Palumbo A. Chemotherapy plus lenalidomide versus autologous transplantation, followed by lenalidomide plus prednisone versus lenalidomide maintenance, in patients with multiple myeloma: a randomised, multicentre, phase 3 trial. Lancet Oncol 2015; 16:1617-29. [PMID: 26596670 DOI: 10.1016/s1470-2045(15)00389-7] [Citation(s) in RCA: 238] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/04/2015] [Accepted: 10/01/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND High-dose melphalan plus autologous stem-cell transplantation (ASCT) is the standard approach in transplant-eligible patients with newly diagnosed myeloma. Our aims were to compare consolidation with high-dose melphalan plus ASCT versus chemotherapy (cyclophosphamide and dexamethasone) plus lenalidomide, and maintenance with lenalidomide plus prednisone versus lenalidomide alone. METHODS We did an open-label, randomised, multicentre, phase 3 study at 59 centres in Australia, Czech Republic, and Italy. We enrolled transplant-eligible patients with newly diagnosed myeloma aged 65 years or younger. Patients received a common induction with four 28-day cycles of lenalidomide (25 mg, days 1-21) and dexamethasone (40 mg, days 1, 8, 15, and 22) and subsequent chemotherapy with cyclophosphamide (3 g/m(2)) followed by granulocyte colony-stimulating factor for stem-cell mobilisation and collection. Using a 2 × 2 partial factorial design, we randomised patients to consolidation with either chemotherapy plus lenalidomide (six cycles of cyclophosphamide [300 mg/m(2), days 1, 8, and 15], dexamethasone [40 mg, days 1, 8, 15, and 22], and lenalidomide [25 mg, days 1-21]) or two courses of high-dose melphalan (200 mg/m(2)) and ASCT. We also randomised patients to maintenance with lenalidomide (10 mg, days 1-21) plus prednisone (50 mg, every other day) or lenalidomide alone. A simple randomisation sequence was used to assign patients at enrolment into one of the four groups (1:1:1:1 ratio), but the treatment allocation was disclosed only when the patient reached the end of the induction and confirmed their eligibility for consolidation. Both the patient and the treating clinician did not know the consolidation and maintenance arm until that time. The primary endpoint was progression-free survival assessed by intention-to-treat. The trial is ongoing and some patients are still receiving maintenance. This study is registered at ClinicalTrials.gov, number NCT01091831. FINDINGS 389 patients were enrolled between July 6, 2009, and May 6, 2011, with 256 eligible for consolidation (127 high-dose melphalan and ASCT and 129 chemotherapy plus lenalidomide) and 223 eligible for maintenance (117 lenalidomide plus prednisone and 106 lenalidomide alone). Median follow-up was 52·0 months (IQR 30·4-57·6). Progression-free survival during consolidation was significantly shorter with chemotherapy plus lenalidomide compared with high-dose melphalan and ASCT (median 28·6 months [95% CI 20·6-36·7] vs 43·3 months [33·2-52·2]; hazard ratio [HR] for the first 24 months 2·51, 95% CI 1·60-3·94; p<0·0001). Progression-free survival did not differ between maintenance treatments (median 37·5 months [95% CI 27·8-not evaluable] with lenalidomide plus prednisone vs 28·5 months [22·5-46·5] with lenalidomide alone; HR 0·84, 95% CI 0·59-1·20; p=0·34). Fewer grade 3 or 4 adverse events were recorded with chemotherapy plus lenalidomide than with high-dose melphalan and ASCT; the most frequent were haematological (34 [26%] of 129 patients vs 107 [84%] of 127 patients), gastrointestinal (six [5%] vs 25 [20%]), and infection (seven [5%] vs 24 [19%]). Haematological serious adverse events were reported in two (2%) patients assigned chemotherapy plus lenalidomide and no patients allocated high-dose melphalan and ASCT. Non-haematological serious adverse events were reported in 13 (10%) patients assigned chemotherapy plus lenalidomide and nine (7%) allocated high-dose melphalan and ASCT. During maintenance, adverse events did not differ between groups. The most frequent grade 3 or 4 adverse events were neutropenia (nine [8%] of 117 patients assigned lenalidomide plus prednisone vs 14 [13%] of 106 allocated lenalidomide alone), infection (eight [8%] vs five [5%]), and systemic toxicities (seven [6%] vs two [2%]). Non-haematological serious adverse events were reported in 13 (11%) patients assigned lenalidomide plus prednisone versus ten (9%) allocated lenalidomide alone. Four patients died because of adverse events, three from infections (two during induction and one during consolidation) and one because of cardiac toxic effects. INTERPRETATION Consolidation with high-dose melphalan and ASCT remains the preferred option in transplant-eligible patients with multiple myeloma, despite a better toxicity profile with chemotherapy plus lenalidomide. FUNDING Celgene.
