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Lipof JJ, Abdallah N, Lipe B. Personalized Treatment of Multiple Myeloma in Frail Patients. Curr Oncol Rep 2024:10.1007/s11912-024-01545-2. [PMID: 38761302 DOI: 10.1007/s11912-024-01545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE OF REVIEW As the treatment landscape for multiple myeloma (MM) continues to expand at a rapid pace, management of older adults and frail patients becomes increasingly challenging. As these patients have traditionally been underrepresented on clinical trials, there is limited guidance on the optimal approach to frail patients with newly diagnosed multiple myeloma (NDMM) or relapsed and refractory multiple myeloma (RRMM). RECENT FINDINGS Frailty is an independent predictor of tolerability and response to antineoplastic treatment. Stringent eligibility criteria have often excluded these patients, but recently some large trials have included frailty sub-analyses to help guide management. In general, triplet regimens are preferred to doublet regimens in this population and enrollment on a clinical trial should be prioritized when possible. In this review, we summarize the MM frailty scoring tools that have been developed to identify and assess this vulnerable population. We present the clinical trials over the past decade that have enrolled frail patients and/or have included subgroup analyses to help elucidate the response and tolerability of different regimens in this underrepresented group. We provide practical advice regarding assessment and management of frail patients NDMM and RRMM.
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Affiliation(s)
- Jodi J Lipof
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA
| | - Nadine Abdallah
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brea Lipe
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY, USA.
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2
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Tang HKK, Fung CY, Hwang YY, Lee H, Lau G, Yip SF, Kho B, Lau CK, Leung KH, Au E, Tse E, Sim J, Kwong YL, Chim CS. Prognostic factors in 448 newly diagnosed multiple myeloma receiving bortezomib-based induction: impact of ASCT, transplant refusal and high-risk MM. Bone Marrow Transplant 2024; 59:660-669. [PMID: 38383715 DOI: 10.1038/s41409-024-02227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
In Hong Kong, newly diagnosed multiple myeloma (NDMM) receives bortezomib-based triplet induction. Upfront autologous stem cell transplant (ASCT) is offered to transplant eligible (TE) patients (NDMM ≤ 65 years of age), unless medically unfit (TE-unfit) or refused (TE-refused). Data was retrieved for 448 patients to assess outcomes. For the entire cohort, multivariate analysis showed that male gender (p = 0.006), international staging system (ISS) 3 (p = 0.003), high lactate dehydrogenase (LDH) (p = 7.6 × 10-7) were adverse predictors for overall survival (OS), while complete response/ near complete response (CR/nCR) post-induction (p = 2.7 × 10-5) and ASCT (p = 4.8 × 10-4) were favorable factors for OS. In TE group, upfront ASCT was conducted in 252 (76.1%). Failure to undergo ASCT in TE patients rendered an inferior OS (TE-unfit p = 1.06 × 10-8, TE-refused p = 0.002) and event free survival (EFS) (TE-unfit p = 0.00013, TE-refused p = 0.002). Among TE patients with ASCT, multivariate analysis showed that age ≥ 60 (p = 8.9 × 10-4), ISS 3 (p = 0.019) and high LDH (p = 2.6 × 10-4) were adverse factors for OS. In those with high-risk features (HR cytogenetics, ISS 3, R-ISS 3), ASCT appeared to mitigate their adverse impact. Our data reaffirmed the importance of ASCT. The poor survival inherent with refusal of ASCT should be recognized by clinicians. Finally, improved outcome with ASCT in those with high-risk features warrant further studies.
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Affiliation(s)
- Hoi Ki Karen Tang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chi Yeung Fung
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yu Yan Hwang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Harold Lee
- Department of Medicine, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Grace Lau
- Department of Medicine, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Sze Fai Yip
- Department of Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Bonnie Kho
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Chi Kuen Lau
- Department of Medicine, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Kwan Hung Leung
- Department of Medicine, United Christian Hospital, Kwun Tong, Hong Kong
| | - Elaine Au
- Department of Pathology, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Eric Tse
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Joycelyn Sim
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yok Lam Kwong
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chor Sang Chim
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong.
- Department of Medicine, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong.
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Garderet L, Ouldjeriouat H, Bekadja MA, Daguenet E, Bigot N, Vincent L, Roos-Weil D, Vignon M, Ikhlef S, Abraham J, Escoffre-Barbe M, Lioure B, Nacer RA, Lafon I, Mariette C, Karlin L, Morel P, Gilis L, Le Ray E, Blouet A, Nguyen Quoc S, Boffa JJ, Ronco P, Lambert J, Cornillon J. Low non-relapse mortality and good haematological and renal responses after autologous haematopoietic stem cell transplantation in multiple myeloma patients with renal insufficiency at transplant: A prospective Société Francophone de Greffe de Moelle-Thérapie Cellulaire observational study. Br J Haematol 2024; 204:1450-1458. [PMID: 37953476 DOI: 10.1111/bjh.19163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 11/14/2023]
Abstract
High-dose melphalan followed by autologous haematopoietic stem cell transplantation is widely used in newly diagnosed multiple myeloma (MM) patients as upfront therapy. However, the safety and efficacy of transplantation in patients with renal insufficiency (RI) are controversial. We followed a multicentre (16 SFGM-TC centres) prospective cohort of 50 newly diagnosed MM patients with a serum creatinine clearance of <40 mL/min at transplantation. Patients received a recommended dose of melphalan of 140 mg/m2. The primary end-point was the non-relapse mortality at Day 100. One death occurred during the first 100 days post-transplant. The median time to neutrophil engraftment was 12 days and to platelet engraftment was 13 days. The haematological response improved in 69% of patients, with best responses from partial response (PR) to very good partial response (VGPR) (10%), from PR to complete response (CR)/stringent complete response (sCR) (16%), from VGPR to CR/sCR (39%) and from CR to sCR (2%). At 2 years, the overall survival was 84%, the progression-free survival was 70% and the cumulative incidence of relapse was 20%. The renal response improved in 59% of patients, with the best renal responses post-transplant being minimal (9%), partial (2%) and complete (48%). Autologous transplantation was safe and effective in myeloma patients with RI at transplant.
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Affiliation(s)
- Laurent Garderet
- Service d'Hématologie, APHP, Hopital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Hafida Ouldjeriouat
- Department of Hematology and Cell Therapy, EHU 1st Novembre 1954 Bir el Djir Usto, University Ahmed Benbella 1, Oran, Algeria
| | - Mohamed-Amine Bekadja
- Department of Hematology and Cell Therapy, EHU 1st Novembre 1954 Bir el Djir Usto, University Ahmed Benbella 1, Oran, Algeria
| | - Elisabeth Daguenet
- Département d'Hématologie Clinique et de Thérapie Cellulaire, CHU de Saint-Etienne, Saint-Etienne, France
| | - Noemie Bigot
- Biostatistics Department, University of Paris, AP-HP, Saint Louis Hospital, Paris, France
| | - Laure Vincent
- Department of Hematology, Montpellier University Hospital, Montpellier, France
| | - Damien Roos-Weil
- Service d'Hématologie, APHP, Hopital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | | | - Souhila Ikhlef
- Department of Hematology, Saint Antoine Hospital, Paris, France
| | - Julie Abraham
- Clinical Hematology Service, CHU Limoges, Limoges, France
| | | | - Bruno Lioure
- Département Hematologie, ICANS, Strasbourg, France
| | | | - Ingrid Lafon
- Hematology Department, Institut de Cancerologie de Bourgogne, Dijon, France
| | - Clara Mariette
- Service d'Hématologie, CHU de Grenoble, Grenoble, France
| | - Lionel Karlin
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre-Bénite, France
| | - Pierre Morel
- Service d'Hématologie Clinique et de Thérapie Cellulaire, CHU Amiens, Salouel, France
| | - Lila Gilis
- Centre Hospitalier Lyon Sud, Pierre Benite, France
| | | | - Anaïse Blouet
- Service Oncologie-Hématologie, Centre Hospitalier Cholet, Cholet, France
| | - Stéphanie Nguyen Quoc
- Service d'Hématologie, APHP, Hopital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Jean Jacques Boffa
- Nephrology Department, Sorbonne Université Hôpital Tenon APHP, Paris, France
| | - Pierre Ronco
- Nephrology Department, Sorbonne Université Hôpital Tenon APHP, Paris, France
| | - Jerome Lambert
- Biostatistics Department, University of Paris, AP-HP, Saint Louis Hospital, Paris, France
| | - Jérôme Cornillon
- Département d'Hématologie Clinique et de Thérapie Cellulaire, CHU de Saint-Etienne, Saint-Etienne, France
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Fu T, Chen Y, Lou L, Li Z, Shi W, Zhang X, Yang J. Risk of atrial fibrillation in patients with multiple myeloma: what is known and directions for future study. Egypt Heart J 2024; 76:14. [PMID: 38300373 PMCID: PMC10834890 DOI: 10.1186/s43044-023-00434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Multiple myeloma (MM) is a prevalent hematological tumor, and recent clinical data have highlighted the significance of atrial fibrillation (AF) as a crucial complication affecting the prognosis of MM. This review aims to consolidate findings from published clinical studies, focusing on the epidemiological characteristics of AF in MM patients and the associated risks arising from MM treatments such as autologous hematopoietic stem cell transplantation, proteasome inhibitors, and immunomodulatory agents. MAIN BODY While existing data partially demonstrate a strong correlation between MM and AF, further clinical studies are necessary to comprehensively investigate their association. These studies should encompass various aspects, including the risk of AF resulting from MM treatment, the impact of AF-induced embolic events and heart failure on MM prognosis, as well as the influence of AF management methods like catheter ablation or left atrial appendage closure on MM prognosis. CONCLUSIONS The supplementation of future data will provide more precise guidance for managing MM patients. By incorporating information regarding AF risk associated with MM treatment and examining the effects of AF management strategies on MM prognosis, healthcare professionals can enhance their decision-making process when caring for individuals with MM.
