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Alnasser SM, Alharbi KS, Almutairy AF, Almutairi SM, Alolayan AM. Autologous Stem Cell Transplant in Hodgkin's and Non-Hodgkin's Lymphoma, Multiple Myeloma, and AL Amyloidosis. Cells 2023; 12:2855. [PMID: 38132175 PMCID: PMC10741865 DOI: 10.3390/cells12242855] [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: 11/12/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Human body cells are stem cell (SC) derivatives originating from bone marrow. Their special characteristics include their capacity to support the formation and self-repair of the cells. Cancer cells multiply uncontrollably and invade healthy tissues, making stem cell transplants a viable option for cancer patients undergoing high-dose chemotherapy (HDC). When chemotherapy is used at very high doses to eradicate all cancer cells from aggressive tumors, blood-forming cells and leukocytes are either completely or partially destroyed. Autologous stem cell transplantation (ASCT) is necessary for patients in those circumstances. The patients who undergo autologous transplants receive their own stem cells (SCs). The transplanted stem cells first come into contact with the bone marrow and then undergo engraftment, before differentiating into blood cells. ASCT is one of the most significant and innovative strategies for treating diseases. Here we focus on the treatment of Hodgkin's lymphoma, non-Hodgkin's lymphoma, multiple myeloma, and AL amyloidosis, using ASCT. This review provides a comprehensive picture of the effectiveness and the safety of ASCT as a therapeutic approach for these diseases, based on the currently available evidence.
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Affiliation(s)
- Sulaiman Mohammed Alnasser
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.F.A.)
| | - Khalid Saad Alharbi
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.F.A.)
| | - Ali F. Almutairy
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia; (K.S.A.); (A.F.A.)
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2
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Freeman CL, Atkins R, Varadarajan I, Menges M, Edelman J, Baz R, Brayer J, Castaneda Puglianini O, Ochoa-Bayona JL, Nishihori T, Shain KH, Shah B, Chen DT, Kelley L, Coppola D, Alsina M, Antonia S, Anasetti C, Locke FL. Survivin Dendritic Cell Vaccine Safely Induces Immune Responses and Is Associated with Durable Disease Control after Autologous Transplant in Patients with Myeloma. Clin Cancer Res 2023; 29:4575-4585. [PMID: 37735756 DOI: 10.1158/1078-0432.ccr-22-3987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/24/2023] [Accepted: 07/20/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE We investigated whether a dendritic cell (DC) vaccine transduced with an adenoviral vector encoded with full-length survivin (Ad-S), with mutations neutralizing its antiapoptotic function, could safely generate an immune response and deepen clinical responses when administered before and after autologous stem cell transplant (ASCT) for multiple myeloma. PATIENTS AND METHODS This phase I first-in-human trial (NCT02851056) evaluated the safety of DC:Ad-S in newly diagnosed multiple myeloma not having achieved complete response with induction, given 7 to 30 days prior to stem cell collection and 20 to 34 days after ASCT. Anti-survivin antibodies and CD4+ and CD8+ specific T cells were quantified. RESULTS A total of 14 patients were treated and 13 included in the primary efficacy analysis. No serious adverse events were attributed to DC:Ad-S vaccine. Detectable anti-survivin antibodies increased from baseline in 9 of 13 (69%) patients, and 11 of 13 (85%) mounted either a cellular or humoral immune response to survivin. Seven patients had an improved clinical response at day +90, all of whom had mounted an immune response, and 6 of 7 patients remain event-free at a median follow-up of 4.2 years. Estimated progression-free survival at 4 years is 71% (95% confidence interval, 41-88). CONCLUSIONS Two doses of DC:Ad-S, one given immediately before and another after ASCT, were feasible and safe. A high frequency of vaccine-specific immune responses was seen in combination with durable clinical outcomes, supporting ongoing investigation into the potential of this approach. See related commentary by Dhodapkar, p. 4524.
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Affiliation(s)
- Ciara L Freeman
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Reginald Atkins
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Indumathy Varadarajan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, University of Virginia, Charlottesville, Virginia
| | - Meghan Menges
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Jeffrey Edelman
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Rachid Baz
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Jason Brayer
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Omar Castaneda Puglianini
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Jose Leonel Ochoa-Bayona
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Kenneth H Shain
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Bijal Shah
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Dung Tsa Chen
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Linda Kelley
- Department of Immunology, Moffitt Cancer Center, Tampa, Florida
| | | | - Melissa Alsina
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Scott Antonia
- Department of Medicine, Duke University, Durham, North Carolina
| | - Claudio Anasetti
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | - Frederick L Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
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Kalff A, Khong T, Ramachandran M, Walker P, Schwarer A, Roberts AW, Campbell P, Filshie R, Norton S, Reynolds J, Young M, Pierceall W, Thakurta A, Guo M, Oppermann U, Wang M, Ren Y, Kennedy N, Parekh S, Spencer A. Cereblon pathway biomarkers and immune profiles in patients with myeloma receiving post-ASCT lenalidomide maintenance (LEOPARD). Leuk Lymphoma 2021; 62:2981-2991. [PMID: 34263697 DOI: 10.1080/10428194.2021.1948030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
LEOPARD was a single arm, phase II study of lenalidomide (LEN) and alternate day prednisolone maintenance in patients with newly diagnosed multiple myeloma (MM) following autologous stem cell transplantation (ASCT). Sixty patients were enrolled. Estimated median potential follow-up was 44 m, median PFS was 38.3 m, median OS was not reached (landmark 36 m OS: 71.4%). Correlative immunohistochemistry performed on pre-ASCT trephines demonstrated high MM tumor cereblon (total/cytoplasmic) was associated with superior OS (p = .045, p = .031, respectively), whereas high c-Myc was associated with inferior PFS (p = .04). Patients with high cereblon (total/nuclear) were more likely to improve depth of response, whereas patients with high c-Myc were less likely, suggesting alternative/more effective post-ASCT strategies for patients with high c-Myc need identification. Peripheral blood immune profiling (mass cytometry) informed a more sustained response to LEN maintenance, demonstrating enrichment of activated/cytotoxic NK cells and cytotoxic T cells in patients with durable responses, contrasting with enrichment of B-regs in early relapsers.
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Affiliation(s)
- Anna Kalff
- Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, Australia.,Myeloma Research Group, Australian Centre for Blood Diseases, Alfred Hospital-Monash University, Melbourne, Australia.,Department of Clinical Haematology, Monash University, Clayton, Australia
| | - Tiffany Khong
- Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, Australia.,Myeloma Research Group, Australian Centre for Blood Diseases, Alfred Hospital-Monash University, Melbourne, Australia
| | - Malarmathy Ramachandran
- Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, Australia.,Myeloma Research Group, Australian Centre for Blood Diseases, Alfred Hospital-Monash University, Melbourne, Australia
| | - Patricia Walker
- Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, Australia
| | | | - Andrew W Roberts
- Clinical Haematology Department, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | | | | | | | - John Reynolds
- Epidemiology and Preventive Medicine Department, Alfred Health - Monash University, Melbourne, Australia
| | - Mary Young
- Bristol-Myers Squibb Corporation, Summit, NJ, USA
| | | | | | - Manman Guo
- Botnar Research Centre, University of Oxford, Oxford, UK
| | - Udo Oppermann
- Botnar Research Centre, University of Oxford, Oxford, UK
| | - Maria Wang
- Bristol-Myers Squibb Corporation, Summit, NJ, USA
| | - Yan Ren
- Bristol-Myers Squibb Corporation, Summit, NJ, USA
| | - Nola Kennedy
- Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, Australia
| | - Samir Parekh
- Icahn School of Medicine, Mt Sinai Hospital, New York City, NY, USA
| | - Andrew Spencer
- Malignant Haematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, Australia.,Myeloma Research Group, Australian Centre for Blood Diseases, Alfred Hospital-Monash University, Melbourne, Australia.,Department of Clinical Haematology, Monash University, Clayton, Australia
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4
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Salvage autologous transplant and lenalidomide maintenance vs. lenalidomide/dexamethasone for relapsed multiple myeloma: the randomized GMMG phase III trial ReLApsE. Leukemia 2020; 35:1134-1144. [PMID: 32694619 DOI: 10.1038/s41375-020-0948-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 11/08/2022]
Abstract
The role of salvage high-dose chemotherapy and autologous stem cell transplantation (sHDCT/ASCT) for relapsed and/or refractory multiple myeloma (RRMM) in the era of continuous novel agent treatment has not been defined. This randomized, open-label, phase III, multicenter trial randomized patients with 1st-3rd relapse of multiple myeloma (MM) to a transplant arm (n = 139) consisting of 3 Rd (lenalidomide 25 mg, day 1-21; dexamethasone 40 mg, day 1, 8, 15, and 22; 4-week cycles) reinduction cycles, sHDCT (melphalan 200 mg/m2), ASCT, and lenalidomide maintenance (10 mg/day) or to a control arm (n = 138) of continuous Rd. Median PFS was 20.7 months in the transplant and 18.8 months in the control arm (HR 0.87; 95% CI 0.65-1.16; p = 0.34). Median OS was not reached in the transplant and 62.7 months in the control arm (HR 0.81; 95% CI 0.52-1.28; p = 0.37). Forty-one patients (29%) did not receive the assigned sHDCT/ASCT mainly due to early disease progression, adverse events, and withdrawal of consent. Multivariate landmark analyses from the time of sHDCT showed superior PFS and OS (p = 0.0087/0.0057) in patients who received sHDCT/ASCT. Incorporation of sHDCT/ASCT into relapse treatment with Rd was feasible in 71% of patients and did not significantly prolong PFS and OS on ITT analysis while patients who received sHDCT/ASCT may have benefitted.