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Affiliation(s)
- Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefania Oliva
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Maria Teresa Petrucci
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Concetta Conticello
- Divisione di Ematologia, Azienda Policlinico-OVE, Università di Catania, Catania, Italy
| | | | - Paolo Corradini
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Valeria Magarotto
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luděk Pour
- Department of Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Alessandra Malfitano
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Daniela Petrò
- Hematology Department, Niquarda Ca'Granda Hospital, Milan, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Turin, Italy
| | - Stefano Spada
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Norbert Pescosta
- Ematologia e Centro TMO Ospedale Centrale Bolzano, Bolzano, Italy
| | - Paola Omedè
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Philip Campbell
- Haematology Department, Cancer Services, Barwon Health, Geelong, VIC, Australia
| | | | | | - Roberto Ria
- University of Bari Aldo Moro Medical School, Department of Biomedical Science, Internal Medicine G Baccelli Policlinico, Bari, Italy
| | - Stefano Pulini
- Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, U O Ematologia Clinica, Ospedale Civile Spirito Santo, Pescara, Italy
| | | | - Roman Hajek
- Department of Haematooncology, University Hospital Ostrava and University of Ostrava, Ostrava, Czech Republic
| | - Andrew Spencer
- Department of Clinical Haematology, Alfred Health, Monash University, Melbourne, VIC, Australia
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
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Zamagni E, Nanni C, Gay F, Pezzi A, Patriarca F, Bellò M, Rambaldi I, Tacchetti P, Hillengass J, Gamberi B, Pantani L, Magarotto V, Versari A, Offidani M, Zannetti B, Carobolante F, Balma M, Musto P, Rensi M, Mancuso K, Dimitrakopoulou-Strauss A, Chauviè S, Rocchi S, Fard N, Marzocchi G, Storto G, Ghedini P, Palumbo A, Fanti S, Cavo M. 18F-FDG PET/CT focal, but not osteolytic, lesions predict the progression of smoldering myeloma to active disease. Leukemia 2015; 30:417-22. [DOI: 10.1038/leu.2015.291] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/17/2015] [Accepted: 09/29/2015] [Indexed: 12/29/2022]
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Herait PE, Berthon C, Thieblemont C, Raffoux E, Magarotto V, Stathis A, Thomas X, Leleu X, Gomez-Roca C, Odore E, Roumier C, Bourdel F, Quesnel B, Zucca E, Michallet M, Recher C, Cvitkovic E, Rezai K, Preudhomme C, Facon T, Palumbo A, Dombret H. Abstract CT231: BET-bromodomain inhibitor OTX015 shows clinically meaningful activity at nontoxic doses: interim results of an ongoing phase I trial in hematologic malignancies. Clin Trials 2014. [DOI: 10.1158/1538-7445.am2014-ct231] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Engelhardt M, Terpos E, Kleber M, Gay F, Wäsch R, Morgan G, Cavo M, van de Donk N, Beilhack A, Bruno B, Johnsen HE, Hajek R, Driessen C, Ludwig H, Beksac M, Boccadoro M, Straka C, Brighen S, Gramatzki M, Larocca A, Lokhorst H, Magarotto V, Morabito F, Dimopoulos MA, Einsele H, Sonneveld P, Palumbo A. European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma. Haematologica 2014; 99:232-42. [PMID: 24497560 DOI: 10.3324/haematol.2013.099358] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Multiple myeloma management has undergone profound changes in the past thanks to advances in our understanding of the disease biology and improvements in treatment and supportive care approaches. This article presents recommendations of the European Myeloma Network for newly diagnosed patients based on the GRADE system for level of evidence. All patients with symptomatic disease should undergo risk stratification to classify patients for International Staging System stage (level of evidence: 1A) and for cytogenetically defined high- versus standard-risk groups (2B). Novel-agent-based induction and up-front autologous stem cell transplantation in medically fit patients remains the standard of care (1A). Induction therapy should include a triple combination of bortezomib, with either adriamycin or thalidomide and dexamethasone (1A), or with cyclophosphamide and dexamethasone (2B). Currently, allogeneic stem cell transplantation may be considered for young patients with high-risk disease and preferably in the context of a clinical trial (2B). Thalidomide (1B) or lenalidomide (1A) maintenance increases progression-free survival and possibly overall survival (2B). Bortezomib-based regimens are a valuable consolidation option, especially for patients who failed excellent response after autologous stem cell transplantation (2A). Bortezomib-melphalan-prednisone or melphalan-prednisone-thalidomide are the standards of care for transplant-ineligible patients (1A). Melphalan-prednisone-lenalidomide with lenalidomide maintenance increases progression-free survival, but overall survival data are needed. New data from the phase III study (MM-020/IFM 07-01) of lenalidomide-low-dose dexamethasone reached its primary end point of a statistically significant improvement in progression-free survival as compared to melphalan-prednisone-thalidomide and provides further evidence for the efficacy of lenalidomide-low-dose dexamethasone in transplant-ineligible patients (2B).
