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Fazio F, Passucci M, Micozzi J, Di Landro F, Fianchi L, Za T, Manieri VM, Annibali O, Cupelli L, Bongarzoni V, Gentili S, De Padua L, Crisanti E, Garzia MG, Rago A, Piciocchi A, Mengarelli A, Morè S, De Stefano V, Bafti MS, Martelli M, Petrucci MT. Effect of daratumumab on stem cell yields in patients with newly diagnosed multiple myeloma: a report from the Multiple Myeloma Group. Bone Marrow Transplant 2024:10.1038/s41409-024-02260-z. [PMID: 38461292 DOI: 10.1038/s41409-024-02260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/11/2024]
Affiliation(s)
- F Fazio
- Hematology, Azienda Policlinico Umberto I-Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - M Passucci
- Hematology, Azienda Policlinico Umberto I-Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - J Micozzi
- Hematology, Azienda Policlinico Umberto I-Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - F Di Landro
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - L Fianchi
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - T Za
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - V M Manieri
- Clinica di Ematologia Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - O Annibali
- Unit of Hematology, Stem Cell Transplantation, University Campus Bio-Medico, Rome, Italy
| | - L Cupelli
- UOC Hematology, Hospital S. Eugenio, Rome, Italy
| | - V Bongarzoni
- Department of Hematology San Giovanni-Addolorata Hospital, Rome, Italy
| | - S Gentili
- UOSD Ematologia Civitanova Marche AST Macerata, Rome, Italy
| | - L De Padua
- Hematology Unit, Fabrizio Spaziani Hospital, Frosinone, Italy
| | - E Crisanti
- Hematology and Transplant Unit, Santa Maria Goretti Hospital, AUSL, Latina, Italy
| | - M G Garzia
- Department of Hematology, Hematology San Camillo Forlanini Hospital Rome Italy, Rome, Italy
| | - A Rago
- UOSD Ematologia ASL Roma1, Rome, Italy
| | - A Piciocchi
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center, Rome, Italy
| | - A Mengarelli
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - S Morè
- Clinica di Ematologia Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - V De Stefano
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - M S Bafti
- Department of Immuno-Hematology and Transfusional Medicine, Policlinico Umberto I, Rome, Italy
| | - M Martelli
- Hematology, Azienda Policlinico Umberto I-Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - M T Petrucci
- Hematology, Azienda Policlinico Umberto I-Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Abstract
Treatment of multiple myeloma (MM) patients has radically changed over the last years following the introduction of next generation proteasome inhibitors (PI) and immunomodulatory derivative (IMiDs). In the last years, one further therapeutic option for MM patients is represented by monoclonal antibodies (MoAbs), that seem to change the paradigm of MM treatment, particularly for heavily pretreated or double refractory to a PI and IMiDs patients. Antibodies have an immune-based mechanism, induce durable responses with limited toxicity and combine well with existing therapies. The therapeutic effects are prevalently obtained by means of antibody-dependent cellular cytotoxicity (ADCC), antibody-dependent cell-mediated phagocytosis (ADCP), complement-dependent cytotoxicity (CDC) and concurrently by the induction of signals on cell effectors. Immunotherapeutic strategies offer a new and exciting approach to target key molecular pathways that continue to be implicated in the survival of malignant plasma cells. These targets include cell surface proteins (CD38, CD138 [SDC1], B cell maturation antigen [BCMA, TNFRSF17]), cytokines that play a role in plasma cell survival and proliferation (interleukin 6 [IL6] and B cell activating factor), signal regulators of bone metabolism (RANKL [TNFSF11], DKK1) and regulators of the immune system (PD-1[PDCD1], PD-L1[CD274]). This article focuses on new MoAbs and related innovative immunotherapeutic modalities currently under investigation in the treatment landscape of MM.
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Affiliation(s)
- Federico Vozella
- Division of Hematology, San Giovanni di Dio Hospital, Florence, Italy -
| | - Francesca Fazio
- Unit of Hematology, Department of Translational and Precision Medicine, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Gianfranco Lapietra
- Unit of Hematology, Department of Translational and Precision Medicine, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Maria T Petrucci
- Unit of Hematology, Department of Translational and Precision Medicine, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Giovanni Martinelli
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Claudio Cerchione
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
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3
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Ferretti A, Baldacci E, Fazio F, Abbruzzese R, Barone F, De Luca ML, Petrucci MT, Chistolini A, Mazzucconi MG, Santoro C. Acquired FXIII deficiency and AL amyloidosis: A case of a rare association. Transfus Apher Sci 2020; 59:102903. [PMID: 32839100 DOI: 10.1016/j.transci.2020.102903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/19/2022]
Affiliation(s)
- A Ferretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy.
| | - E Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - F Fazio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - R Abbruzzese
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - F Barone
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - M L De Luca
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - M T Petrucci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - A Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - M G Mazzucconi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - C Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
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4
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Offidani M, Boccadoro M, Di Raimondo F, Petrucci MT, Tosi P, Cavo M. Expert Panel Consensus Statement for Proper Evaluation of First Relapse in Multiple Myeloma. Curr Hematol Malig Rep 2020; 14:187-196. [PMID: 31077067 DOI: 10.1007/s11899-019-00507-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW A working group of six expert physicians convened to assess the spectrum of multiple myeloma relapse presentations, discussed the features that can define the disease as aggressive and not aggressive, and established whether this information could help in selecting treatment together with the characteristics of disease and of patients and type of prior therapy. RECENT FINDINGS The working group agreed that relapse should be distinguished between biochemical and clinical according to IMWG. Moreover, the expert panel defined "aggressive disease" as a clinical condition that requires therapy able to induce a rapid and as deep as possible response to release symptoms and to avoid impending danger of new events. According to this definition, relapse was considered aggressive if it presents with at least one of the following features: doubling of M protein rate over 2 months, renal insufficiency, hypercalcemia, extramedullary disease, elevated LDH, high plasma cell proliferative index, presence of plasma cells in peripheral blood, or skeletal-related complications. Moreover, the panel agreed that this classification can be useful to choose therapy in first relapse together with other patient, disease, and prior therapy characteristics. So, this item was included in a new therapeutic algorithm. The treatment choice in MM at relapse is wider than in the past with the availability of many new therapeutic regimens leading to increased diversity of approaches and relevant risk of inappropriate treatment decisions. A practical classification of relapses into aggressive or non-aggressive, included in a decisional algorithm on MM management at first relapse, could help to make the appropriate treatment decisions.
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Affiliation(s)
- M Offidani
- Clinica di Ematologia, A.O.U. Ospedali Riuniti di Ancona, via Conca, 71, 60126, Ancona, Italy.
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - F Di Raimondo
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - M T Petrucci
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - P Tosi
- Hematology Unit, Infermi Hospital Rimini, Rimini, Italy
| | - M Cavo
- Institute of Hematology Seragnoli, DIMES, University of Bologna, Bologna, Italy
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5
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Zingoni A, Vulpis E, Cecere F, Amendola MG, Fuerst D, Saribekyan T, Achour A, Sandalova T, Nardone I, Peri A, Soriani A, Fionda C, Mariggiò E, Petrucci MT, Ricciardi MR, Mytilineos J, Cippitelli M, Cerboni C, Santoni A. MICA-129 Dimorphism and Soluble MICA Are Associated With the Progression of Multiple Myeloma. Front Immunol 2018; 9:926. [PMID: 29765374 PMCID: PMC5938351 DOI: 10.3389/fimmu.2018.00926] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/13/2018] [Indexed: 12/11/2022] Open
Abstract
Natural killer (NK) cells are immune innate effectors playing a pivotal role in the immunosurveillance of multiple myeloma (MM) since they are able to directly recognize and kill MM cells. In this regard, among activating receptors expressed by NK cells, NKG2D represents an important receptor for the recognition of MM cells, being its ligands expressed by tumor cells, and being able to trigger NK cell cytotoxicity. The MHC class I-related molecule A (MICA) is one of the NKG2D ligands; it is encoded by highly polymorphic genes and exists as membrane-bound and soluble isoforms. Soluble MICA (sMICA) is overexpressed in the serum of MM patients, and its levels correlate with tumor progression. Interestingly, a methionine (Met) to valine (Val) substitution at position 129 of the α2 heavy chain domain classifies the MICA alleles into strong (MICA-129Met) and weak (MICA-129Val) binders to NKG2D receptor. We addressed whether the genetic polymorphisms in the MICA-129 alleles could affect MICA release during MM progression. The frequencies of Val/Val, Val/Met, and Met/Met MICA-129 genotypes in a cohort of 137 MM patients were 36, 43, and 22%, respectively. Interestingly, patients characterized by a Val/Val genotype exhibited the highest levels of sMICA in the sera. In addition, analysis of the frequencies of MICA-129 genotypes among different MM disease states revealed that Val/Val patients had a significant higher frequency of relapse. Interestingly, NKG2D was downmodulated in NK cells derived from MICA-129Met/Met MM patients. Results obtained by structural modeling analysis suggested that the Met to Val dimorphism could affect the capacity of MICA to form an optimal template for NKG2D recognition. In conclusion, our findings indicate that the MICA-129Val/Val variant is associated with significantly higher levels of sMICA and the progression of MM, strongly suggesting that the usage of soluble MICA as prognostic marker has to be definitely combined with the patient MICA genotype.
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Affiliation(s)
- Alessandra Zingoni
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Istituto Pasteur Italia-Cenci Bolognetti Fondazione, Rome, Italy
| | - Elisabetta Vulpis
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Istituto Pasteur Italia-Cenci Bolognetti Fondazione, Rome, Italy
| | - Francesca Cecere
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Maria G Amendola
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Istituto Pasteur Italia-Cenci Bolognetti Fondazione, Rome, Italy
| | - Daniel Fuerst
- German Red Cross Blood Donor Services, Baden-Wuerttemberg-Hessia, Ulm, Germany
| | - Taron Saribekyan
- German Red Cross Blood Donor Services, Baden-Wuerttemberg-Hessia, Ulm, Germany
| | - Adnane Achour
- Science for Life Laboratory, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Tatyana Sandalova
- Science for Life Laboratory, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ilaria Nardone
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Istituto Pasteur Italia-Cenci Bolognetti Fondazione, Rome, Italy
| | - Agnese Peri
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Istituto Pasteur Italia-Cenci Bolognetti Fondazione, Rome, Italy
| | - Alessandra Soriani
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Istituto Pasteur Italia-Cenci Bolognetti Fondazione, Rome, Italy
| | - Cinzia Fionda
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Istituto Pasteur Italia-Cenci Bolognetti Fondazione, Rome, Italy
| | - Elena Mariggiò
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Maria T Petrucci
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Maria R Ricciardi
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Joannis Mytilineos
- German Red Cross Blood Donor Services, Baden-Wuerttemberg-Hessia, Ulm, Germany
| | - Marco Cippitelli
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Istituto Pasteur Italia-Cenci Bolognetti Fondazione, Rome, Italy
| | - Cristina Cerboni
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Istituto Pasteur Italia-Cenci Bolognetti Fondazione, Rome, Italy
| | - Angela Santoni
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.,Istituto Pasteur Italia-Cenci Bolognetti Fondazione, Rome, Italy
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6
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Fung P, Bedogni G, Bedogni A, Petrie A, Porter S, Campisi G, Bagan J, Fusco V, Saia G, Acham S, Musto P, Petrucci MT, Diz P, Colella G, Mignogna MD, Pentenero M, Arduino P, Lodi G, Maiorana C, Manfredi M, Hallberg P, Wadelius M, Takaoka K, Leung YY, Bonacina R, Schiødt M, Lakatos P, Taylor T, De Riu G, Favini G, Rogers SN, Pirmohamed M, Nicoletti P, Fedele S. Time to onset of bisphosphonate-related osteonecrosis of the jaws: a multicentre retrospective cohort study. Oral Dis 2017; 23:477-483. [PMID: 28039941 DOI: 10.1111/odi.12632] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [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: 08/12/2016] [Revised: 12/04/2016] [Accepted: 12/20/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of bisphosphonates (BP). Although the risk of ONJ increases with increasing duration of BP treatment, there are currently no reliable estimates of the ONJ time to onset (TTO). The objective of this study was to estimate the TTO and associated risk factors in BP-treated patients. SUBJECTS AND METHODS Retrospective analysis of data from 22 secondary care centres in seven countries relevant to 349 patients who developed BP-related ONJ between 2004 and 2012. RESULTS The median (95%CI) TTO was 6.0 years in patients treated with alendronate (n = 88) and 2.2 years in those treated with zoledronate (n = 218). Multivariable Cox regression showed that dentoalveolar surgery was inversely associated, and the use of antiangiogenics directly associated, with the TTO in patients with cancer treated with zoledronate. CONCLUSIONS The incidence of ONJ increases with the duration of BP therapy, with notable differences observed with respect to BP type and potency, route of administration and underlying disease. When data are stratified by BP type, a time of 6.0 and 2.2 years of oral alendronate and intravenous zoledronate therapy, respectively, is required for 50% of patients to develop ONJ. After stratification by disease, a time of 5.3 and 2.2 years of BP therapy is required for 50% of patients with osteoporosis and cancer, respectively, to develop ONJ. These findings have significant implications for the design of future clinical studies and the development of risk-reduction strategies aimed at either assessing or modulating the risk of ONJ associated with BP.