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Affiliation(s)
- Ting Fu
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Cardiology, Yiwu Central Hospital, Jinhua, China
| | - Yuxiao Chen
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lian Lou
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhihang Li
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wen Shi
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xuan Zhang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Jian Yang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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5
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Ursu SG, Maples S, Williams KJ, Patrus G, Samhouri Y, Fazal S, Mewawalla P, Sadashiv S. The Impact of Renal Impairment in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation With Melphalan Conditioning. J Hematol 2023; 12:201-207. [PMID: 37936977 PMCID: PMC10627361 DOI: 10.14740/jh1148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/13/2023] [Indexed: 11/09/2023] Open
Abstract
Background There are no standard renal dose adjustments for melphalan conditioning for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients. The objective of this study was to evaluate the effect of melphalan dosing and chronic kidney disease (CKD) on transplant-related outcomes, progression-free survival (PFS), and overall survival (OS). Methods A retrospective chart review was performed, and MM patients who underwent ASCT between February 2016 and September 2021 were included. Melphalan 200 mg/m2 (Mel200) or 140 mg/m2 (Mel140) was administered. The cohort was divided based on renal function: creatinine clearance (CrCl) ≥ 60 mL/min (no-CKD) and CrCl < 60 mL/min (CKD). Outcomes measured include PFS, OS, treatment-related mortality (TRM), incidence of adverse events, hospitalization duration, and hospital readmission within 30 days. Statistical analysis included Chi-square test, t-test, and Kaplan-Meier method. Logistic regression model was used to account for melphalan dose adjustment. Results A total of 124 patients were included (n = 108 no-CKD, and n = 16 CKD). Median age was 62 years, majority (62%) were male, and 97% had at least a partial response at time of ASCT. Of the 124 patients, nine (7%) received Mel140. Five of these patients had CKD (CrCl range: 26 - 58 mL/min), with one on hemodialysis. Median time to neutrophil engraftment was 13.6 vs. 14.9 days and median time to platelet engraftment was 18.3 vs. 18.5 days in the CKD group vs. no-CKD group, respectively (P = 0.03 and P = 0.8). When adjusting for melphalan dose reduction, the median time to neutrophil engraftment was not statistically significant (P = 0.11). At a median follow-up of 28.7 months, the median PFS for the CKD vs. no-CKD group was 60 vs. 46 months (P = 0.3). One-year OS was 93.8% in the CKD group vs. 97% in the no-CKD group. There was a higher incidence of grade 3 or 4 mucositis in the CKD group vs. no-CKD group (P = 0.013). Conclusions There is no significant difference in engraftment, PFS, or OS for MM patients with CKD vs. no-CKD receiving melphalan conditioning for ASCT. Severe mucositis was significantly more common in the CKD group, including when accounting for melphalan dose reduction.
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Affiliation(s)
- Sorana G. Ursu
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Samantha Maples
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Kiersten J. Williams
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Gina Patrus
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Yazan Samhouri
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Salman Fazal
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Prerna Mewawalla
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
| | - Santhosh Sadashiv
- Division of Hematology/Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA 15224, USA
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6
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Nesr G, Shah R, Kyriakou C, Sive J, Popat R, Yong K, Wisniowski B, Xu K, Wechalekar A, Lee L, Ings S, Papanikolaou X, Mahmood S, Mcmillan A, Horder J, Newrick F, Marfil J, Ainley L, Asher S, Cheesman S, Rabin N. Impact of timing of stem cell return following high dose melphalan in multiple myeloma patients with renal impairment: a single center experience. Leuk Lymphoma 2023; 64:1465-1471. [PMID: 37259553 DOI: 10.1080/10428194.2023.2216817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/19/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
High dose melphalan (HDM) followed by autologous stem cell transplantation (ASCT) remains the standard consolidation in transplant eligible multiple myeloma (MM) patients. The timing between HDM administration and hematopoietic stem cell return (HSCR) varies among institutions, with a 'rest period' of 48 hours (h) employed by some for patients with renal impairment (RI). We investigated the differences in hematopoietic recovery and HDM toxicity between MM patients with RI who had HSCR after 24 vs 48 h from HDM. Fifty MM patients with RI (48 h group; n = 31 and 24 h group; n = 19) were included. No statistically significant differences were noted in surrogates for hematopoietic recovery and HDM toxicity between both groups. Only one death occurred in the 24 h group. No patients required renal replacement therapy. Therefore, a 24 h period between HDM and AHSC infusion appears safe for MM patients with RI.
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Affiliation(s)
- George Nesr
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Raakhee Shah
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Charalampia Kyriakou
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jonathan Sive
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rakesh Popat
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Kwee Yong
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Brendan Wisniowski
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ke Xu
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ashu Wechalekar
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lydia Lee
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stuart Ings
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Xenofon Papanikolaou
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Shameem Mahmood
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Annabel Mcmillan
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jackie Horder
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Fiona Newrick
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jotham Marfil
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Louise Ainley
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Samir Asher
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Simon Cheesman
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Neil Rabin
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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7
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Kumar L, Sahoo RK, Kumar S, Baa AK, Tansir G, Pathak N, Malik PS, Sharma OD, Mathew A, Jha A, Gupta R, Sharma A, Biswas A, Kumar R, Thulkar S, Malik S, Dutt A. Autologous stem cell transplant for multiple myeloma: Impact of melphalan dose on the transplant outcome. Leuk Lymphoma 2023; 64:378-387. [PMID: 36416679 DOI: 10.1080/10428194.2022.2148214] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We evaluated impact of melphalan dose on transplant outcomes for multiple myeloma. Between 1995 and 2019 459 consecutive patients received a transplant; 69(15%) received melphalan ≤150 mg/m2 (Mel 150 cohort) and 390 (85%) melphalan 200 mg/m2 (MEL 200 cohort). The primary outcome was overall survival (OS) from the date of transplant. Progression-free survival (PFS), engraftment, transplant response, and cumulative relapse at 2 years were secondary outcome measures. Patients in Mel 150 cohort had adverse clinical and laboratory parameters at base line. Transplant response was better for Mel 200 cohort (p < 0.024). Median OS at a median follow-up of 88 months was similar in the two cohorts; 100 Vs 102 months (Mel 200), p = 0.817. Median PFS (60.0 Vs 53 months, p = 0.746), relapse at two years (32.4% Vs 30.9%, p = 0.745) and grade 3-4 mucositis (p = 0.823) were similar. Initial treatment prepares patients better for subsequent similar transplant outcomes despite differences in baseline characteristics.
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Affiliation(s)
- Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudhir Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Annie K Baa
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ghazal Tansir
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Pathak
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat S Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Om Dutt Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Anisha Mathew
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Jha
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Soumyaranjan Malik
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Dutt
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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8
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Chaireti R, Uttervall K, Luong V, Lund J, Kashif M, Gahrton G, Alici E, Nahi H, Afram G. Response to Caravita di Toritto and Rago. Eur J Haematol Suppl 2023; 110:224-225. [PMID: 36300846 DOI: 10.1111/ejh.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Roza Chaireti
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Uttervall
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Vincent Luong
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Johan Lund
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Muhammad Kashif
- Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Gösta Gahrton
- Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Evren Alici
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Hareth Nahi
- Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Gabriel Afram
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,Pfizer AB, Sollentuna, Sweden
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9
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Safety and efficacy of autologous stem cell transplantation in dialysis-dependent myeloma patients-The DIADEM study from the chronic malignancies working party of the EBMT. Bone Marrow Transplant 2023; 58:424-429. [PMID: 36681775 DOI: 10.1038/s41409-023-01915-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
The role of high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) in the treatment of myeloma (MM) patients with severe and/or dialysis-dependent renal impairment remains uncertain. We report on the outcomes of 110 patients (median age 57 years) who had become dialysis-dependent pre-ASCT and who underwent a first ASCT between 1997 and 2017. Sixty-three (57%) patients had light chain MM. All patients required dialysis (94% hemodialysis and 6% peritoneal). Forty-four of 71 (62%) patients received bortezomib-based induction regimens and 42 (39%) patients had achieved at least a very good partial response (VGPR) pre-ASCT. Melphalan dosing was as follows: ≤140 mg/m2 (82%), and >140 mg/m2 (18%). The median PFS after ASCT was 35 months (95% CI: 21.5-42.2) and the median OS 102 months (95% CI: 70.4-129.1). At 1, 2, and 5 years after ASCT, 8% (95% CI 3-14%), 13% (6-20%), and 20% (12-29%) of patients, respectively, had achieved dialysis independence. In multivariate analyses of OS and PFS including age at ASCT, response at ASCT, and year of ASCT, younger age at ASCT and better response at ASCT (CR/VGPR/PR vs. MR/SD/progression) were significantly associated with better OS and PFS.
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10
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Nath CE, Grigg A, Rosser SPA, Estell J, Newman E, Tiley C, Ramanathan S, Ho SJ, Larsen S, Gibson J, Presgrave P, Shaw PJ, Trotman J. Challenges associated with test dose pharmacokinetic predictions of high dose melphalan exposure in patients with multiple myeloma. Eur J Clin Pharmacol 2022; 78:1911-1921. [PMID: 36205743 PMCID: PMC9649448 DOI: 10.1007/s00228-022-03396-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
Abstract
Aim To evaluate the accuracy of melphalan test dose pharmacokinetic (PK) predictions of the subsequent high dose (HDM) area under the concentration-versus-time curve (AUC) and to identify sources of prediction error (PE). Methods A prospective multicentre PK study was conducted in 40 myeloma patients of median age 60 (range:35–71) years using a 20 mg/m2 test dose administered 1–3 days prior to HDM (predominantly 180 mg/m2). PK data were collected post the test and high doses to compare predicted versus actual AUCs determined using the trapezoidal rule. Test and high dose infusion concentration, volume and duration and the time from preparation to infusion were compared using the paired Wilcoxin rank sign test. The impact of Melphalan administration parameters on PE was evaluated using the Mann–Whitney test. The predictive capacity of a previously published population PK (PopPK) model was also examined. Results Predicted HDM AUC was within 15% of the observed values in only 63% of patients when analysed using the trapezoidal rule and 70% of patients using PopPK. Test dose infusion concentration, volume, duration and time from preparation to infusion were significantly lower than for HDM (p < 0.005). Test dose administration within 15 min of reconstitution (n = 5) was associated with significantly lower PE than administration times of 16–60 min (n = 22), p < 0.05. Test and HDM infusion concentrations were lower in patients with large PE (> ± 15%), but the differences were not significant (p = 0.078, 0.228, respectively). Conclusion Test dose PK has the potential to predict subsequent HDM exposure to achieve a target AUC once melphalan administration parameters are optimised to account for stability issues in the formulation. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-022-03396-x.
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Affiliation(s)
- Christa Ellen Nath
- Biochemistry Department, The Children's Hospital at Westmead, Westmead, Australia.
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, Australia.