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Rocci A, Hofmeister CC, Geyer S, Stiff A, Gambella M, Cascione L, Guan J, Benson DM, Efebera YA, Talabere T, Dirisala V, Smith EM, Omedè P, Isaia G, De Luca L, Rossi D, Gentili S, Uccello G, Consiglio J, Ria R, Benevolo G, Bringhen S, Callea V, Weiss B, Ferro A, Magarotto V, Alder H, Byrd JC, Boccadoro M, Marcucci G, Palumbo A, Pichiorri F. Circulating miRNA markers show promise as new prognosticators for multiple myeloma. Leukemia 2014; 28:1922-6. [PMID: 24813918 PMCID: PMC4155011 DOI: 10.1038/leu.2014.155] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- A Rocci
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - C C Hofmeister
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - S Geyer
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - A Stiff
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - M Gambella
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - L Cascione
- 1] Molecular Virology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA [2] Lymphoma & Genomics Research Program, Institute of Oncology Research-IOR, Bellinzona, Switzerland
| | - J Guan
- Molecular Virology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - D M Benson
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Y A Efebera
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - T Talabere
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - V Dirisala
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - E M Smith
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - P Omedè
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - G Isaia
- Department of Clinical and Biological Sciences, Division of Geriatric, S. Luigi Gonzaga Hospital, University of Torino, Torino, Italy
| | - L De Luca
- Laboratory of Preclinical and Translational Research, IRCCS-Referral Cancer Center of Basilicata (CROB), Rionero in Vulture, Italy
| | - D Rossi
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - S Gentili
- Italian Multiple Myeloma Network, GIMEMA, Italy
| | - G Uccello
- Italian Multiple Myeloma Network, GIMEMA, Italy
| | - J Consiglio
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - R Ria
- Italian Multiple Myeloma Network, GIMEMA, Italy
| | - G Benevolo
- Italian Multiple Myeloma Network, GIMEMA, Italy
| | - S Bringhen
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - V Callea
- Italian Multiple Myeloma Network, GIMEMA, Italy
| | - B Weiss
- Abramson Cancer Center, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - A Ferro
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - V Magarotto
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - H Alder
- Molecular Virology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - J C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - M Boccadoro
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - G Marcucci
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - F Pichiorri
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Morabito F, Bringhen S, Larocca A, Wijermans P, Victoria Mateos M, Gimsing P, Mazzone C, Gottardi D, Omedè P, Zweegman S, José Lahuerta J, Zambello R, Musto P, Magarotto V, Schaafsma M, Oriol A, Juliusson G, Cerrato C, Catalano L, Gentile M, Isabel Turel A, Marina Liberati A, Cavalli M, Rossi D, Passera R, Rosso S, Beksac M, Cavo M, Waage A, San Miguel J, Boccadoro M, Sonneveld P, Palumbo A, Offidani M. Bortezomib, melphalan, prednisone (VMP) versus melphalan, prednisone, thalidomide (MPT) in elderly newly diagnosed multiple myeloma patients: A retrospective case-matched study. Am J Hematol 2014; 89:355-62. [PMID: 24273190 DOI: 10.1002/ajh.23641] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 12/11/2022]
Abstract
Novel agents in combination with melphalan and prednisone (MP) significantly improved progression-free survival (PFS) and overall survival (OS) in multiple myeloma (MM). Randomized trials comparing MP plus bortezomib (VMP) versus MP plus thalidomide (MPT) are lacking. Nine hundred and fifty-six elderly (>65 years) newly diagnosed MM patients from six European randomized trials were retrospectively analyzed and matched for age, albumin, and beta2-microglobulin at diagnosis, 296 patients were selected from the VMP groups, and 294 from MPT. Complete response rate was 21% in the VMP patients and 13% in the MPT patients (P = 0.007). After a median follow-up of 34 months (range, 1-92), VMP significantly prolonged both PFS (median 32.5 vs. 22.9 months, HR 0.65; 95% CI 0.52-0.82; P < 0.001) and OS (median 79.7 vs. 45.1 months, HR 0.44; 95% CI 0.32-0.59; P < 0.001) in comparison with MPT. The benefit in terms of OS of the VMP group was quite similar among patients with different risk factors defined by sex, ISS, ECOG performance status, or serum creatinine but not among patients ≥ 75 years. Multivariate analysis confirmed that VMP was an independent predictor of longer PFS and OS. In a control-case matched analysis, PFS and OS were prolonged in patients who received VMP in comparison with those treated with MPT.