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Holstein SA, Suman VJ, Owzar K, Santo K, Benson DM, Shea TC, Martin T, Silverman M, Isola L, Vij R, Cheson BD, Linker C, Anderson KC, Richardson PG, McCarthy PL. Long-Term Follow-up of CALGB (Alliance) 100001: Autologous Followed by Nonmyeloablative Allogeneic Transplant for Multiple Myeloma. Biol Blood Marrow Transplant 2020; 26:1414-1424. [PMID: 32325171 DOI: 10.1016/j.bbmt.2020.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 11/18/2022]
Abstract
CALGB (Alliance) 100001 was a phase II study evaluating autologous stem cell transplant (ASCT) followed by nonmyeloablative allogeneic stem cell transplant (alloSCT) in patients with multiple myeloma who had received no more than 18 months of prior therapy and had experienced no more than 1 prior progression event. Conditioning for ASCT was with high-dose melphalan (200 mg/m2). The alloSCT reduced-intensity conditioning (RIC) regimen consisted of fludarabine (30 mg/m2/d i.v. on days -7 through -3) and cyclophosphamide (1 g/m2/d i.v. on days -4 through -3). The primary objective was to determine the 6-month post-alloSCT treatment-related mortality (TRM) rate. Additional objectives included determining the proportion of patients who could complete this tandem ASCT-alloSCT approach in a cooperative group setting, overall response rates, rates of donor chimerism, rates of graft-versus-host disease (GVHD), disease-free survival, and overall survival (OS). Sixty patients were enrolled, of whom 57 (95%) completed ASCT and 49 (82%) completed tandem ASCT-alloSCT. The TRM rate was 2% (1/49; 90% confidence interval, 0.10% to 9.3%). Moderate to severe (grades 2 to 3) acute GVHD was observed in 13 of 49 alloSCT patients (27%). One patient died due to GVHD within 9 months of alloSCT. Twenty-seven of the 49 patients (55%) who underwent alloSCT reported chronic GVHD as either limited (15/49; 31%) or extensive (12/49; 24%) in the first year post-alloSCT and prior to the start of nonprotocol therapy for progressive disease. With a median follow-up for survival of 11 years, the median OS time is 6.6 years and the median time to disease progression is 3.6 years. Similar to other studies, this study confirmed that tandem ASCT/alloSCT is associated with durable disease control in a subset of patients. This study demonstrated the feasibility of performing tandem ASCT/alloSCT in a cooperative group setting and determined that a fludarabine/cyclophosphamide RIC regimen is associated with a very low TRM rate.
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Affiliation(s)
| | - Vera J Suman
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Kouros Owzar
- Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Katelyn Santo
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Don M Benson
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Thomas C Shea
- UNC Lineberger Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Thomas Martin
- University of California at San Francisco, San Francisco, California
| | | | - Luis Isola
- Mount Sinai School of Medicine, New York, New York
| | - Ravi Vij
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Charles Linker
- University of California at San Francisco, San Francisco, California
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Abstract
PURPOSE OF REVIEW While the traditional gold standard for demonstrating clinical benefit of a therapy has been to show prolongation of overall survival (OS), there are multiple factors which can hinder the use of OS as a primary endpoint in randomized clinical trials (RCTs). Here, we analyze recent myeloma RCTs and evaluate the issues relevant to current and future myeloma RCT design. RECENT FINDINGS A review of recent phase III RCTs that led to approval of new agents/combinations reveals that none were designed with OS as the primary endpoint, but instead utilized time to progression (TTP) or progression-free survival (PFS). These studies illuminate the inherent difficulties of designing trials with the primary endpoint of OS/PFS in a disease characterized by increasingly prolonged survival times, availability of effective salvage therapies, and competing events such as co-morbid conditions. Alternative primary endpoints other than OS or PFS need to be developed for future myeloma RCTs. Validated surrogate endpoints with novel clinical trial designs will help improve the feasibility of conducting comparative clinical trials in a timely manner.
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7
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Rosenberg AS, Brunson A, Jonas BA, Keegan THM, Wun T. Association Between Autologous Stem Cell Transplant and Survival Among Californians With Multiple Myeloma. J Natl Cancer Inst 2020; 111:78-85. [PMID: 29897481 DOI: 10.1093/jnci/djy073] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/16/2018] [Indexed: 12/22/2022] Open
Abstract
Background Autologous hematopoietic stem cell transplant (aHSCT) is an efficacious treatment for newly diagnosed multiple myeloma patients. However, as rapid advances have resulted in other highly efficacious and less intensive therapies, the role of aHSCT has been questioned. Methods We utilized population-based data to identify 13 494 newly diagnosed patients younger than age 80 years between 1998 and 2012. Patient characteristics of aHSCT and non-aHSCT groups were balanced using inverse probability weighting of a propensity score predicting aHSCT use. Multivariable models adjusted for baseline comorbidities, demographics, and socioeconomic status estimated the adjusted hazard ratio (aHR) and 95% confidence intervals (CIs) of death. Results Twenty point eight percent (2807) of patients underwent aHSCT, and this rate increased over time from 15.4% in 1998-2002 to 23.9% in 2008-2012. aHSCT was utilized among 37.6% and 11.5% of patients younger than age 60 years and 60 to 79 years, respectively. The median time to aHSCT was 9.4 months, and 89% of all aHSCTs occurred within two years of diagnosis. The median overall survival from time of aHSCT was 72.9 months (95% confidence interval [CI] = 68 to 78). Autologous HSCT at any time was associated with improved survival (aHR = 0.83, 95% CI = 0.75 to 0.92). Among aHSCT recipients, transplant more than 12 months after diagnosis (vs ≤12 months) was associated with worse survival (aHR = 1.33, 95% CI = 1.16 to 1.51). The positive effect of aHSCT on overall survival was similar across study time periods and age groups. Conclusion In the era of highly efficacious induction therapies, aHSCT remained infrequently used but continued to be associated with improved survival for multiple myeloma patients and should be considered for newly diagnosed patients.
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Affiliation(s)
- Aaron S Rosenberg
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California, Davis School of Medicine, Sacramento, CA.,University of California, Davis Comprehensive Cancer Center, Sacramento, CA
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California, Davis School of Medicine, Sacramento, CA
| | - Brian A Jonas
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California, Davis School of Medicine, Sacramento, CA.,University of California, Davis Comprehensive Cancer Center, Sacramento, CA.,VA Northern California Health Care System, Sacramento, CA
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California, Davis School of Medicine, Sacramento, CA.,University of California, Davis Comprehensive Cancer Center, Sacramento, CA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, University of California, Davis School of Medicine, Sacramento, CA.,University of California, Davis Comprehensive Cancer Center, Sacramento, CA.,VA Northern California Health Care System, Sacramento, CA
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Kumar L, Ramavath D, Kataria B, Tiwari A, Raj A, Chellapuram SK, Mookerjee A, Sahoo RK, Malik PS, Sharma A, Gupta R, Sharma OD, Biswas A, Kumar R, Thulkar S. High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome. Indian J Med Res 2020; 149:730-739. [PMID: 31496525 PMCID: PMC6755776 DOI: 10.4103/ijmr.ijmr_1593_18] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background & objectives Survival of patients with multiple myeloma (MM) has improved in the past two decades following use of novel agents and autologous stem cell transplantation. To determine predictors of long-term outcome, data of MM patients who underwent autologous stem cell transplantation (ASCT) at a tertiary care centre in north India were retrospectively analyzed. Methods Between 1995 and 2016, 349 MM patients underwent ASCT. Patients' median age was 52 yr, ranging from 29 to 68 yr, 68.2 per cent were males. Thirty three per cent patients had international staging system (ISS) Stage III and 68.5 per cent had received novel agents-based induction. High-dose melphalan (200 mg/m2) was used for conditioning; patients with renal insufficiency (estimated glomerular filtration rate <40 ml/min) received melphalan 140-150 mg/m2. Results Post-transplant, 317 of 349 (90.8%) patients responded; complete [complete response (CR)] -213 (61%)], very good partial response (VGPR) -62 (17.8%) and PR in 42 (12%)]. Induction with novel agents, pre-transplant chemosensitive disease, transplant in first remission and serum albumin (≥3.5 g/dl) were predictors of significant response. At a median follow up of 73 months, median overall survival (OS) was 90 months [95% confidence interval (CI) 70.8-109.2], and progression-free survival (PFS) was 41 months (95% CI 33.0-49.0). On multivariate analysis, achievement of CR post-transplant, transplant in first remission, ISS Stages I and II (vs. III), absence of extramedullary disease and serum albumin ≥3.5 g/dl were predictors of prolonged OS. For PFS, achievement of post-transplant CR and transplant in first remission were predictors of superior outcome. Interpretation & conclusions Treatment with novel agents, achievement of complete remission post-transplant, ISS Stages I and II, absence of extramedullary disease and transplant in first remission were predictors of long-term survival for patients with MM.