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Affiliation(s)
- Ppl Fung
- University College London/University College London Hospital Eastman Dental Institute and Hospital, London, UK
| | - G Bedogni
- Clinical Epidemiology Unit, Liver Research Centre, Basovizza, Trieste, Italy
| | - A Bedogni
- Department of Maxillofacial Surgery, University of Verona, Italy.,Department of Maxillofacial Surgery, University of Padua, Italy
| | - A Petrie
- University College London/University College London Hospital Eastman Dental Institute and Hospital, London, UK
| | - S Porter
- University College London/University College London Hospital Eastman Dental Institute and Hospital, London, UK
| | - G Campisi
- Dip. Discipline Chirurgiche, Oncologiche e Stomatologiche, University of Palermo, Italy
| | - J Bagan
- Department of Oral and Maxillofacial Surgery, Oral Medicine, University General Hospital, Valencia University, Spain
| | - V Fusco
- Medical Oncology Unit, Department of Oncology and Haematology, Ospedale SS Antonio e Biagio e C Arrigo, Alessandria, Italy
| | - G Saia
- Department of Maxillofacial Surgery, University of Padua, Italy
| | - S Acham
- Department of Oral Surgery and Orthodontics, University Clinic of Dental Health and Oral Medicine, Medical University of Graz, Austria
| | - P Musto
- Scientific Direction, Referral Cancer Center of Basilicata, IRCCS, Rionero in Vulture, Potenza, Italy
| | - M T Petrucci
- Department of Cellular Biotechnologies and Haematology, "Sapienza" University, Rome, Italy
| | - P Diz
- School of Medicine and Dentistry, Santiago de Compostela University, Spain
| | - G Colella
- Department of Medical, Surgical and Dental Specialties, Second University of Naples, Italy
| | - M D Mignogna
- Head & Neck Clinical Section, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - M Pentenero
- Oral Medicine and Oral Oncology Unit, Department of Oncology, University of Turin, Italy
| | - P Arduino
- CIR Dental School, University of Turin, Italy
| | - G Lodi
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Italy
| | - C Maiorana
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Fondazione IRCCS Policlinico Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - M Manfredi
- Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali - S.Bi.Bi.T., Unità di Odontostomatologia, Parma University, Italy
| | - P Hallberg
- Clinical Pharmacology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Sweden
| | - M Wadelius
- Clinical Pharmacology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Sweden
| | - K Takaoka
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Y Y Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - R Bonacina
- Department of Dentistry, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Schiødt
- Department of Oral and Maxillofacial Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - P Lakatos
- First Department of Medicine, Semmelweis University Medical School, Budapest, Hungary
| | - T Taylor
- Department of Oral Surgery, King's College Hospital, London, UK
| | - G De Riu
- Department of Maxillofacial Surgery, University Hospital of Sassari, Italy
| | - G Favini
- Department of Dentistry, San Francesco Hospital, Nuoro, Italy
| | - S N Rogers
- University Hospital Aintree, Liverpool, UK
| | - M Pirmohamed
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - P Nicoletti
- Department of Systems Biology, Columbia University, New York, NY, USA
| | | | - S Fedele
- University College London/University College London Hospital Eastman Dental Institute and Hospital, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, London, UK
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7
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Gay F, Oliva S, Petrucci MT, Montefusco V, Conticello C, Musto P, Catalano L, Evangelista A, Spada S, Campbell P, Ria R, Salvini M, Offidani M, Carella AM, Omedé P, Liberati AM, Troia R, Cafro AM, Malfitano A, Falcone AP, Caravita T, Patriarca F, Nagler A, Spencer A, Hajek R, Palumbo A, Boccadoro M. Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: a pooled analysis. Leukemia 2016; 31:1727-1734. [PMID: 28008174 DOI: 10.1038/leu.2016.381] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 12/22/2022]
Abstract
In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.
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Affiliation(s)
- F Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - S Oliva
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M T Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Roma, Roma, Italy
| | - V Montefusco
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - C Conticello
- Division of Hematology, Azienda Policlinico 'Vittorio Emanuele', University of Catania, Catania, Italy
| | - P Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Potenza, Italy
| | - L Catalano
- Hematology, Department of Clinical Medicine and Surgery, AOU Federico II, Napoli, Italy
| | - A Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - S Spada
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - P Campbell
- Haematology Department, Cancer Services, Barwon Health, Geelong, Australia
| | - R Ria
- Department of Biomedical Science, University of Bari 'Aldo Moro' Medical School, Internal Medicine 'G. Baccelli' Policlinico, Bari, Italy
| | - M Salvini
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Offidani
- Hematology Department, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - A M Carella
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Martino-Ist, Genova, Italy
| | - P Omedé
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Liberati
- Department of Oncohematology, AO S.Maria di Terni, Terni, Italy
| | - R Troia
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Cafro
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - A Malfitano
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A P Falcone
- Division of Hematology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - T Caravita
- UOC Ematologia S. Eugenio ASL RM2 Roma, Roma, Italy
| | - F Patriarca
- Department of Hematology, Azienda Ospedaliera-Universitaria di Udine, DISM, Università di Udine, Udine, Italy
| | - A Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Spencer
- Department of Clinical Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - R Hajek
- Blood Cancer Research Group, Department of Haematooncology, Faculty Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - A Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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8
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Hájek R, Masszi T, Petrucci MT, Palumbo A, Rosiñol L, Nagler A, Yong KL, Oriol A, Minarik J, Pour L, Dimopoulos MA, Maisnar V, Rossi D, Kasparu H, Van Droogenbroeck J, Yehuda DB, Hardan I, Jenner M, Calbecka M, Dávid M, de la Rubia J, Drach J, Gasztonyi Z, Górnik S, Leleu X, Munder M, Offidani M, Zojer N, Rajangam K, Chang YL, San-Miguel JF, Ludwig H. A randomized phase III study of carfilzomib vs low-dose corticosteroids with optional cyclophosphamide in relapsed and refractory multiple myeloma (FOCUS). Leukemia 2016; 31:107-114. [PMID: 27416912 PMCID: PMC5220126 DOI: 10.1038/leu.2016.176] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/16/2016] [Accepted: 04/28/2016] [Indexed: 02/07/2023]
Abstract
This randomized, phase III, open-label, multicenter study compared carfilzomib monotherapy against low-dose corticosteroids and optional cyclophosphamide in relapsed and refractory multiple myeloma (RRMM). Relapsed and refractory multiple myeloma patients were randomized (1:1) to receive carfilzomib (10-min intravenous infusion; 20 mg/m2 on days 1 and 2 of cycle 1; 27 mg/m2 thereafter) or a control regimen of low-dose corticosteroids (84 mg of dexamethasone or equivalent corticosteroid) with optional cyclophosphamide (1400 mg) for 28-day cycles. The primary endpoint was overall survival (OS). Three-hundred and fifteen patients were randomized to carfilzomib (n=157) or control (n=158). Both groups had a median of five prior regimens. In the control group, 95% of patients received cyclophosphamide. Median OS was 10.2 (95% confidence interval (CI) 8.4-14.4) vs 10.0 months (95% CI 7.7-12.0) with carfilzomib vs control (hazard ratio=0.975; 95% CI 0.760-1.249; P=0.4172). Progression-free survival was similar between groups; overall response rate was higher with carfilzomib (19.1 vs 11.4%). The most common grade ⩾3 adverse events were anemia (25.5 vs 30.7%), thrombocytopenia (24.2 vs 22.2%) and neutropenia (7.6 vs 12.4%) with carfilzomib vs control. Median OS for single-agent carfilzomib was similar to that for an active doublet control regimen in heavily pretreated RRMM patients.
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Affiliation(s)
- R Hájek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - T Masszi
- St István and St László Hospital of Budapest, Budapest, Hungary
| | | | | | - L Rosiñol
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Nagler
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - K L Yong
- University College London Cancer Institute, London, UK
| | - A Oriol
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - J Minarik
- University Hospital Olomouc and Medical Faculty of Palacky, University Olomouc, Olomouc, Czech Republic
| | - L Pour
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - M A Dimopoulos
- National and Kapodistrian University of Athens, Athens, Greece
| | - V Maisnar
- Charles University Teaching Hospital, Hradec Králové, Czech Republic
| | - D Rossi
- Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - H Kasparu
- Hospital Elisabethinen Linz, Linz, Austria
| | | | - D B Yehuda
- Hadassah Medical Center, Jerusalem, Israel
| | - I Hardan
- Meir Medical Center, Kfar-Saba, Israel
| | - M Jenner
- Southampton General Hospital, Hampshire, UK
| | - M Calbecka
- Nicolaus Copernicus Hospital, Toruń, Poland
| | - M Dávid
- University of Pécs, Pécs, Hungary
| | - J de la Rubia
- University Hospital La Fe and Universidad Católica de València 'San Vicente Mártir', València, Spain
| | - J Drach
- Medical University of Vienna, Vienna, Austria
| | - Z Gasztonyi
- Petz Aladár Megyei Oktató Kórház, Vasvári Pál, Hungary
| | - S Górnik
- Zamojski Szpital Niepubliczny, Zamosc, Poland
| | - X Leleu
- Hopital Huriez, CHRU, Lille, France
| | - M Munder
- University Medicine Mainz, Mainz, Germany
| | - M Offidani
- Clinica di Ematologia Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - N Zojer
- Center for Oncology, Hematology with Outpatient Department and Palliative Care, Wilhelminenspital, Vienna, Austria
| | - K Rajangam
- Onyx Pharmaceuticals, Inc., an Amgen subsidiary, South San Francisco, CA, USA
| | - Y-L Chang
- Onyx Pharmaceuticals, Inc., an Amgen subsidiary, South San Francisco, CA, USA
| | - J F San-Miguel
- Clínica Universidad de Navarra-CIMA-IDISNA, Navarra, Spain
| | - H Ludwig
- Wilhelminen Cancer Research Institute, Vienna, Austria
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9
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Larocca A, Bringhen S, Petrucci MT, Oliva S, Falcone AP, Caravita T, Villani O, Benevolo G, Liberati AM, Morabito F, Montefusco V, Passera R, De Rosa L, Omedé P, Vincelli ID, Spada S, Carella AM, Ponticelli E, Derudas D, Genuardi M, Guglielmelli T, Nozzoli C, Aghemo E, De Paoli L, Conticello C, Musolino C, Offidani M, Boccadoro M, Sonneveld P, Palumbo A. A phase 2 study of three low-dose intensity subcutaneous bortezomib regimens in elderly frail patients with untreated multiple myeloma. Leukemia 2016; 30:1320-6. [PMID: 26898189 DOI: 10.1038/leu.2016.36] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/19/2016] [Accepted: 02/02/2016] [Indexed: 12/16/2022]
Abstract
This phase 2 trial evaluated three low-dose intensity subcutaneous bortezomib-based treatments in patients ⩾75 years with newly diagnosed multiple myeloma (MM). Patients received subcutaneous bortezomib plus oral prednisone (VP, N=51) or VP plus cyclophosphamide (VCP, N=51) or VP plus melphalan (VMP, N=50), followed by bortezomib maintenance, and half of the patients were frail. Response rate was 64% with VP, 67% with VCP and 86% with VMP, and very good partial response rate or better was 26%, 28.5% and 49%, respectively. Median progression-free survival was 14.0, 15.2 and 17.1 months, and 2-year OS was 60%, 70% and 76% in VP, VCP, VMP, respectively. At least one drug-related grade ⩾3 non-hematologic adverse event (AE) occurred in 22% of VP, 37% of VCP and 33% of VMP patients; the discontinuation rate for AEs was 12%, 14% and 20%, and the 6-month rate of toxicity-related deaths was 4%, 4% and 8%, respectively. The most common grade ⩾3 AEs included infections (8-20%), and constitutional (10-14%) and cardiovascular events (4-12%); peripheral neuropathy was limited (4-6%). Bortezomib maintenance was effective and feasible. VP, VCP and VMP regimens demonstrated no substantial difference. Yet, toxicity was higher with VMP, suggesting that a two-drug combination followed by maintenance should be preferred in frail patients.
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Affiliation(s)
- A Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - S Bringhen
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - M T Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, 'Sapienza' University, Rome, Italy
| | - S Oliva
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - A P Falcone
- IRCCS Casa Sollievo della Sofferenza, Unità di Ematologia, San Giovanni Rotondo, Italy
| | - T Caravita
- UOC Ematologia, Ospedale S Eugenio, Roma, Italy
| | - O Villani
- Unit of Hematology and Stem Cell Transplantation, IRCCS, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (Pz), Italy
| | - G Benevolo
- SC Ematologia, Dipartimento di Ematologia ed Oncologia, AO Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Liberati
- AO S Maria di Terni, SC Oncoematologia, Terni, Italy
| | - F Morabito
- UOC di Ematologia AO Cosenza, Cosenza, Italy
| | - V Montefusco
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Passera
- Division of Nuclear Medicine, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - L De Rosa
- Hematology and SCT Unit, Osp SCamillo, Rome, Italy
| | - P Omedé
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - I D Vincelli
- Azienda Ospedaliera Bianchi Melacrino Morelli, Divisione di Ematologia, Reggio Calabria, Italy
| | - S Spada
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - E Ponticelli
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - D Derudas
- UO Ematologia e Centro Trapianti, Ospedale Oncologico di Riferimento Regionale 'Armando Businco', Cagliari, Italy
| | - M Genuardi
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - T Guglielmelli
- Divisione di Medicina Interna ed Ematologia, AUO San Luigi Gonzaga, Orbassano, Italy
| | - C Nozzoli
- SODc Ematologia, AOU Careggi, Florence, Italy
| | - E Aghemo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - L De Paoli
- Division of Hematology, Department of Translational Medicine Amedeo Avogadro University, Ospedale Maggiore della Carità, Novara, Italy
| | - C Conticello
- Division of Hematology, Azienda Policlinico-OVE, University of Catania, Catania, Italy
| | - C Musolino
- UOC Ematologia, Azienda Ospedaliera Universitaria, G Martino, Messina, Italy
| | - M Offidani
- Clinica di Ematologia AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - P Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - A Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
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10
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Brunetti GA, Palumbo G, Morano GS, Baldacci E, Carmosino I, Annechini G, Talone R, Kiflom S, Mastrogiacomo G, Grammatico S, Chisini M, Costa A, Tendas A, Scaramucci L, Giovannini M, Niscola P, Petrucci MT, Cartoni C. Tapentadol PR for Pain Syndromes in Real Life Patients with Hematological Malignancy. Cardiovasc Hematol Agents Med Chem 2016; 14:68-74. [PMID: 27048320 DOI: 10.2174/1871525714666160405110833] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/25/2016] [Accepted: 03/14/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND More than 50% of oncohematological patients suffer from pain syndrome, mostly originating from the bone, which often include nociceptive and neuropathic complaints. Tapentadol, a recently available treatment option for cancer pain, exerts a dual analgesic mechanisms (opioid and noradrenergic), allowing for a high clinical efficacy as well as for a reduction in adverse events compared to traditional opioids. AIM To explore the safety and efficacy of tapentadol as a suitable agent for the pain management in the setting of oncohematology. METHODS Our observational study included 36 patients with basal pain intensity (NRS) ranging from 5 to 10. Tapentadol prolonged release (PR) was given at the initial dose of 50 mg BID and careful titrated according to the achieved pain control. RESULTS Tapentadol PR was given at the dosages ranging from 200 and 260 mg/day after a careful titration, allowed for a clinically (-7 points NRS) remarkable reduction of pain intensity without any significant side effects. CONCLUSION In oncohematological patients on pain, tapentadol PR was effective and well tolerated, so representing a suitable treatment option in this difficult setting.