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Affiliation(s)
| | - Sara Bringhen
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | - Alessandra Larocca
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | - Pierre Wijermans
- Department of Hematology; Haga Hospital; the Hague The Netherlands
| | | | - Peter Gimsing
- Department of Hematology; Rigs hospitalet and University of Copenhagen; Denmark
| | | | - Daniela Gottardi
- SCDU Ematologia e Terapie Cellulari; A.O. Ordine Mauriziano - Umberto I; Torino Italy
| | - Paola Omedè
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | - Sonja Zweegman
- Department of Hematology; VU University Medical Center; Amsterdam The Netherlands
| | | | - Renato Zambello
- Padova University School of Medicine; Department of Clinical and Experimental Medicine; Hematology and Clinical Immunology; Padova Italy
| | - Pellegrino Musto
- Department of Onco-Haematology; IRCCS, Referral Cancer Centre of Basilicata; Rionero in Vulture (Pz) Italy
| | - Valeria Magarotto
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | | | - Albert Oriol
- Clinical Hematology; Institut Català d'Oncologia, Hospital Germans Trias i Pujol; Badalona Spain
| | - Gunnar Juliusson
- Department of Hematology; Stem Cell Center, Lund University, and Skåne University Hospital; Lund Sweden
| | - Chiara Cerrato
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | - Lucio Catalano
- Divisione di Ematologia; Università Federico II; Napoli Italy
| | | | - Ana Isabel Turel
- Hematology and Oncology Service; Hospital Clínico Universitario; Valencia Spain
| | - Anna Marina Liberati
- Department of Transplant Oncohematology; Perugia University; S. Maria Terni Italy
| | - Maide Cavalli
- Divisione di Ematologia; Ospedale Ferrarotto, Universtà di Catania; Catania Italy
| | - Davide Rossi
- Division of Hematology; Department of Translational Medicine; Amedeo Avogadro University of Eastern Piedmont; Novara Italy
| | - Roberto Passera
- Divisione di Medicina Nucleare 2 AO Città della Salute e della Scienza di Torino; Italy
| | - Stefano Rosso
- Registro Tumori Regione Piemonte AO Città della Salute e della Scienza di Torino; Italy
| | - Meral Beksac
- Department of Hematology; Faculty of Medicine, Ankara University; Ankara Turkey
| | - Michele Cavo
- Seràgnoli Institute of Hematology; Bologna University School of Medicine; Bologna Italy
| | - Anders Waage
- Department of Hematology; St Olavs Hospital/NTNU; Trondheim Norway
| | - Jesus San Miguel
- Servicio de Hematología; Hospital Universitario de Salamanca, CIC, IBMCC (USAL-CSIC); Spain
| | - Mario Boccadoro
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | | | - Antonio Palumbo
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | - Massimo Offidani
- Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona; Ancona Italy
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Rocci A, Gambella M, Aschero S, Baldi I, Trusolino L, Cavallo F, Gay F, Larocca A, Magarotto V, Omedè P, Isaia G, Bertotti A, Liberati AM, Catalano L, De Rosa L, Musto P, Vallone R, Falcone A, Drandi D, Ladetto M, Comoglio PM, Boccadoro M, Palumbo A. MET dysregulation is a hallmark of aggressive disease in multiple myeloma patients. Br J Haematol 2014; 164:841-50. [PMID: 24450886 DOI: 10.1111/bjh.12719] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/02/2013] [Indexed: 11/30/2022]
Abstract
Abnormal activation of MET/HGF (Hepatocyte Growth Factor) pathway has been described in several tumours and increased HGF plasmatic levels have been detected in patients with aggressive multiple myeloma (MM). MET and HGF mRNA expression was investigated in 105 samples of purified plasma cells derived from newly diagnosed MM patients treated with bortezomib-based induction therapy. Gene expression was compared with response to therapy and clinical outcome. MET gene copy number was also evaluated. MET mRNA expression was higher in CD138(+) than in CD138(-) cells (median 76·90 vs. 11·24; P = 0·0009). Low MET mRNA expression characterized patients with better response (complete response or very good partial response) compared to other patients (median 56·10 vs. 134·83; P = 0·0006). After a median follow-up of 50 months, patients with high MET mRNA expression displayed a worse progression-free survival (PFS; P = 0·0029) and overall survival (OS; P = 0·0023) compared to those with low MET mRNA levels. Patients with both high MET mRNA expression and high β2-microglobulin level (>5·5 mg/l) had further worse median PFS (P < 0·0001) and OS (P < 0·0001). Patients carrying 4 MET gene copies (8 out of 82, 9·8%) also had a short PFS. High MET mRNA expression identifies patients with dismal PFS and OS and the combination with high β2-microglobulin further characterizes patients with worse outcome.