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Affiliation(s)
- Lalit Kumar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Dev Ramavath
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Babita Kataria
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Tiwari
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Raj
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Santosh Kumar Chellapuram
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Anjali Mookerjee
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat S Malik
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Laboratory Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Om Dutt Sharma
- Department of Laboratory Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radio-diagnosis, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Bair SM, Brandstadter JD, Ayers EC, Stadtmauer EA. Hematopoietic stem cell transplantation for blood cancers in the era of precision medicine and immunotherapy. Cancer 2020; 126:1837-1855. [PMID: 32073653 DOI: 10.1002/cncr.32659] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/08/2019] [Accepted: 09/19/2019] [Indexed: 01/12/2023]
Abstract
Hematopoietic stem cell transplantation (HCT) has been an integral component in the treatment of many hematologic malignancies. Since the development of HCT nearly 50 years ago, the role of this modality has evolved as newer treatment approaches have been developed and integrated into the standard of care. In the last decade, novel and highly active targeted therapies and immunotherapies have been approved for many hematologic malignancies, raising the question of whether HCT continues to retain its prominent role in the treatment paradigms of various hematologic malignancies. In this review, the authors have described the current role of autologous and allogeneic HCT in the treatment of patients with acute leukemias, aggressive B-cell lymphomas, and multiple myeloma and discussed how novel targeted therapies and immunotherapies have changed the potential need, timing, and goal of HCT in patients with these diseases.
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Affiliation(s)
- Steven M Bair
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua D Brandstadter
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily C Ayers
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edward A Stadtmauer
- Division of Hematology-Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Li T, Timmins HC, King T, Kiernan MC, Goldstein D, Park SB. Characteristics and risk factors of bortezomib induced peripheral neuropathy: A systematic review of phase III trials. Hematol Oncol 2020; 38:229-243. [DOI: 10.1002/hon.2706] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Tiffany Li
- Brain and Mind Centre Faculty of Medicine and Health, The University of Sydney Camperdown New South Wales Australia
| | - Hannah C. Timmins
- Brain and Mind Centre Faculty of Medicine and Health, The University of Sydney Camperdown New South Wales Australia
| | - Tracy King
- Cancer Nursing Research Unit University of Sydney Sydney New South Wales Australia
- Institute of Haematology Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Matthew C. Kiernan
- Brain and Mind Centre Faculty of Medicine and Health, The University of Sydney Camperdown New South Wales Australia
- Institute of Clinical Neurosciences Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - David Goldstein
- Prince of Wales Clinical School University of New South Wales Kensington New South Wales Australia
- Prince of Wales Hospital Randwick New South Wales Australia
| | - Susanna B. Park
- Brain and Mind Centre Faculty of Medicine and Health, The University of Sydney Camperdown New South Wales Australia
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11
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A comparative effectiveness study of lipegfilgrastim in multiple myeloma patients after high dose melphalan and autologous stem cell transplant. Ann Hematol 2019; 99:331-341. [PMID: 31853703 DOI: 10.1007/s00277-019-03901-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/11/2019] [Indexed: 12/16/2022]
Abstract
G-CSF administration after high-dose chemotherapy and autologous stem cell transplantation (ASCT) has been shown to expedite neutrophil recovery. Several studies comparing filgrastim and pegfilgrastim in the post-ASCT setting concluded that the two are at least equally effective. Lipegfilgrastim (LIP) is a new long-acting, once-per-cycle G-CSF. This multicentric, prospective study aimed to describe the use of LIP in multiple myeloma patients receiving high-dose melphalan and autologous stem cell transplantation (ASCT) and compare LIP with historic controls of patients who received short-acting agent (filgrastim [FIL]). Overall, 125 patients with a median age of 60 years received G-CSF after ASCT (80 patients LIP on day 1 post-ASCT and 45 patients FIL on day 5 post-ASCT). The median duration of grade 4 neutropenia (absolute neutrophil count [ANC] < 0.5 × 10 [9]/L) was 5 days in both LIP and FIL groups, whereas the median number of days to reach ANC ≥ 0.5 × 10 [9]/L was 10% lower in the LIP than in the FIL group (10 vs 11 days), respectively. Male sex was significantly associated with a faster ANC ≥ 0.5 × 10 [9] L response (p = 0.015). The incidence of FN was significantly lower in the LIP than in the FIL group (29% vs 49%, respectively, p = 0.024). The days to discharge after ASCT infusion were greater in patients with FN (p < 0.001). The study indicates that LIP had a shorter time to ANC recovery and is more effective than FIL for the prevention of FN in the ASCT setting.
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Martino M, Rossi M, Ferreri A, Loteta B, Morabito A, Moscato T, Console G, Innao V, Naso V, Provenzano PF, Recchia AG, Gentile M. Quality of life outcomes in multiple myeloma patients: a summary of recent clinical trials. Expert Rev Hematol 2019; 12:665-684. [PMID: 31251688 DOI: 10.1080/17474086.2019.1634541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Management of multiple myeloma (MM) has improved over recent years. Health-related quality of life (HRQoL) data is becoming increasingly important, owing to improved survival outcomes. Areas covered: The authors performed an expert review of the literature to identify evidence-based data available on HRQoL in frontline and relapsed/refractory MM (RRMM) patients. Expert opinion: De-novo patients should be informed that the HRQoL is expected to improve during first-line treatment with different degrees of possible deterioration during the first cycles. Achievement of a maximal response should be strongly considered, particularly in the frontline setting, but must also be balanced with tolerability, HRQoL, and patient preferences. The same degree of improvement in HRQoL cannot be expected during conventional relapse treatments, where patients should be prepared only for stabilization of HRQoL. However, focusing attention only on measures such as toxicity may provide just a partial view of overall treatment effectiveness. Nonetheless, the authors believe the added value of taking into consideration the patient's perspectives and the importance of patient-reported outcomes in the evaluation of treatment effects should be considered mandatory. The incorporation of quality of life assessment into clinical and research practice has the potential of improving treatment outcomes.
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Affiliation(s)
- Massimo Martino
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Marco Rossi
- b Department of Experimental and Clinical Medicine, Magna Græcia University , Catanzaro , Italy
| | - Anna Ferreri
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Barbara Loteta
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Antonella Morabito
- c Pharmacy Unit, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Tiziana Moscato
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Giuseppe Console
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Vanessa Innao
- d Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina , Messina , Italy
| | - Virginia Naso
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Pasquale Fabio Provenzano
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Anna Grazia Recchia
- e Department of Hematology, Unità di Ricerca Biotecnologica (URB) , Cosenza , Italy
| | - Massimo Gentile
- f Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata , Cosenza , Italy
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Holstein SA, Ye JC, Howard A, Bhutani M, Gormley N, Hahn T, Hillengass J, Krishnan A, Landgren CO, Munshi NC, Oliva S, Owen RG, Pasquini MC, Puig N, Weinhold N, Weisel K, McCarthy PL. Summary of the Second Annual BMT CTN Myeloma Intergroup Workshop on Minimal Residual Disease and Immune Profiling. Biol Blood Marrow Transplant 2019; 25:e89-e97. [PMID: 30408566 PMCID: PMC6445685 DOI: 10.1016/j.bbmt.2018.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/01/2018] [Indexed: 12/18/2022]
Abstract
The second annual Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Myeloma Intergroup Workshop on Minimal Residual Disease and Immune Profiling was convened on December 7, 2017, at the American Society of Hematology (ASH) meeting. During this workshop, investigators from around the world presented their latest research involving assessment of minimal residual disease (MRD) and immune profiling (IP) in myeloma. This document summarizes the workshop presentations as well as relevant ASH abstracts and focuses on the regulatory issues involved in the integration of MRD and IP assessment in clinical trial design and practice.