- Faculty of Health and Medicine, The University of Sydney, Camperdown, Australia.
| | - Andrew Grigg
- Clinical Haematology Department, Austin Hospital, Heidelberg, Australia
| | - Sebastian P A Rosser
- Biochemistry Department, The Children's Hospital at Westmead, Westmead, Australia
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, Australia
| | - Jane Estell
- Haematology Department, Concord Repatriation General Hospital, Concord, Australia
- Faculty of Health and Medicine, The University of Sydney, Camperdown, Australia
| | - Elizabeth Newman
- Haematology Department, Concord Repatriation General Hospital, Concord, Australia
| | - Campbell Tiley
- Haematology Department, Gosford Hospital, Gosford, Australia
| | | | - Shir Jing Ho
- Haematology Department, St George Hospital, Kogarah, Australia
- The University of New South Wales, Kensington, Australia
| | - Stephen Larsen
- Haematology Department, Royal Prince Alfred Hospital, Camperdown, Australia
- Faculty of Health and Medicine, The University of Sydney, Camperdown, Australia
| | - John Gibson
- Haematology Department, Royal Prince Alfred Hospital, Camperdown, Australia
- Faculty of Health and Medicine, The University of Sydney, Camperdown, Australia
| | - Peter Presgrave
- Haematology Department, Wollongong Hospital, Wollongong, Australia
| | - Peter John Shaw
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, Australia
- Faculty of Health and Medicine, The University of Sydney, Camperdown, Australia
| | - Judith Trotman
- Haematology Department, Concord Repatriation General Hospital, Concord, Australia
- Faculty of Health and Medicine, The University of Sydney, Camperdown, Australia
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11
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Ali MO, Al Hadidi S. High dose (conditioning) regimens used prior to autologous stem cell transplantation in multiple myeloma. Transplant Cell Ther 2022; 28:572-580. [DOI: 10.1016/j.jtct.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/03/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022]
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12
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Wieland J, Chang BK, Ding W. 69-Year-Old Man With Dysuria and Right Lower Abdominal Pain. Mayo Clin Proc 2022; 97:1182-1187. [PMID: 35662430 DOI: 10.1016/j.mayocp.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 10/18/2022]
Affiliation(s)
- Jana Wieland
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Bryce Kalei Chang
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Wei Ding
- Advisor to residents and Consultant in Hematology, Mayo Clinic, Rochester, MN.
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13
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Autologous stem cell transplantation for multiple myeloma patients with chronic kidney disease: a safe and effective option. Bone Marrow Transplant 2022; 57:959-965. [PMID: 35413986 PMCID: PMC9200631 DOI: 10.1038/s41409-022-01657-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/10/2022] [Accepted: 03/22/2022] [Indexed: 11/20/2022]
Abstract
Chronic Kidney Disease (CKD) is a frequent complication in patients with multiple myeloma (MM) and is associated with adverse outcomes. The use of autologous stem cell transplantation (ASCT) has improved disease outcomes, however, the safety and efficacy of ASCT in patients with CKD has been the subject of debate. To investigate this, we conducted a retrospective analysis of 370 MM patients who underwent their first ASCT, including those with mild, moderate and severe CKD as well as normal renal function at the time of transplant. No significant difference in ASCT-related mortality, Progression-Free or Overall Survival was noted between the different renal function groups. A decline in estimated glomerular filtration rate (eGFR) at 1-year of >8.79% was associated with poorer overall survival (p < 0.001). The results of this study show that ASCT is a safe and effective option for myeloma patients with CKD, including those on dialysis. Patients who demonstrate renal deterioration at 1-year post-transplant should be closely monitored as this is a predictor for poor survival.
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14
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Keruakous AR, Asch A, Aljumaily R, Zhao D, Yuen C. Prognostic impact of natural killer cell recovery on minimal residual disease after autologous stem cell transplantation in multiple myeloma. Transpl Immunol 2022; 71:101544. [PMID: 35093506 PMCID: PMC10434759 DOI: 10.1016/j.trim.2022.101544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Natural killer cells are a potent effector lymphocyte subset that can induce cytotoxicity without the need for antigen sensitization or presentation. NK cells are a tempting target -for immune therapy, monoclonal antibody, or genetic engineering-to enhance immune surveillance mechanisms against myeloma cells. MATERIALS AND METHODS We hypothesized an association between natural killer cell recovery after autologous stem cell transplantation (ASCT) and disease outcomes in multiple myeloma patients. We concluded a prospective study that started enrolling patients in January 2020 to identify the association between absolute NK cell count two to three after ASCT and disease outcomes after autologous stem cell transplantation in multiple myeloma using univariate and multivariate analysis. RESULTS Natural killer cell recovery was evaluated during the third month after ASCT, day +60 to +90 post-ASCT. Our patients had a mean NK cell count of 90.53, ranging from 14 to 282 Cell/μL (Std Dev 84.64 Cell/μL). The odds of having a minimal residual disease (MRD-positivity) among patients with partial remission before transplantation is four times higher than patients with very good partial response or better (95% confidence interval 0.45-35.79). Our patients were classified into two groups based on MRD status after ASCT, an MRD-negative group of eight participants and an MRD-positive group of seven participants. The mean absolute NK cell count was significantly higher in the MRD-negative cohort, 131.38 Cell/μL, versus 43.86 Cell/μL in the MRD-positive group (p = 0.049). CONCLUSION We conclude that for multiple myeloma patients treated with ASCT, high absolute NK cell counts two to three months after ASCT is an independent predictor for MRD negativity.
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Affiliation(s)
- Amany R Keruakous
- Georgia Cancer Center at Augusta University, Augusta, GA, United States of America.
| | - Adam Asch
- Department of Hematology/Oncology, University of Oklahoma, Oklahoma City, OK, United States of America
| | - Raid Aljumaily
- Department of Hematology/Oncology, University of Oklahoma, Oklahoma City, OK, United States of America
| | - Daniel Zhao
- Department of Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Carrie Yuen
- Department of Hematology/Oncology, University of Oklahoma, Oklahoma City, OK, United States of America
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15
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Abudayyeh A, Wanchoo R. Kidney Disease Following Hematopoietic Stem Cell Transplantation. Adv Chronic Kidney Dis 2022; 29:103-115.e1. [PMID: 35817518 DOI: 10.1053/j.ackd.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/07/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022]
Abstract
Hematopoietic stem cell transplantation (SCT) provides a curative option for the treatment of several malignancies. Its growing use is associated with an increased burden of kidney disease. Acute kidney injury is usually seen within the first 100 days of transplantation and has an incidence ranging between 12 and 73%, with the highest rate in myeloablative allogeneic SCT. A large subset of patients after SCT develop chronic kidney disease. They can be broadly classified into thrombotic microangiopathy, nephrotic syndrome, and calcineurin toxicity. Dialysis requirement after SCT is associated with mortality exceeding 80%. Given the higher morbidity and mortality related to development kidney disease, nephrologists need to be aware of the various causes and best treatment options.
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Affiliation(s)
- Ala Abudayyeh
- Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rimda Wanchoo
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY.
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16
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Kundu S, Jha SB, Rivera AP, Flores Monar GV, Islam H, Puttagunta SM, Islam R, Sange I. Multiple Myeloma and Renal Failure: Mechanisms, Diagnosis, and Management. Cureus 2022; 14:e22585. [PMID: 35371791 PMCID: PMC8958144 DOI: 10.7759/cureus.22585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/05/2022] Open
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17
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Inoguchi T, Hamada R, Kubota W, Terano C, Harada R, Honda M, Yamaoka S, Yokokawa Y, Yuza Y, Hataya H. Successful High-dose Chemotherapy in Combination With Autologous Peripheral Blood Stem Cell Transplantation in an Anuric Child With Neuroblastoma. J Pediatr Hematol Oncol 2021; 43:e1156-e1158. [PMID: 33625080 DOI: 10.1097/mph.0000000000002090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/23/2020] [Indexed: 11/27/2022]
Abstract
No reports describe high-dose chemotherapy (HDCT) with autologous peripheral blood stem cell transplantation (auto-PBSCT) in pediatric patients with neuroblastoma and end-stage renal disease. Here, we report the case of a patient with high-risk neuroblastoma who developed anuria during treatment. HDCT with auto-PBSCT under hemodialysis, with strict attention to the ultrafiltration volume and dose modification of alkylating agents, was performed. Although the first auto-PBSCT led to engraftment failure, the second auto-PBSCT resulted in successful myeloid engraftment 8 months after anuria. This case demonstrated that HDCT with auto-PBSCT can be safely performed in children with renal failure under hemodialysis.
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Affiliation(s)
| | | | | | | | | | | | - Shoko Yamaoka
- Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuichi Yokokawa
- Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuki Yuza
- Hematology and Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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18
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Nooka AK, Joseph NS, Lonial S. "I took the road less traveled, and that has made all the difference": Making a case for high-dose therapy and autologous stem cell transplantation in elderly patients with newly diagnosed multiple myeloma. Cancer 2021; 127:4133-4136. [PMID: 34374440 DOI: 10.1002/cncr.33825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 01/19/2023]
Abstract
LAY SUMMARY Elderly patients with myeloma derive benefits from transplantation similar to those for younger patients. Age should not be the sole criterion for determining transplant eligibility. Performance status assessment and other tools for assessing comorbidities such as the Charlson comorbidity score may potentially help in determining transplant eligibility and will allow us to move away from our heavy reliance on numerical age.
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Affiliation(s)
- Ajay K Nooka
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nisha S Joseph
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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19
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Elsayed M, Usher S, Habib MH, Ahmed N, Ali J, Begemann M, Shabbir SA, Shune L, Al-Hilli J, Cossor F, Sperry BW, Raza S. Current Updates on the Management of AL Amyloidosis. J Hematol 2021; 10:147-161. [PMID: 34527111 PMCID: PMC8425803 DOI: 10.14740/jh866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022] Open
Abstract
Systemic immunoglobulin light chain (AL) amyloidosis is a rare but fatal disease. It results from clonal proliferation of plasma cells with excessive production of insoluble misfolded proteins that aggregate in the extracellular matrix, causing damage to the normal architecture and function of various organs. For decades, treatment for AL amyloidosis was based mainly on therapeutic agents previously studied for its more common counterpart, multiple myeloma. As the prevalence and incidence of AL amyloidosis have increased, ongoing research has been conducted with treatments typically used in myeloma with varying success. In this review, we focus on current treatment strategies and updates to clinical guidelines and therapeutics for AL amyloidosis.
