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Initial Therapeutic Approaches to Patients with Multiple Myeloma. Adv Ther 2021; 38:3694-3711. [PMID: 34145483 DOI: 10.1007/s12325-021-01824-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/08/2021] [Indexed: 12/11/2022]
Abstract
Multiple Myeloma (MM) is part of a spectrum of plasma cell disorders that may result in end organ damage. MM is subclassified into high and standard risk based on cytogenetic and laboratory markers. The treatment of newly diagnosed multiple myeloma is constantly changing with the advent of novel therapies. Recent advances in therapies have resulted in longer time to remission and overall survival. the introduction of targeted therapy with monoclonal antibodies such as Daratumumab has improved stringent complete response to 39%. In this review, we outline the current approach to diagnosis, prognosis, and management of newly diagnosed multiple myeloma in both transplant eligible and ineligible patients.
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Reece DE, Masih-Khan E, Atenafu EG, Jimenez-Zepeda VH, McCurdy A, Song K, LeBlanc R, Sebag M, White D, Cherniawsky H, Reiman A, Stakiw J, Louzada ML, Kotb R, Aslam M, Gul E, Venner CP. Retrospective study of treatment patterns and outcomes post-lenalidomide for multiple myeloma in Canada. Eur J Haematol 2021; 107:416-427. [PMID: 34129703 DOI: 10.1111/ejh.13678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/28/2022]
Abstract
Lenalidomide is an important component of initial therapy in newly diagnosed multiple myeloma, either as maintenance therapy post-autologous stem cell transplantation (ASCT) or as first-line therapy with dexamethasone for patients' ineligible for ASCT (non-ASCT). This retrospective study investigated treatment patterns and outcomes for ASCT-eligible and -ineligible patients who relapsed after lenalidomide as part of first-line therapy, based on data from the Canadian Myeloma Research Group Database for patients treated between January 2007 and April 2019. Among 256 patients who progressed on lenalidomide maintenance therapy, 28.5% received further immunomodulatory derivative-based (IMiD-based) therapy (lenalidomide/pomalidomide) without a proteasome inhibitor (PI) (bortezomib/carfilzomib/ixazomib), 26.2% received PI-based therapy without an IMiD, 19.5% received both an IMiD plus PI, 13.5% received daratumumab-based regimens, and 12.1% underwent salvage ASCT. Median progression-free survival (PFS) was longest for daratumumab-based therapy (22.7 months) and salvage ASCT (23.4 months) and ranged from 6.6 to 7.3 months for the other treatments (P < .0001). Median overall survival (OS) was also longest for daratumumab and salvage ASCT. A total of 87 non-ASCT patients received subsequent therapy, with 66.7% receiving bortezomib-based therapy and 13.8% receiving other PI-based therapy. Median PFS was 15.4 and 24.8 months for bortezomib-based and other PI-based therapy, respectively (P = .404). During most of the study period, daratumumab was not funded; in this setting, switching to a different therapeutic class following relapse on lenalidomide produced the longest remissions for non-ASCT patients. Further prospective studies are warranted to determine optimum treatment following relapse on lenalidomide, especially in the light of increased access to daratumumab.