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Affiliation(s)
- Alberto Rocci
- Myeloma Unit, Division of Haematology, University of Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
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Palumbo A, Bringhen S, Larocca A, Rossi D, Di Raimondo F, Magarotto V, Patriarca F, Levi A, Benevolo G, Vincelli ID, Grasso M, Franceschini L, Gottardi D, Zambello R, Montefusco V, Falcone AP, Omedé P, Marasca R, Morabito F, Mina R, Guglielmelli T, Nozzoli C, Passera R, Gaidano G, Offidani M, Ria R, Petrucci MT, Musto P, Boccadoro M, Cavo M. Bortezomib-melphalan-prednisone-thalidomide followed by maintenance with bortezomib-thalidomide compared with bortezomib-melphalan-prednisone for initial treatment of multiple myeloma: updated follow-up and improved survival. J Clin Oncol 2014; 32:634-40. [PMID: 24449241 DOI: 10.1200/jco.2013.52.0023] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Bortezomib-melphalan-prednisone (VMP) has improved overall survival in multiple myeloma. This randomized trial compared VMP plus thalidomide (VMPT) induction followed by bortezomib-thalidomide maintenance (VMPT-VT) with VMP in patients with newly diagnosed multiple myeloma. PATIENTS AND METHODS We randomly assigned 511 patients who were not eligible for transplantation to receive VMPT-VT (nine 5-week cycles of VMPT followed by 2 years of VT maintenance) or VMP (nine 5-week cycles without maintenance). RESULTS In the initial analysis with a median follow-up of 23 months, VMPT-VT improved complete response rate from 24% to 38% and 3-year progression-free-survival (PFS) from 41% to 56% compared with VMP. In this analysis, median follow-up was 54 months. The median PFS was significantly longer with VMPT-VT (35.3 months) than with VMP (24.8 months; hazard ratio [HR], 0.58; P < .001). The time to next therapy was 46.6 months in the VMPT-VT group and 27.8 months in the VMP group (HR, 0.52; P < .001). The 5-year overall survival (OS) was greater with VMPT-VT (61%) than with VMP (51%; HR, 0.70; P = .01). Survival from relapse was identical in both groups (HR, 0.92; P = .63). In the VMPT-VT group, the most frequent grade 3 to 4 adverse events included neutropenia (38%), thrombocytopenia (22%), peripheral neuropathy (11%), and cardiologic events (11%). All of these, except for thrombocytopenia, were significantly more frequent in the VMPT-VT patients. CONCLUSION Bortezomib and thalidomide significantly improved OS in multiple myeloma patients not eligible for transplantation.
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Affiliation(s)
- Antonio Palumbo
- Antonio Palumbo, Sara Bringhen, Alessandra Larocca, Valeria Magarotto, Paola Omedé, Roberto Mina, Mario Boccadoro, and Giulia Benevolo, Azienda Ospedaliera (A.O.) Città della Salute e della Scienza di Torino; Daniela Gottardi, A.O. Ordine Mauriziano; Roberto Passera, San Giovanni Battista Hospital, University of Torino, Torino; Davide Rossi and Gianluca Gaidano, Amedeo Avogadro University of Eastern Piedmont, Novara; Francesco Di Raimondo, Ferrarotto Hospital, University of Catania, Catania; Francesca Patriarca, A.O. Universitaria, Udine; Anna Levi and Maria Teresa Petrucci, Sapienza University of Rome; Luca Franceschini, Tor Vergata University Hospital, Rome; Iolanda Donatella Vincelli, A.O. Bianchi-Melacrino-Morelli, Reggio Calabria; Mariella Grasso, S. Croce e Carle Hospital, Cuneo; Renato Zambello, Università degli Studi di Padova, Padova; Vittorio Montefusco, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori Milano, University of Milano, Milan; Antonietta Pia Falcone, IRCCS Casa Sollievo della Sofferenza and Unità di Ematologia, San Giovanni Rotondo; Roberto Marasca, University of Modena, Modena; Fortunato Morabito, A.O. di Cosenza, Cosenza; Tommasina Guglielmelli, "S. Luigi Gonzaga" Hospital, Orbassano; Chiara Nozzoli, A.O. Universitaria Careggi, Firenze; Massimo Offidani, Ospedali Riuniti, Ancona; Roberto Ria, University of Bari "Aldo Moro" Medical School, Bari; Pellegrino Musto, IRCCS-Centro Regionale Oncologico Basilicata, Rionero in Vulture; and Michele Cavo, Università degli Studi di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
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Pautasso C, Bringhen S, Cerrato C, Magarotto V, Palumbo A. The mechanism of action, pharmacokinetics, and clinical efficacy of carfilzomib for the treatment of multiple myeloma. Expert Opin Drug Metab Toxicol 2013; 9:1371-9. [DOI: 10.1517/17425255.2013.817556] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Klepin HD, Rizzieri D, Palumbo A, Magarotto V, Eichhorst B. Individualizing treatment decisions for older adults with hematologic malignancies. Am Soc Clin Oncol Educ Book 2013. [PMID: 23714504 DOI: 10.1200/edbook_am.2013.33.208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hematologic malignancies are a common cause of morbidity and mortality among older adults, who represent the majority of patients diagnosed with these diseases. Treatment options and disease outcomes have improved in recent years because of the development of novel treatment strategies and the design of elderly-specific clinical trials. Despite this, extrapolation of clinical trial data to patients routinely seen in practice is challenging because of the presence of multimorbidity and functional impairments. Individualized treatment decision making requires not only an understanding of underlying tumor biology but also careful estimation of an older patient's anticipated ability to withstand the stresses of therapy. This article will discuss approaches to standardizing patient assessment strategies and tailoring therapeutic decisions for older adults with hematologic malignancies with a focus on acute myeloid leukemia (AML), allogeneic bone marrow transplantation, multiple myeloma (MM), and chronic lymphocytic leukemia (CLL).