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Affiliation(s)
- Marwa Elsayed
- St Luke’s Hospital of Kansas City, University of Missouri Kansas City, Wornall Rd, Kansas City, MO 64111, USA
| | - Sara Usher
- St Luke’s Cancer Institute, University of Missouri Kansas City, 4321 Washington St, Ste 4000, Kansas City, MO 64111, USA
| | - Muhammad Hamza Habib
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, USA
| | - Nausheen Ahmed
- University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Jawad Ali
- West Midland Deanery, 213 Hagley Road, Birmingham, B16 9RG, UK
| | - Madeline Begemann
- St Luke’s Cancer Institute, University of Missouri Kansas City, 4321 Washington St, Ste 4000, Kansas City, MO 64111, USA
| | | | - Leila Shune
- University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Jaffar Al-Hilli
- University of Missouri Columbia, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Furha Cossor
- St Luke’s Cancer Institute, University of Missouri Kansas City, 4321 Washington St, Ste 4000, Kansas City, MO 64111, USA
| | - Brett W. Sperry
- Mid America Heart Institute, St Luke’s Hospital of Kansas City, Wornall Rd, Kansas City, MO 64111, USA
| | - Shahzad Raza
- St Luke’s Cancer Institute, University of Missouri Kansas City, 4321 Washington St, Ste 4000, Kansas City, MO 64111, USA
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20
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Straka C, Salwender H, Knop S, Vogel M, Müller J, Metzner B, Langer C, Sayer H, Jung W, Dürk HA, Bassermann F, Gramatzki M, Rösler W, Wolf HH, Brugger W, Engelhardt M, Fischer T, Liebisch P, Einsele H. Full or intensity-reduced high-dose melphalan and single or double autologous stem cell transplant with or without bortezomib consolidation in patients with newly diagnosed multiple myeloma. Eur J Haematol 2021; 107:529-542. [PMID: 34270825 DOI: 10.1111/ejh.13690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE A post hoc subgroup analysis of two phase III trials (NCT00416273, NCT00416208) was carried out to investigate the influence of 100/140 and 200 mg/m² melphalan as well as single/double autologous stem cell transplantation (ASCT) on progression-free survival (PFS). Additionally, the effect of bortezomib consolidation on PFS was analyzed. METHODS Following induction therapy and high-dose melphalan with subsequent ASCT, patients with newly diagnosed multiple myeloma (NDMM) were randomized 1:1 to either four 35-day cycles of bortezomib consolidation (1.6 mg/m² IV on days 1, 8, 15, 22) or observation. RESULTS Of the 340 patients included in this analysis, 13.5% received 1 × MEL100/140, 22.9% 2 × MEL100/140, 31.2% 1 × MEL200, and 32.4% 2 × MEL200. With higher cumulative melphalan dose, PFS improved (P = .0085). PFS curves of patients treated with 2 × MEL100/140 and 1 × MEL200 were very similar. The superior dose effect of MEL200 over MEL100/140 was non-existent in the bortezomib consolidation arm but pronounced in the observation arm (P = .0015). Similarly, double ASCT was only beneficial in patients without bortezomib consolidation (P = .0569). CONCLUSIONS Full dose melphalan and double transplantation seem advantageous only as long as patients are not receiving bortezomib consolidation afterwards.
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Affiliation(s)
| | - Hans Salwender
- Asklepios Tumorzentrum, AK Altona und AK St. Georg, Hamburg, Germany
| | - Stefan Knop
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
| | | | | | - Bernd Metzner
- Universitätsklinik für Innere Medizin II, Oldenburg, Germany
| | - Christian Langer
- Universitätsklinikum Ulm, Klinik für Innere Medizin II, Ulm, Germany
| | - Herbert Sayer
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Jena, Germany
| | - Wolfram Jung
- Universitätsmedizin Göttingen, Göttingen, Germany
| | | | - Florian Bassermann
- Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | | | - Wolf Rösler
- Universitätsklinikum Erlangen, Erlangen, Germany
| | | | | | | | | | - Peter Liebisch
- Universitätsklinikum Ulm, Klinik für Innere Medizin II, Ulm, Germany
| | - Hermann Einsele
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
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21
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Yasuda H, Yasuda M, Komatsu N. Chemotherapy for non-Hodgkin lymphoma in the hemodialysis patient: A comprehensive review. Cancer Sci 2021; 112:2607-2624. [PMID: 33938097 PMCID: PMC8253291 DOI: 10.1111/cas.14933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 12/17/2022] Open
Abstract
Chemotherapy for non‐Hodgkin lymphoma (NHL) in the hemodialysis (HD) patient is a challenging situation. Because many drugs are predominantly eliminated by the kidneys, chemotherapy in the HD patient requires special considerations concerning dose adjustments to avoid overdose and toxicities. Conversely, some drugs are removed by HD and may expose the patient to undertreatment, therefore the timing of drug administration in relation to HD sessions must be carefully planned. Also, the metabolites of some drugs show different toxicities and dialysability as compared with the parent drug, therefore this must also be catered for. However, the pharmacokinetics of many chemotherapeutics and their metabolites in HD patients are unknown, and the fact that NHL patients are often treated with distinct multiagent chemotherapy regimens makes the situation more complicated. In a realm where uncertainty prevails, case reports and case series reporting on actual treatment and outcomes are extremely valuable and can aid physicians in decision making from drug selection to dosing. We carried out an exhaustive review of the literature and adopted 48 manuscripts consisting of 66 HD patients undergoing 71 chemotherapy regimens for NHL, summarized the data, and provide recommendations concerning dose adjustments and timing of administration for individual chemotherapeutics where possible. The chemotherapy regimens studied in this review include, but are not limited to, rituximab, cyclophosphamide + vincristine + prednisolone (CVP) and cyclophosphamide + doxorubicin + vincristine + prednisolone (CHOP)‐like regimens, chlorambucil, ibrutinib, bendamustine, methotrexate, platinum compounds, cytarabine, gemcitabine, etoposide, ifosfamide, melphalan, busulfan, fludarabine, mogamulizumab, brentuximab vedotin, and 90Y‐ibritumomab tiuxetan.
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Affiliation(s)
- Hajime Yasuda
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Mutsuko Yasuda
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
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22
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Chandra S, Mizuno K, Zhao J, Davies SM, Marsh RA, Fukuda T, Setchell KDR, Vinks AA, Mehta PA. Test-dose pharmacokinetics guided melphalan dose adjustment in reduced intensity conditioning allogeneic transplant for non-malignant disorders. Br J Clin Pharmacol 2021; 88:115-127. [PMID: 34075614 DOI: 10.1111/bcp.14932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/07/2021] [Accepted: 05/23/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS We studied melphalan pharmacokinetics (PK) and feasibility of melphalan full-dose adjustment based on test-dose PK in children and young adults with non-malignant disorders (NMD) undergoing allogeneic hematopoietic cell transplantation (HCT) using reduced intensity conditioning (RIC) containing alemtuzumab, fludarabine and melphalan. METHODS Patients received test-dose melphalan (10% of planned full-dose) prior to conditioning. Blood samples for PK were obtained around test and full-dose melphalan (140 mg/m2 or 4.7 mg/kg in patients <10 kg). Melphalan concentration was measured by liquid chromatography electrospray ionization tandem mass-spectrometry assay and data were analysed using a population-PK model and Bayesian estimation. Test and full-dose melphalan clearance estimates were evaluated by pairwise Wilcoxon test and Bland-Altman plot. RESULTS Twenty-four patients undergoing 25 transplants were included in the final analysis. Patients received standard full-dose melphalan in 17 transplants, with median area under the concentration-time curve (AUC) of 5.5 mg*h/L (range, 3.0-9.5 mg*h/L). Patients received test-dose melphalan in 23 transplants with a test-dose PK predicted full-dose AUC range of 2.9-16.8 mg*h/L. In seven transplants where patients had baseline organ impairment, test-dose PK predicted higher exposure for standard full-dose (median AUC 13.8 mg*h/L). Melphalan full-dose was adjusted in these patients, with achievement of desired target AUC (3.6-5.4 mg*h/L) and no excess toxicity. Mean ratio of test-dose clearance to full-dose clearance was 1.03. Twenty of 22 patients (91%) were within the 95% confidence intervals of the clearance ratio. CONCLUSION Melphalan test-dose PK reliably predicts full-dose PK and allows for accurate adjustment of full-dose melphalan in RIC-HCT for NMD. This approach can avoid excess toxicity from increased systemic exposure, especially in patients with organ impairment.
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Affiliation(s)
- Sharat Chandra
- Divisions of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Kana Mizuno
- Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Junfang Zhao
- Pathology & Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Stella M Davies
- Divisions of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Rebecca A Marsh
- Divisions of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Tsuyoshi Fukuda
- Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Kenneth D R Setchell
- Pathology & Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Alexander A Vinks
- Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Parinda A Mehta
- Divisions of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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23
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Sive J, Cuthill K, Hunter H, Kazmi M, Pratt G, Smith D. Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. Br J Haematol 2021; 193:245-268. [PMID: 33748957 DOI: 10.1111/bjh.17410] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan Sive
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Hannah Hunter
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Majid Kazmi
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dean Smith
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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UNCU ULU B, BAKIRTAŞ M, YİĞENOĞLU TN, BAŞCI S, YILDIZ J, ŞAHİN D, DARÇIN T, MERDİN A, BATGİ H, İSKENDER D, BAYSAL NA, DAL S, KIZIL ÇAKIR M, ALTUNTAŞ F. Efficacy of reduced dose melphalan conditioning for multiple myeloma patients undergoing autologous stem cell transplantation: in the era of combined induction with novel agents. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.868279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Cohen C, Joly F, Sibille A, Javaugue V, Desport E, Goujon JM, Touchard G, Fermand JP, Sirac C, Bridoux F. Randall-Type Monoclonal Immunoglobulin Deposition Disease: New Insights into the Pathogenesis, Diagnosis and Management. Diagnostics (Basel) 2021; 11:diagnostics11030420. [PMID: 33801393 PMCID: PMC7999117 DOI: 10.3390/diagnostics11030420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Abstract
Randall-type monoclonal immunoglobulin deposition disease (MIDD) is a rare disease that belongs to the spectrum of monoclonal gammopathy of renal significance (MGRS). Renal involvement is prominent in MIDD, but extra-renal manifestations can be present and may affect global prognosis. Recent data highlighted the central role of molecular characteristics of nephrotoxic monoclonal immunoglobulins in the pathophysiology of MIDD, and the importance of serum free light chain monitoring in the diagnosis and follow-up disease. Clone-targeted therapy is required to improve the overall and renal survival, and the achievement of a rapid and deep hematological response is the goal of therapy. This review will focus on the recent progress in the pathogenesis and management of this rare disease.
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Affiliation(s)
- Camille Cohen
- Department of Nephrology Hôpital Necker, and INSERM U830 “Stress and Cancer” Laboratory, Institut Curie, 75015 Paris, France
- Correspondence:
| | - Florent Joly
- Department of Nephrology, CHU Poitiers, 86000 Poitiers, France; (F.J.); (A.S.); (V.J.); (E.D.); (G.T.); (F.B.)
- Centre National de Référence Maladies Rares: Amylose AL et Autres Maladies à Dépôts d’Immunoglobulines Monoclonales, 86000 Poitiers, France
| | - Audrey Sibille
- Department of Nephrology, CHU Poitiers, 86000 Poitiers, France; (F.J.); (A.S.); (V.J.); (E.D.); (G.T.); (F.B.)
- Centre National de Référence Maladies Rares: Amylose AL et Autres Maladies à Dépôts d’Immunoglobulines Monoclonales, 86000 Poitiers, France
| | - Vincent Javaugue
- Department of Nephrology, CHU Poitiers, 86000 Poitiers, France; (F.J.); (A.S.); (V.J.); (E.D.); (G.T.); (F.B.)
- Centre National de Référence Maladies Rares: Amylose AL et Autres Maladies à Dépôts d’Immunoglobulines Monoclonales, 86000 Poitiers, France
- INSERM CIC 1402, 86000 Poitiers, France
- CNRS UMR 7276-CRIBL, University of Limoges, 87000 Limoges, France;
| | - Estelle Desport
- Department of Nephrology, CHU Poitiers, 86000 Poitiers, France; (F.J.); (A.S.); (V.J.); (E.D.); (G.T.); (F.B.)