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Affiliation(s)
- Donna E Reece
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Canadian Myeloma Research Group, Toronto, ON, Canada
| | - Esther Masih-Khan
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Canadian Myeloma Research Group, Toronto, ON, Canada
| | | | | | | | - Kevin Song
- BC Cancer, Vancouver General Hospital, Vancouver, BC, Canada
| | - Richard LeBlanc
- Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montreal, QC, Canada
| | - Michael Sebag
- Departments of Medicine and Oncology, Division of Hematology, McGill University, Montreal, QC, Canada
| | - Darrell White
- Dalhousie University and QEII Health Sciences Centre, Halifax, NS, Canada
| | | | - Anthony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, NB, Canada
| | - Julie Stakiw
- University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Rami Kotb
- Cancer Care Manitoba, Winnipeg, MB, Canada
| | | | - Engin Gul
- Canadian Myeloma Research Group, Toronto, ON, Canada
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Venner CP, LeBlanc R, Sandhu I, White D, Belch AR, Reece DE, Chen C, Dolan S, Lalancette M, Louzada M, Kew A, McCurdy A, Monteith B, Reiman T, McDonald G, Sherry M, Gul E, Chen BE, Hay AE. Weekly carfilzomib plus cyclophosphamide and dexamethasone in the treatment of relapsed/refractory multiple myeloma: Final results from the MCRN-003/MYX.1 single arm phase II trial. Am J Hematol 2021; 96:552-560. [PMID: 33650179 DOI: 10.1002/ajh.26147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/29/2021] [Accepted: 02/14/2021] [Indexed: 11/09/2022]
Abstract
The MCRN-003/CCTGMYX.1 is a single arm phase II trial of weekly carfilzomib, cyclophosphamide and dexamethasone (wKCd), exploring a convenient immunomodulator (IMiD)-free regimen in relapsed myeloma. Weekly carfilzomib (20/70 mg/m2 ), dexamethasone 40 mg and cyclophosphamide 300 mg/m2 was delivered over 28-day cycles. The primary endpoint was overall response after four cycles. Secondary endpoints included toxicity, response depth, PFS and OS. Exploratory endpoints included the impact of cytogenetics, prior therapy exposure and serum free light chain (sFLC) escape; 76 patients were accrued. The ORR was 85% (68% ≥very good partial response [VGPR] and 29% ≥complete response [CR]). The median OS and PFS were 27 and 17 months respectively. High-risk cytogenetics conferred a worse ORR (75% vs. 97%, p = .013) and median OS (18 months vs. NR, p = .002) with a trend toward a worse median PFS (14 vs. 22 months, p = .06). Prior proteasome inhibitor (PI) or lenalidomide did not influence OS or PFS. The sFLC was noted in 15% of patients with a median PFS of 17 months when included as a progression event. The most common ≥ grade 3 non-hematologic adverse events were infectious (40%), vascular (17%) and cardiac (15%). The wKCD is a safe and effective regimen in relapse, especially for patients ineligible for lenalidomide-based therapies.
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Affiliation(s)
| | - Richard LeBlanc
- CIUSSS de lʼEst de lʼIle de Montréal Université de Montréal Montreal Quebec Canada
| | - Irwindeep Sandhu
- The Cross Cancer Institute University of Alberta Edmonton Alberta Canada
| | - Darrell White
- Queen Elizabeth II Health Sciences Centre Dalhousie University Halifax Nova Scotia Canada
| | - Andrew R. Belch
- The Cross Cancer Institute University of Alberta Edmonton Alberta Canada
| | | | | | - Sean Dolan
- University of New Brunswick Saint John Regional Hospital Saint John New Brunswick Canada
| | | | - Martha Louzada
- London Regional Cancer Centre University of Western Ontario London Ontario Canada
| | - Andrea Kew
- The Ottawa Hospital University of Ottawa Ottawa Ontario Canada
| | - Arleigh McCurdy
- The Ottawa Hospital University of Ottawa Ottawa Ontario Canada
| | - Bethany Monteith
- Queenʼs University Canadian Cancer Trials Group Kingston Ontario Canada
| | - Tony Reiman
- University of New Brunswick Saint John Regional Hospital Saint John New Brunswick Canada
| | - Gail McDonald
- Queenʼs University Canadian Cancer Trials Group Kingston Ontario Canada
| | - Max Sherry
- Queenʼs University Canadian Cancer Trials Group Kingston Ontario Canada
| | - Engin Gul
- Canadian Myeloma Research Group (formerly the Myeloma Canada Research Network) Vaughan Ontario Canada
| | - Bingshu E. Chen
- Queenʼs University Canadian Cancer Trials Group Kingston Ontario Canada
| | - Annette E. Hay
- Queenʼs University Canadian Cancer Trials Group Kingston Ontario Canada
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Gentile M, Morabito F, Martino M, Vigna E, Martino EA, Mendicino F, Martinelli G, Cerchione C. Chemotherapy-based regimens in multiple myeloma in 2020. Panminerva Med 2020; 63:7-12. [PMID: 32955186 DOI: 10.23736/s0031-0808.20.04145-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multiple myeloma (MM) represents the second-most common hematologic malignancy. In the 1980s, induction therapy with alkylating agents, such as anthracyclines and steroids, as well as high-dose chemotherapy followed by autologous stem cell transplantation were the main therapeutic approaches for MM. Since the introduction of more effective drugs, such as proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies and histone deacetylase inhibitor, the new therapeutic algorithm allows of achieving a significantly improvement of prognosis. Numerous regimens, which differently combine these new agents, have been developed and tested in clinical trials. The results of these new regimens are reported each year. In this variegated new contest, old chemotherapeutic drugs still maintain an overriding weight, especially when beneficially combined with new drugs. Also, this is particular true in specific situations, such as extramedullary manifestations, in which tumor mass reduction becomes an urgent clinical need, or in case of chemotherapy-induced stem-cell mobilization. Moreover, melphalan represents the gold standard conditioning regimen since 2002, either alone or, possibly in the next future, in combination with busulfan. Finally, new chemotherapeutic agents with new mechanisms of action, such as melflufen, are in early experimental phase.