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Affiliation(s)
- Gregorio A Brunetti
- Department of Cellular Biotechnology and Hematology, University La Sapienza of Rome, Italy.
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11
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Finsinger P, Grammatico S, Chisini M, Piciocchi A, Foà R, Petrucci MT. Clinical features and prognostic factors in solitary plasmacytoma. Br J Haematol 2015; 172:554-60. [DOI: 10.1111/bjh.13870] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/06/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Paola Finsinger
- Haematology Division; Department of Cellular Biotechnologies and Haematology; ‘Sapienza’ University; Rome Italy
| | - Sara Grammatico
- Haematology Division; Department of Cellular Biotechnologies and Haematology; ‘Sapienza’ University; Rome Italy
| | - Marta Chisini
- Haematology Division; Department of Cellular Biotechnologies and Haematology; ‘Sapienza’ University; Rome Italy
| | | | - Robin Foà
- Haematology Division; Department of Cellular Biotechnologies and Haematology; ‘Sapienza’ University; Rome Italy
| | - Maria T. Petrucci
- Haematology Division; Department of Cellular Biotechnologies and Haematology; ‘Sapienza’ University; Rome Italy
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12
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Palumbo A, Gay F, Cavallo F, Di Raimondo F, Larocca A, Hardan I, Nagler A, Petrucci MT, Hajek R, Pezzatti S, Delforge M, Patriarca F, Donato F, Cerrato C, Nozzoli C, Yu Z, Boccadifuoco L, Caravita T, Benevolo G, Guglielmelli T, Vincelli D, Jacques C, Dimopoulos MA, Ciccone G, Musto P, Corradini P, Cavo M, Boccadoro M. Continuous Therapy Versus Fixed Duration of Therapy in Patients With Newly Diagnosed Multiple Myeloma. J Clin Oncol 2015; 33:3459-66. [DOI: 10.1200/jco.2014.60.2466] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Continuous therapy (CT) prolongs progression-free survival 1 (PFS1; time from random assignment until the first progression or death), but chemotherapy-resistant relapse may negatively impact overall survival (OS). Progression-free survival 2 (PFS2; time from random assignment until the second progression or death) may represent an additional tool to estimate outcome. This study evaluates the benefit of novel agent–based CT versus fixed duration of therapy (FDT) in patients with newly diagnosed myeloma. Methods We included patients enrolled onto three phase III trials that randomly assigned patients to novel agent–based CT versus FDT. Primary analyses were restricted to the intent-to-treat population eligible for CT (patients progression free and alive at 1 year after random assignment). Primary end points were PFS1, PFS2, and OS. All hazard ratios (HRs) and 95% CIs were adjusted for several potential confounders using Cox models. Results In the pooled analysis of the three trials, 604 patients were randomly assigned to CT and 614 were assigned to FDT. Median follow-up was 52 months. In the intent-to-treat CT population, CT (n = 417), compared with FDT (n = 410), significantly improved PFS1 (median, 32 v 16 months, respectively; HR, 0.47; 95% CI, 0.40 to 0.56; P < .001), PFS2 (median, 55 v 40 months, respectively; HR, 0.61; 95% CI, 0.50 to 0.75; P < .001), and OS (4-year OS, 69% v 60%, respectively; HR, 0.69; 95% CI, 0.54 to 0.88; P = .003). Conclusion In this pooled analysis, CT significantly improved PFS1, PFS2, and OS. The improvement in PFS2 suggests that the benefit reported during first remission is not cancelled by a shorter second remission. PFS2 is a valuable end point to estimate long-term clinical benefit and should be included in future trials.
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Affiliation(s)
- Antonio Palumbo
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Francesca Gay
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Federica Cavallo
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Francesco Di Raimondo
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Alessandra Larocca
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Izhar Hardan
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Arnon Nagler
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Maria T. Petrucci
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Roman Hajek
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Sara Pezzatti
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Michel Delforge
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Francesca Patriarca
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Francesca Donato
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Chiara Cerrato
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Chiara Nozzoli
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Zhinuan Yu
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Luana Boccadifuoco
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Tommaso Caravita
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Giulia Benevolo
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Tommasina Guglielmelli
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Donatella Vincelli
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Christian Jacques
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Meletios A. Dimopoulos
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Giovannino Ciccone
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Pellegrino Musto
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Paolo Corradini
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Michele Cavo
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
| | - Mario Boccadoro
- Antonio Palumbo, Francesca Gay, Federica Cavallo, Alessandra Larocca, Francesca Donato, Chiara Cerrato, Luana Boccadifuoco, and Mario Boccadoro, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino; Giulia Benevolo, S.C. Ematologia A.O. Città della Salute e della Scienza di Torino; Tommasina Guglielmelli, University of Turin and San Luigi Hospital; Giovannino Ciccone, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO
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Abstract
BACKGROUND To evaluate the results of surgery for vertebral involvement in multiple myeloma (MM) following the introduction of the new chemotherapy in 2006. METHODS Retrospective cohort study evaluating the patients with MM vertebral lesions from January 2006 to January 2014. Outcomes were based upon participation in ODI and EQ-5D. Statistical interpretation of the data was performed with SPSS version 19 software (SPSS Inc, Chicago, IL, USA). RESULTS One hundred twenty patients affected by MM were potentially eligible for recruitment. About 1/3 patients needed an operation for vertebral involvement. The disability was mainly related to the number of vertebrae affected by MM. No difference in disability and quality of life was observed between operated and non-operated patients, according to age, levels, and follow-up. The operated patients with a Thoracic location reported lower disability and higher quality of life than non-operated patients. Non-operated patients with one or two vertebrae affected reported lower levels of quality of life. CONCLUSIONS When a spinal column involvement occurs, the probability of undergoing surgery is about 40%. Operated patients show a moderate disability and the increased tendency is related to the number of vertebrae involved. The quality of life is middle in average and middle-high in patients operated for thoracic lesions. Nowadays the spinal surgeon must have a perspective view about MM vertebral lesions, evaluating the stability of the spine, the presence of deformity, the risk of vertebral fractures and the presence of drug resistant pain, that deteriorate the disability and the quality of life related to the underlying disease.
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Affiliation(s)
- Pasquale Donnarumma
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy -
| | - Roberto Tarantino
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Marika Rullo
- Department of Psychology of Developmental and Socialization Processes, "Sapienza" University of Rome, Rome, Italy
| | - Adele Grisaro
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Maria T Petrucci
- Department of Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Delfini
- Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
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14
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Cavo M, Pantani L, Pezzi A, Petrucci MT, Patriarca F, Di Raimondo F, Marzocchi G, Galli M, Montefusco V, Zamagni E, Gamberi B, Tacchetti P, Brioli A, Palumbo A, Sonneveld P. Bortezomib-thalidomide-dexamethasone (VTD) is superior to bortezomib-cyclophosphamide-dexamethasone (VCD) as induction therapy prior to autologous stem cell transplantation in multiple myeloma. Leukemia 2015; 29:2429-31. [PMID: 26442610 DOI: 10.1038/leu.2015.274] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- M Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - L Pantani
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - A Pezzi
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - M T Petrucci
- Azienda Policlinico Umberto I, University La Sapienza, Roma, Italy
| | - F Patriarca
- Hematology and Bone Marrow Transplant Unit, Udine, Italy
| | - F Di Raimondo
- Department of Clinical and Molecular Bio-Medicine, University of Catania, Catania, Italy
| | - G Marzocchi
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - M Galli
- Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - V Montefusco
- Hematology-Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - E Zamagni
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - B Gamberi
- Arcispedale S. Maria Nuova, Hematology, Reggio Emilia, Italy
| | - P Tacchetti
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - A Brioli
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - A Palumbo
- University of Torino, Azienda Ospedaliero-Universitaria (AOU) S. Giovanni Battista Torino, Torino, Italy
| | - P Sonneveld
- Department of Hematology, Erasmus MC, Rotterdam, The Netherlands
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15
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Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L, Richardson P, Caltagirone S, Lahuerta JJ, Facon T, Bringhen S, Gay F, Attal M, Passera R, Spencer A, Offidani M, Kumar S, Musto P, Lonial S, Petrucci MT, Orlowski RZ, Zamagni E, Morgan G, Dimopoulos MA, Durie BGM, Anderson KC, Sonneveld P, San Miguel J, Cavo M, Rajkumar SV, Moreau P. Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group. J Clin Oncol 2015; 33:2863-9. [PMID: 26240224 DOI: 10.1200/jco.2015.61.2267] [Citation(s) in RCA: 1296] [Impact Index Per Article: 144.0] [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
PURPOSE The clinical outcome of multiple myeloma (MM) is heterogeneous. A simple and reliable tool is needed to stratify patients with MM. We combined the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization after CD138 plasma cell purification and serum lactate dehydrogenase (LDH) to evaluate their prognostic value in newly diagnosed MM (NDMM). PATIENTS AND METHODS Clinical and laboratory data from 4,445 patients with NDMM enrolled onto 11 international trials were pooled together. The K-adaptive partitioning algorithm was used to define the most appropriate subgroups with homogeneous survival. RESULTS ISS, CA, and LDH data were simultaneously available in 3,060 of 4,445 patients. We defined the following three groups: revised ISS (R-ISS) I (n = 871), including ISS stage I (serum β2-microglobulin level < 3.5 mg/L and serum albumin level ≥ 3.5 g/dL), no high-risk CA [del(17p) and/or t(4;14) and/or t(14;16)], and normal LDH level (less than the upper limit of normal range); R-ISS III (n = 295), including ISS stage III (serum β2-microglobulin level > 5.5 mg/L) and high-risk CA or high LDH level; and R-ISS II (n = 1,894), including all the other possible combinations. At a median follow-up of 46 months, the 5-year OS rate was 82% in the R-ISS I, 62% in the R-ISS II, and 40% in the R-ISS III groups; the 5-year PFS rates were 55%, 36%, and 24%, respectively. CONCLUSION The R-ISS is a simple and powerful prognostic staging system, and we recommend its use in future clinical studies to stratify patients with NDMM effectively with respect to the relative risk to their survival.