- Centre National de Référence Maladies Rares: Amylose AL et Autres Maladies à Dépôts d’Immunoglobulines Monoclonales, 86000 Poitiers, France
| | | | - Guy Touchard
- Department of Nephrology, CHU Poitiers, 86000 Poitiers, France; (F.J.); (A.S.); (V.J.); (E.D.); (G.T.); (F.B.)
- Department of Pathology, CHU Poitiers, 86000 Poitiers, France;
| | - Jean-Paul Fermand
- Department of Immunology and Hematology, Hôpital Saint Louis, 75010 Paris, France;
| | - Christophe Sirac
- CNRS UMR 7276-CRIBL, University of Limoges, 87000 Limoges, France;
| | - Frank Bridoux
- Department of Nephrology, CHU Poitiers, 86000 Poitiers, France; (F.J.); (A.S.); (V.J.); (E.D.); (G.T.); (F.B.)
- Centre National de Référence Maladies Rares: Amylose AL et Autres Maladies à Dépôts d’Immunoglobulines Monoclonales, 86000 Poitiers, France
- INSERM CIC 1402, 86000 Poitiers, France
- CNRS UMR 7276-CRIBL, University of Limoges, 87000 Limoges, France;
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Devarakonda S, Efebera Y, Sharma N. Role of Stem Cell Transplantation in Multiple Myeloma. Cancers (Basel) 2021; 13:863. [PMID: 33670709 PMCID: PMC7922596 DOI: 10.3390/cancers13040863] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022] Open
Abstract
Autologous stem cell transplantation (auto-SCT) has been the standard of care in eligible newly diagnosed multiple myeloma (MM) patients. Outcomes of patients with MM have improved significantly due to the advent of several novel drugs. Upfront use of these drugs in induction therapy has significantly increased the rate and depth of responses that have translated into longer remission and survival. This has now raised a debate regarding the role and relevance of auto-SCT in the management of myeloma. However, clinical trials have confirmed the utility of auto-SCT even in the era of novel drugs. Tandem auto-SCT followed by maintenance has shown a progression-free survival (PFS) benefit in high-risk MM, and hence can be considered in young and fit patients with high-risk disease. Auto-SCT has the advantages of resetting the bone marrow microenvironment, short-lived toxicity compared to the long-term physical and financial toxicities of continued chemotherapy in the absence of SCT, very low transplant-related mortality (TRM) in high volume centers, and providing longer disease-free survival when followed by maintenance therapy. Allogeneic SCT is one potentially curative option for MM, albeit with an increased risk of death due to high TRM. Strategies to modulate the graft-versus-host disease (GVHD) while maintaining or improving the graft-versus-myeloma (GVM) effect could place allogeneic SCT back in the treatment armamentarium of MM.
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Affiliation(s)
| | - Yvonne Efebera
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, Columbus, OH 43210, USA; (S.D.); (N.S.)
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Abudayyeh A, Lin H, Mamlouk O, Abdelrahim M, Saliba R, Rondon G, Martinez CS, Delgado R, Page V, Rajasekaran A, Sanders PW, Qazilbash M. Impact of autologous stem cell transplantation on long term renal function and associated progression-free and overall survival in multiple myeloma. Leuk Lymphoma 2020; 61:3101-3111. [PMID: 32723196 PMCID: PMC9074107 DOI: 10.1080/10428194.2020.1797719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
The long-term impact of Autologous hematopietic stem cell transplantation (ASCT) on renal function, and the impact of renal function on progression-free survival (PFS) and overall survival (OS) in patients with multiple myeloma are not known. We retrospectively reviewed the records of 885 patients at our institution. We used linear mixed effect models to study the change in estimated glomerular filtration rate (eGFR) and a joint model approach to assess associations between the eGFR, PFS and OS. Sensitivity analyses were conducted at days 0, 100, 180, and 365 post-SCT. eGFR post-ASCT was significantly lower than at day 0 but stabilized at approximately 80 mL/min/1.73 m2. There was no association between eGFR and PFS or OS.; However, relapsed disease and ISS stage were associated with shorter PFS and OS. This data suggests that although there is a modest decline in eGFR post-ASCT, it is not associated with an adverse impact on PFS or OS. KEY POINTS Advanced MM stage at diagnosis was associated with reduced eGFR at all stages of chronic kidney disease. eGFR was not associated with PFS or OS in any of the analyses, but disease-related factors prior to ASCT were all associated with reduced eGFR, PFS and OS. ASCT did not adversely impact kidney function and mitigated the risk of CKD on outcomes in MM.
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Affiliation(s)
- Ala Abudayyeh
- Division of Internal Medicine, Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Heather Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Omar Mamlouk
- Division of Internal Medicine, Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maen Abdelrahim
- Institute of Academic Medicine and Weill Cornell Medical College, Houston Methodist Cancer Center, Houston, Texas, USA
| | - Rima Saliba
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Charles S. Martinez
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ruby Delgado
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Valda Page
- Division of Internal Medicine, Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arun Rajasekaran
- Department of Medicine, University of Alabama at Birmingham and Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Paul W. Sanders
- Department of Medicine, University of Alabama at Birmingham and Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Muzaffar Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Firsova MV, Mendeleeva LP, Solovev MV, Rekhtina IG, Pokrovskaya OS, Urnova ES, Soboleva NP, Dvirnyk VN, Klyasova GA, Kuzmina LA, Savchenko VG. [Autologous haematopoietic stem cell transplantation in patients with multiple myeloma complicated by dialysis-dependent renal failure]. TERAPEVT ARKH 2020; 92:70-76. [PMID: 33346447 DOI: 10.26442/00403660.2020.07.000777] [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: 08/25/2020] [Indexed: 01/02/2023]
Abstract
AIM To assess the safety and efficacy of autologous haematopoietic stem cell transplantation (auto-HSCT) in multiple myeloma (MM) patients with dialysis-dependent renal failure. MATERIALS AND METHODS During a period from May 2010 to December 2016 fourteen MM patients with dialysis-dependent renal failure aged 48 to 65 years underwent auto-HSCT. After the induction therapy complete response, very good partial response, partial response were documented in 64, 29, 7% of patients, respectively. In no case was a renal response achieved. Haematopoietic stem cell mobilization in most patients (13/14) was performed according to the scheme: G-CSF 10 g/kg. Melphalan in 3 dosages was used as pre-transplant conditioning: 100, 140 and 200 mg/m2; 13 patients underwent a single and in one case underwent a tandem auto-HSCT against the background of hemodialysis. Evaluation of the antitumor and renal response was assessed on the 100th day after auto-HSCT. Subsequently, against the background of programmed hemodialysis and in the setting of high-dosed melphalan (100200 mg/m2), 13 patients underwent a single and one patient underwent a tandem auto-HSCT. At +100 days after auto-HSCT, an antitumor response and renal response were assessed. RESULTS The period of agranulocytosis after auto-HSCT was from 5 to 12 days (median 8,5) and was accompanied by infectious complications, cardiac and neurological dysfunctions. At +100 days after auto-HSCT, the complete response was confirmed in 71% patients and very good partial response was confirmed in 29% patients. The minimal renal response was registered in 2 patients (14%), hemodialysis was stopped. The transplant-related mortality was absent. After a median follow-up of 53 months 5-year progression-free survival was 59%, and overall survival was 93%. CONCLUSION Carrying out auto-HSCT in patients with dialysis-dependent renal failure contributed to the achievement of a minimal renal response in 14% of cases, which allowed these patients to stop hemodialysis. Patients whose conditioning regimen was performed using melphalan at a dose of 200 mg/m2showed more frequent complications in the early post-transplant period compared to patients who received a lower dose of melphalan (100140 mg/m2). Auto-HSCT in MM patients with dialysis-dependent renal failure is a feasible and effective treatment method, which in some cases contributes to independence from hemodialysis.
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Mohyuddin GR, Abbasi S, Okoniewski M, McClune B, Abdallah AO, Ganguly S, McGuirk J, Shune L. Inpatient mortality of patients with multiple myeloma and renal impairment undergoing autologous stem cell transplantation. Eur J Haematol 2020; 105:571-577. [PMID: 32662224 DOI: 10.1111/ejh.13487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Further data are needed on the safety of high-dose melphalan and autologous stem cell transplant (HDM-ASCT) in patients with multiple myeloma (MM) and renal impairment. The objective of our study was to use the National Inpatient Sample (NIS) to determine inpatient mortality for patients with MM and renal impairment undergoing HDM-ASCT, as well as trends over time. METHODS Using the NIS, we tracked hospital admissions for MM patients from 2002 to 2014 who underwent HDM-ASCT, using ICD 9 coding. RESULTS The total weighted estimate of inpatient admissions for HDM-ASCT among MM patients was 47,253 from 2002 to 2014. A weighted total of 45 and 1709 patients with MM received peritoneal dialysis (PD) and hemodialysis (HD) during HDM-ASCT for MM, respectively. There was a markedly increased risk of inpatient mortality in patients on dialysis undergoing transplant (20.5% for PD patients, 13.8% for HD patients), even after accounting for other comorbidities (odds ratio of inpatient mortality of 6.193 [CI 3.585-10.701]). A significant decrease was noted in inpatient mortality for patients with ESRD undergoing HDM-ASCT over time from 15.6% in 2009 to 5% in 2014 (P < .001). CONCLUSION Patients with MM on dialysis undergoing HDM-ASCT are at significantly increased risk of inpatient mortality.
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Affiliation(s)
| | - Saqib Abbasi
- University of Kansas Cancer Center, Kansas City, KS, USA
| | - Maire Okoniewski
- Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Brian McClune
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Al-Ola Abdallah
- Department of Hematological Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, KS, USA
| | - Siddhartha Ganguly
- Department of Hematological Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, KS, USA
| | - Joseph McGuirk
- Department of Hematological Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, KS, USA
| | - Leyla Shune
- Department of Hematological Malignancies and Cellular Therapeutics, University of Kansas, Kansas City, KS, USA
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Monoclonal Gammopathy of Undetermined Significance (MGUS)-Not So Asymptomatic after All. Cancers (Basel) 2020; 12:cancers12061554. [PMID: 32545521 PMCID: PMC7352603 DOI: 10.3390/cancers12061554] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022] Open
Abstract
Monoclonal Gammopathy of Undetermined Significance (MGUS) is considered to be a benign precursor condition that may progress to a lymphoproliferative disease or multiple myeloma. Most patients do not progress to an overt condition, but nevertheless, MGUS is associated with a shortened life expectancy and, in a minority of cases, a number of co-morbid conditions that include an increased fracture risk, renal impairment, peripheral neuropathy, secondary immunodeficiency, and cardiovascular disease. This review aims to consolidate current evidence for the significance of these co-morbidities before considering how best to approach these symptoms and signs, which are often encountered in primary care or within a number of specialties in secondary care.