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Affiliation(s)
- Sarah A Holstein
- Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, Nebraska.
| | - J Christine Ye
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
| | - Alan Howard
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Manisha Bhutani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Charlotte, North Carolina
| | - Nicole Gormley
- US Food and Drug Administration, Silver Spring, Maryland
| | - Theresa Hahn
- The Transplant & Cellular Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Jens Hillengass
- The Transplant & Cellular Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Amrita Krishnan
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - C Ola Landgren
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nikhil C Munshi
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Center for Multiple Myeloma Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stefania Oliva
- Division of Hematology, Myeloma Unit, University of Torino, Torino, Italy
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service, St James's Institute of Oncology, Leeds, United Kingdom
| | - Marcelo C Pasquini
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Noemi Puig
- Department of Hematology, Universit Hospital of Salamanca, Salamanca, Spain
| | - Niels Weinhold
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Katja Weisel
- Department of Hematology, Oncology, Immunology and Rheumatology, Universitatsklinikum Tubingen, Tubingen, Germany
| | - Philip L McCarthy
- The Transplant & Cellular Therapy Center, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Efficacy and safety of autologous stem cell transplantation in patients aged ≥ 65 years with multiple myeloma in the era of novel agents. Bone Marrow Transplant 2019; 54:1595-1604. [PMID: 30783208 DOI: 10.1038/s41409-019-0478-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 12/17/2022]
Abstract
Clinical trials evaluating the role of autologous hematopoietic stem cell transplantation (auto-HCT) in multiple myeloma have mostly included patients aged <65 years. Therefore, this study was aimed to evaluate the efficacy and safety of auto-HCT in elderly patients with multiple myeloma in the era of novel agents. We retrospectively analyzed 2056 patients with multiple myeloma, who underwent auto-HCT in 2007-2014 (287 were aged ≥65 years). We evaluated the 100-day treatment-related mortality (TRM) and overall survival (OS) in two groups; elderly patients ( ≥65 years) who underwent auto-HCT compared with younger patients ( <65 years). In the propensity score-matched-pair analysis used to adjust for possible selection bias, the incidence of 100-day TRM between patients aged <65 (0.4%; 95% confidence interval [CI]: 0.0-2.0%) and ≥65 years (1.2%; 95% CI: 0.3-3.1%) showed no statistically significant difference (p = 0.31). The probability of the 5-year OS after transplantation in those aged <65 (62.5%; 95% CI: 58.6-66.1%) and ≥65 (63.5%; 95% CI: 52.2-72.7%) years was also not significantly different (p = 0.56). This study showed that the safety and efficacy of auto-HCT in elderly patients with multiple myeloma in the era of novel agents compared with younger patients were similar.
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Su B, Zhu X, Jiang Y, Wang L, Zhao N, Ran X, Zheng X, Guo H. A meta-analysis of autologous transplantation for newly diagnosed multiple myeloma in the era of novel agents. Leuk Lymphoma 2018; 60:1381-1388. [PMID: 30516074 DOI: 10.1080/10428194.2018.1543874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To evaluate the role of high-dose melphalan plus autologous stem-cell transplantation (ASCT) as consolidation therapy for patients with newly diagnosed multiple myeloma (NDMM) in the era of novel agents, we undertook this meta-analysis. Medline, Embase, the Cochrane controlled trials register, the SCI, ASH, EHA, and ASCO were searched for clinical trials including high-dose chemotherapy plus ASCT for patients with NDMM. Finally, we identified four RCTs of ASCT versus novel agents based consolidations, and 10 single-arm prospective trials of ASCT alone. Pooled analysis indicated that response quality improved further after ASCT in the era of novel agents (≥CR rates of 13% pre-ASCT versus 29% post-ASCT, p = .003). When compared to novel agents containing consolidation regimens, high-dose chemotherapy plus ASCT significantly improved progression-free survival (PFS) (HR =0.56, p < .001). No significant difference in overall survival (OS) was found between them (HR =0.66, p = .22). Of note, subgroup analysis indicated that ASCT could significantly improve OS (HR =0.49, p = .0004) when compared to alkylating agent-based regimens plus lenalidomide consolidation. In summary, response quality and PFS improved further over ASCT in the era of novel agents. ASCT could improve survival than alkylating agent-based regimens plus lenalidomide consolidations for patients with NDMM.
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Affiliation(s)
- Baohua Su
- a Department of Hematology , Weifang People's Hospital , Weifang , China
| | - Xu Zhu
- a Department of Hematology , Weifang People's Hospital , Weifang , China
| | - Yina Jiang
- b Department of Ultrasonography , Weifang People's Hospital , Weifang , China
| | - Lida Wang
- c E.N.T. Department , Weifang People's Hospital , Weifang , China
| | - Ningning Zhao
- a Department of Hematology , Weifang People's Hospital , Weifang , China
| | - Xuehong Ran
- a Department of Hematology , Weifang People's Hospital , Weifang , China
| | - Xiaobin Zheng
- d Department of Respiration , The Fifth Affiliated Hospital Sun Yat-sen University , Zuhai , China
| | - Hui Guo
- e Department of Neurosurgery , Weifang People's Hospital , Weifang , China
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González-Calle V, Slack A, Keane N, Luft S, Pearce KE, Ketterling RP, Jain T, Chirackal S, Reeder C, Mikhael J, Noel P, Mayo A, Adams RH, Ahmann G, Braggio E, Stewart AK, Bergsagel PL, Van Wier SA, Fonseca R. Evaluation of Revised International Staging System (R-ISS) for transplant-eligible multiple myeloma patients. Ann Hematol 2018; 97:1453-1462. [DOI: 10.1007/s00277-018-3316-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
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17
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Cavo M, Terpos E, Bargay J, Einsele H, Cavet J, Greil R, de Wit E. The multiple myeloma treatment landscape: international guideline recommendations and clinical practice in Europe. Expert Rev Hematol 2018; 11:219-237. [PMID: 29415570 DOI: 10.1080/17474086.2018.1437345] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Guidelines provide recommendations on the management of multiple myeloma (MM), but there are no standard algorithms for the choice and sequencing of treatments. As a result, there is widespread variation in the interpretation and implementation of these guidelines. Areas covered: This review will cover: the real-world data on MM treatment patterns; the approved agents available for the treatment of MM; a comparative summary of the national and international clinical guidelines; a discussion on the impact reimbursement decisions have on treatment availability. Expert commentary: In the future, treatment choices may become even more complex as clonal heterogeneity is better understood in the context of response to treatment, and next-generation agents become available. Although information on real-world practice patterns can provide further guidance, to date, few studies have generated data on patients treated with the newer agents in real-world settings. Furthermore, the translation of guideline recommendations into clinical practice across Europe is inconsistent. Additional real-world data are therefore vital to understanding current clinical practice patterns, so that new agents can be effectively incorporated into existing treatment strategies. Such information may aid the development of better guidance, which will ultimately help to ensure that patients receive the best possible care.
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Affiliation(s)
- Michele Cavo
- a "Seràgnoli" Institute of Hematology and Medical Oncology , Bologna University School of Medicine , Bologna , Italy
| | - Evangelos Terpos
- b Department of Clinical Therapeutics , National and Kapodistrian University of Athens School of Medicine , Athens , Greece
| | - Joan Bargay
- c Department of Hematology and Hemotherapy , Hospital Son Llàtzer , Mallorca , Spain
| | - Hermann Einsele
- d Julius-Maximilians-University of Würzburg, and Department of Internal Medicine II , University Hospital Würzburg , Würzburg , Germany
| | - Jim Cavet
- e Consultant Hematologist , Christie National Health Service Foundation Trust , Manchester , UK.,f University of Manchester , Manchester , UK
| | - Richard Greil
- g University Clinic for Internal Medicine III, and Laboratory of Immunological and Molecular Cancer Research (LIMCR), Third Medical Department , Paracelsus Medical University, and Salzburg Cancer Research Institute , Salzburg , Austria
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Tan D, Lee JH, Chen W, Shimizu K, Hou J, Suzuki K, Nawarawong W, Huang SY, Sang Chim C, Kim K, Kumar L, Malhotra P, Chng WJ, Durie B. Recent advances in the management of multiple myeloma: clinical impact based on resource-stratification. Consensus statement of the Asian Myeloma Network at the 16th international myeloma workshop. Leuk Lymphoma 2018; 59:2305-2317. [PMID: 29390932 DOI: 10.1080/10428194.2018.1427858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Predicated on our improved understanding of the disease biology, we have seen remarkable advances in the management of multiple myeloma over the past few years. Recently approved drugs have radically transformed the treatment paradigm and improved survivals of myeloma patients. The progress has necessitated revision of the diagnostic criteria, risk-stratification and response definition. The huge disparities in economy, healthcare infrastructure and access to novel drugs among different Asian countries will hinder the delivery of optimum myeloma care to patients managed in resource-constrained environments. In the light of the tremendous recent changes and evolution in myeloma management, it is timely that the resource-stratified guidelines from the Asian Myeloma Network be revised to provide updated recommendations for Asia physicians practicing under various healthcare reimbursement systems. This review will highlight the most recent advances and our recommendations on how they could be integrated in both resource-abundant and resource-constrained facilities.
