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de Moraes Hungria VT, Martínez-Baños DM, Peñafiel CR, Miguel CE, Vela-Ojeda J, Remaggi G, Duarte FB, Cao C, Cugliari MS, Santos T, Machnicki G, Fernandez M, Grings M, Ammann EM, Lin JH, Chen YW, Wong YN, Barreyro P. Multiple myeloma treatment patterns and clinical outcomes in the Latin America Haemato-Oncology (HOLA) Observational Study, 2008-2016. Br J Haematol 2019; 188:383-393. [PMID: 31392724 PMCID: PMC7003731 DOI: 10.1111/bjh.16124] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/05/2019] [Indexed: 01/08/2023]
Abstract
Limited data are available regarding contemporary multiple myeloma (MM) treatment practices in Latin America. In this retrospective cohort study, medical records were reviewed for a multinational cohort of 1103 Latin American MM patients (median age, 61 years) diagnosed in 2008–2015 who initiated first‐line therapy (LOT1). Of these patients, 33·9% underwent autologous stem cell transplantation (ASCT). During follow‐up, 501 (45·4%) and 129 (11·7%) patients initiated second‐ (LOT2) and third‐line therapy (LOT3), respectively. In the LOT1 setting, from 2008 to 2015, there was a decrease in the use of thalidomide‐based therapy, from 66·7% to 42·6%, and chemotherapy from, 20·2% to 5·9%, whereas use of bortezomib‐based therapy or bortezomib + thalidomide increased from 10·7% to 45·5%. Bortezomib‐based therapy and bortezomib + thalidomide were more commonly used in ASCT patients and in private clinics. In non‐ASCT and ASCT patients, median progression‐free survival (PFS) was 15·0 and 31·1 months following LOT1 and 10·9 and 9·5 months following LOT2, respectively. PFS was generally longer in patients treated with bortezomib‐based or thalidomide‐based therapy versus chemotherapy. These data shed light on recent trends in the management of MM in Latin America. Slower uptake of newer therapies in public clinics and poor PFS among patients with relapsed MM point to areas of unmet therapeutic need in Latin America.
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Affiliation(s)
| | | | | | - Carlos E Miguel
- Fundacao Faculdade Regional de Medicina Sao Jose do Rio Preto, Sao Jose do Rio Preto, Brazil
| | | | | | | | - Carmen Cao
- Instituto Nacional del Cancer, Santiago, Chile
| | | | - Telma Santos
- Janssen-Cilag Farmacêutica Ltda., Sao Paulo, Brazil
| | | | | | | | | | | | | | | | - Paula Barreyro
- Janssen-Cilag Farmacêutica Ltda., Buenos Aires, Argentina
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Kerbauy LN, Parmar S, Kutner JM, de Gusmão BM, Hamerschlak N. Hematological approaches to multiple myeloma: trends from a Brazilian subset of hematologists. A cross-sectional study. SAO PAULO MED J 2016; 134:335-41. [PMID: 27557143 PMCID: PMC10876334 DOI: 10.1590/1516-3180.2015.0223030416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/03/2016] [Indexed: 01/17/2023] Open
Abstract
CONTEXT AND OBJECTIVE For the last nine years, hematologists and oncologists have gathered annually at an educational symposium organized by a Brazilian and an American hospital. During the 2015 Board Review, a survey among the attendees evaluated the differences in management and treatment methods for multiple myeloma (MM). DESIGN AND SETTING Cross-sectional study during an educational hematology symposium in São Paulo, Brazil. METHODS Hematologists present at the symposium gave responses to an electronic survey by means of mobile phone. RESULTS Among the 350 attendees, 217 answered the questionnaire. Most of the participants believed that immunotargeting agents (iTA) might be effective for slowing MM progression in heavily pretreated patients (67%) and that continued exposure to therapy might lead to emergence of resistant clones in patients with MM (76%). Most of the physicians use maintenance therapy after hematopoietic stem cell transplantation (95%) and 45% of them would further restrict it to post-transplantation patients with underlying high-risk disease. The first-line drugs used for transplantation-ineligible patients (TI-MM) were bortezomib-thalidomide-dexamethasone (31%), bortezomib-dexamethasone (28%), lenalidomide-dexamethasone (Rd; 17%) and melphalan-based therapy (10%). Lenalidomide was the drug of choice for post-transplantation maintenance for half of the participants. No significant differences were observed regarding age or length of experience. CONCLUSION The treatment choices for TI-MM patients were highly heterogenous and the melphalan-based regimen represented only 10% of the first-line options. Use of maintenance therapy after transplantation was a common choice. Some results from the survey were divergent from the evidence in the literature.
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Affiliation(s)
- Lucila Nassif Kerbauy
- MD. Attending Physician at the Oncology and Hematology Center Família Dayan-Daycoval, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Simrit Parmar
- MD, MSCI. Associate Professor of Medicine, Department of Stem Cell Transplant and Cellular Therapy, University of Texas at MD Anderson Cancer Center, Houston, Texas. United States.
| | - José Mauro Kutner
- MD, PhD. Attending physician at the Oncology and Hematology Center Família Dayan-Daycoval, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Breno Moreno de Gusmão
- MD. Attending Physician at the Oncology and Hematology Center Família Dayan-Daycoval, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Nelson Hamerschlak
- MD, PhD. Attending physician at the Oncology and Hematology Center Família Dayan-Daycoval, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Bitelman VM, Lopes JADDO, Nogueira AB, Frassetto FP, Duarte-Neto AN. "Punched out" multiple myeloma lytic lesions in the skull. AUTOPSY AND CASE REPORTS 2016; 6:7-9. [PMID: 27284535 PMCID: PMC4880428 DOI: 10.4322/acr.2016.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Vanessa Munhoz Bitelman
- Anatomic Pathology Department - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil
| | | | - Ariel Barreto Nogueira
- Anatomic Pathology Department - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil
| | | | - Amaro Nunes Duarte-Neto
- Anatomic Pathology Department - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil.; Emergency Department - Hospital das Clínicas - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil
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