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Batko K, Malyszko J, Jurczyszyn A, Vesole DH, Gertz MA, Leleu X, Suska A, Krzanowski M, Sułowicz W, Malyszko JS, Krzanowska K. The clinical implication of monoclonal gammopathies: monoclonal gammopathy of undetermined significance and of renal significance. Nephrol Dial Transplant 2020; 34:1440-1452. [PMID: 30169860 DOI: 10.1093/ndt/gfy259] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Indexed: 12/23/2022] Open
Abstract
Monoclonal gammopathy of renal significance (MGRS) has introduced a new perspective to several well-known disease entities impacting nephrology, haematology and pathology. Given the constantly changing disease spectrum of these entities, it is clinically imperative to establish diagnostic and treatment pathways supported by evidence-based medicine. MGRS is a disease of the kidney, secondary to plasma cell clonal proliferation or immune dysfunction, requiring therapeutic intervention to eradicate the offending clone. To fully understand the disease(s), it is prerequisite to determine the significance of the findings. The diagnostic work up should be extensive due to the wide heterogeneity of clinical presentation, ultimately necessitating kidney biopsy. Particular patient profiles such as AL amyloidosis, which may be diagnosed through biopsies of other tissues/organs, may be an exception. Treatment decisions should be formulated by multi-disciplinary consensus: nephrologists, haematologists and pathologists. The ultimate goal in managing MGRS is eradication of the offending plasma cell clone which requires targeted chemotherapy and, in eligible cases, haematopoietic stem cell transplantation. We present a review of diagnostic procedures, treatment options and advances in the last few years in the management of MGRS in an effort to acquaint specialists with this new face of several older diseases.
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Affiliation(s)
- Krzysztof Batko
- Departament of Nephrology, Jagiellonian University Medical College, Kraków, Poland
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warszawa, Poland
| | - Artur Jurczyszyn
- Departament of Hematology, Jagiellonian University Medical College, Kraków, Poland
| | - David H Vesole
- Myeloma DIvision, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Xavier Leleu
- Service d`Hematologie CHU, Hopital de la Miletrie, Poitiers, France
| | - Anna Suska
- Departament of Hematology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Krzanowski
- Departament of Nephrology, Jagiellonian University Medical College, Kraków, Poland
| | - Władysław Sułowicz
- Departament of Nephrology, Jagiellonian University Medical College, Kraków, Poland
| | - Jacek S Malyszko
- 1st Department of Nephrology, Medical University, Bialystok, Poland
| | - Katarzyna Krzanowska
- Departament of Nephrology, Jagiellonian University Medical College, Kraków, Poland
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Autologous Stem Cell Transplantation in Multiple Myeloma with Renal Failure: Friend or Foe? Stem Cells Int 2019; 2019:9401717. [PMID: 31781250 PMCID: PMC6875020 DOI: 10.1155/2019/9401717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 09/22/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
Autologous stem cell transplantation (ASCT) is a standard treatment for multiple myeloma (MM), but the clinical response and renal curative effect in MM patients with renal failure (RF) remain controversial. The myeloma kidney disease has different types, and most are due to the direct toxic effects of light chain. Although ASCT can effectively clear the light chain, the data of renal function improvement are still limited. We reviewed the published literatures, focusing on the prospective studies, the retrospective analysis studies, and the case reports. RF patients who received ASCT displayed a low survival rate (OS: HR 1.95, 95% CI 1.020 to 3.720; I2 = 64.9%, P = 0.014) and a shorter EFS/PFS (EFS/PFS: HR 1.53, 95% CI 1.090 to 2.140; I2 = 0%, P = 0.669). However, ASCT was feasible and could have the similar clinical response outcomes compared with the normal renal function (CR: OR 1.013, 95% CI 0.569 to 1.804; I2 = 48.5%, P = 0.101; PR: OR 1.013, 95% CI 0.342 to 1.226; I2 = 46.3%, P = 0.144). Moreover, MM with RF after ASCT had a good improvement of renal function and melphalan is still an important factor affecting the treatment of ASCT.
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Ntanasis-Stathopoulos I, Gavriatopoulou M, Kastritis E, Terpos E, Dimopoulos MA. Multiple myeloma: Role of autologous transplantation. Cancer Treat Rev 2019; 82:101929. [PMID: 31770695 DOI: 10.1016/j.ctrv.2019.101929] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/31/2019] [Accepted: 11/05/2019] [Indexed: 01/07/2023]
Abstract
Autologous stem cell transplantation (ASCT) has been the mainstay of multiple myeloma (MM) treatment for approximately 30 years. Although the continuous introduction of novel agents in the armamentarium against MM has questioned its value, ASCT remains a backbone treatment for fit MM patients. However, there is no unanimous approach for several aspects including the positioning of ASCT in the therapeutic algorithm either upfront or following the first relapse, the need for single or tandem ASCT, as well as the role of ASCT as salvage therapy. Furthermore, the anti-CD38 monoclonal antibodies along with the next generation proteasome inhibitors and immunomodulatory drugs provide a platform for optimizing the induction and consolidation/maintenance regimens. In this review, we present current data pertaining to all aspects of ASCT in MM, whereas we highlight the open issues that should be addressed in the design of future clinical trials in the field.
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Affiliation(s)
- Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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Morita K, Ashizawa M, Toda Y, Ikeda T, Kawaguchi SI, Ito S, Ochi SI, Nagayama T, Mashima K, Umino K, Minakata D, Nakano H, Yamasaki R, Yamamoto C, Hatano K, Fujiwara SI, Sato K, Oh I, Ohmine K, Muroi K, Matsumoto K, Kanda Y. Salvage Chemotherapy Followed by Autologous Stem-Cell Transplantation Using Targeted Busulfan for Refractory Diffuse Large B-Cell Lymphoma With Dialysis-Dependent End-Stage Renal Disease. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e92-e96. [PMID: 31787588 DOI: 10.1016/j.clml.2019.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND A treatment strategy is needed for hemodialysis-dependent patients with end-stage renal disease who have relapsed/refractory diffuse large B-cell lymphoma (DLBCL). We examined the feasibility of salvage chemotherapy followed by autologous stem-cell transplantation (ASCT) and busulfan as a conditioning regimen. PATIENTS AND METHODS We provided a patient with refractory DLBCL who was receiving hemodialysis with modified salvage chemotherapies that were based on the mechanism of drug pharmacokinetics and an evaluation of the pharmacokinetics of busulfan. After chemotherapy, the patient underwent ASCT. RESULTS The regimen was successfully administered without adverse events. CONCLUSION Chemotherapy followed by ASCT using a conditioning regimen of reduced melphalan and pharmacokinetically targeted busulfan is a promising strategy for treating patients with relapsed or refractory DLBCL who also have end-stage renal disease and are receiving hemodialysis.
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Affiliation(s)
- Kaoru Morita
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yumiko Toda
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Takashi Ikeda
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Shin-Ichiro Kawaguchi
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Shoko Ito
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Shin-Ichi Ochi
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Takashi Nagayama
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kiyomi Mashima
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kento Umino
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Daisuke Minakata
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hirofumi Nakano
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Ryoko Yamasaki
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Chihiro Yamamoto
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kaoru Hatano
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Shin-Ichiro Fujiwara
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kazuya Sato
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Iekuni Oh
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Ken Ohmine
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kazuo Muroi
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kana Matsumoto
- Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Doshisha Women's College of Liberal Arts, Kyoto, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
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Radhakrishnan SV, Boyer M, Sherwin CM, Zangari M, Tricot G. A Phase 1 Study of Intravenous Busulfan as a Conditioning Regimen for Multiple Myeloma. Cell Transplant 2019; 28:1624-1631. [PMID: 31619057 PMCID: PMC6923548 DOI: 10.1177/0963689719880541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The efficacy of melphalan (MEL) 140 mg/m2 pre-transplant conditioning versus
MEL 200 mg/m2 for the elderly is still debated. We hypothesized that
single-agent intravenous busulfan (BU) would show significant anti-myeloma efficacy and be
better tolerated by elderly patients. A prospective 3+3 dose escalation study enrolled
symptomatic multiple myeloma (MM) patients 65 years or older with SWOG performance 0–2 for
treatment with intravenous BU pre-transplant at different administration levels. The
primary objective was to determine the maximum tolerated dose (MTD) of BU that could be
safely given over the least number of days. All patients, except one, received maintenance
treatment post-transplant, mostly for 2 years. We enrolled 13 patients, mean age of 73
years (range 68–80). Pharmacokinetic analysis showed no greater than 2% accumulation in
the 13 patients, confirming a lack of accumulation in the multi-dose regimen. No deaths
occurred in the peri-transplant period. Grade 3/4 adverse effects were hematological, no
dose-limiting toxicity was observed and MTD was not reached. Three patients developed
grade 3 mucositis but none developed veno-occlusive disease. Ten (77%) patients achieved a
complete remission (CR) post-transplant with a remarkably long average time to best
response of 6.7 months (range: 6–14 m), and two attained a partial response. Median
overall survival was 84 months (95% CI, 21–104) and the median progression-free survival
was 60 months (95% CI, 9–93). Our results suggest that IV BU could be an alternative
conditioning regimen to MEL 140 in elderly patients with MM, and supports future
randomized trials.
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Affiliation(s)
- Sabarinath V Radhakrishnan
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Michael Boyer
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Catherine M Sherwin
- Department of Pediatrics, Dayton Children's Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Maurizio Zangari
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Guido Tricot
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Li AY, Atenafu EG, Bernard RS, Masih-Khan E, Reece D, Franke N, Tiedemann R, Prica A, Trudel S, Kukreti V, Chen CI. Toxicity and survival outcomes of autologous stem cell transplant in multiple myeloma patients with renal insufficiency: an institutional comparison between two eras. Bone Marrow Transplant 2019; 55:578-585. [PMID: 31558786 DOI: 10.1038/s41409-019-0697-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/29/2019] [Accepted: 09/10/2019] [Indexed: 01/05/2023]
Abstract
Autologous stem cell transplant (ASCT) is a feasible treatment option for multiple myeloma (MM) patients with renal insufficiency; however, these patients tend to experience higher rates of drug toxicity and transplant-related mortality (TRM) during ASCT. Recent adoption of bortezomib-based induction regimens and dose reduction of melphalan during conditioning may improve outcomes in this population. In this single center retrospective study, we compared the toxicity and survival outcomes of 96 MM patients with renal insufficiency undergoing ASCT between two eras: 1998-2007 and 2008-2016. The proportion of dialysis dependent patients was similar in both groups (49 and 45%). We found no TRM in those transplanted more recently as compared with 13% in the older era of ASCT. There were significantly more high grade (grades 3-4) toxicities in the older era of ASCT including high grade electrolyte abnormalities, mucositis, delirium, and bleeding. Patients transplanted more recently had significantly higher overall response rate (ORR) as well as deeper responses to ASCT (≥VGPR in 79% vs 39%). Progression-free survival (PFS) was prolonged by 26 months in the more recent era compared with the older era. Overall, improvements in treatment regimens have resulted in reduced TRM and toxicities for patients with renal insufficiency undergoing ASCT.