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Affiliation(s)
- Daryl Tan
- a Raffles Cancer Center , Raffles Hospital , Singapore.,b Department of Hematology , Singapore General Hospital , Singapore
| | - Jae Hoon Lee
- c Gil Hospital, Gachon University , Incheon , South Korea
| | - Wenming Chen
- d Beijing Chaoyang Hospital, Capital Medical University , Beijing , China
| | - Kazuyuki Shimizu
- e Higashi Nagoya National Hospital , National Hospital Organization , Nagoya , Japan
| | - Jian Hou
- f Department of Haematology , Changzheng Hospital, The Second Military Medical University , Shanghai , China
| | - Kenshi Suzuki
- g Department of Hematology , Japanese Red Cross Medical Center , Tokyo , Japan
| | | | | | - Chor Sang Chim
- j Queen Mary Hospital, University of Hong Kong , Hong Kong , China
| | - Kihyun Kim
- k Samsung Medical Center , Sungkyunkwan University , Seoul , South Korea
| | - Lalit Kumar
- l Department of Medical Oncology , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences , New Delhi , India
| | - Pankaj Malhotra
- m Department of Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Wee Joo Chng
- n Cancer Science Institute of Singapore , National University of Singapore , Singapore.,o Department of Haematology-Oncology , National University Cancer Institute of Singapore National University Health System , Singapore
| | - Brian Durie
- p Cedars-Sinai Comprehensive Cancer Center , Los Angeles , CA , USA
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19
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Abstract
Multiple myeloma (MM) is a malignancy of terminally differentiated B cells/plasma cells and is primarily located in the bone marrow. Symptomatic multiple myeloma typically presents with osteolyses, anemia, reduced renal function, and/or hypercalcemia. In the case of such MM-related end organ damage, urgent systemic treatment is indicated. In order to prevent end organ damage, current guidelines now recommend treatment initiation already when certain biomarkers are met. Current first-line treatment is based on proteasome inhibition and immunomodulation. Eligible patients still benefit from the addition of high-dose chemotherapy and autologous stem cell transplantation. Radiotherapy and orthopedic interventions play an important role in the treatment of localized skeletal complications. For relapsed MM, five novel agents have been approved in Europe during the last two years. These are second-generation proteasome inhibitors (carfilzomib, ixazomib) as well as first-in-class monoclonal antibodies (daratumumab, elotuzumab) and a histone deacetylase inhibitor (panobinostat). Triple combinations based on the established regimens lenalidomide/dexamethasone and bortezomib/dexamethasone plus one of the novel agents have been shown to significantly prolong progression-free survival. Median overall survival of patients with MM has doubled since the turn of the millennium.
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Affiliation(s)
- M-A Baertsch
- Medizinische Klinik V, Universitätsklinikum Heidelberg, INF 410, 69120, Heidelberg, Deutschland.
| | - H Goldschmidt
- Medizinische Klinik V, Universitätsklinikum Heidelberg, INF 410, 69120, Heidelberg, Deutschland. .,Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg, Heidelberg, Deutschland.
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Sivaraj D, Bacon W, Long GD, Rizzieri DA, Horwitz ME, Sullivan KM, Kang Y, Li Z, Chao NJ, Gasparetto C. High-dose BCNU/Melphalan conditioning regimen before autologous stem cell transplantation in newly diagnosed multiple myeloma. Bone Marrow Transplant 2017; 53:34-38. [DOI: 10.1038/bmt.2017.208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/08/2017] [Accepted: 08/16/2017] [Indexed: 01/31/2023]
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Zannetti BA, Tacchetti P, Pantani L, Gamberi B, Tosi P, Rocchi S, Cellini C, Ronconi S, Pezzi A, Mancuso K, Rizzello I, Caratozzolo I, Martello M, Dozza L, Cavo M, Zamagni E. Novel agent-based salvage autologous stem cell transplantation for relapsed multiple myeloma. Ann Hematol 2017; 96:2071-2078. [PMID: 29063955 DOI: 10.1007/s00277-017-3140-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a standard frontline therapy for multiple myeloma (MM). Therapeutic options for patients with relapsed MM after ASCT include novel agents in different combos, salvage ASCT (sASCT), and allogeneic transplant, with no unique standard of care. We retrospectively analyzed 66 MM patients who relapsed after up-front single or double ASCT(s) and received novel agent-based sASCT at five Italian centers. Median event-free survival from up-front ASCT(s) to first relapse (EFS1) was 44 months. Seventy-three percent of patients received sASCT at first disease progression. Re-induction regimens were bortezomib based in 87% of patients. Response to re-induction therapy included complete response (CR) 18%, ≥ very good partial response (VGPR) 48%, and overall response rate (ORR) 83%. Response to sASCT included CR 44%, ≥ VGPR 77%, and ORR 94%. With a median follow-up of 24 months after sASCT, 39 patients experienced disease progression. Median EFS from sASCT (EFS2) was 17 months. Median overall survival from ASCT (OS1) and sASCT (OS2) was 166 and 43 months, respectively. EFS2 and OS2 were significantly shorter in patients with EFS1 ≤ 24 months, in patients who did not receive sASCT at first disease progression and in patients with extramedullary disease (EMD). In multivariate analysis, EFS1 ≤ 24 months was associated with shorter EFS2 and OS2, EMD was associated with shorter EFS2, and < CR after sASCT was associated with shorter OS2. Novel agent-based sASCT is a safe and effective procedure for relapsed MM.
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Affiliation(s)
- Beatrice Anna Zannetti
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Paola Tacchetti
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lucia Pantani
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Barbara Gamberi
- Hematology Unit, "Arcispedale Santa Maria Nuova - IRCCS" Hospital, Reggio Emilia, Italy
| | | | - Serena Rocchi
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Claudia Cellini
- Hematology Unit, "S. Maria delle Croci" Hospital, Ravenna, Italy
| | - Sonia Ronconi
- Oncology and Hematology Unit, "Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori" Hospital, Meldola, Italy
| | - Annalisa Pezzi
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Katia Mancuso
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Ilaria Rizzello
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Isola Caratozzolo
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Marina Martello
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Luca Dozza
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Michele Cavo
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Elena Zamagni
- "Seràgnoli" Institute of Hematology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
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Abstract
PURPOSE OF REVIEW New risk stratification systems and treatment strategies have been introduced in recent years. We aim to provide an overview of these recent changes and summarise these data in a concise article that would be useful for clinicians. RECENT FINDINGS Apart from clinical stage, disease genetics are now recognised as important prognostic risk factors, and various new cytogenetic changes with negative prognostic impact have been identified. New technologies such as minimal residual disease detection are also playing an important role in prognostic assessment. Recent introduction of combination therapy with proteasome inhibitors and immunomodulatory drugs is showing promising results in high-risk patients and may partially abrogate the negative impact associated with some of the adverse risk factors. Recent advance has improved our understanding of high-risk multiple myeloma, and new therapeutic agents are now coming through the pipeline for this patient group with once dismal outcome.
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Affiliation(s)
- Henry S H Chan
- Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Christine I Chen
- Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Donna E Reece
- Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
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23
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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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Prognostic implications of abnormalities of chromosome 13 and the presence of multiple cytogenetic high-risk abnormalities in newly diagnosed multiple myeloma. Blood Cancer J 2017; 7:e600. [PMID: 28862698 PMCID: PMC5709752 DOI: 10.1038/bcj.2017.83] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 12/26/2022] Open
Abstract
Fluorescence in situ hybridization evaluation is essential for initial risk stratification in multiple myeloma. While the presence of specific cytogenetic high-risk abnormalities (HRA) is known to confer a poor prognosis, less is known about the cumulative effect of multiple HRA. We studied 1181 patients with newly diagnosed multiple myeloma who received novel agents as first-line therapy. High-risk abnormalities were defined as t(4;14), t(14;16), t(14;20) and del(17p). There were 884 patients (75%) without any HRA and 297 patients (25%) with HRA, including 262 (22%) with one HRA and 35 (3%) with two HRA. The presence of one HRA (versus zero, hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.32–2.05, p<0.001) and the presence of two HRA (versus zero, HR 3.15, 95% CI 2.00–4.96, p<0.001) were of prognostic significance after adjusting for other prognostic factors. Abnormalities of chromosome 13 were of prognostic significance independent of the established HRA: Monosomy 13 (HR 1.27, 95% CI 1.04–1.56, P=0.022) and del(13q) (HR 0.48, 95% CI 0.28–0.81, P=0.006) with opposite effects. Patients with HRA experienced worse overall survival suggesting a cumulative adverse effect of multiple HRA. Abnormalities of chromosome 13 were of prognostic significance after adjusting for other prognostic factors.