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Affiliation(s)
- Antonio Palumbo
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Hervé Avet-Loiseau
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Stefania Oliva
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Henk M Lokhorst
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Hartmut Goldschmidt
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Laura Rosinol
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Paul Richardson
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Simona Caltagirone
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Juan José Lahuerta
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Thierry Facon
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Sara Bringhen
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Francesca Gay
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Michel Attal
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Roberto Passera
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Andrew Spencer
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Massimo Offidani
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Shaji Kumar
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Pellegrino Musto
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Sagar Lonial
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Maria T Petrucci
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Robert Z Orlowski
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Elena Zamagni
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Gareth Morgan
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Meletios A Dimopoulos
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Brian G M Durie
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Kenneth C Anderson
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Pieter Sonneveld
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Jésus San Miguel
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Michele Cavo
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - S Vincent Rajkumar
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
| | - Philippe Moreau
- Antonio Palumbo, Stefania Oliva, Simona Caltagirone, Sara Bringhen, and Francesca Gay, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute della Salute e della Scienza di Torino; Roberto Passera, University of Torino, Torino; Massimo Offidani, Clinica di Ematologia, AUO Ospedali Riuniti di Ancona, Ancona; Pellegrino Musto, Istituto di Ricovero e Cura a Carattere Scientifico, Referral Cancer Center of Basilicata, Rionero in Vulture; Maria T. Petrucci, Sapienza University of Rome, Rome; Elena Zamagni and Michele Cavo, Istituto di Ematologia Seragnoli, Università di Bologna, Bologna, Italy; Hervé Avet-Loiseau and Michel Attal, Institut Claudius Regaud, L'Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse; Thierry Facon, Service des Maladies du Sang, Hôpital Claude Huriez, Centre Hospitalier Regionale et Universitaire Lille, Lille; Philippe Moreau, University Hospital Hotel-Dieu, Nantes, France; Henk M. Lokhorst, VU University Medical Center, Amsterdam; Pieter Sonneveld, Erasmus MC, Rotterdam, the Netherlands; Hartmut Goldschmidt, University Hospital and National Center for Tumor Diseases Heidelberg, Heidelberg, Germany; Laura Rosinol, Hospital Clínic, Institut Clínic d'Investigacions Biomèdiques Ausgust Pi i Sunyer, Barcelona; Juan José Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jésus San Miguel, Clínica Universidad de Navarra, Centro de Investigaciones Médicas Aplicadas, IDISNA, Pamplona, Spain; Paul Richardson and Kenneth C. Anderson, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA; Shaji Kumar and S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Sagar Lonial, Winship Cancer Institute, Emory University, Atlanta, GA; Robert Z. Orlowski, The University of Texas MD Anderson Comprehensive Cancer Center, Houston, TX; Gareth Morgan, Myeloma Institutes for Research Therapy, University of Arkansas for Medical Sciences, Little Rock, AR; Brian G.M. Durie, Cedars-Sinai Comprehensive Canc
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Dimopoulos MA, Petrucci MT, Foà R, Catalano J, Kropff M, Terpos E, Zhang J, Grote L, Jacques C, Palumbo A. Impact of maintenance therapy on subsequent treatment in patients with newly diagnosed multiple myeloma: use of "progression-free survival 2" as a clinical trial end-point. Haematologica 2015; 100:e328-30. [PMID: 25840600 PMCID: PMC5004436 DOI: 10.3324/haematol.2014.120790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | | | | | - John Catalano
- Frankston Hospital, Monash University, Victoria, Australia
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Caltagirone S, Ruggeri M, Aschero S, Gilestro M, Oddolo D, Gay F, Bringhen S, Musolino C, Baldini L, Musto P, Petrucci MT, Gaidano G, Passera R, Bruno B, Palumbo A, Boccadoro M, Omedè P. Chromosome 1 abnormalities in elderly patients with newly diagnosed multiple myeloma treated with novel therapies. Haematologica 2014; 99:1611-7. [PMID: 25015938 DOI: 10.3324/haematol.2014.103853] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Multiple myeloma is a plasma cell disorder characterized by malignant plasma cell infiltration in the bone marrow, serum and/or urine monoclonal protein and organ damage. The aim of this study was to investigate the impact of chromosome 1 abnormalities in a group of elderly patients (>65 years) with newly diagnosed multiple myeloma enrolled in the GIMEMA-MM-03-05 trial and treated with bortezomib, melphalan and prednisone or bortezomib, melphalan, prednisone and thalidomide followed by bortezomib and thalidomide maintenance. We also evaluated the link between chromosome 1 abnormalities and other clinical, genetic and immunophenotypic features by a multivariate logistic regression model. Interphase fluorescence in situ hybridization on immunomagnetically purified plasma cells and bone marrow multiparameter flow cytometry were employed. A multivariate Cox model showed that chromosome 1 abnormalities, age >75 years and a CD19(+)/CD117(-) immunophenotype of bone marrow plasma cells were independent risk factors for overall survival in elderly patients with newly diagnosed multiple myeloma. Moreover, a detrimental effect of thalidomide, even when administered in association with bortezomib, was observed in patients with abnormal chromosome 1 as well as in those with 17p deletion, while the benefit of adding thalidomide to the bortezomib-melphalan-prednisone regimen was noted in patients carrying an aggressive CD19(+)/CD117(-) bone marrow plasma cell immunophenotype. This trial was registered at www.clinicaltri-als.gov as #NCT01063179.
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Affiliation(s)
- Simona Caltagirone
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy Scuola di specializzazione in medicina clinica, Università di Torino, Italy
| | - Marina Ruggeri
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Simona Aschero
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Milena Gilestro
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Daniela Oddolo
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Francesca Gay
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Sara Bringhen
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Caterina Musolino
- Divisione di Ematologia, Dipartimento di Chirurgia Generale e Oncologia, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Luca Baldini
- Divisione di Ematologia, Fondazione IRCCS Ca Granda, OM Policlinico, Università di Milano, Italy
| | - Pellegrino Musto
- Direzione Scientifica, IRCCS - CROB, Centro di riferimento ongcologico della Basilicata, Rionero in Vulture, Italy
| | - Maria T Petrucci
- Dipartimento di Biotecnologia cellulare e di Ematologia, Università"La Sapienza" di Roma, Italy
| | - Gianluca Gaidano
- Divisione di Ematologia, Dipartimento di Medicina Traslazionale, Università degli studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | - Roberto Passera
- Divisione di medicina nucleare, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Università di Torino, Italy
| | - Benedetto Bruno
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Antonio Palumbo
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Mario Boccadoro
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
| | - Paola Omedè
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Italy
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18
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Palumbo A, Bringhen S, Kumar SK, Lupparelli G, Usmani S, Waage A, Larocca A, van der Holt B, Musto P, Offidani M, Petrucci MT, Evangelista A, Zweegman S, Nooka AK, Spencer A, Dimopoulos MA, Hajek R, Cavo M, Richardson P, Lonial S, Ciccone G, Boccadoro M, Anderson K, Barlogie B, Sonneveld P, McCarthy PL. Second primary malignancies with lenalidomide therapy for newly diagnosed myeloma: a meta-analysis of individual patient data. Lancet Oncol 2014; 15:333-42. [PMID: 24525202 DOI: 10.1016/s1470-2045(13)70609-0] [Citation(s) in RCA: 210] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Lenalidomide has been linked to second primary malignancies in myeloma. We aimed to pool and analyse available data to compare the incidence of second primary malignancies in patients with and without lenalidomide exposure. METHODS We identified relevant studies through a search of PubMed and abstracts from the American Society of Clinical Oncology, American Society of Hematology, and the International Myeloma Workshop. Randomised, controlled, phase 3 trials that recruited patients with newly diagnosed multiple myeloma between Jan 1, 2000, and Dec 15, 2012, and in which at least one group received lenalidomide were eligible for inclusion. We obtained individual patient data (age, sex, date of diagnosis, allocated treatment and received treatment, duration of treatment and cause of discontinuation, maintenance treatment, date of first relapse, date of second primary malignancy diagnosis, type of second primary malignancy, date of death or last contact, and cause of death) by direct collaboration with the principal investigators of eligible trials. Primary outcomes of interest were cumulative incidence of all second primary malignancies, solid second primary malignancies, and haematological second primary malignancies, and were analysed by a one-step meta-analysis. FINDINGS We found nine eligible trials, of which seven had available data for 3254 patients. 3218 of these patients received treatment (2620 had received lenalidomide and 598 had not), and were included in our analyses. Cumulative incidences of all second primary malignancies at 5 years were 6·9% (95% CI 5·3-8·5) in patients who received lenalidomide and 4·8% (2·0-7·6) in those who did not (hazard ratio [HR] 1·55 [95% CI 1·03-2·34]; p=0·037). Cumulative 5-year incidences of solid second primary malignancies were 3·8% (95% CI 2·7-4·9) in patients who received lenalidomide and 3·4% (1·6-5·2) in those that did not (HR 1·1 [95% CI 0·62-2·00]; p=0·72), and of haematological second primary malignancies were 3·1% (95% CI 1·9-4·3) and 1·4% (0·0-3·6), respectively (HR 3·8 [95% CI 1·15-12·62]; p=0·029). Exposure to lenalidomide plus oral melphalan significantly increased haematological second primary malignancy risk versus melphalan alone (HR 4·86 [95% CI 2·79-8·46]; p<0·0001). Exposure to lenalidomide plus cyclophosphamide (HR 1·26 [95% CI 0·30-5·38]; p=0·75) or lenalidomide plus dexamethasone (HR 0·86 [95% CI 0·33-2·24]; p=0·76) did not increase haematological second primary malignancy risk versus melphalan alone. INTERPRETATION Patients with newly diagnosed myeloma who received lenalidomide had an increased risk of developing haematological second primary malignancies, driven mainly by treatment strategies that included a combination of lenalidomide and oral melphalan. These results suggest that alternatives, such as cyclophosphamide or alkylating-free combinations, should be considered instead of oral melphalan in combination with lenalidomide for myeloma. FUNDING Celgene Corporation.
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Affiliation(s)
- Antonio Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
| | - Sara Bringhen
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Giulia Lupparelli
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Saad Usmani
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Anders Waage
- Department of Hematology, St Olavs Hospital/Norwegian University of Science and Technology (NTNU) and KG Jebsen Myeloma Research Center, Trondheim, Norway
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | | | - Pellegrino Musto
- Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Massimo Offidani
- Clinica di Ematologia, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Maria T Petrucci
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - Ajay K Nooka
- Division of Bone Marrow Transplant, Winship Cancer Institute, Atlanta, GA, USA
| | - Andrew Spencer
- Department of Clinical Hematology and Bone Marrow Transplant, Alfred Health-Monash University, Melbourne, VIC, Australia
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
| | - Roman Hajek
- Faculty of Medicine, and Department of Haematooncology, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Michele Cavo
- "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, GA, USA
| | | | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | | | - Bart Barlogie
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pieter Sonneveld
- HOVON Data Center, Erasmus MC-Clinical Trial Center, Rotterdam, Netherlands; Department of Hematology, Erasmus MC, Rotterdam, Netherlands
| | - Philip L McCarthy
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
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19
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Sonneveld P, Verelst SG, Lewis P, Gray-Schopfer V, Hutchings A, Nixon A, Petrucci MT. Review of health-related quality of life data in multiple myeloma patients treated with novel agents. Leukemia 2013; 27:1959-69. [PMID: 23783393 PMCID: PMC3806249 DOI: 10.1038/leu.2013.185] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 01/09/2023]
Abstract
In multiple myeloma (MM), health-related quality of life (HRQoL) data is becoming increasingly important, owing to improved survival outcomes and the impact of treatment-related toxicity on HRQoL. Researchers are more frequently including HRQoL assessments in clinical trials, but analysis and reporting of this data has not been consistent. A systematic literature review assessed the effect of novel agents (thalidomide, bortezomib and lenalidomide) on HRQoL in MM patients, and evaluated the subsequent reporting of these HRQoL results. A relatively small body of literature addresses HRQoL data in MM patients treated with novel MM therapeutic agents: 9 manuscripts and 15 conference proceedings. The literature demonstrates the complementary value of HRQoL when assessing clinical response, progression, overall survival and toxicity. However, weaknesses and inconsistencies in analysis and presentation of HRQoL data were observed, often complicating interpretation of the impact of treatment on HRQoL in MM. Further evaluation of HRQoL in MM patients treated with novel agents is required in larger cohorts, and ideally in head-to-head comparative studies. Additionally, the development of standardised MM-specific best practice guidelines in HRQoL data collection and analysis is recommended. These would ensure that future data are more useful in guiding predictive models and clinical decisions.
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Affiliation(s)
- P Sonneveld
- Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S G Verelst
- Department of Hematology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P Lewis
- Celgene GmbH, Munich, Germany
| | | | | | - A Nixon
- Oxford Outcomes, an ICON plc. company, Oxford, UK
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20
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Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia 2013; 28:222-5. [PMID: 23958922 DOI: 10.1038/leu.2013.241] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- P Musto
- Scientific Direction, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - V Simeon
- Laboratory of Pre-clinical and Translational Research, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - M C Martorelli
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - M T Petrucci
- Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy
| | - N Cascavilla
- Division of Hematology and Stem Cell Transplantation, Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - F Di Raimondo
- Division of Hematology, Department of Biomedical Sciences, Azienda Ospedaliera Ferrarotto, University of Catania, Catania, Italy
| | - T Caravita
- Department of Hematology, Azienda Ospedaliera S. Eugenio, Tor Vergata University, Rome, Italy
| | - F Morabito
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - M Offidani
- Hematology Clinic, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - A Olivieri
- Hematology and Medicine Clinic, Marche Polytechnic University, Ancona, Italy
| | - G Benevolo
- Hematology 2, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - R Mina
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - R Guariglia
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - G D'Arena
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - G Mansueto
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - N Filardi
- Unit of Hematology, San Carlo Hospital, Potenza, Italy
| | - F Nobile
- Division of Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - A Levi
- Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy
| | - A Falcone
- Division of Hematology and Stem Cell Transplantation, Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - M Cavalli
- Division of Hematology, Department of Biomedical Sciences, Azienda Ospedaliera Ferrarotto, University of Catania, Catania, Italy
| | - G Pietrantuono
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - O Villani
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - S Bringhen
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - P Omedè
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - R Lerose
- Pharmacy Unit, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - L Agnelli
- Department of Clinical Sciences and Community Health, University of Milan; Hematology 1, Fondazione Ca' Grande Ospedale Maggiore Policlinico, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - K Todoerti
- Laboratory of Pre-clinical and Translational Research, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - A Neri
- Department of Clinical Sciences and Community Health, University of Milan; Hematology 1, Fondazione Ca' Grande Ospedale Maggiore Policlinico, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - M Boccadoro
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - A Palumbo
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
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21
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Dimopoulos MA, Delforge M, Hájek R, Kropff M, Petrucci MT, Lewis P, Nixon A, Zhang J, Mei J, Palumbo A. Lenalidomide, melphalan, and prednisone, followed by lenalidomide maintenance, improves health-related quality of life in newly diagnosed multiple myeloma patients aged 65 years or older: results of a randomized phase III trial. Haematologica 2013; 98:784-8. [PMID: 23242595 PMCID: PMC3640125 DOI: 10.3324/haematol.2012.074534] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 11/22/2012] [Indexed: 12/23/2022] Open
Abstract
The MM-015 trial assessed the effect of lenalidomide-based therapy on health-related quality of life. Patients (n=459) with newly diagnosed multiple myeloma aged 65 years or over were randomized 1:1:1 to nine 4-week cycles of lenalidomide, melphalan, and prednisone, followed by lenalidomide maintenance; or lenalidomide, melphalan, and prednisone, or melphalan and prednisone, with no maintenance therapy. Patients completed health-related quality of life questionnaires at baseline, after every third treatment cycle, and at treatment end. Health-related quality of life improved in all treatment groups during induction therapy. Patients receiving lenalidomide maintenance had the most pronounced improvements, Global Health Status/Quality of Life (P<0.05), Physical Functioning (P<0.01), and Side Effects of Treatment (P<0.05) out of 6 pre-selected health-related quality of life domains. More patients receiving lenalidomide maintenance achieved minimal important differences (P<0.05 for Physical Functioning). Therefore, lenalidomide, melphalan, and prednisone, followed by lenalidomide maintenance, improves health-related quality of life in patients with newly diagnosed multiple myeloma. (Clinicaltrials.gov identifier NCT00405756).