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Affiliation(s)
| | | | - Massimo Martino
- Unit of Stem Cell Transplantation and Cellular Therapies, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Ernesto Vigna
- Unit of Hematology, Hospital of Cosenza, Cosenza, Italy
| | | | | | - Giovanni Martinelli
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Claudio Cerchione
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
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Leng S, Bhutani D, Lentzsch S. How I treat a refractory myeloma patient who is not eligible for a clinical trial. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:125-136. [PMID: 31808850 PMCID: PMC6913488 DOI: 10.1182/hematology.2019000016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Myeloma patients not eligible for clinical trials have many treatment options. Choosing the next best therapy starts with careful assessment of the biology and dynamics of the disease at relapse, as well as the condition and situation of the patient. Fit patients should be considered for triplet regimens, whereas intermediate and frail patients warrant dose-reduced triplets or doublets. An indolent serologic relapse may be treated with dose intensification, especially in a maintenance situation, whereas a rapid relapse requires a more aggressive approach with drug class change or a second-generation immunomodulatory drug (IMID) or proteasome inhibitor (PI). Monoclonal antibodies, in combination with PIs and IMIDs, have proven highly efficacious in early and late relapse. Key elements of supportive care include infection prevention, bone health, thromboprophylaxis, and management of active symptoms, such as pain and distress.
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Affiliation(s)
- Siyang Leng
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Divaya Bhutani
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Suzanne Lentzsch
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Li J, Chen X, Qu Y. Effects of cyclophosphamide combined with prednisone on TNF-α expression in treatment of patients with interstitial lung disease. Exp Ther Med 2019; 18:4443-4449. [PMID: 31777548 PMCID: PMC6862246 DOI: 10.3892/etm.2019.8099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 08/06/2019] [Indexed: 12/25/2022] Open
Abstract
Effects of cyclophosphamide combined with prednisone on TNF-α expression in the treatment of patients with interstitial lung disease (ILD), and its clinical significance were investigated. A prospective analysis was performed on 198 patients with ILD in Jinan Central Hospital Affiliated to Shandong University from January 2010 to December 2017. Among them, 101 patients treated with cyclophosphamide combined with prednisone were assigned in the combined treatment group, and 97 patients treated with prednisone alone in the control group. Patients in the two groups were compared in terms of lung function, St. George's Respiratory Questionnaire (SGRQ) score, clinical efficacy, adverse reactions and TNF-α expression levels before and after treatment. After treatment, the patients in the combined treatment group had significantly higher forced vital capacity (FVC) and forced expiratory volume in first second (FEV1) compared with the control group, but significantly lower diffusing capacity of lung for carbon monoxide (DLCO) and DLCO% (P<0.05). In both groups, patients after treatment had higher FVC and FEV1, but lower DLCO and DLCO% (P<0.05), compared with before treatment, while SGRQ score before treatment was higher than that after treatment (P<0.05). Compared with control group, the combined treatment group had significantly more patients with complete remission (CR) and higher total effective rate, however less patients with stable disease (SD) (P<0.05). Patients with adverse reactions in the combined treatment group were less than those in the control group (P<0.05). After treatment, TNF-α expression level in the combined treatment group was significantly lower than that in the control group (P<0.05), and TNF-α expression before treatment was higher than that after treatment in both groups (P<0.05). In conclusion, cyclophosphamide combined with prednisone is effective and safe in the treatment of ILD without severe adverse reactions, reducing TNF-α expression level, and therefore is worthy of clinical application.