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Holstein SA, Jung SH, Richardson PG, Hofmeister CC, Hurd DD, Hassoun H, Giralt S, Stadtmauer EA, Weisdorf DJ, Vij R, Moreb JS, Callander NS, van Besien K, Gentile TG, Isola L, Maziarz RT, Bashey A, Landau H, Martin T, Qazilbash MH, Rodriguez C, McClune B, Schlossman RL, Smith SE, Hars V, Owzar K, Jiang C, Boyd M, Schultz C, Wilson M, Hari P, Pasquini MC, Horowitz MM, Shea TC, Devine SM, Linker C, Anderson KC, McCarthy PL. Updated analysis of CALGB (Alliance) 100104 assessing lenalidomide versus placebo maintenance after single autologous stem-cell transplantation for multiple myeloma: a randomised, double-blind, phase 3 trial. LANCET HAEMATOLOGY 2017; 4:e431-e442. [PMID: 28826616 PMCID: PMC5718627 DOI: 10.1016/s2352-3026(17)30140-0] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 02/01/2023]
Abstract
Background CALGB 100104 (Alliance) studied lenalidomide vs. placebo following autologous stem cell transplant (ASCT) for newly diagnosed myeloma patients, demonstrating improved time to progression (TTP) and overall survival (OS), and an increase in second primary malignancies (SPM) for lenalidomide at 34-months median follow-up. Here we report an updated intent-to-treat analysis at 91-months median follow-up. Methods Patients were eligible if they had active myeloma, had received at most two induction regimens and had achieved stable disease or better in the first 100 days after ASCT. In this phase 3 study, 460 patients were randomised in a double-blind manner to either lenalidomide (n=231) or placebo (n=229) utilizing a permutated-block randomisation with fixed block size. Randomisation was stratified by three factors: normal or elevated β2-microglobulin level at registration (≤2·5 mg/L vs > 2·5 mg/L), prior use or nonuse of thalidomide during induction therapy, and prior use or nonuse of lenalidomide during induction therapy. The starting dose was 10 mg daily, escalated to 15 mg daily after three months. The primary endpoint was TTP (time of progressive disease or death from any cause) using intent-to-treat analysis. After three interim analyses, the study was unblinded at median follow-up of 18 months and 86/128 placebo patients without progressive disease chose to cross over to lenalidomide. This study is registered with ClinicalTrials.gov identifier NCT00114101; new patients are no longer being recruited, but some patients remain on treatment and in follow-up. Findings The median TTP for lenalidomide is 57·3 months (95% CI 44·2–73·3) and 28·9 months (95% CI 23·0–36·3) for placebo (hazard ratio (HR): 0·57, 95% CI 0·46–0·71, p<0·0001). The TTP benefit with lenalidomide was observed regardless of whether patients were in a complete response at time of randomisation or whether they had received thalidomide or lenalidomide induction therapy. The most common grade 3–4 adverse events were neutropenia (116 (50%) of 231 patients in the lenalidomide arm and 37 (16%) of 229 patients in the placebo arm) and thrombocytopenia (34 patients (15%) in the lenalidomide arm and 11 patients (4·8%) in the placebo arm. Eighteen haematological (7·8%) and 14 solid tumour (6·1%) SPMs have been diagnosed following randomisation and prior to disease progression in the lenalidomide arm vs. three haematological (1·3%) and nine solid tumour (3·9%) SPMs in the placebo arm. Of the placebo SPMs, three haematological and five of nine solid tumour SPMs were in the crossover subgroup. Interpretation Despite an increase in haematological adverse events and SPMs, lenalidomide maintenance therapy following ASCT significantly improves TTP and can be considered a standard of care.
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Affiliation(s)
| | - Sin-Ho Jung
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | | | - Craig C Hofmeister
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - David D Hurd
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Hani Hassoun
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Ravi Vij
- Washington University School of Medicine, St Louis, MO, USA
| | - Jan S Moreb
- University of Florida Health, Gainesville, FL, USA
| | | | - Koen van Besien
- Weill Medical College of Cornell University, New York, NY, USA
| | - Teresa G Gentile
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Luis Isola
- Mount Sinai School of Medicine, New York, NY, USA
| | | | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Heather Landau
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas Martin
- University of California at San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Scott E Smith
- Alliance for Clinical Trials in Oncology, Chicago, IL, USA; Loyola University, Chicago, IL, USA
| | - Vera Hars
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | - Kouros Owzar
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | - Chen Jiang
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | - Molly Boyd
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Chelsea Schultz
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Marcia Wilson
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | | | | | - Mary M Horowitz
- Medical College of Wisconsin, Milwaukee, WI, USA; Blood and Marrow Transplant Clinical Trials Network, Rockville, MD, USA
| | - Thomas C Shea
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Steven M Devine
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Charles Linker
- University of California at San Francisco, San Francisco, CA, USA
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Shah GL, Landau H, Londono D, Devlin SM, Kosuri S, Lesokhin AM, Lendvai N, Hassoun H, Chung DJ, Koehne G, Jhanwar SC, Landgren O, Levine R, Giralt SA. Gain of chromosome 1q portends worse prognosis in multiple myeloma despite novel agent-based induction regimens and autologous transplantation. Leuk Lymphoma 2017; 58:1823-1831. [PMID: 28078910 PMCID: PMC5554510 DOI: 10.1080/10428194.2016.1260126] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We aimed to identify whether the use of autologous hematopoietic cell transplantation (HCT) impacts outcomes for multiple myeloma patients with gains of chromosome 1q (+1q). We retrospectively identified 95 patients, 21% having +1q. For patients with +1q, the overall response rate to induction was 85%, with 40% having ≥ VGPR and 20% achieving a CR, similar to non +1q patients (p = .64). The median PFS from diagnosis with +1q was 2.1 years (95% CI: 1.2-not reached (NR)) vs 4.3 years (95% CI: 3.3 yrs-NR) without +1q (p = .003). Median OS from diagnosis was 4.4 years (95% CI: 2.9-NR) vs not reached, respectively (p = .005). On molecular analysis using the Foundation One Heme assay, the most common mutations seen in +1q patients included TP53 (38%) and KRAS (25%). Overall, gain of 1q portends worse PFS and OS which was not negated by auto HCT. Such patients will likely require additional therapy to improve their survival.
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Affiliation(s)
- Gunjan L. Shah
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather Landau
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, NY Presbyterian Hospital – Weill Cornell Medical College, New York, NY, USA
| | - Dory Londono
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean M. Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Satyajit Kosuri
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander M. Lesokhin
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, NY Presbyterian Hospital – Weill Cornell Medical College, New York, NY, USA
| | - Nikoletta Lendvai
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, NY Presbyterian Hospital – Weill Cornell Medical College, New York, NY, USA
| | - Hani Hassoun
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, NY Presbyterian Hospital – Weill Cornell Medical College, New York, NY, USA
| | - David J. Chung
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, NY Presbyterian Hospital – Weill Cornell Medical College, New York, NY, USA
| | - Guenther Koehne
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, NY Presbyterian Hospital – Weill Cornell Medical College, New York, NY, USA
| | - Suresh C. Jhanwar
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, NY Presbyterian Hospital – Weill Cornell Medical College, New York, NY, USA
| | - Ross Levine
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, NY Presbyterian Hospital – Weill Cornell Medical College, New York, NY, USA
| | - Sergio A. Giralt
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, NY Presbyterian Hospital – Weill Cornell Medical College, New York, NY, USA
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Esma F, Salvini M, Troia R, Boccadoro M, Larocca A, Pautasso C. Melphalan hydrochloride for the treatment of multiple myeloma. Expert Opin Pharmacother 2017; 18:1127-1136. [DOI: 10.1080/14656566.2017.1349102] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Fabrizio Esma
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Salvini
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Rossella Troia
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Pautasso
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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28
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Moreau P, San Miguel J, Sonneveld P, Mateos MV, Zamagni E, Avet-Loiseau H, Hajek R, Dimopoulos MA, Ludwig H, Einsele H, Zweegman S, Facon T, Cavo M, Terpos E, Goldschmidt H, Attal M, Buske C. Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28:iv52-iv61. [PMID: 28453614 DOI: 10.1093/annonc/mdx096] [Citation(s) in RCA: 455] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P Moreau
- Haematology Department, University Hospital Hôtel-Dieu, Nantes, France
| | - J San Miguel
- Clinica Universidad de Navarra, CIMA, IDISNA, Pamplona, Spain
| | - P Sonneveld
- Erasmus Medical Center Institute, Rotterdam, The Netherlands
| | - M V Mateos
- University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - E Zamagni
- Seragnoli Institute of Hematology, School of Medicine, Bologna University, Bologna, Italy
| | - H Avet-Loiseau
- The Cancer Research Center of Toulouse, CRCT, INSERM U 1037, Toulouse, France
| | - R Hajek
- Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, University of Athens, Athens, Greece
| | - H Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - H Einsele
- Department of Internal Medicine II, University Hospital Wuerzburg, Wuerzburg, Germany
| | - S Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - T Facon
- University Hospital Huriez, Lille, France
| | - M Cavo
- Seragnoli Institute of Hematology, School of Medicine, Bologna University, Bologna, Italy
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, University of Athens, Athens, Greece
| | - H Goldschmidt
- Department of Medicine, University of Heidelberg, Heidelberg
| | - M Attal
- The Cancer Research Center of Toulouse, CRCT, INSERM U 1037, Toulouse, France
| | - C Buske
- Comprehensive Cancer Center Ulm and Department of Internal Medicine III, Institute of Experimental Cancer Research, University Hospital, Ulm, Germany
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29
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Martino M, Console G, Russo L, Meliado' A, Meliambro N, Moscato T, Irrera G, Messina G, Pontari A, Morabito F. Autologous Stem Cell Transplantation in Patients With Multiple Myeloma: An Activity-based Costing Analysis, Comparing a Total Inpatient Model Versus an Early Discharge Model. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017. [PMID: 28647402 DOI: 10.1016/j.clml.2017.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Activity-based costing (ABC) was developed and advocated as a means of overcoming the systematic distortions of traditional cost accounting. MATERIALS AND METHODS We calculated the cost of high-dose chemotherapy and autologous stem cell transplantation (ASCT) in patients with multiple myeloma using the ABC method, through 2 different care models: the total inpatient model (TIM) and the early-discharge outpatient model (EDOM) and compared this with the approved diagnosis related-groups (DRG) Italian tariffs. RESULTS The TIM and EDOM models involved a total cost of €28,615.15 and €16,499.43, respectively. In the TIM model, the phase with the greatest economic impact was the posttransplant (recovery and hematologic engraftment) with 36.4% of the total cost, whereas in the EDOM model, the phase with the greatest economic impact was the pretransplant (chemo-mobilization, apheresis procedure, cryopreservation, and storage) phase, with 60.4% of total expenses. In an analysis of each episode, the TIM model comprised a higher absorption than the EDOM. In particular, the posttransplant represented 36.4% of the total costs in the TIM and 17.7% in EDOM model, respectively. The estimated reduction in cost per patient using an EDOM model was over €12,115.72. The repayment of the DRG in Calabrian Region for the ASCT procedure is €59,806. Given the real cost of the transplant, the estimated cost saving per patient is €31,190.85 in the TIM model and €43,306.57 in the EDOM model. CONCLUSION In conclusion, the actual repayment of the DRG does not correspond to the real cost of the ASCT procedure in Italy. Moreover, using the EDOM, the cost of ASCT is approximately the half of the TIM model.