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22
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Petrucci MT, Giraldo P, Corradini P, Teixeira A, Dimopoulos MA, Blau IW, Drach J, Angermund R, Allietta N, Broer E, Mitchell V, Bladé J. A prospective, international phase 2 study of bortezomib retreatment in patients with relapsed multiple myeloma. Br J Haematol 2013; 160:649-59. [PMID: 23293914 DOI: 10.1111/bjh.12198] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 11/06/2012] [Indexed: 01/17/2023]
Abstract
Multiple myeloma (MM) typically follows a relapsing course with many patients requiring multiple therapies. This single-arm phase 2 study prospectively evaluated the efficacy and safety of bortezomib retreatment in MM patients who had relapsed after achieving at least a partial response (≥ PR) to prior bortezomib-based therapy. Patients aged ≥ 18 years, with measurable, secretory MM, who relapsed ≥ 6 months after prior bortezomib treatment were eligible. Patients received up to eight cycles of bortezomib (± dexamethasone). The primary endpoint was best confirmed response at retreatment; secondary endpoints included duration of response (DOR), time to progression (TTP), and safety. Adverse events (AEs) were graded by National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. A total of 130 patients (median of two prior lines of therapy) were enrolled and received retreatment. At retreatment, 28% and 72% of patients received bortezomib and bortezomib-dexamethasone, respectively. Overall response rate was 40%. In patients who achieved ≥ PR, median DOR and TTP were 6.5 and 8.4 months, respectively. Thrombocytopenia was the most common grade ≥ 3 AE (35%). Forty percent of patients experienced neuropathy events, which improved and resolved in a median of 1.5 and 8.9 months, respectively. In conclusion, bortezomib retreatment was effective and tolerable in relapsed MM patients, with no evidence of cumulative toxicities.
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Affiliation(s)
- Maria T Petrucci
- Department of Cellular Biotechnology and Haematology, Sapienza University of Rome, Rome, Italy.
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23
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Truini A, Biasiotta A, Di Stefano G, La Cesa S, Leone C, Cartoni C, Leonetti F, Casato M, Pergolini M, Petrucci MT, Cruccu G. Peripheral nociceptor sensitization mediates allodynia in patients with distal symmetric polyneuropathy. J Neurol 2012; 260:761-6. [PMID: 23052607 DOI: 10.1007/s00415-012-6698-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/26/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
Abstract
Patients with painful neuropathy frequently complain of pain in response to normally non-painful brushing, namely dynamic mechanical allodynia. Despite many animal studies suggesting that allodynia arises when the spontaneous firing in damaged nociceptive afferents sensitise second-order nociceptive neurons to Aβ-fibre input, no studies have sought to confirm this mechanism by investigating Aβ-fibre sparing in human patients with allodynia. In this study we compared data from Aβ-fibre-mediated nerve conduction studies and nociceptive-fibre-mediated laser-evoked potentials (LEPs) in 200 patients with distal symmetric polyneuropathy (114 with neuropathic pain, 86 without). Of the 114 patients with painful neuropathy studied, 44 suffered from allodynia. Whereas no statistical difference was found in nerve conduction study data between patients with and without allodynia, LEP amplitudes were larger in patients with allodynia than in those without (P < 0.01 by Mann-Whitney U test). The lack of difference in NCS data between patients with and without allodynia suggest that this type of pain, rather than arising through second-order nociceptive neuron sensitization to Aβ-fibre input, might reflect a reduced mechanical threshold in sensitised intraepidermal nociceptive nerve terminals.
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Affiliation(s)
- A Truini
- Department of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185, Rome, Italy
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24
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Andriani A, Petrucci MT, Caravita T, Montanaro M, Villivà N, Levi A, Siniscalchi A, Bongarzoni V, Pisani F, De Muro M, Coppetelli U, Avvisati G, Zullo A, Agrillo A, Gaglioti D. Evolution of bisphosphonate-related osteonecrosis of the jaw in patients with multiple myeloma and Waldenstrom's macroglobulinemia: a retrospective multicentric study. Blood Cancer J 2012; 2:e62. [PMID: 22829257 PMCID: PMC3317527 DOI: 10.1038/bcj.2012.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 09/13/2011] [Accepted: 09/28/2011] [Indexed: 02/05/2023] Open
Abstract
Bisphosphonates (BPs) are used intravenously to treat cancer-related conditions for the prevention of pathological fractures. Osteonecrosis of the jaw (BRONJ) is a rare complication reported in 4-15% of patients. We studied, retrospectively, 55 patients with multiple myeloma or Waldenstrom's macroglobulinemia followed up from different haematological departments who developed BRONJ. All patients were treated with BPs for bone lesions and/or fractures. The most common trigger for BRONJ was dental alveolar surgery. After a median observation of 26 months, no death caused by BRONJ complication was reported. In all, 51 patients were treated with antibiotic therapy, and in 6 patients, this was performed in association with surgical debridement of necrotic bone, in 16 with hyperbaric O(2) therapy/ozonotherapy and curettage and in 12 with sequestrectomy and O(2)/hyperbaric therapy. Complete response was observed in 20 cases, partial response in 21, unchanged in 9 and worsening in 3. The association of surgical treatment with antibiotic therapy seems to be more effective in eradicating the necrotic bone than antibiotic treatment alone. O(2) hyperbaric/ozonotherapy is a very effective treatment. The cumulative dosage of BPs is important for the evolution of BRONJ. Because the most common trigger for BRONJ was dental extractions, all patients, before BP treatment, must achieve an optimal periodontal health.
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Affiliation(s)
- A Andriani
- Haematology Unit, P.T.P. Nuovo Regina Margherita, Rome, Italy
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Cavallo F, Bringhen S, Milone G, Ben-Yehuda D, Nagler A, Calabrese E, Cascavilla N, Montefusco V, Lupo B, Liberati AM, Crippa C, Rossini F, Passera R, Patriarca F, Cafro AM, Omedè P, Carella AM, Peccatori J, Catalano L, Caravita T, Musto P, Petrucci MT, Boccadoro M, Palumbo A. Stem cell mobilization in patients with newly diagnosed multiple myeloma after lenalidomide induction therapy. Leukemia 2011; 25:1627-31. [PMID: 21637283 DOI: 10.1038/leu.2011.131] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Lenalidomide has raised concerns regarding its potential impact on the ability to collect stem cells for autologous stem cell transplantation, especially after prolonged exposure. The use of cyclophosphamide plus granulocyte colony-stimulating factor (G-CSF) to mobilize peripheral blood stem cells may overcome this concern. In newly diagnosed multiple myeloma (MM) patients, we investigated the influence of lenalidomide on stem cell collection. In a prospective study, 346 patients received four cycles of lenalidomide-dexamethasone (Rd). Stem cells were mobilized with cyclophosphamide and G-CSF. Patients failing to collect a minimum of 4 × 10(6) CD34(+)/kg cells received a second mobilization course. After mobilization, a median yield of 8.7 × 10(6) CD34(+)/kg was obtained from patients receiving Rd induction. After first mobilization, inadequate yield was observed in 21% of patients, whereas only 9% of patients failed to collect the target yield after the second mobilization attempt. In conclusion, we confirm that a short induction with lenalidomide allowed sufficient stem cells collection to perform autologous transplantation in 91% of newly diagnosed patients.
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Affiliation(s)
- F Cavallo
- Myeloma Unit, Division of Hematology, University of Torino, AOU S Giovanni Battista, Torino, Italy
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Delforge M, Terpos E, Richardson PG, Shpilberg O, Khuageva NK, Schlag R, Dimopoulos MA, Kropff M, Spicka I, Petrucci MT, Samoilova OS, Mateos MV, Magen-Nativ H, Goldschmidt H, Esseltine DL, Ricci DS, Liu K, Deraedt W, Cakana A, van de Velde H, San Miguel JF. Fewer bone disease events, improvement in bone remodeling, and evidence of bone healing with bortezomib plus melphalan-prednisone vs. melphalan-prednisone in the phase III VISTA trial in multiple myeloma. Eur J Haematol 2011; 86:372-84. [PMID: 21366694 DOI: 10.1111/j.1600-0609.2011.01599.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Bone disease is a key presenting feature of myeloma. This post hoc analysis of the phase III VISTA trial of bortezomib plus melphalan-prednisone (VMP) vs. MP in previously untreated myeloma patients assessed clinical bone disease events and changes in alkaline phosphatase (ALP), a marker for osteoblast activation, and serum Dickkopf-1 (DKK-1), an inhibitor of osteoblast differentiation, during treatment. METHODS Patients received nine 6-wk cycles of VMP (bortezomib 1.3 mg/m(2) , days 1, 4, 8, 11, 22, 25, 29, 32, cycles 1-4, days 1, 8, 22, 29, cycles 5-9, plus melphalan 9mg/m(2) and prednisone 60mg/m(2) , days 1-4, cycles 1-9; N=344) or MP alone (N=338). RESULTS Rates of bisphosphonates use during treatment (73% vs. 82%), progression because of worsening bone disease (3% vs. 11%), and requirement for subsequent radiotherapy (3% vs. 8%) were lower with VMP vs. MP. Median maximum ALP increase was significantly higher with VMP vs. MP overall (49.7% vs. 30.3%, P=0.029), and higher by response group (complete response [CR]: 68.7% vs. 43.9%; partial response [PR]: 41.5% vs. 31.2%). Greater maximum ALP increase was strongly associated with achievement of CR (P≤0.0001) and CR/PR (P≤0.01). Median DKK-1 decreased with VMP by 694.4pg/mL and increased with MP by 1273.3pg/mL from baseline to day 4 (P=0.0069). Available radiologic data revealed evidence of bone healing in 6/11 VMP-treated patients, who achieved best responses of three CR, one PR, and two stable disease. CONCLUSIONS These results suggest a positive effect of bortezomib on bone metabolism and potentially bone healing in myeloma.
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Affiliation(s)
- Michel Delforge
- Myeloma Study Group, Belgian Hematological Society, Belgium.
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27
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Guglielmelli T, Bringhen S, Rrodhe S, Gay F, Cavallo F, Berruti A, Montefusco V, Piro E, Benevolo G, Petrucci MT, Caravita T, Offidani M, Corradini P, Boccadoro M, Saglio G, Palumbo A. Previous thalidomide therapy may not affect lenalidomide response and outcome in relapse or refractory multiple myeloma patients. Eur J Cancer 2011; 47:814-8. [PMID: 21334196 DOI: 10.1016/j.ejca.2010.12.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 12/23/2010] [Accepted: 12/23/2010] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Lenalidomide is a thalidomide analogue, designed to have improved efficacy and tolerability over the parent drug. The aim of this retrospective analysis is to evaluate the impact of thalidomide therapy on lenalidomide response and outcome in relapse or refractory multiple myeloma patients. PATIENTS AND METHODS A total of 106 relapsed or refractory multiple myeloma patients received lenalidomide 25mg plus dexamethasone as salvage therapy; 80 patients progressed on thalidomide treatment (thalidomide-resistant) and 26 patients discontinued thalidomide in at least partial remission (thalidomide-sensitive). Median time from diagnosis to lenalidomide treatment was 57 months. Median prior lines of therapies were 3, range 1-6. 62% of patients were previously treated with autologous stem cell transplantation, and 71% with bortezomib-based regimens. RESULTS In the thalidomide-resistant and -sensitive groups, the at least partial response rates were 56.2% and 61.5% (P = .45), including at least VGPR rates of 16.2% and 11.5%; the median progression free survival was 10 and 12 months (P=.12) and the median overall survival was 17 and 18.5 months (P = .50), respectively. CONCLUSION Lenalidomide may be equally effective in heavily pre-treated multiple myeloma patients who are thalidomide-resistant or thalidomide-sensitive to a previous therapy.
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Affiliation(s)
- T Guglielmelli
- Department of Clinical and Biological Sciences, University of Turin and San Luigi Hospital, Orbassano, Turin, Italy.
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28
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Pagano L, Valentini CG, De Stefano V, Venditti A, Visani G, Petrucci MT, Candoni A, Specchia G, Visco C, Pogliani EM, Ferrara F, Galieni P, Gozzetti A, Fianchi L, De Muro M, Leone G, Musto P, Pulsoni A. Primary plasma cell leukemia: a retrospective multicenter study of 73 patients. Ann Oncol 2011; 22:1628-1635. [PMID: 21252060 DOI: 10.1093/annonc/mdq646] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Epidemiological and clinical information on primary plasma cell leukemia (pPCL) are rarely reported. The aims are to evaluate the clinical features, prognostic factors, and efficacy of treatments in pPCL. PATIENTS AND METHODS A multicenter retrospective cohort study was carried out from January 2000 to December 2008 in 26 Italian hematology divisions. A total of 128 cases of plasma cell leukemia were collected, and 73 of them (57%) were classified as primary (male/female 43/30). RESULTS Sixty-four patients had at least 1 sign of end-organ damage and 10 had extramedullary localization. One patient died early; of the remaining patients, 36 (50%) received anthracycline-based regimens as first-line therapy, 17 (24%) single alkylating agents, and 30 (42%) bortezomib or thalidomide as additional (n = 11) or unique treatments (n = 19). Twenty-three patients (31%) underwent autologous and/or allogeneic hematopoietic stem cell transplantation (HSCT). The median overall survival (OS) was 12.6 months; complete or partial response was achieved in 22 (30%) and 18 patients (25%), respectively; the median duration of response (DOR) was 16.4 months. HSCT patients had a longer OS and DOR (median 38.1 and 25.8 months, respectively) compared with nontransplanted patients (9.1 and 7.3 months, respectively, P < 0.001). OS was influenced by nonresponse to treatment, hypoalbuminemia, and HSCT. DOR was favorably influenced only by HSCT. CONCLUSIONS pPCL is an aggressive disease with a poor prognosis and a low response rate to conventional therapy. HSCT is effective, increasing OS and DOR by 69% and 88%, respectively. The use of bortezomib and thalidomide may improve outcomes.