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Affiliation(s)
- Jun Li
- Department of Respiratory Medicine, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250014, P.R. China
| | - Xiuling Chen
- Department of Gynaecology and Obstetrics, First People's Hospital of Jinan, Jinan, Shandong 250014, P.R. China
| | - Yunping Qu
- Department of Stomatology, First People's Hospital of Jinan, Jinan, Shandong 250014, P.R. China
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Lam SW, Siebenaller C, Earl M, Hill BT, Kalaycio M, Rini B, Carraway HE, Leonard M, Sekeres MA. Descriptive comparison of hospital formulary decisions with published oncology valuation methods. J Oncol Pharm Pract 2019; 26:891-905. [PMID: 31594520 DOI: 10.1177/1078155219877927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION As cost of cancer therapy continues to increase, several organizations have developed rubrics to ascertain treatment. No studies have evaluated these methods for hospital formulary decision-making. We applied different value measurement tools to formulary decisions from one hospital system to assess their operational utility. METHODS We evaluated four value systems: National Comprehensive Cancer Network Evidence Blocks, DrugAbacus drug pricing, European Society for Medical Oncology clinical benefit scale, and the American Society of Clinical Oncology net health benefit. Each value score or cost was assessed against our hospital formulary requests between 2012 and 2016. Formulary requests accepted and rejected were compared with respect to their relative numbers of National Comprehensive Cancer Network blocks, difference between DrugAbacus and actual cost, and European Society for Medical Oncology and American Society of Clinical Oncology scores. RESULTS Twenty-two chemotherapy requests were included, with 20 approvals and 2 rejections. No correlation was observed between number of evidence blocks and formulary acceptance (p = 0.13). Most drugs had a higher actual price than the DrugAbacus suggested cost (p = 0.036). No significant differences were observed in European Society for Medical Oncology (p = 0.90) or American Society of Clinical Oncology (p = 0.70) scores between drugs that were accepted or rejected. When evaluating monthly cost per point of American Society of Clinical Oncology score, a numerical difference between groups was observed (median = $369.7 versus $1256.8 per point, p = 0.61). CONCLUSIONS Existing oncology value assessment systems only variably inform hospital formulary decisions. The American Society of Clinical Oncology net health benefit score deserves further study as a method to systematically quantify the clinical safety and efficacy of formulary medication addition relative to cost.
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Affiliation(s)
- Simon W Lam
- Department of Pharmacy, Cleveland Clinic, Cleveland, USA
| | | | - Marc Earl
- Department of Pharmacy, Cleveland Clinic, Cleveland, USA
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Center, Cleveland, USA
| | - Matt Kalaycio
- Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Center, Cleveland, USA
| | - Brian Rini
- Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Center, Cleveland, USA
| | - Hetty E Carraway
- Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Center, Cleveland, USA
| | - Mandy Leonard
- Department of Pharmacy, Cleveland Clinic, Cleveland, USA
| | - Mikkael A Sekeres
- Department of Hematology and Medical Oncology, Cleveland Clinic, Taussig Cancer Center, Cleveland, USA
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Wildes TM, Anderson KC. Approach to the treatment of the older, unfit patient with myeloma from diagnosis to relapse: perspectives of a US hematologist and a geriatric hematologist. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:88-96. [PMID: 30504296 PMCID: PMC6245982 DOI: 10.1182/asheducation-2018.1.88] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Mrs. A. is a 73-year-old woman who has developed increasing fatigue and lower back pain over the past year. The pain limits her exercise tolerance such that she can now walk only 1 block. She is a retired schoolteacher who does volunteer efforts in her community but has limited her activities due to fatigue. Karnofsky performance status is 70%. She has a history of chronic hypertension treated with a diuretic, adult-onset diabetes mellitus treated with metformin, and hypothyroidism treated with levothyroxine. Initial evaluation reveals anemia, renal dysfunction, an elevated total protein, and an L2 compression fracture on lumbosacral radiographs. Results of initial and subsequent evaluation are shown below, and she is referred to a hematologist for further evaluation, which revealed the following: calcium 9.0 mg/dL, creatinine 3.2 mg/dL with estimated creatinine clearance using the Modification of Diet in Renal Disease equation of 15 mL/min, hemoglobin 9.6 g/dL, total protein 11 g/dL, albumin 3.2 g/dL, immunoglobulin A (IgA) λ M protein 6.8 g/dL, total IgA 7.2 g/dL, IgG 0.4g/dL, IgM 0.03 g/dL, free κ <0.01 mg/L, free λ 1000 mg/L, serum free light chain ratio <0.01, β-2-microglobulin 4.2, viscosity 3.0, lactate dehydrogenase 200 U/L, urine protein electrophoresis: 125 mg/dL with 30% M protein, and urine immunofixation: λ light chain. Skeletal bone survey showed lytic lesions in femurs and humeri and diffusely in ribs bilaterally as well as compression fractures at T4, T6, and L2. Bone marrow biopsy revealed λ-restricted plasma cells comprising 50% of the bone marrow core. Fluorescence in situ hybridization testing on marrow showed that del 17p was present in 80% of the plasma cells. Mrs. A. is informed of the diagnosis of multiple myeloma and the need for therapy. She requests consultation with 2 of the leading world experts. However, she wants to be treated near her home and does not want treatment on a clinical trial.
