Response adaptive salvage with KTd and ASCT for functional high-risk multiple myeloma-The Australasian Leukemia and Lymphoma Group (ALLG) MM17 Trial

We evaluated re-induction incorporating carfilzomib-thalidomide-dexamethasone (KTd) and autologous stem cell transplantation (ASCT) for newly diagnosed multiple myeloma (NDMM) refractory, or demonstrating a suboptimal response, to non-IMID bortezomib-based induction. KTd salvage consisted of thalidomide 100 mg daily and dexamethasone 20 mg orally combined with carfilzomib 56 mg/m² days 1, 2, 8, 9, 15 and 16, of each 28-day cycle. Following four cycles, patients achieving a stringent complete response proceeded to ASCT whereas those who did not received a further two cycles then ASCT. Consolidation consisted of two cycles of KTd then Td to a total of 12 months post-ASCT therapy. Primary end-point was the overall response rate (ORR) with KTd prior to ASCT. Fifty patients were recruited. The ORR was 78% with EuroFlow MRD negativity of 34% in the intention-to-treat population and 65% in the evaluable population at 12 months post-ASCT. With follow-up >38 months median PFS and OS have not been reached with PFS and OS at 36 months of 64% and 80%, respectively. KTd was well tolerated with grade 3 and grade ≥4 adverse events rates of 32% and 10%, respectively. Response adaptive utilisation of KTd with ASCT is associated with both high-quality responses and durable disease control in functional high-risk NDMM.

Subunit composition, regulatory properties, and phosphorylation of phosphofructokinase from human gliomas

In this study, we investigated the alterations in the activity, subunit profile, and kinetic regulatory properties of phosphofructokinase (PFK) from human gliomas compared with those from normal human brain. Gliomas showed a decrease in the enzyme activity as compared to normal brain. This decrease in PFK activity was accompanied by a relative increase in the expression of the liver type subunit of PFK. The enzymes from the tumor and normal brain showed no significant differences in their affinity toward the substrate fructose 6-phosphate. However, tumor and normal brain PFK showed major differences with respect to their behavior towards citrate and fructose 2,6-bisphosphate. The enzyme from the gliomas was less sensitive to citrate inhibition. More importantly, the enzyme from the tumor was more sensitive to the activation by fructose 2,6-bisphosphate. In addition, we found that in gliomas the L-type subunit could be phosphorylated, most probably by a cyclic AMP-independent protein kinase. This phosphorylation could not be detected in normal human brain. It is proposed that the preferential expression of the liver type subunit by undifferentiated cancer cells may be explained in terms of the unique regulatory properties of this isozyme.