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Affiliation(s)
- Massimo Martino
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
| | - Giuseppe Console
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Letteria Russo
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Antonella Meliado'
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Nicola Meliambro
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Tiziana Moscato
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Giuseppe Irrera
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Giuseppe Messina
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Antonella Pontari
- Hematology, Stem Cell Collection, and Transplant Unit, Oncology and Hematology Department, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Fortunato Morabito
- Hematology Unit, Azienda Ospedaliera Cosenza, Cosenza, Italy; Biotechnology Research Unit, Azienda Sanitaria Provinciale di Cosenza, Aprigliano (CS), Italy
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30
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Laubach JP, Paba Prada CE, Richardson PG, Longo DL. Daratumumab, Elotuzumab, and the Development of Therapeutic Monoclonal Antibodies in Multiple Myeloma. Clin Pharmacol Ther 2017; 101:81-88. [PMID: 27806428 DOI: 10.1002/cpt.550] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 01/25/2023]
Abstract
There has been substantial progress in clinical outcomes for patients with multiple myeloma (MM). This encouraging trend derives in large part from the increasing number of effective therapeutic options and the ability because of this to achieve higher quality responses to treatment. The approval of both daratumumab and of elotuzumab in combination with lenalidomide and dexamethasone, in late 2015, was a notable achievement in the field, as daratumumab and elotuzumab represent the first monoclonal antibodies available for use in MM. Given their unique mechanisms of action and favorable side effect profiles, daratumumab and elotuzumab have considerable potential as therapeutic partners with agents in other drug classes and in different clinical settings ranging from newly diagnosed to relapsed disease. This review discusses the development of daratumumab and elotuzumab as well as other monoclonal antibodies currently being evaluated for use in MM.
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Affiliation(s)
- J P Laubach
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - C E Paba Prada
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - P G Richardson
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - D L Longo
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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31
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Schriber JR, Hari PN, Ahn KW, Fei M, Costa LJ, Kharfan-Dabaja MA, Angel-Diaz M, Gale RP, Ganguly S, Girnius SK, Hashmi S, Pawarode A, Vesole DH, Wiernik PH, Wirk BM, Marks DI, Nishihori T, Olsson RF, Usmani SZ, Mark TM, Nieto YL, D'Souza A. Hispanics have the lowest stem cell transplant utilization rate for autologous hematopoietic cell transplantation for multiple myeloma in the United States: A CIBMTR report. Cancer 2017; 123:3141-3149. [PMID: 28472539 DOI: 10.1002/cncr.30747] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Race/ethnicity remains an important barrier in clinical care. The authors investigated differences in the receipt of autologous hematopoietic cell transplantation (AHCT) among patients with multiple myeloma (MM) and outcomes based on race/ethnicity in the United States. METHODS The Center for International Blood and Marrow Transplant Research database was used to identify 28,450 patients who underwent AHCT for MM from 2008 through 2014. By using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results 18 registries, the incidence of MM was calculated, and a stem cell transplantation utilization rate (STUR) was derived. Post-AHCT outcomes were analyzed among patients ages 18 to 75 years who underwent melphalan-conditioned peripheral cell grafts (N = 24,102). RESULTS The STUR increased across all groups from 2008 to 2014. The increase was substantially lower among Hispanics (range, 8.6%-16.9%) and non-Hispanic blacks (range, 12.2%-20.5%) compared with non-Hispanic whites (range, 22.6%-37.8%). There were 18,046 non-Hispanic whites, 4123 non-Hispanic blacks, and 1933 Hispanic patients. The Hispanic group was younger (P < .001). Fewer patients older than 60 years underwent transplantation among Hispanics (39%) and non-Hispanic blacks (42%) compared with non-Hispanic whites (56%). A Karnofsky score <90% and a hematopoietic cell transplantation comorbidity index score >3 were more common in non-Hispanic blacks compared with Hispanic and non-Hispanic whites (P < .001). More Hispanics (57%) versus non-Hispanic blacks (54%) and non-Hispanic whites (52%; P < .001) had stage III disease. More Hispanics (48%) versus non-Hispanic blacks (45%) and non-Hispanic whites (44%) had a very good partial response or better before transplantation (P = .005). Race/ethnicity did not impact post-AHCT outcomes. CONCLUSIONS Although the STUR increased, it remained low and was significantly lower among Hispanics followed by non-Hispanic blacks compared with non-Hispanic whites. Race/ethnicity did not impact transplantation outcomes. Efforts to increase the rates of transplantation for eligible patients who have MM, with an emphasis on groups that underuse transplantation, are warranted. Cancer 2017;123:3141-9. © 2017 American Cancer Society.
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Affiliation(s)
- Jeffrey R Schriber
- Cancer Transplant Institute, Virginia G. Piper Cancer Center, Scottsdale, Arizona.,Arizona Oncology, Scottsdale, Arizona
| | - Parameswaran N Hari
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mingwei Fei
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Luciano J Costa
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mohamad A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Miguel Angel-Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Robert P Gale
- Hematology Research Center, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Siddharatha Ganguly
- Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas
| | - Saulius K Girnius
- Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Attaphol Pawarode
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, Michigan
| | - David H Vesole
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey
| | - Peter H Wiernik
- Division of Hematology/Oncology, Our Lady of Mercy Medical Center, Bronx, New York
| | - Baldeep M Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol National Health Service Trust, Bristol, United Kingdom
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Center for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - Saad Z Usmani
- Department of Hematology and Medical Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Tomer M Mark
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Yago L Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Munker R, Baghian A, Koleva Y, Andrews P, Matharoo GS, Wright AE, Saba NS, Weiner RS, Safah H. Long-term follow-up of patients with multiple myeloma treated with total body irradiation-Melphalan conditioning. Eur J Haematol 2017; 99:56-59. [PMID: 28370630 DOI: 10.1111/ejh.12890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Since a study published in 2002 showed a survival advantage of melphalan-only conditioning for stem cell transplantation (HSCT) over melphalan-total body irradiation (mel-TBI) in patients with multiple myeloma (MM), most centers abandoned mel-TBI. Mel-TBI causes more early toxicity and is more complicated to administer, but we speculated it may result in longer term survival with radiation as an independent treatment modality. Therefore, we analyzed the long-term outcome of patients with MM who received mel-TBI as part of conditioning at our center. PATIENTS AND METHODS From 1995 to 2013, 50 patients with MM underwent autologous HSCT at Tulane University Medical Center using mel-TBI conditioning. We used Kaplan-Meier survival analysis and compared our patients with data available from the Louisiana Tumor Registry. RESULTS The mean survival of our patients was 70.98 months from time of transplant and 84.2 months from time of initial diagnosis. No differences were observed according to gender, ethnicity, or age at transplant. The expected median survival in a population-based registry (matched for age and year of treatment) was 27 months (P<.001). CONCLUSIONS Total body irradiation in conjunction with melphalan as conditioning is feasible and can lead to long-term survival. More research is necessary to determine which patients benefit most. Mel-TBI should also be explored in conjunction with immunotherapy.