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Affiliation(s)
- Heidi D Klepin
- From the Comprehensive Cancer Center of Wake Forest University, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC; Department of Medicine, Division of Hematologic Malignancies and Cell Therapy, Duke University Medical Center, Durham, NC; Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy; Department I of Internal Medicine and Center of Integrated Oncology Köln Bonn, University of Cologne, Köln, Germany
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Palumbo A, Magarotto V. Novel treatment paradigm for elderly patients with multiple myeloma. Am J Blood Res 2011; 1:190-204. [PMID: 22432080 PMCID: PMC3301431] [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] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 09/12/2011] [Indexed: 05/31/2023]
Abstract
The treatment of multiple myeloma has undergone important changes in the last few years. The use of novel agents, such as the immunomodulatory drugs thalidomide and lenalidomide, and the proteasome inhibitor bortezomib, has increased the treatment options available and significantly improved the outcome of this rare disease. Several trials have shown the advantages linked to the use of novel agents both in young patients, who are considered eligible for transplantation, and elderly patients, who are considered transplant ineligible. In the non-transplant setting, novel agent-containing regimens have replaced the traditional melphalan-prednisone approach. Preliminary data also support the role of consolidation and maintenance therapy to further improve outcomes. An appropriate management of side effects is fundamental for the success of the treatment, and outcome should always be balanced against the toxicity profile associated with the regimen used. This review provides an overview of the latest strategies including novel agents used to treat elderly patients with multiple myeloma.
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Affiliation(s)
- Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, AOU San Giovanni Battista Torino, Italy
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Palumbo A, Cavo M, Bringhen S, Zamagni E, Romano A, Patriarca F, Rossi D, Gentilini F, Crippa C, Galli M, Nozzoli C, Ria R, Marasca R, Montefusco V, Baldini L, Elice F, Callea V, Pulini S, Carella AM, Zambello R, Benevolo G, Magarotto V, Tacchetti P, Pescosta N, Cellini C, Polloni C, Evangelista A, Caravita T, Morabito F, Offidani M, Tosi P, Boccadoro M. Aspirin, Warfarin, or Enoxaparin Thromboprophylaxis in Patients With Multiple Myeloma Treated With Thalidomide: A Phase III, Open-Label, Randomized Trial. J Clin Oncol 2011; 29:986-93. [DOI: 10.1200/jco.2010.31.6844] [Citation(s) in RCA: 249] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose In patients with myeloma, thalidomide significantly improves outcomes but increases the risk of thromboembolic events. In this randomized, open-label, multicenter trial, we compared aspirin (ASA) or fixed low-dose warfarin (WAR) versus low molecular weight heparin (LMWH) for preventing thromboembolism in patients with myeloma treated with thalidomide-based regimens. Patients and Methods A total of 667 patients with previously untreated myeloma who received thalidomide-containing regimens and had no clinical indication or contraindication for a specific antiplatelet or anticoagulant therapy were randomly assigned to receive ASA (100 mg/d), WAR (1.25 mg/d), or LMWH (enoxaparin 40 mg/d). A composite primary end point included serious thromboembolic events, acute cardiovascular events, or sudden deaths during the first 6 months of treatment. Results Of 659 analyzed patients, 43 (6.5%) had serious thromboembolic events, acute cardiovascular events, or sudden death during the first 6 months (6.4% in the ASA group, 8.2% in the WAR group, and 5.0% in the LMWH group). Compared with LMWH, the absolute differences were +1.3% (95% CI, −3.0% to 5.7%; P = .544) in the ASA group and +3.2% (95% CI, −1.5% to 7.8%; P = .183) in the WAR group. The risk of thromboembolism was 1.38 times higher in patients treated with thalidomide without bortezomib. Three major (0.5%) and 10 minor (1.5%) bleeding episodes were recorded. Conclusion In patients with myeloma treated with thalidomide-based regimens, ASA and WAR showed similar efficacy in reducing serious thromboembolic events, acute cardiovascular events, and sudden deaths compared with LMWH, except in elderly patients where WAR showed less efficacy than LMWH.