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Affiliation(s)
- L Pagano
- Institute of Hematology, Catholic University, Rome.
| | | | - V De Stefano
- Institute of Hematology, Catholic University, Rome
| | - A Venditti
- Division of Hematology, "Tor Vergata" University, Rome
| | - G Visani
- Hematology and Hematopoietic Stem Cell Transplant Center, San Salvatore Hospital, Pesaro
| | - M T Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, University "La Sapienza," Rome
| | - A Candoni
- Division of Hematology and Bone Marrow Transplantation, University of Udine, Udine
| | - G Specchia
- Hematology Section, University of Bari, Bari
| | - C Visco
- Department of Hematology, Ospedale San Bortolo, Vicenza
| | - E M Pogliani
- Department of Hematology, "San Gerardo" Hospital, Monza
| | - F Ferrara
- Division of Hematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Naples
| | - P Galieni
- Division of Hematology, Ascoli Piceno Hospital, Ascoli Piceno
| | - A Gozzetti
- Department of Medicine and Immunological Sciences, Division of Hematology and Transplants, University of Siena, Siena
| | - L Fianchi
- Institute of Hematology, Catholic University, Rome
| | - M De Muro
- Division of Hematology, Campus Biomedico University, Rome
| | - G Leone
- Institute of Hematology, Catholic University, Rome
| | - P Musto
- Unit of Hematology and Stem Cell Transplantation, IRCCS-CROB, Rionero in Vulture, Italy
| | - A Pulsoni
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, University "La Sapienza," Rome
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29
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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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Mateos MV, Richardson PG, Schlag R, Khuageva NK, Dimopoulos MA, Shpilberg O, Kropff M, Spicka I, Petrucci MT, Palumbo A, Samoilova OS, Dmoszynska A, Abdulkadyrov KM, Schots R, Jiang B, Esseltine DL, Liu K, Cakana A, van de Velde H, San Miguel JF. Bortezomib plus melphalan and prednisone compared with melphalan and prednisone in previously untreated multiple myeloma: updated follow-up and impact of subsequent therapy in the phase III VISTA trial. J Clin Oncol 2010; 28:2259-66. [PMID: 20368561 DOI: 10.1200/jco.2009.26.0638] [Citation(s) in RCA: 319] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The purpose of this study was to confirm overall survival (OS) and other clinical benefits with bortezomib, melphalan, and prednisone (VMP) versus melphalan and prednisone (MP) in the phase III VISTA (Velcade as Initial Standard Therapy in Multiple Myeloma) trial after prolonged follow-up, and evaluate the impact of subsequent therapies. PATIENTS AND METHODS Previously untreated symptomatic patients with myeloma ineligible for high-dose therapy received up to nine 6-week cycles of VMP (n = 344) or MP (n = 338). RESULTS With a median follow-up of 36.7 months, there was a 35% reduced risk of death with VMP versus MP (hazard ratio, 0.653; P < .001); median OS was not reached with VMP versus 43 months with MP; 3-year OS rates were 68.5% versus 54.0%. Response rates to subsequent thalidomide- (41% v 53%) and lenalidomide-based therapies (59% v 52%) appeared similar after VMP or MP; response rates to subsequent bortezomib-based therapy were 47% versus 59%. Among patients treated with VMP (n = 178) and MP (n = 233), median survival from start of subsequent therapy was 30.2 and 21.9 months, respectively, and there was no difference in survival from salvage among patients who received subsequent bortezomib, thalidomide, or lenalidomide. Rates of adverse events were higher with VMP versus MP during cycles 1 to 4, but similar during cycles 5 to 9. With VMP, 79% of peripheral neuropathy events improved within a median of 1.9 months; 60% completely resolved within a median of 5.7 months. CONCLUSION VMP significantly prolongs OS versus MP after lengthy follow-up and extensive subsequent antimyeloma therapy. First-line bortezomib use does not induce more resistant relapse. VMP used upfront appears more beneficial than first treating with conventional agents and saving bortezomib- and other novel agent-based treatment until relapse.
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Affiliation(s)
- Maria-Victoria Mateos
- Hospital Universitario de Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain
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31
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Dimopoulos MA, Richardson PG, Schlag R, Khuageva NK, Shpilberg O, Kastritis E, Kropff M, Petrucci MT, Delforge M, Alexeeva J, Schots R, Masszi T, Mateos MV, Deraedt W, Liu K, Cakana A, van de Velde H, San Miguel JF. VMP (Bortezomib, Melphalan, and Prednisone) Is Active and Well Tolerated in Newly Diagnosed Patients With Multiple Myeloma With Moderately Impaired Renal Function, and Results in Reversal of Renal Impairment: Cohort Analysis of the Phase III VISTA Study. J Clin Oncol 2009; 27:6086-93. [DOI: 10.1200/jco.2009.22.2232] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo assess bortezomib plus melphalan and prednisone (VMP) and melphalan and prednisone (MP) in previously untreated patients with multiple myeloma (MM) with renal impairment enrolled on the phase III VISTA study, and to evaluate renal impairment reversibility.Patients and MethodsPatients received nine 6-week cycles of VMP (bortezomib 1.3 mg/m2, melphalan 9 mg/m2, prednisone 60 mg/m2) or MP. Patients with serum creatinine higher than 2 mg/dL were excluded.ResultsIn the VMP/MP arms, 6%/4%, 27%/30%, and 67%/66% of patients had baseline glomerular filtration rate (GFR) of ≤ 30, 31 to 50, and higher than 50 mL/min, respectively. Response rates were higher and time to progression (TTP) and overall survival (OS) longer with VMP versus MP across renal cohorts. Response rates with VMP and TTP in both arms did not appear significantly different between patients with GFR ≤ 50 or higher than 50 mL/min; OS appeared somewhat longer in patients with normal renal function in both arms. Renal impairment reversal (baseline GFR < 50 improving to > 60 mL/min) was seen in 49 (44%) of 111 patients receiving VMP versus 40 (34%) of 116 patients receiving MP. By multivariate analysis, younger age (< 75 years; P = .006) and less severe impairment (GFR ≥ 30 mL/min; P = .027) were associated with higher reversal rates. In addition, treatment with VMP approached significance (P = .07). In both arms, rates of grade 4 and 5 adverse events (AEs) and serious AEs appeared higher in patients with renal impairment; with VMP, rates of discontinuations/bortezomib dose reductions due to AEs did not appear affected.ConclusionVMP is a feasible, active, and well-tolerated treatment option for previously untreated patients with MM with moderate renal impairment, resulting in 44% renal impairment reversal.
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Affiliation(s)
- Meletios A. Dimopoulos
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Paul G. Richardson
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Rudolf Schlag
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Nuriet K. Khuageva
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Ofer Shpilberg
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Efstathios Kastritis
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Martin Kropff
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Maria T. Petrucci
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Michel Delforge
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Julia Alexeeva
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Rik Schots
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Tamás Masszi
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Maria-Victoria Mateos
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - William Deraedt
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Kevin Liu
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Andrew Cakana
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Helgi van de Velde
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
| | - Jesús F. San Miguel
- From the Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece; Dana-Farber Cancer Institute, Boston, MA; Johnson & Johnson Pharmaceutical Research & Development LLC, Raritan, NJ; Praxisklinik Dr Schlag, Würzburg; University of Münster, Münster, Germany; SP Botkin Moscow City Clinical Hospital, Russian Federation, Rabin Medical Center, Petah-Tiqva, Israel; University La Sapienza, Rome, Italy; Myeloma Study Group Belgian Hematological Society,
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Morabito F, Gentile M, Ciolli S, Petrucci MT, Galimberti S, Mele G, Casulli AF, Mannina D, Piro E, Pinotti G, Palmieri S, Catalano L, Callea V, Offidani M, Musto P, Bringhen S, Baldini L, Tosi P, Di Raimondo F, Boccadoro M, Palumbo A, Cavo M. Safety and efficacy of bortezomib-based regimens for multiple myeloma patients with renal impairment: a retrospective study of Italian Myeloma Network GIMEMA. Eur J Haematol 2009; 84:223-8. [PMID: 19930441 DOI: 10.1111/j.1600-0609.2009.01385.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Renal impairment (RI) is a severe complication throughout the course of multiple myeloma (MM). Bortezomib has been shown to be highly active in MM patients with RI. We designed this retrospective analysis to investigate the safety and efficacy of bortezomib-based therapy in 117 MM patients with RI, 14 cases required dialysis. A total of 603 cycles of bortezomib were administered (median number, five cycles/patient). Ten patients required early discontinuation of bortezomib because of WHO grade IV toxicity. The rate of bortezomib discontinuation in cases with severe, moderate and mild RI was 11%, 5% and 0%, respectively (P = NS). Overall, 91 episodes of WHO grade III/IV toxicity were observed. At least a partial response was documented in 83/113 evaluable patients (73%), including complete response (19%) and near complete response (8%). The overall response rate was similar across RI subgroups. Reversal of RI was documented in 41% of patients after a median of 2.3 months (range 0.4-7.9). In three of 14 patients on dialysis, renal replacement therapy was discontinued after 1, 1 and 4 months. The 2-yr estimate of response duration and overall survival was 70% and 51%, respectively. In conclusion, bortezomib-based regimens are safe and effective and should be considered as appropriate treatment options for MM patients with any degree of RI.
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Affiliation(s)
- Fortunato Morabito
- Unità Operativa di Ematologia, Azienda Ospedaliera dell'Annunziata, 87100 Cosenza, Italy.
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Ricciardi MR, Petrucci MT, Gregorj C, Martini V, Levi A, De Cuia MR, Latagliata R, Petti MC, Mandelli F, Foà R, Tafuri A. Apoptosis Susceptibility and Cell-Cycle Distribution in Cells from Myelodysplastic Syndrome Patients: Modulatory In-Vitro Effects of G-CSF and Interferon-α. Leuk Lymphoma 2009; 45:1437-43. [PMID: 15359645 DOI: 10.1080/10428190310001657335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Susceptibility to apoptosis varies in different forms of myelodysplastic syndromes (MDS). Our in vitro study aimed at better defining the cell kinetic profile by investigating whether G-CSF and interferon-alpha (IFNalpha) were capable of controling apoptotic/proliferative mechanisms in RAEB as well as in RAEB-t forms. Apoptosis and cell-cycle distribution were measured in mononuclear and in CD34+ cells from bone marrow samples of 27 MDS patients with RAEB (n = 15) and RAEB-t (n = 12). In selected samples, the in vitro influence of G-CSF and lymphoblastoid (Ly)-IFNalpha on the apoptotic susceptibility and on the cell kinetics of the above MDS populations was evaluated. RAEB samples showed a significantly greater apoptosis than RAEB-t ones, both in mononuclear cells (14.76%+/-8.73 vs. 5.95%+/-3.88, P= 0.0058) and in CD34+ cells (24.66%+/-16.08 vs. 3.96%+/-2.57, P = 0.0007). Short-term cell culture in the presence of G-CSF reduced apoptosis in CD34+ cells in all 4 RAEB samples tested (39.1%+/-40.7 vs. 21.0%+/-23.5, P = n.s.); the percentage of cells in S-phase significantly increased in 3/4 samples (19.90%+/-4.40 vs. 32.40%+/-7.85, P = 0.03). Ly-IFNalpha protected CD34+ cells from apoptosis in 3/4 RAEB samples (25.7%+/-8.06 vs. 10.9%+/-8.8, P = n.s.), but did not modulate cell-cycle distribution. G-CSF and Ly-IFNalpha failed to affect apoptosis and proliferation in RAEB-t. These observations indicate that in RAEB forms increased apoptosis can be efficiently counteracted in most of the samples by both G-CSF and Ly-IFNalpha, suggesting that only in these forms a retained regulatory mechanism on the apoptotic/ proliferative balance may allow therapeutic intervention with apoptotic regulators.
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Affiliation(s)
- Maria R Ricciardi
- Haematology, Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza of Rome, Rome, Italy
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34
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Dimopoulos MA, Chen C, Spencer A, Niesvizky R, Attal M, Stadtmauer EA, Petrucci MT, Yu Z, Olesnyckyj M, Zeldis JB, Knight RD, Weber DM. Long-term follow-up on overall survival from the MM-009 and MM-010 phase III trials of lenalidomide plus dexamethasone in patients with relapsed or refractory multiple myeloma. Leukemia 2009; 23:2147-52. [PMID: 19626046 DOI: 10.1038/leu.2009.147] [Citation(s) in RCA: 280] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We present a pooled update of two large, multicenter MM-009 and MM-010 placebo-controlled randomized phase III trials that included 704 patients and assessed lenalidomide plus dexamethasone versus dexamethasone plus placebo in patients with relapsed/refractory multiple myeloma (MM). Patients in both studies were randomized to receive 25 mg daily oral lenalidomide or identical placebo, plus 40 mg oral dexamethasone. In this pooled analysis, using data up to unblinding (June 2005 for MM-009 and August 2005 for MM-010), treatment with lenalidomide plus dexamethasone significantly improved overall response (60.6 vs 21.9%, P<0.001), complete response rate (15.0 vs 2.0%, P<0.001), time to progression (median of 13.4 vs 4.6 months, P<0.001) and duration of response (median of 15.8 months vs 7 months, P<0.001) compared with dexamethasone-placebo. At a median follow-up of 48 months for surviving patients, using data up to July 2008, a significant benefit in overall survival (median of 38.0 vs 31.6 months, P=0.045) was retained despite 47.6% of patients who were randomized to dexamethasone-placebo receiving lenalidomide-based treatment after disease progression or study unblinding. Low beta(2)-microglobulin and low bone marrow plasmacytosis were associated with longer survival. In conclusion, these data confirm the significant response and survival benefit with lenalidomide and dexamethasone.