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Affiliation(s)
- Reinhold Munker
- Department of Medicine (Hematology/Oncology), Tulane University Medical Center, New Orleans, LA, USA
| | - Ali Baghian
- Department of Medicine (Hematology/Oncology), Tulane University Medical Center, New Orleans, LA, USA
| | - Yordanka Koleva
- Department of Medicine (Hematology/Oncology), Tulane University Medical Center, New Orleans, LA, USA
| | - Patricia Andrews
- Louisiana Tumor Registry, LSU School of Public Health, New Orleans, LA, USA
| | - Gunita S Matharoo
- School of Public Health, Tulane University Medical Center, New Orleans, LA, USA
| | - Ato E Wright
- Department of Radiation Oncology, Tulane University Medical Center, New Orleans, LA, USA
| | - Nakhle S Saba
- Department of Medicine (Hematology/Oncology), Tulane University Medical Center, New Orleans, LA, USA
| | - Roy S Weiner
- Department of Medicine (Hematology/Oncology), Tulane University Medical Center, New Orleans, LA, USA
| | - Hana Safah
- Department of Medicine (Hematology/Oncology), Tulane University Medical Center, New Orleans, LA, USA
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute c/o First Department of Medicine, Center for Oncology, Haematology and Palliative Care, Vienna 1160, Austria.
| | - Michel Delforge
- Department of Hematology, University Hospital Leuven, Leuven, Belgium
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Raza S, Safyan RA, Rosenbaum E, Bowman AS, Lentzsch S. Optimizing current and emerging therapies in multiple myeloma: a guide for the hematologist. Ther Adv Hematol 2017; 8:55-70. [PMID: 28203342 PMCID: PMC5298389 DOI: 10.1177/2040620716680548] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Multiple myeloma (MM) is the second most common hematologic malignancy. The diagnosis of MM requires ⩾10% clonal plasma cells in the bone marrow or biopsy-proven plasmacytoma, plus evidence of end-organ damage (hypercalcemia, renal failure, anemia, and lytic bone lesions). The definition of MM has recently been expanded to include a ⩾60% clonal plasma cell burden in the bone marrow, serum involved/uninvolved light chain ratio of ⩾100, or more than one focal lesion on magnetic resonance imaging ⩾5 mm in the absence of end-organ damage. MM is an incurable malignancy previously associated with poor survival rates. However, over the past two decades, the introduction of novel treatment options has resulted in a dramatic improvement in response rates and overall survival (OS). The combination of a proteasome inhibitor and an immunomodulator (IMiD) is the preferred induction treatment for newly diagnosed transplant-eligible MM patients. After induction, high-dose therapy with autologous stem cell transplant (ASCT) is still the standard of care for these patients. In patients who are transplant ineligible, dose adjusted IMiDs or proteasome inhibitor-based combinations are the preferred treatment option. With the recent approval of novel drugs like carfilzomib, ixazomib, pomalidomide, panobinostat, and monoclonal antibodies (elotuzumab and daratumumab), as well as improved understanding of risk stratification, management of comorbidities and treatment side effects, clinicians can optimize anti-MM therapy, particularly in relapse/refractory MM patients. In this review, we outline the current therapeutic approach to the management of MM.
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Affiliation(s)
- Shahzad Raza
- Division of Hematology & Oncology, Columbia University Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Rachael A. Safyan
- Division of Hematology & Oncology, Columbia University Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Evan Rosenbaum
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Alex S. Bowman
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Suzanne Lentzsch
- Professor of Medicine, Director, Multiple Myeloma and Amyloidosis Service, Columbia University Medical Center, Herbert Irving Pavilion, R 953, 161 Ft. Washington Ave, New York, NY 10032, USA
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Gay F, Oliva S, Petrucci MT, Montefusco V, Conticello C, Musto P, Catalano L, Evangelista A, Spada S, Campbell P, Ria R, Salvini M, Offidani M, Carella AM, Omedé P, Liberati AM, Troia R, Cafro AM, Malfitano A, Falcone AP, Caravita T, Patriarca F, Nagler A, Spencer A, Hajek R, Palumbo A, Boccadoro M. Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: a pooled analysis. Leukemia 2016; 31:1727-1734. [PMID: 28008174 DOI: 10.1038/leu.2016.381] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 12/22/2022]
Abstract
In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.
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Affiliation(s)
- F Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - S Oliva
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M T Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Roma, Roma, Italy
| | - V Montefusco
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - C Conticello
- Division of Hematology, Azienda Policlinico 'Vittorio Emanuele', University of Catania, Catania, Italy
| | - P Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Potenza, Italy
| | - L Catalano
- Hematology, Department of Clinical Medicine and Surgery, AOU Federico II, Napoli, Italy
| | - A Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - S Spada
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - P Campbell
- Haematology Department, Cancer Services, Barwon Health, Geelong, Australia
| | - R Ria
- Department of Biomedical Science, University of Bari 'Aldo Moro' Medical School, Internal Medicine 'G. Baccelli' Policlinico, Bari, Italy
| | - M Salvini
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Offidani
- Hematology Department, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - A M Carella
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Martino-Ist, Genova, Italy
| | - P Omedé
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Liberati
- Department of Oncohematology, AO S.Maria di Terni, Terni, Italy
| | - R Troia
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Cafro
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - A Malfitano
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A P Falcone
- Division of Hematology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - T Caravita
- UOC Ematologia S. Eugenio ASL RM2 Roma, Roma, Italy
| | - F Patriarca
- Department of Hematology, Azienda Ospedaliera-Universitaria di Udine, DISM, Università di Udine, Udine, Italy
| | - A Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Spencer
- Department of Clinical Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - R Hajek
- Blood Cancer Research Group, Department of Haematooncology, Faculty Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - A Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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Outcome with lenalidomide plus dexamethasone followed by early autologous stem cell transplantation in patients with newly diagnosed multiple myeloma on the ECOG-ACRIN E4A03 randomized clinical trial: long-term follow-up. Blood Cancer J 2016; 6:e466. [PMID: 27588519 PMCID: PMC5056965 DOI: 10.1038/bcj.2016.68] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 12/22/2022] Open
Abstract
In Eastern Cooperative Oncology Group-ACRIN E4A03, on completion of four cycles of therapy, newly diagnosed multiple myeloma patients had the option of proceeding to autologous peripheral blood stem cell transplant (ASCT) or continuing on their assigned therapy lenalidomide plus low-dose dexamethasone (Ld) or lenalidomide plus high-dose dexamethasone (LD). This landmark analysis compared the outcome of 431 patients surviving their first four cycles of therapy pursuing early ASCT to those continuing on their assigned therapy. Survival distributions were estimated using the Kaplan–Meier method and compared with log-rank test. Ninety patients (21%) opted for early ASCT. The 1-, 2-, 3-, 4- and 5-year survival probability estimates were higher for early ASCT versus no early ASCT at 99, 93, 91, 85 and 80% versus 94, 84, 75, 65 and 57%, respectively. The median overall survival (OS) in the early versus no early ASCT group was not reached (NR) versus 5.78 years. In patients <65 years of age, median OS in the early versus no early ASCT groups was NR in both, hazard ratio 0.79, 95% confidence interval: (0.50, 0.25). In patients ⩾65 years of age, median OS in the early versus no early ASCT was NR versus 5.11 years. ASCT dropped out of statistical significance (P=0.080). Patients opting for ASCT after induction Ld/LD had a higher survival probability and improvement in OS regardless of dexamethasone dose density.
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Lehners N, Hayden PJ, Goldschmidt H, Raab MS. Management of high-risk Myeloma: an evidence-based review of treatment strategies. Expert Rev Hematol 2016; 9:753-65. [PMID: 27337562 DOI: 10.1080/17474086.2016.1204908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Despite the progress made in the treatment of patients with multiple myeloma over recent decades, a significant cohort with high-risk disease as defined by specific clinical and genetic criteria continue to respond poorly to standard treatment. These patients represent a particular challenge to the treating physician and require early identification as well as personalized treatment strategies. AREAS COVERED In this review, we discuss the prognostic impact of adverse clinical, radiological and genetic factors, evaluate available scoring systems and highlight key aspects of the therapeutic management of high-risk myeloma. MEDLINE and recent scientific meetings' databases were searched for the keywords 'high-risk' and 'multiple myeloma' and relevant studies relating to both diagnostic and therapeutic approaches were identified. Expert commentary: A case is made for intensive induction using combinations of novel agents, early high-dose therapy supported by autologous stem cell transplantation and the widespread use of maintenance therapies. Novel therapeutic options, especially in the field of immunotherapy, are currently explored in clinical trials and have the potential to further improve outcomes for patients with high-risk multiple myeloma.
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Affiliation(s)
- Nicola Lehners
- a Department of Hematology , University Hospital of Heidelberg , Heidelberg , Germany
| | - Patrick J Hayden
- b Academic Department of Haematology , St. James's Hospital, Trinity College Dublin, College Green , Dublin 2 , Ireland
| | - Hartmut Goldschmidt
- a Department of Hematology , University Hospital of Heidelberg , Heidelberg , Germany
| | - Marc-Steffen Raab
- a Department of Hematology , University Hospital of Heidelberg , Heidelberg , Germany
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