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Affiliation(s)
- Antonio Palumbo
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Michele Cavo
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Sara Bringhen
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Elena Zamagni
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Alessandra Romano
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Francesca Patriarca
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Davide Rossi
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Fabiana Gentilini
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Claudia Crippa
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Monica Galli
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Chiara Nozzoli
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Roberto Ria
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Roberto Marasca
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Vittorio Montefusco
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Luca Baldini
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Francesca Elice
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Vincenzo Callea
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Stefano Pulini
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Angelo M. Carella
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Renato Zambello
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Giulia Benevolo
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Valeria Magarotto
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Paola Tacchetti
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Norbert Pescosta
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Claudia Cellini
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Claudia Polloni
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Andrea Evangelista
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Tommaso Caravita
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Fortunato Morabito
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Massimo Offidani
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Patrizia Tosi
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Mario Boccadoro
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
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Hunsucker SA, Magarotto V, Kuhn DJ, Kornblau SM, Wang M, Weber DM, Thomas SK, Shah JJ, Voorhees PM, Xie H, Cornfeld M, Nemeth JA, Orlowski RZ. Blockade of interleukin-6 signalling with siltuximab enhances melphalan cytotoxicity in preclinical models of multiple myeloma. Br J Haematol 2011; 152:579-92. [PMID: 21241278 DOI: 10.1111/j.1365-2141.2010.08533.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Signalling through the interleukin (IL)-6 pathway induces proliferation and drug resistance of multiple myeloma cells. We therefore sought to determine whether the IL-6-neutralizing monoclonal antibody siltuximab, formerly CNTO 328, could enhance the activity of melphalan, and to examine some of the mechanisms underlying this interaction. Siltuximab increased the cytotoxicity of melphalan in KAS-6/1, INA-6, ANBL-6, and RPMI 8226 human myeloma cell lines (HMCLs) in an additive-to-synergistic manner, and sensitized resistant RPMI 8226.LR5 cells to melphalan. These anti-proliferative effects were accompanied by enhanced activation of drug-specific apoptosis in HMCLs grown in suspension, and in HMCLs co-cultured with a human-derived stromal cell line. Siltuximab with melphalan enhanced activation of caspase-8, caspase-9, and the downstream effector caspase-3 compared with either of the single agents. This increased induction of cell death occurred in association with enhanced Bak activation. Neutralization of IL-6 also suppressed signalling through the phosphoinositide 3-kinase/Akt pathway, as evidenced by decreased phosphorylation of Akt, p70 S6 kinase and 4E-BP1. Importantly, the siltuximab/melphalan regimen demonstrated enhanced anti-proliferative effects against primary plasma cells derived from patients with myeloma, monoclonal gammopathy of undetermined significance, and amyloidosis. These studies provide a rationale for translation of siltuximab into the clinic in combination with melphalan-based therapies.
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Affiliation(s)
- Sally A Hunsucker
- Department of Lymphoma and Myeloma, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA
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Palumbo A, Larocca A, Falco P, Sanpaolo G, Falcone AP, Federico V, Canepa L, Crugnola M, Genuardi M, Magarotto V, Petrucci MT, Boccadoro M. Lenalidomide, melphalan, prednisone and thalidomide (RMPT) for relapsed/refractory multiple myeloma. Leukemia 2010; 24:1037-42. [PMID: 20376079 DOI: 10.1038/leu.2010.58] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This multicenter, open-label, non-comparative phase II trial evaluated the safety and efficacy of salvage therapy with lenalidomide, melphalan, prednisone and thalidomide (RMPT) in patients with relapsed/refractory multiple myeloma (MM). Oral lenalidomide (10 mg/day) was administered on days 1-21, and oral melphalan (0.18 mg/kg) and oral prednisone (2 mg/kg) on days 1-4 of each 28-day cycle. Thalidomide was administered at 50 mg/day or 100 mg/day on days 1-28; six cycles were administered in total. Maintenance included lenalidomide 10 mg/day on days 1-21, until unacceptable adverse events or disease progression. Aspirin (100 mg/day) was given as thromboprophylaxis. A total of 44 patients with relapsed/refractory MM were enrolled and 75% achieved at least a partial response (PR), including 32% very good PR (VGPR) and 2% complete response (CR). The 1-year progression-free survival (PFS) was 51% and the 1-year overall survival (OS) from study entry was 72%. Grade 4 hematologic adverse events included neutropenia (18%), thrombocytopenia (7%) and anemia (2%). Grade 3 non-hematologic adverse events were infections (14%), neurological toxicity (4.5%) and fatigue (7%). No grade 3/4 thromboembolic events or peripheral neuropathy were reported. In conclusion, RMPT is an active salvage therapy with good efficacy and manageable side effects. This study represents the basis for larger phase III randomized trials.
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Affiliation(s)
- A Palumbo
- Divisione di Ematologia dell'Università di Torino, AOU S. Giovanni Battista, Turin, Italy.