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Affiliation(s)
- M A Dimopoulos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece.
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35
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Avvisati G, Petrucci MT, Pulsoni A, Tribalto M, Lauta VM, Gernone A, Boccadoro M, Marmont F, Pileri A, Dammacco F. Alpha-2b recombinant interferon (Intron-A) as maintenance treatment in multiple myeloma. Eur J Haematol Suppl 2009; 52:9-11. [PMID: 2279547 DOI: 10.1111/j.1600-0609.1990.tb00897.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- G Avvisati
- Department of Human Biopathology, University La Sapienza, Rome, Italy
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36
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37
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Patriarca F, Petrucci MT, Bringhen S, Baldini L, Caravita T, Corradini P, Corso A, Di Raimondo F, Falcone A, Ferrara F, Morabito F, Musto P, Offidani M, Petrini M, Rizzi R, Semenzato G, Tosi P, Vacca A, Cavo M, Boccadoro M, Palumbo A. Considerations in the treatment of multiple myeloma: a consensus statement from Italian experts. Eur J Haematol 2009; 82:93-105. [DOI: 10.1111/j.1600-0609.2008.01179.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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38
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San Miguel JF, Schlag R, Khuageva NK, Dimopoulos MA, Shpilberg O, Kropff M, Spicka I, Petrucci MT, Palumbo A, Samoilova OS, Dmoszynska A, Abdulkadyrov KM, Schots R, Jiang B, Mateos MV, Anderson KC, Esseltine DL, Liu K, Cakana A, van de Velde H, Richardson PG. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med 2008; 359:906-17. [PMID: 18753647 DOI: 10.1056/nejmoa0801479] [Citation(s) in RCA: 1409] [Impact Index Per Article: 88.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The standard treatment for patients with multiple myeloma who are not candidates for high-dose therapy is melphalan and prednisone. This phase 3 study compared the use of melphalan and prednisone with or without bortezomib in previously untreated patients with multiple myeloma who were ineligible for high-dose therapy. METHODS We randomly assigned 682 patients to receive nine 6-week cycles of melphalan (at a dose of 9 mg per square meter of body-surface area) and prednisone (at a dose of 60 mg per square meter) on days 1 to 4, either alone or with bortezomib (at a dose of 1.3 mg per square meter) on days 1, 4, 8, 11, 22, 25, 29, and 32 during cycles 1 to 4 and on days 1, 8, 22, and 29 during cycles 5 to 9. The primary end point was the time to disease progression. RESULTS The time to progression among patients receiving bortezomib plus melphalan-prednisone (bortezomib group) was 24.0 months, as compared with 16.6 months among those receiving melphalan-prednisone alone (control group) (hazard ratio for the bortezomib group, 0.48; P<0.001). The proportions of patients with a partial response or better were 71% in the bortezomib group and 35% in the control group; complete-response rates were 30% and 4%, respectively (P<0.001). The median duration of the response was 19.9 months in the bortezomib group and 13.1 months in the control group. The hazard ratio for overall survival was 0.61 for the bortezomib group (P=0.008). Adverse events were consistent with established profiles of toxic events associated with bortezomib and melphalan-prednisone. Grade 3 events occurred in a higher proportion of patients in the bortezomib group than in the control group (53% vs. 44%, P=0.02), but there were no significant differences in grade 4 events (28% and 27%, respectively) or treatment-related deaths (1% and 2%). CONCLUSIONS Bortezomib plus melphalan-prednisone was superior to melphalan-prednisone alone in patients with newly diagnosed myeloma who were ineligible for high-dose therapy. (ClinicalTrials.gov number, NCT00111319.)
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Affiliation(s)
- Jesús F San Miguel
- Hospital Universitario Salamanca, CIC, IBMCC (USAL-CSIC), Salamanca, Spain.
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39
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Gregorj C, Ricciardi MR, Petrucci MT, Scerpa MC, De Cave F, Fazi P, Vignetti M, Vitale A, Mancini M, Cimino G, Palmieri S, Di Raimondo F, Specchia G, Fabbiano F, Cantore N, Mosna F, Camera A, Luppi M, Annino L, Miraglia E, Fioritoni G, Ronco F, Meloni G, Mandelli F, Andreeff M, Milella M, Foà R, Tafuri A. ERK1/2 phosphorylation is an independent predictor of complete remission in newly diagnosed adult acute lymphoblastic leukemia. Blood 2007; 109:5473-6. [PMID: 17351113 DOI: 10.1182/blood-2006-05-021071] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Extracellular signal-regulated kinase-1/2 (ERK1/2) is frequently found constitutively activated (p-ERK1/2) in hematopoietic diseases, suggesting a role in leukemogenesis. The aim of this study was to assess the expression and clinical role of p-ERK1/2 in adult acute lymphoblastic leukemia (ALL). In 131 primary samples from adult de novo ALL patients enrolled in the Gruppo Italiano per le Malattie Ematologiche dell'Adulto (GIMEMA) Leucemia Acute Linfoide (LAL) 2000 protocol and evaluated by flow cytometry, constitutive ERK1/2 activation was found in 34.5% of cases; these results were significantly associated with higher white blood cell (WBC) values (P=.013). In a multivariate analysis, p-ERK1/2 expression was an independent predictor of complete remission achievement (P=.027). Effective approaches toward MEK inhibition need to be explored in order to evaluate whether this may represent a new therapeutic strategy for adult ALL patients.
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Affiliation(s)
- Chiara Gregorj
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, University La Sapienza of Rome, Italy
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40
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Milella M, Precupanu CM, Gregorj C, Ricciardi MR, Petrucci MT, Kornblau SM, Tafuri A, Andreeff M. Beyond single pathway inhibition: MEK inhibitors as a platform for the development of pharmacological combinations with synergistic anti-leukemic effects. Curr Pharm Des 2005; 11:2779-95. [PMID: 16101455 DOI: 10.2174/1381612054546842] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The MEK/MAPK signaling module is a key integration point along signal transduction cascades that regulate cell growth, survival, and differentiation, and is aberrantly activated in many human tumors. In tumor cells, constitutive MAPK activation affords increased proliferation and resistance to apoptotic stimuli, including classical cytotoxic drugs. In most instances, however, MAPK inhibition has cytostatic rather than cytotoxic effects, which may explain the lack of objective responses observed in early clinical trials of MEK inhibitors. Nevertheless, amenability of the MAPK pathway to pharmacodynamic evaluation and negligible clinical toxicity make MEK inhibitors an ideal platform to build pharmacological combinations with synergistic antitumor activity. In AML, the MEK/MAPK pathway is constitutively activated in the majority of cases (75%), conferring a uniformly poor prognosis; in preclinical models of AML, MEK blockade profoundly inhibits cell growth and proliferation and downregulates the expression of several anti-apoptotic players, thereby lowering the apoptotic threshold. Apoptosis induction, however, requires concentrations of MEK inhibitors much higher than those required to inhibit proliferation. Nevertheless, MEK blockade efficiently and selectively sensitizes leukemic cells to sub-optimal doses of other apoptotic stimuli, including classical cytotoxics (nucleoside analogs, microtubule-targeted drugs, gamma-irradiation), biologicals (retinoids, interferons, arsenic trioxide), and, most interestingly, other signal transduction/apoptosis modulators (UCN-01, STI571, Bcl-2 antagonists). In most instances, these MEK inhibition-based combinations result in a striking pro-apoptotic synergism in preclinical models. Here we briefly discuss evidence suggesting that MAPK pathway inhibition could play a prominent role in the development of integrated therapeutic strategies aimed at synergistic anti-leukemic effects.
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Affiliation(s)
- M Milella
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy.
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41
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Morino S, Petrucci MT, Gragnani F, Ceschin V, Clemenzi A, Di Pasquale A, Antonimi G. Thalidomide-associated neuropathy in multiple myeloma. J Peripher Nerv Syst 2004. [DOI: 10.1111/j.1085-9489.2004.009209am.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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Lemoli RM, Bertolini F, Petrucci MT, Gregorj C, Ricciardi MR, Fogli M, Curti A, Rabascio C, Pandolfi S, Ferrari S, Foá R, Baccarani M, Tafuri A, Rabascio C, Fo R. Functional and kinetic characterization of granulocyte colony-stimulating factor-primed CD34−
human stem cells. Br J Haematol 2003; 123:720-9. [PMID: 14616978 DOI: 10.1046/j.1365-2141.2003.04673.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We assessed the functional properties and the kinetic status in vitro, and the engraftment potential in vivo of human haematopoietic stem cells according to the expression of CD34 antigen. Lin-CD34- and Lin-CD34+ cells were isolated from granulocyte colony-stimulating factor-primed peripheral blood (PB) cells of healthy donors. The CD34- cell fraction did not contain either clonogenic cells in semisolid culture or long-term culture initiating cells (LTC-IC). However, stroma-dependent liquid cultures and cytokines induced CD34 expression on a minority of stem cells, acquisition of clonogenic capacity and generation of LTC-IC. Significantly higher percentages of quiescent G0 cells and lower percentages of cycling G1 cells were found in Lin-CD34- cells when compared with Lin-CD34+ cells. Kinetic quiescence of Lin-CD34- cells was associated with a significantly higher expression of the negative regulators of the cell cycle, p27Kip1 and p21(cip1/waf1). Cytokine-mediated induction of CD34, in vitro, resulted in cycling of stem cells and downregulation of p27. There was a higher rate of human long-term engraftment in immunocompromised non-obese diabetic (NOD)/recombination activating gene 1null and NOD/severe combined immunodeficient-beta2microglobulin(null) mice injected with CD34+ cells. Thus, our study indicated that CD34 expression on human PB stem cells was associated with haematopoietic activity, cell-cycle recruitment and downregulation of p27Kip1 in vitro and higher engraftment capacity in vivo.
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Affiliation(s)
- Roberto M Lemoli
- Istituto di Ematologia e Oncologia Medica L. & A. Seràgnoli, University of Bologna, Bologna, Italy.
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43
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Petti MC, Tafuri A, Latagliata R, Aloe Spiriti MA, Montefusco E, Mancini M, Meloni G, Petrucci MT, Spadea A, Redi R, Alimena G, Mandelli F. High-dose hydroxyurea in the treatment of poor-risk myeloid leukemias. Ann Hematol 2003; 82:476-480. [PMID: 12835916 DOI: 10.1007/s00277-003-0693-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2003] [Accepted: 05/15/2003] [Indexed: 11/28/2022]
Abstract
The aim of the study was to evaluate the antileukemic effectiveness and toxicity of high-dose hydroxyurea (HHY) and to assess its acute toxicity. Between August 1997 and October 1998, 12 consecutive adult patients (>18 years) with high-risk acute myeloid leukemia (AML) (four patients in first early relapse, seven patients with secondary AML, and one patient with de novo AML concomitant to a lymphoproliferative disorder) were enrolled to receive a single course of HY (100 mg/kg per day) until bone marrow aplasia or for a maximum of 30 days. Of the 12 patients, 5 (41.6%) achieved complete remission (CR), 1 achieved partial remission (PR), 4 were resistant to treatment, and 2 died during induction from infection. No patient with relapsed AML achieved CR, while it was achieved by five of eight patients with secondary AML at diagnosis; five of six MDR1+ patients achieved CR. As concerns follow-up of the CR patients, one did not receive any further treatment and died in CR from pulmonary aspergillosis, and one with a concomitant chronic lymphocytic leukemia (CLL) received two courses of FLAG (fludarabine, cytarabine, granulocyte colony-stimulating factor) regimen with disappearance of the clonal Ig rearrangement, but relapsed after 11 months and died from pneumonia. The remaining three patients were consolidated with two courses of high-dose cytosine arabinoside (AraC), followed by peripheral blood stem cell transplantation (PBSCT) in one patient. One of them relapsed after 3 months, while the other two are still in continuous complete remission (CCR) after 16 and 28 months, respectively. This study has demonstrated the safety and efficacy of HHY in inducing CR in AML patients with unfavorable prognosis. Despite the small number of patients, these encouraging results warrant further studies.