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Affiliation(s)
- Tanya M. Wildes
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO; and
| | - Kenneth C. Anderson
- Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Kumar SK, Grzasko N, Delimpasi S, Jedrzejczak WW, Grosicki S, Kyrtsonis MC, Spencer A, Gupta N, Teng Z, Byrne C, Labotka R, Dimopoulos MA. Phase 2 study of all-oral ixazomib, cyclophosphamide and low-dose dexamethasone for relapsed/refractory multiple myeloma. Br J Haematol 2018; 184:536-546. [PMID: 30460684 DOI: 10.1111/bjh.15679] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/08/2018] [Indexed: 02/06/2023]
Abstract
There is a need for efficacious, convenient treatments with long-term tolerability for patients with relapsed/refractory multiple myeloma (RRMM). This phase 2 study evaluated the all-oral combination of ixazomib, cyclophosphamide and dexamethasone (ICd). Patients with RRMM received ixazomib 4 mg and cyclophosphamide 300 mg/m2 on days 1, 8 and 15, and dexamethasone 40 mg on days 1, 8, 15 and 22 in 28-day cycles. The primary endpoint was overall response rate (ORR). Seventy-eight patients were enrolled (median age 63·5 years). At data cut-off, patients had received a median of 12 treatment cycles; 31% remained on treatment. ORR was 48% [16% very good partial response or better (≥VGPR)]. ORR was 64% and 32% in patients aged ≥65 and <65 years (25% and 16% ≥VGPR), respectively. At a median follow-up of 15·2 months, median progression-free survival (PFS) was 14·2 months, with a trend towards better PFS in patients aged ≥65 years vs. <65 years (median 18·7 months vs. 12·0 months; hazard ratio 0·62, P = 0·14). ICd was well tolerated. The most common treatment-emergent adverse events were diarrhoea (33%), nausea (24%), upper respiratory tract infection (24%), and thrombocytopenia (22%); 10 patients (13%) had peripheral neuropathy (one grade 3). This study is registered at ClinicalTrials.gov (NCT02046070).