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Affiliation(s)
- Amanda Yan Li
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rosanne St Bernard
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Esther Masih-Khan
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Donna Reece
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Norman Franke
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rodger Tiedemann
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anca Prica
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Suzanne Trudel
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Vishal Kukreti
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Christine I Chen
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Kumar L, Chellapuram SK, Dev R, Varshneya A, Pawar S, Sharma A, Mookerjee A, Sahoo RK, Malik PS, Sharma A, Gupta R, Sharma O, Biswas A, Kumar R, Thulkar S, Mallick S. Induction Therapy with Novel Agents and Autologous Stem Cell Transplant Overcomes the Adverse Impact of Renal Impairment in Multiple Myeloma. Clin Hematol Int 2019; 1:205-219. [PMID: 34595432 PMCID: PMC8432369 DOI: 10.2991/chi.d.190805.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/21/2019] [Indexed: 11/29/2022] Open
Abstract
We investigated the impact of renal impairment (RI) on the outcome in multiple myeloma (MM) patients following induction and autologous stem cell transplantation (ASCT). Among 349 patients who received a first ASCT for MM, 86 (24.6%) had RI at diagnosis, defined as estimation of glomerular filtration rate (eGFR) <40 mL/min/1.73 m2 according to the modification of diet in renal disease (MDRD) formula. Post induction reversal of renal function occurred in 68 (79%) patients including complete renal response in 37.2%. Two hundred and fifty-one patients had received novel agents for induction; posttransplant complete response (CR) rates were 71.4% for patients with renal impairment (RI) versus 67.2% in those without RI, p = 0.23. The quality of stem cell collection and days to engraftment were similar except that patients with RI required higher transfusion numbers of packed red cells (p < 0.002) and platelets (p < 0.007). The median overall survival (OS) was 96 months (95% confidence interval [CI] 72.80–119.20) for patients with eGFR ≥40 mL/min, n = 195) versus 62 months (95% CI 28.7–95.3) for 56 patients with RI (eGFR <40 mL/min), p = 0.15. The 5-year OS was 64.6% versus 54.4%, respectively. The median progression-free survival (PFS) was 52 months (95% CI 36.3–67.7) for patients with eGFR ≥40 mL/min versus “not reached” for those with eGFR <40 mL/min p = 0.87; and the 5-year PFS was 48.1% versus 51%, respectively. We conclude that induction with novel agents results in reversal of renal dysfunction in the majority of patients. Consolidation with Hemopoietic Stem Cell Transplantation (HSCT) overcomes the adverse impact of RI on survival.
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Affiliation(s)
- Lalit Kumar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Santosh Kumar Chellapuram
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Ramavat Dev
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Ankur Varshneya
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Satyajit Pawar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Aparna Sharma
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Anjali Mookerjee
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Atul Sharma
- Department of Medical Oncology, Institute Rotary Cancer Hospital, Room 234, IRCH Building, All India Institute of Medical sciences, New Delhi 110029, India
| | - Ritu Gupta
- Department of Lab Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical sciences, New Delhi 110029, India
| | - Omdutta Sharma
- Department of Lab Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical sciences, New Delhi 110029, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical sciences, New Delhi 110029, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, Institute Rotary Cancer Hospital, All India Institute of Medical sciences, New Delhi 110029, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Institute Rotary Cancer Hospital, All India Institute of Medical sciences, New Delhi 110029, India
| | - Sauumyaranjan Mallick
- Department of Pathology, Institute Rotary Cancer Hospital, All India Institute of Medical sciences, New Delhi 110029, India
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Sweiss K, Calip GS, Johnson JJ, Rondelli D, Patel PR. Pretransplant hemoglobin and creatinine clearance correlate with treatment-free survival after autologous stem cell transplantation for multiple myeloma. Bone Marrow Transplant 2019; 54:2081-2087. [PMID: 31388085 DOI: 10.1038/s41409-019-0628-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/23/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022]
Abstract
Melphalan is given at a dose of 200 mg/m2 (Mel200) prior to ASCT for multiple myeloma (MM). Pharmacokinetic (PK) studies show a high degree of interpatient variability. We aimed to test the impact of clinical factors previously shown to affect melphalan PK such as hemoglobin (Hgb), fat-free mass (FFM), and creatinine clearance (CrCl) on outcomes. Median Hgb (from day -2 to -1) and FFM were grouped as low or high relative to their sample medians, and CrCl was divided into ≥60 or <60 ml/min. In 133 MM patients, median TFS (defined as time from ASCT to initiation of next subsequent line of therapy or death) was longer in patients with lower Hgb (35 vs. 16 months, p = 0.02). Patients with both lower Hgb and CrCl experienced longer TFS compared to those with higher Hgb and CrCl (35 vs. 13 months, p = 0.03). In multivariate analysis, lower hemoglobin, lower CrCl, and a combined low hemoglobin and CrCl were strongly associated with improved TFS. Patients with a lower hemoglobin or creatinine clearance experienced significantly more toxicity. We show for the first time that Hgb and CrCl are important predictors of outcomes after Mel200. PK-directed melphalan dosing may be beneficial in achieving optimal outcomes.
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Affiliation(s)
- Karen Sweiss
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA. .,Cancer Center, University of Illinois, Chicago, IL, USA.
| | - Gregory S Calip
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Jeremy J Johnson
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA.,Cancer Center, University of Illinois, Chicago, IL, USA
| | - Damiano Rondelli
- Cancer Center, University of Illinois, Chicago, IL, USA.,Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Pritesh R Patel
- Cancer Center, University of Illinois, Chicago, IL, USA.,Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, USA
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Dehqan Niri A, Karimi Zarchi AA, Ghadiri Harati P, Salimi A, Mujokoro B. Tissue engineering scaffolds in the treatment of brain disorders in geriatric patients. Artif Organs 2019; 43:947-960. [DOI: 10.1111/aor.13485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Alireza Dehqan Niri
- Nanobiotechnology Research Center Baqiyatallah University of Medical Sciences Tehran Iran
| | | | - Parisa Ghadiri Harati
- Department of Physiotherapy, School of Rehabilitation Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Ali Salimi
- Nanobiotechnology Research Center Baqiyatallah University of Medical Sciences Tehran Iran
| | - Basil Mujokoro
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine Tehran University of Medical Sciences Tehran Iran
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40
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Al Hamed R, Bazarbachi AH, Malard F, Harousseau JL, Mohty M. Current status of autologous stem cell transplantation for multiple myeloma. Blood Cancer J 2019; 9:44. [PMID: 30962422 PMCID: PMC6453900 DOI: 10.1038/s41408-019-0205-9] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/22/2022] Open
Abstract
More than 30 years after its introduction, autologous stem cell transplantation (ASCT) remains the standard of care for young patients with newly diagnosed multiple myeloma. Not only did the arrival of novel agents such as immunomodulatory drugs (IMiDs), proteasome inhibitors (PI) and monoclonal antibodies not replace ASCT, instead they solidified its central role as standard of care. Novel agent use is now inarguably essential in induction, maintenance, and possibly consolidation. In light of these new advancements, new challenges arise in deciding on optimal practice. Who is most suited to undergo ASCT? Is there an age threshold that should not be surpassed? Should transplantation be embarked on early or is it reasonable to delay it? What are the optimal induction, consolidation, and maintenance therapies? What is the role of tandem transplantation in the era of novel agents and where do patient-specific cytogenetics come into the equation when deciding on treatment? These are some of the questions addressed in this review which we will attempt to answer with the latest currently available data.
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Affiliation(s)
- Rama Al Hamed
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938 and université Sorbonne, Paris, France
| | - Abdul Hamid Bazarbachi
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938 and université Sorbonne, Paris, France
| | - Florent Malard
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938 and université Sorbonne, Paris, France
| | - Jean-Luc Harousseau
- Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Nantes-St Herblain, France
| | - Mohamad Mohty
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938 and université Sorbonne, Paris, France.
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41
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Randall-type monoclonal immunoglobulin deposition disease: novel insights from a nationwide cohort study. Blood 2019; 133:576-587. [DOI: 10.1182/blood-2018-09-872028] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/15/2018] [Indexed: 12/27/2022] Open
Abstract
Abstract
Monoclonal immunoglobulin deposition disease (MIDD) is a rare complication of B-cell clonal disorders, defined by Congo red negative–deposits of monoclonal light chain (LCDD), heavy chain (HCDD), or both (LHCDD). MIDD is a systemic disorder with prominent renal involvement, but little attention has been paid to the description of extrarenal manifestations. Moreover, mechanisms of pathogenic immunoglobulin deposition and factors associated with renal and patient survival are ill defined. We retrospectively studied a nationwide cohort of 255 patients, with biopsy-proven LCDD (n = 212) (including pure LCDD [n = 154], LCDD with cast nephropathy (CN) [n = 58]), HCDD (n = 23), or LHCDD (n = 20). Hematological diagnosis was monoclonal gammopathy of renal significance in 64% and symptomatic myeloma in 34%. Renal presentation was acute kidney injury in patients with LCCD and CN, and chronic glomerular disease in the other types, 35% of whom had symptomatic extrarenal (mostly hepatic and cardiac) involvement. Sequencing of 18 pathogenic LC showed high isoelectric point values of variable domain complementarity determining regions, possibly accounting for tissue deposition. Among 169 patients who received chemotherapy (bortezomib-based in 58%), 67% achieved serum free light chain (FLC) response, including very good partial response (VGPR) or above in 52%. Renal response occurred in 62 patients (36%), all of whom had achieved hematological response. FLC response ≥ VGPR and absence of severe interstitial fibrosis were independent predictors of renal response. This study highlights an unexpected frequency of extrarenal manifestations in MIDD. Rapid diagnosis and achievement of deep FLC response are key factors of prognosis.
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Abstract
Multiple myeloma is a malignant plasma cell disease, which typically affects older patients, with a median age at diagnosis of 70 years. The recent introduction of novel drugs and ongoing improvements in supportive care have significantly contributed to overall better management and outcomes for patients with multiple myeloma. Autologous stem-cell transplantation has been a standard part of therapy for myeloma patients for many years, first in younger patients and increasingly in older, and may still be considered in selected older patients with myeloma. In addition, in both newly diagnosed patients and in the relapsed/refractory setting, a number of novel agents tested in large phase III trials have yielded improvements in overall outcomes. As clinical trials under-enrol older patients and have stringent exclusion criteria, the data and results from them may not be generalizable to all older adults. In this review, we examine the treatment options for older adults with myeloma with a specific focus on the currently available data on novel agents in this cohort. The clinical efficacy and unique toxicity profile of each novel agent must be considered prior to the treatment plan in older adults.