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MESH Headings
- Adult
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Bone Marrow Transplantation
- Cytogenetic Analysis
- Dose-Response Relationship, Drug
- Female
- Gene Expression
- Genes, MDR
- Humans
- Hydroxyurea/administration & dosage
- Hydroxyurea/adverse effects
- In Situ Hybridization, Fluorescence
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid/surgery
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/etiology
- Lymphoproliferative Disorders/complications
- Male
- Middle Aged
- Myelodysplastic Syndromes/complications
- Neoplasm Recurrence, Local
- Prognosis
- Remission Induction
- Treatment Outcome
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Affiliation(s)
- M C Petti
- Sezione di Ematologia, Istituto Regina Elena, IFO, Italy.
| | - A Tafuri
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Rome, Italy
| | - R Latagliata
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Rome, Italy
| | - M A Aloe Spiriti
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Rome, Italy
| | - E Montefusco
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Rome, Italy
| | - M Mancini
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Rome, Italy
| | - G Meloni
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Rome, Italy
| | - M T Petrucci
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Rome, Italy
| | - A Spadea
- Sezione di Ematologia, Istituto Regina Elena, IFO, Italy
| | - R Redi
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Rome, Italy
| | - G Alimena
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Rome, Italy
| | - F Mandelli
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Rome, Italy
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44
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Tafuri A, Gregorj C, Petrucci MT, Ricciardi MR, Mancini M, Cimino G, Mecucci C, Tedeschi A, Fioritoni G, Ferrara F, Di Raimondo F, Gallo E, Liso V, Fabbiano F, Cascavilla N, Pizzolo G, Camera A, Pane F, Lanza F, Cilloni D, Annino L, Vitale A, Vegna ML, Vignetti M, Foà R, Mandelli F. MDR1 protein expression is an independent predictor of complete remission in newly diagnosed adult acute lymphoblastic leukemia. Blood 2002; 100:974-81. [PMID: 12130511 DOI: 10.1182/blood-2001-12-0371] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Little is known about the prognostic role of multidrug resistance (MDR) in adults with newly diagnosed acute lymphoblastic leukemia (ALL). In the context of the GIMEMA ALL0496 protocol, we evaluated the impact of MDR1 (protein expression and function) on the achievement of complete remission (CR) and clinical outcome. Flow cytometric analysis of MDR1 expression (D) and function (rhodamine-123 efflux) was obtained in 203 and 158 patients, respectively. MDR1 expression was detected in 44 (21.7%) of 203 patients, and function was found in 23 (14.6%) of 158 (14.6%) patients. Expression of the multidrug resistance-associated protein 1 (MRP1) and lung-resistance protein (LRP) evaluated in 43 samples was found in 13 and 26 patients, respectively. Among the 200 patients evaluable for the clinical correlation study, 125 (79.6%) of 157 without MDR1 expression achieved CR compared with 23 (53.5%) of 43 with MDR1 expression (P =.001). At univariate analysis, MDR1 expression was significantly associated with CR when considered as a dichotomized (P =.001) or continuous (P =.01) variable. At multivariate analysis, dichotomized evaluation of MDR1 expression independently predicted CR (P =.004) with age (P =.03) and CD34 (P =.03); as a continuous variable, MDR1 expression (P =.03) was the only significant factor other than CD34 (P =.01). MDR1 function failed to predict achievement of CR or of MRP1 and LRP expression. MDR1 expression did not correlate with CR duration, nor did it predict for survival duration. These results demonstrate that MDR1 expression in de novo adult ALL is an independent predictor of CR achievement.
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Affiliation(s)
- Agostino Tafuri
- Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza, Roma, Italy.
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Curti A, Tafuri A, Ricciardi MR, Tazzari P, Petrucci MT, Fogli M, Ratta M, Lapalombella R, Ferri E, Tura S, Baccarani M, Lemoli RM. Interleukin-11 induces proliferation of human T-cells and its activity is associated with downregulation of p27(kip1). Haematologica 2002; 87:373-80. [PMID: 11940481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We have recently shown that interleukin (IL-)11 induces polarization of human T-cells by inhibiting macrophage production of IL-12 and by exerting a direct effect on CD4+ T-cells. In this study, we investigated the effects of IL-11 on the kinetic activation and apoptosis of T-cell subsets stimulated with anti-CD3/CD28 antibodies, anti-CD3 and IL-2 or dendritic cells. DESIGN AND METHODS Apoptosis and cell cycle analysis of T-cells were assessed by double staining with propidium iodide and intracellular Ki-67 and by acridine orange staining. The expression of the negative regulator of the cell cycle p27Kip1 (p27) was also determined by flow cytometry. RESULTS Our results show that 18 hours of incubation with IL-11 resulted in a significantly higher number of cycling CD4+ cells, CD4+CD45RA+ naive T-cells and CD4+CD45RO+ memory T-cells, but not of CD8+ cells. The kinetic activity of IL-11 was observed up to 72 hours, when the peak value of S-phase cells occurred. IL-11 also significantly enhanced CD4+ and CD4+CD45RA+ cell proliferation when T-cells were co-incubated with allogeneic dendritic cells. Conversely, IL-11 did not protect any of the T-cell subsets from apoptosis. At the functional level, a type-2 cytokine pattern of cultured T-lymphocytes was observed after 5 days of incubation with IL-11. Proliferation and functional activation of T-cells were preceeded by downregulation of p27, which occurred as early as 12 hours after incubation with IL-11. INTERPRETATION AND CONCLUSIONS IL-11 induces Th-2 polarization and cell-cycle entry of human CD4+, CD4+CD45RA+ and CD4+CD45RO+cells and their activation is associated with the downregulation of p27.
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Affiliation(s)
- Antonio Curti
- Institute of Hematology and Medical Oncology Lorenzo & Ariosto Seràgnoli , University of Bologna, Bologna, Italy
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46
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Petti MC, Pinazzi MB, Diverio D, Romano A, Petrucci MT, De Santis S, Meloni G, Tafuri A, Mandelli F, Lo Coco F. Prolonged molecular remission in advanced acute promyelocytic leukaemia after treatment with gemtuzumab ozogamicin (Mylotarg CMA-676). Br J Haematol 2001; 115:63-5. [PMID: 11722411 DOI: 10.1046/j.1365-2141.2001.03091.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a patient with acute promyelocytic leukaemia (APL) who received two doses of gemtuzumab ozogamicin for advanced disease. Previous treatments included front-line all-trans retinoic acid and anthracyclines, polychemotherapy consolidation, salvage chemotherapy for the first relapse followed by autologous stem cell transplantation (ASCT), arsenic trioxide for the second relapse followed by a second ASCT and then high-dose methotrexate for more advanced systemic disease with central nervous system involvement. The patient achieved prolonged haematological and molecular remission after monotherapy with gemtuzumab ozogamicin given at the time of the third relapse.
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MESH Headings
- Adult
- Aminoglycosides
- Anti-Bacterial Agents/therapeutic use
- Antibiotics, Antineoplastic/therapeutic use
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antigens, CD/immunology
- Antigens, Differentiation, Myelomonocytic/immunology
- Arsenic Trioxide
- Arsenicals/therapeutic use
- Central Nervous System/immunology
- Combined Modality Therapy
- Female
- Gemtuzumab
- Gene Rearrangement
- Genes, MDR
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/immunology
- Leukemic Infiltration
- Oxides/therapeutic use
- Sialic Acid Binding Ig-like Lectin 3
- Translocation, Genetic
- Tretinoin/therapeutic use
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Affiliation(s)
- M C Petti
- Department of Cellular Biotechnology and Haematology, University La Sapienza, Roma, Italy
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Ricciardi MR, Petrucci MT, Gregorj C, Ariola C, Lemoli RM, Fogli M, Mauro FR, Cerretti R, Foà R, Mandelli F, Tafuri A. Reduced susceptibility to apoptosis correlates with kinetic quiescence in disease progression of chronic lymphocytic leukaemia. Br J Haematol 2001; 113:391-9. [PMID: 11380404 DOI: 10.1046/j.1365-2141.2001.02708.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The role of apoptosis and cell kinetics in the mechanisms of disease progression of chronic lymphocytic leukaemia (CLL) is still unclear. In the present study, we investigated the susceptibility of leukaemic cells taken from 75 CLL patients with either stable (STD) or progressive disease (PRD) to enter apoptosis. Particular attention was paid to the relationship between cell cycle status and autologous serum (AS). The susceptibility to enter apoptosis was significantly greater in STD than in PRD, both in standard medium (mean = 23.62% +/- 14.7 versus 14.23% +/- 7.2; P = 0.02) and in the presence of AS (mean = 23.03% +/- 17.9 versus 11.27% +/- 7.6; P = 0.01). Furthermore, cell kinetics studies revealed a higher quiescence in PRD than in STD cases, both in terms of a lower RNA content (P = 0.04) and of higher expression of the negative cell cycle regulator p27kip1 (P = 0.03). These kinetic differences were confirmed by short-term in vitro culture both in fetal calf serum and in AS. The results of this study indicate that CLL cells from PRD cases are characterized by a higher degree quiescence and much lower susceptibility to apoptosis when compared with STD ones. In this context, AS does not appear to play a specific role. The association between these kinetic characteristics and disease progression in CLL prompts further studies to establish whether higher quiescence may be responsible for the decreased susceptibility of PRD cells to enter apoptosis.
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Affiliation(s)
- M R Ricciardi
- Haematology, Dipartimento di Biotecnologie Cellulari ed Ematologia, University 'La Sapienza' of Rome, Italy
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48
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Petrucci MT, Ricciardi MR, Gregorj C, Ariola C, Mazzola F, Fogli M, Lemoli RM, Tafuri A. Thrombopoietin, interleukin-11, and early-acting megakaryocyte growth factors in human myeloid leukemia cells. Leuk Lymphoma 2000; 40:179-90. [PMID: 11426619 DOI: 10.3109/10428190009054895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In this study we report our data on effects of early-acting megakaryocyte growth factors, particularly the c-mpl ligand also known as thrombopoietin (TPO) and interleukin-11 (IL-11), on cell proliferation and apoptosis (Apo) of primary acute myeloid leukemia (AML) cells. A proliferative response to TPO was noticed in the majority of AML samples (17/19) with an average increase of S-phase cells from 7.8% +/- 1.5 to 14.5% +/- 2.1 (p=0.0006). Resulting cell cycle activation did not always correlate with expression of the c-mpl receptor, although it was coupled, in the majority of samples, by an average decrease of apoptotic cells from 13% +/- 0.7 to 8.8% +/- 1.8 (p=0.05). Clonogenic cell growth (CFU-L) was confirmed in 5/17 of the samples with a mean colony number of 21.4 +/- 9.6 x 10(5) cells plated. Conversely, effects of IL-11 on AML cells demonstrated that cell cycle changes (recruitment from G0 to S phase) were promoted only in a minority of samples (2/14) and there was little, if any, effect on CFU-L growth (mean colony number=17.5 +/- 9.5) or Apo (from 13% +/- 0.7 to 13.3 +/- 1.9). Combination of TPO with IL-11 induced a slight increase of clonogenic cell growth, while the addition of IL-3 or SCF to the c-mpl ligand significantly raised the mean colony numbers up to 119.2 +/- 68.3 and 52.9 +/- 22.1 x 10(5) cells plated, respectively. In summary, TPO shows activity on AML cells by stimulating their proliferation in a significant proportion of cases and generally protecting the majority of AML blast cells from induction of Apo. Conversely, IL-11 exerts little effect on the cell cycle activation and Apo. These data help to understand regulation of myeloid leukemia cell growth and should be considered in the clinical use of early-acting megakaryocyte growth factors in acute leukemia.
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Affiliation(s)
- M T Petrucci
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università La Sapienza di Roma, Italia
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Meloni G, Capria S, Trasarti S, Ferrazza G, Micozzi A, Petrucci MT, Simone F, Trisolini SM, Mandelli F. High-dose idarubicine, busulphan and melphalan as conditioning for autologous blood stem cell transplantation in multiple myeloma. A feasibility study. Bone Marrow Transplant 2000; 26:1045-9. [PMID: 11108301 DOI: 10.1038/sj.bmt.1702668] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Extensive studies have tested the clinical impact of double and triple sequential transplants as front-line therapy in MM, following the suggestion that dose escalation can overcome the marked drug resistance characteristic of this disease, but the superiority of such approaches vs one single transplant has still to be demonstrated. The aim of our study was to evaluate the feasibility and efficacy of high-dose idarubicine intensification of a standard busulphan-melphalan conditioning regimen in MM. Twenty-eight patients (median age 55 years) with sensitive disease received PBSCT after high-dose idarubicine combined with busulphan and melphalan and followed by s.c. rhG-CSF until PMN recovery. The most severe toxicity was represented by oral mucositis which resolved with hemopoietic reconstitution. Overall response and CR rate were 52% and 40%, respectively. Currently, 36 patients are alive and 19 are progression-free a median of 20 months (12-36) from transplant. The 3-year projected probability of progression-free survival for patients transplanted after first-line treatment is 60%. The combination of Ida/Bu/Melph appears a promising alternative regimen for PBSCT in myeloma, with low transplant-related toxicity and fast hematological recovery. Long-term follow-up and a prospective randomized study, now ongoing, will probably clarify whether an idarubicine-intensified regimen will result in superior outcomes to conventional conditioning and even be comparable to a double consecutive transplant program.
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Affiliation(s)
- G Meloni
- Department of Biotecnologie Cellulari ed Ematologia, University La Sapienza, Roma, Italy
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Petrucci MT, Tafuri A, Mandelli F. [The role of biotherapy in multiple myeloma]. Recenti Prog Med 2000; 91:488-93. [PMID: 11072735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Despite considerable progress in recent years in the understanding of the biology of multiple myeloma (MM), this disease remains incurable, although many new therapeutic approaches are under evaluation. The rapid development of recombinant technologies has permitted the production of large amounts of cytokines and growth factors, favoring the use of biotherapies also in this disease. Among these products, the interferons have been the most extensively used in clinical trials, giving the most promising results especially in the setting of minimal residual disease, as maintenance therapy after response to conventional therapies, or to high dose chemotherapies followed by bone marrow (BM) or peripheral blood stem cell (PBSC) transplantation. However, more recently, a large number of cytokines and growth factors have been introduced in the clinical practice. Data of the use of erythropoietin have consistently demonstrated the role of this growth factor in ameliorating the grade of anemia as well as the quality of life of those MM patients whose disease is complicated by the presence of a severe or moderate anemia. Using hematopoietic growth factor in the mobilization of PBSC, the quantity of progenitor cells in the peripheral blood increased and the hematological toxicity of chemotherapy could be reduced. Despite the large amount of experimental data indicating a role for interleukins, as IL-2 and IL-6, in controlling tumor growth, there are only few clinical studies dealing with their use in MM. Results show that they arrest tumor progression rather than aid tumor regression, for this reason it appears that IL-2 and anti IL-6 antibodies should be investigated as maintenance therapy, in MM patients responding to chemotherapy. In the future it will be necessary to clarify for MM patients the role of other cytokines such as IL-1 beta and TNF alpha. A possible strategy to improve the clinical outcome of MM patients is to prevent the regrowth of residual tumor cells by establishing adoptive immunity at the stages of minimal residual disease previous obtained using chemotherapy. To this end a possible strategy is to induce an immune response against residual tumor cells by passive (using monoclonal antibodies) or active (using the idiotype expressed by malignant cells) immunotherapy.
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Affiliation(s)
- M T Petrucci
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università La Sapienza, Roma
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