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Affiliation(s)
- Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Norbert Grzasko
- Department of Haematology, St. John's Cancer Centre, Lublin, Poland.,Department of Experimental Haemato-oncology, Medical University of Lublin, Lublin, Poland
| | - Sosana Delimpasi
- Department of Haematology, Evangelismos Hospital, Athens, Greece
| | - Wieslaw W Jedrzejczak
- Department of Haematology and Oncology, Medical University of Warsaw, MTZ Clinical Research, Warsaw, Poland
| | - Sebastian Grosicki
- Department of Cancer Prevention, Silesian Medical University, Katowice, Poland
| | - Marie-Christine Kyrtsonis
- Haematology Section - 1st Department of Propaedeutic Internal Medicine, Laikon University Hospital, Athens, Greece
| | - Andrew Spencer
- Malignant Haematology and Stem Cell Transplantation Service, The Alfred Hospital/MONASH University/Australian Centre for Blood Diseases, Melbourne, Australia
| | - Neeraj Gupta
- Millennium Pharmaceuticals, Inc., Cambridge, MA, USA
| | - Zhaoyang Teng
- Millennium Pharmaceuticals, Inc., Cambridge, MA, USA
| | | | | | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Moreira MMC, Rodrigues AB, Oliveira PPD, Aguiar MIFD, Cunha GHD, Pinto RMC, Fonseca DF, Mata LRFD. Neuropatia periférica em pessoas com mieloma múltiplo. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Investigar a prevalência e incidência de neuropatia periférica relacionada ao tratamento com antineoplásicos de pessoas com mieloma múltiplo bem como a associação entre os esquemas quimioterápicos e a neuropatia periférica após o tratamento. Método Estudo documental, correlacional, realizado em dois locais de referência para tratamento oncológico, localizados nos estados do Ceará e Minas Gerais, com análise de pacientes atendidos entre janeiro/2013 e janeiro/2016. Os dados foram analisados utilizando-se análise descritiva e inferencial a partir dos testes qui-quadrado e exato de fisher. Resultados Foram avaliados 100 prontuários de pessoas com mieloma múltiplo com média de idade de 62,7 anos, maioria de homens (64%). O esquema quimioterápico mais utilizado (60%) foi o bortezomibe, dexametasona e ciclofosfamida; 20% dos pacientes apresentavam neuropatia periférica antes do tratamento, 68% desenvolveram durante o tratamento e 56% ao finalizar o tratamento. Não houve associação entre os esquemas quimioterápicos e a neuropatia periférica após o tratamento. Conclusão O presente estudo mostrou um aumento da incidência de NP em indivíduos em tratamento para o MM, 80% apresentaram sintomas de neuropatia antes e/ou durante e/ou após o tratamento com esquemas quimioterápicos. A predominância foi de homens idosos aposentados. O esquema quimioterápico mais utilizado foi o VDC e não foi identificada associação entre os esquemas utilizados e a NP após término o tratamento. As implicações dessas observações recaem sobre a necessidade de avaliação contínua da NP em pessoas com MM, além da monitorização rigorosa desse evento no decorrer do tratamento e após o mesmo, bem como o manejo dos eventos adversos e alterações relacionadas a doença. Não houve associação entre os esquemas quimioterápicos e a neuropatia periférica após o tratamento. Espera-se que os resultados obtidos auxiliem na organização de um registro de dados sobre NP em pacientes com câncer, com o objetivo principal de determinar alvos de intervenção, tornando o cuidado mais eficiente e integral.
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Podar K, Pecherstorfer M. Current and developing synthetic pharmacotherapy for treating relapsed/refractory multiple myeloma. Expert Opin Pharmacother 2017; 18:1061-1079. [PMID: 28604120 DOI: 10.1080/14656566.2017.1340942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The introduction of novel agents has significantly improved multiple myeloma (MM) patient outcome during the last two decades. MM received the most drug approvals for any one malignancy during this time period, both in the United States as well as in Europe. Areas covered: Proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies are prototype drug classes, which target both specific MM cell functions, as well as the tumor supportive bone marrow microenvironment, and represent current cornerstones of MM therapy. Importantly, the unprecedented extent and frequency of durable responses, in relapsed/refractory multiple myeloma (RRMM), in particular, is predominantly based on the combinatorial use of these agents with conventional chemotherapeutics or representatives of other drug classes. This article will summarize past landmark discoveries in MM that led to the dramatic progress of today's clinical practice. Moreover, developing strategies will be discussed that are likely to yet improve patient outcome even further. Expert opinion: Despite significant therapeutic advancements, MM remains an incurable disease. With several novel agents in the preclinical and early clinical pipeline, among those novel CD38 and BCMA mAbs, immune checkpoint inhibitors, as well as ricolinostat, selinexor, venetoclax, CAR-T cells, and vaccines, further advances in MM patient outcome are expected in the near future.
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Affiliation(s)
- Klaus Podar
- a Department of Internal Medicine , Karl Landsteiner University of Health Sciences, University Hospital , Krems , Austria
| | - Martin Pecherstorfer
- a Department of Internal Medicine , Karl Landsteiner University of Health Sciences, University Hospital , Krems , Austria
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