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Palumbo A, Larocca A, Genuardi M, Kotwica K, Gay F, Rossi D, Benevolo G, Magarotto V, Cavallo F, Bringhen S, Rus C, Masini L, Iacobelli M, Gaidano G, Mitsiades C, Anderson K, Boccadoro M, Richardson P. Melphalan, prednisone, thalidomide and defibrotide in relapsed/refractory multiple myeloma: results of a multicenter phase I/II trial. Haematologica 2010; 95:1144-9. [PMID: 20053869 DOI: 10.3324/haematol.2009.017913] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Defibrotide is a novel orally bioavailable polydisperse oligonucleotide with anti-thrombotic and anti-adhesive effects. In SCID/NOD mice, defibrotide showed activity in human myeloma xenografts. This phase I/II study was conducted to identify the most appropriate dose of defibrotide in combination with melphalan, prednisone and thalidomide in patients with relapsed and relapsed/refractory multiple myeloma, and to determine its safety and tolerability as part of this regimen. DESIGN AND METHODS This was a phase I/II, multicenter, dose-escalating, non-comparative, open label study. Oral melphalan was administered at a dose of 0.25 mg/kg on days 1-4, prednisone at a dose of 1.5 mg/kg also on days 1-4 and thalidomide at a dose of 50-100 mg/day continuously. Defibrotide was administered orally at three dose-levels: 2.4, 4.8 or 7.2 g on days 1-4 and 1.6, 3.2, or 4.8 g on days 5-35. RESULTS Twenty-four patients with relapsed/refractory multiple myeloma were enrolled. No dose-limiting toxicity was observed. In all patients, the complete response plus very good partial response rate was 9%, and the partial response rate was 43%. The 1-year progression-free survival and 1-year overall survival rates were 34% and 90%, respectively. The most frequent grade 3-4 adverse events included neutropenia, thrombocytopenia, anemia and fatigue. Deep vein thrombosis was reported in only one patient. CONCLUSIONS This combination of melphalan, prednisone and thalidomide together with defibrotide showed anti-tumor activity with a favorable tolerability. The maximum tolerated dose of defibrotide was identified as 7.2 g p.o. on days 1-4 followed by 4.8 g p.o. on days 5-35. Further trials are needed to confirm the role of this regimen and to evaluate the combination of defibrotide with new drugs.
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Affiliation(s)
- Antonio Palumbo
- Divisione, di Ematologia Dell'Università di Torino, Azienda Ospedaliera San, Giovanni Battista, Via Genova 3, 10126 Torino, Italy.
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Palumbo A, Falco P, Falcone A, Benevolo G, Canepa L, Gay F, Larocca A, Magarotto V, Gozzetti A, Luraschi A, Morabito F, Nozza A, Knight RD, Zeldis JB, Boccadoro M, Petrucci MT. Melphalan, Prednisone, and Lenalidomide for Newly Diagnosed Myeloma: Kinetics of Neutropenia and Thrombocytopenia and Time-to-Event Results. ACTA ACUST UNITED AC 2009; 9:145-50. [DOI: 10.3816/clm.2009.n.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Palumbo A, Magarotto V, Gay F, Falco P, Bringhen S, Boccadoro M. Update on Recent Developments for Patients with Newly Diagnosed Multiple Myeloma. Ann N Y Acad Sci 2008; 1138:19-21. [DOI: 10.1196/annals.1414.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Larocca A, Cavallo F, Magarotto V, Rossi D, Patriarca F, Boccadoro M, Palumbo A. Defibrotide: a review on clinical use and future development. Expert Opin Biol Ther 2008; 8:1201-12. [PMID: 18613771 DOI: 10.1517/14712598.8.8.1201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Defibrotide is a deoxyribonucleic acid derivative that has been developed for the treatment of different vascular disorders. OBJECTIVE The authors reviewed the literature to give due representation to the spectrum of pharmacological properties and clinical application of this drug, evaluating consolidate and innovative application. METHODS The authors used PubMed from November 1982 to December 2007 and meeting abstracts (form American Society of Hematology Annual Meeting) with updated data as the sources for this review and selecting the most relevant papers when two or more articles covered the same point of interest. CONCLUSIONS Defibrotide has been used effectively in the treatment of endothelial complications of allogeneic stem cell transplantation and recent preclinical evidences suggest an antiangiogenic effect and an anticancer activity. Further in vivo and in vitro investigations are needed.
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Affiliation(s)
- A Larocca
- Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliero Universitaria San Giovanni Battista, Torino, Italy
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Palumbo A, Gay F, Bringhen S, Falcone A, Pescosta N, Callea V, Caravita T, Morabito F, Magarotto V, Ruggeri M, Avonto I, Musto P, Cascavilla N, Bruno B, Boccadoro M. Bortezomib, doxorubicin and dexamethasone in advanced multiple myeloma. Ann Oncol 2008; 19:1160-5. [DOI: 10.1093/annonc/mdn018] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Multiple myeloma remains a fatal neoplasm and new treatments are urgently needed. In recent years, advances in understanding the molecular pathophysiology of myeloma and the mechanisms of drug resistance led to the development of several novel agents. The drugs with the most available clinical data are thalidomide, bortezomib and lenalidomide. Impressive results obtained with these agents - both in relapsed disease and in newly diagnosed patients - have significantly improved the outcome of myeloma patients. Several other new targeted agents are presently under investigation. These include monoclonal antibodies, agents that target mammalian target of rapamycin, histone acetylation, heat-shock proteins, growth factor signalling cascades, oncogenes, signal transducer and activators of the transcription pathway, Akt pathway and MAPK pathway. Their mechanisms of action, the available knowledge on their efficacy, safety and possible future clinical application are reviewed.
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Affiliation(s)
- Sara Bringhen
- Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera San Giovanni Battista, Via Genova 3, 10126 Torino, Italy
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