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Waszczuk-Gajda A, Lewandowski Z, Drozd-Sokołowska J, Boguradzki P, Dybko J, Wróbel T, Basak GW, Jurczyszyn A, Mądry K, Snarski E, Frączak E, Charliński G, Feliksbrot-Bratosiewicz M, Król M, Matuszkiewicz-Rowińska J, Klinger M, Krajewska M, Augustyniak-Bartosik H, Kościelska M, Rusicka P, Dwilewicz-Trojaczek J, Wiktor Jędrzejczak W. Autologous peripheral blood stem cell transplantation in dialysis-dependent multiple myeloma patients-DAUTOS Study of the Polish Myeloma Study Group. Eur J Haematol 2018; 101:475-485. [DOI: 10.1111/ejh.13101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Anna Waszczuk-Gajda
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Zbigniew Lewandowski
- Department of Epidemiology and Biostatistics; Warsaw Medical University; Warsaw Poland
| | - Joanna Drozd-Sokołowska
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Piotr Boguradzki
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Jarosław Dybko
- Department and Clinic of Haematology, Blood Neoplasms and Bone Marrow Transplantation; Wroclaw Medical University; Warsaw Poland
| | - Tomasz Wróbel
- Department and Clinic of Haematology, Blood Neoplasms and Bone Marrow Transplantation; Wroclaw Medical University; Warsaw Poland
| | - Grzegorz Władysław Basak
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Artur Jurczyszyn
- Department of Haematology; Jagiellonian University; Kraków Poland
| | - Krzysztof Mądry
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Emilian Snarski
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Ewa Frączak
- Department and Clinic of Haematology, Blood Neoplasms and Bone Marrow Transplantation; Wroclaw Medical University; Warsaw Poland
| | - Grzegorz Charliński
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
- Department of Haematology; Nicolaus Copernicus Specialist Municipal Hospital; Toruń Poland
| | | | - Małgorzata Król
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | | | - Marian Klinger
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wrocław Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wrocław Poland
| | | | - Małgorzata Kościelska
- Department of Nephrology and Internal Diseases; Medical University of Warsaw; Warsaw Poland
| | - Patrycja Rusicka
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
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Augeul-Meunier K, Chretien ML, Stoppa AM, Karlin L, Benboubker L, Diaz JMT, Mohty M, Yakoub-Agha I, Bay JO, Perrot A, Bulabois CE, Huynh A, Mercier M, Frenzel L, Avet-Loiseau H, de Latour RP, Cornillon J. Extending autologous transplantation as first line therapy in multiple myeloma patients with severe renal impairment: a retrospective study by the SFGM-TC. Bone Marrow Transplant 2018. [DOI: 10.1038/s41409-018-0122-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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45
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Mahajan S, Tandon N, Kumar S. The evolution of stem-cell transplantation in multiple myeloma. Ther Adv Hematol 2018; 9:123-133. [PMID: 29713445 DOI: 10.1177/2040620718761776] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 02/06/2018] [Indexed: 12/11/2022] Open
Abstract
Autologous stem-cell transplantation (ASCT) remains an integral part of treatment for previously untreated, and may have value in the treatment of relapsed patients with, multiple myeloma (MM). The addition of novel agents like immunomodulators and proteasome inhibitors as induction therapy before and as consolidation/maintenance therapy after ASCT has led to an improvement in complete response (CR) rates, progression-free survival (PFS) and overall survival (OS). With advances in supportive care, older patients and patients with renal insufficiency are now able to safely undergo the procedure. The data concerning the timing of ASCT (early in the disease course or at first relapse), single versus tandem (double) ASCT and the role and duration of consolidation and maintenance therapy post ASCT remain conflicting. This review aims to discuss the evolution of stem-cell transplant over the past 3 decades and its current role in the context of newer, safer and more effective therapeutic agents.
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Affiliation(s)
| | - Nidhi Tandon
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Shaji Kumar
- Professor of Medicine, Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55906, USA
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Martini F, Buda G, Orciuolo E, Galimberti S, Mazziotta F, Petrini M. Plasma Cell Disorders and Dialysis-Dependent Renal Failure: Safety and Efficacy of Autologous Stem Cell Transplantation. Acta Haematol 2018; 139:101-103. [PMID: 29414797 DOI: 10.1159/000486359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022]
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47
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Amit O, Ram R. Autologous Hematopoietic Cell Transplantation for Dialysis-Dependent Myeloma: More Efficient, Less Toxic. Acta Haematol 2018; 139:104-105. [PMID: 29414800 DOI: 10.1159/000486890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/16/2018] [Indexed: 11/19/2022]
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48
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Auner HW, Iacobelli S, Sbianchi G, Knol-Bout C, Blaise D, Russell NH, Apperley JF, Pohlreich D, Browne PV, Kobbe G, Isaksson C, Lenhoff S, Scheid C, Touzeau C, Jantunen E, Anagnostopoulos A, Yakoub-Agha I, Tanase A, Schaap N, Wiktor-Jedrzejczak W, Krejci M, Schönland SO, Morris C, Garderet L, Kröger N. Melphalan 140 mg/m 2 or 200 mg/m 2 for autologous transplantation in myeloma: results from the Collaboration to Collect Autologous Transplant Outcomes in Lymphoma and Myeloma (CALM) study. A report by the EBMT Chronic Malignancies Working Party. Haematologica 2017; 103:514-521. [PMID: 29217776 PMCID: PMC5830386 DOI: 10.3324/haematol.2017.181339] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/01/2017] [Indexed: 12/22/2022] Open
Abstract
Melphalan at a dose of 200 mg/m2 is standard conditioning prior to autologous hematopoietic stem cell transplantation for multiple myeloma, but a dose of 140 mg/m2 is often used in clinical practice in patients perceived to be at risk of excess toxicity. To determine whether melphalan 200 mg/m2 and melphalan 140 mg/m2 are equally effective and tolerable in clinically relevant patient subgroups we analyzed 1964 first single autologous transplantation episodes using a series of Cox proportional-hazards models. Overall survival, progression-free survival, cumulative incidence of relapse, non-relapse mortality, hematopoietic recovery and second primary malignancy rates were not significantly different between the melphalan 140 mg/m2 (n=245) and melphalan 200 mg/m2 (n=1719) groups. Multivariable subgroup analysis showed that disease status at transplantation interacted with overall survival, progression-free survival, and cumulative incidence of relapse, with a significant advantage associated with melphalan 200 mg/m2 in patients transplanted in less than partial response (adjusted hazard ratios for melphalan 200 mg/m2versus melphalan 140 mg/m2: 0.5, 0.54, and 0.56). In contrast, transplantation in very good partial or complete response significantly favored melphalan 140 mg/m2 for overall survival (adjusted hazard ratio: 2.02). Age, renal function, prior proteasome inhibitor treatment, gender, or Karnofsky score did not interact with overall/progression-free survival or relapse rate in the melphalan dose groups. There were no significant survival or relapse rate differences between melphalan 200 mg/m2 and melphalan 140 mg/m2 patients with high-risk or standard-risk chromosomal abnormalities. In conclusion, remission status at the time of transplantation may favor the use of melphalan 200 mg/m2 or melphalan 140 mg/m2 for key transplant outcomes (NCT01362972).
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Affiliation(s)
| | | | - Giulia Sbianchi
- Department of Biology, Tor Vergata University of Rome, Italy
| | | | | | | | | | | | - Paul V Browne
- St. James's Hospital, Trinity College Dublin, Ireland
| | - Guido Kobbe
- Heinrich Heine Universität, Düsseldorf, Germany
| | | | | | | | | | | | | | | | | | - Nicolaas Schaap
- Radboud University Medical Centre, Nijmegen, the Netherlands
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Martino M, Recchia AG, Console G, Gentile M, Cimminiello M, Gallo GA, Ferreri A, Naso V, Irrera G, Messina G, Moscato T, Vigna E, Vincelli ID, Morabito F. Can we improve the conditioning regimen before autologous stem cell transplantation in multiple myeloma? Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1387050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Massimo Martino
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | | | - Giuseppe Console
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Massimo Gentile
- Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata, Cosenza, Italy
| | - Michele Cimminiello
- Hematology and Stem Cell Transplantation Unit, “S. Carlo” Hospital, Potenza, Italy
| | - Giuseppe Alberto Gallo
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Anna Ferreri
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Virginia Naso
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Giuseppe Irrera
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Giuseppe Messina
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Tiziana Moscato
- Stem Cell Transplant Unit, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Ernesto Vigna
- Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata, Cosenza, Italy
| | - Iolanda Donatella Vincelli
- Hematology, Department of Onco-Hematology and Radiotherapy, Great Metropolitan Hospital BMM, Reggio, Italy
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50
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Waszczuk-Gajda A, Drozd-Sokołowska J, Boguradzki P, Dybko J, Wróbel T, Basak GW, Mądry K, Snarski E, Charliński G, Frączak E, Matuszkiewicz-Rowińska J, Klinger M, Augustyniak-Bartosik H, Krajewska M, Żebrowski P, Król M, Urbanowska E, Jurczyszyn A, Taszner M, Jędrzejczak WW, Dwilewicz-Trojaczek J. Stem cell mobilization in patients with dialysis-dependent multiple myeloma: Report of the Polish Myeloma Study Group. J Clin Apher 2017; 33:249-258. [DOI: 10.1002/jca.21584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Anna Waszczuk-Gajda
- Department of Hematology, Oncology, and Internal Medicine; Warsaw Medical University; Warsaw Poland
| | - Joanna Drozd-Sokołowska
- Department of Hematology, Oncology, and Internal Medicine; Warsaw Medical University; Warsaw Poland
| | - Piotr Boguradzki
- Department of Hematology, Oncology, and Internal Medicine; Warsaw Medical University; Warsaw Poland
| | - Jarosław Dybko
- Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation; Wroclaw Medical University; Wrocław Poland
| | - Tomasz Wróbel
- Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation; Wroclaw Medical University; Wrocław Poland
| | - Grzegorz Władysław Basak
- Department of Hematology, Oncology, and Internal Medicine; Warsaw Medical University; Warsaw Poland
| | - Krzysztof Mądry
- Department of Hematology, Oncology, and Internal Medicine; Warsaw Medical University; Warsaw Poland
| | - Emilian Snarski
- Department of Hematology, Oncology, and Internal Medicine; Warsaw Medical University; Warsaw Poland
| | - Grzegorz Charliński
- Department of Hematology, Oncology, and Internal Medicine; Warsaw Medical University; Warsaw Poland
- Department of Hematology; Nicolaus Copernicus Specialist Municipal Hospital; Toruń Poland
| | - Ewa Frączak
- Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation; Wroclaw Medical University; Wrocław Poland
| | | | - Marian Klinger
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wrocław Poland
| | | | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wrocław Poland
| | - Paweł Żebrowski
- Department of Nephrology and Internal Medicine; Medical University of Warsaw; Warsaw Poland
| | - Maria Król
- Department of Hematology, Oncology, and Internal Medicine; Warsaw Medical University; Warsaw Poland
| | - Elżbieta Urbanowska
- Department of Hematology, Oncology, and Internal Medicine; Warsaw Medical University; Warsaw Poland
| | - Artur Jurczyszyn
- Department of Hematology; Jagiellonian University; Kraków Poland
| | - Michał Taszner
- Department of Hematology and Bone Marrow Transplantation; Medical University of Gdańsk; Gdańsk Poland
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