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Bao L, Wang YT, Liu P, Lu MQ, Zhuang JL, Zhang M, Xia ZJ, Li ZL, Yang Y, Yan ZY, Jing HM, Dong F, Chen WM, Wu Y, Zhou HB, Fu R, Gong YP, Huang WR, Zhang YQ. Ixazomib-based frontline therapy followed by ixazomib maintenance in frail elderly newly diagnosed with multiple myeloma: a prospective multicenter study. EClinicalMedicine 2024; 68:102431. [PMID: 38318126 PMCID: PMC10839574 DOI: 10.1016/j.eclinm.2024.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
Background Frail elderly patients with newly diagnosed multiple myeloma (NDMM) have inferior survival and less benefit from high-dose therapies. This prospective study aimed to investigate the efficacy, safety, and quality of life (QoL) of induction treatment of ixazomib/lenalidomide/dexamethasone (IRd) and ixazomib/pegylated liposomal doxorubicin/dexamethasone (IDd) followed by ixazomib/dexamethasone (Id) maintenance therapy in frail, elderly patients with NDMM. Methods From July 2019 to December 2021, this non-randomized concurrent controlled clinical study enrolled 120 NDMM patients aged ≥65 years with frailty defined by the International Myeloma Working Group (IMWG) frailty score or Mayo geriatric scoring system. The enrolled patients received 6-8 cycles of IRd or IDd followed by Id maintenance therapy for a minimum of 2 years at the discretion of physicians based on patient's clinical characteristics (chiCTR1900024917). Findings The median age was 71 years and 55% of the patients were males. The overall response rate (ORR) was 82% and 77%, complete response (CR) rate was 25% and 12% for IRd and IDd groups, respectively. The difference in ORR of the Idd group minus the IRd group was -5.36% (95% CI: -18.9% to 8.19%), indicating that the ORR of the IDd group was neither inferior nor non-inferior to the IRd group. After a median follow-up of 34.3 months, the median progression-free survival (PFS) was 21.6 and 13.9 months, OS was not reached and 29.2 months in IRd and IDd groups, respectively. 28 and 33 patients discontinued induction therapy, 20 and 19 discontinued maintenance therapy in IRd and IDd groups, respectively. Cumulative Grade 3 or higher hematological adverse events (AEs) occurred in 10 of the 60 patients (17%) and non-hematological AEs occurred in 15 of the 60 patients (25%) in the IRd group, while 13 of the 60 patients (22%) and 21 of the 60 patients (35%) in the IDd group. Patients were observed with clinically significant improvement in QoL when compared with that at baseline in both IRd and IDd groups by evaluation per cycle (P < 0.0001). Interpretation The results demonstrated that compared with IRd regimen, IDd regimen showed no significant advantage, but the survival of the IDd group was shorter than that of the IRd group, indicating an all-oral outpatient triplet regimen with IRd, which has low toxicity and has improved QoL, could be the viable first-line treatment option for frail NDMM patients. Funding The Young Elite Scientist sponsorship program by bast of Beijing Association for Science and Technology (No. BYESS2023116) and Beijing Medical Award Foundation (No. YXJL-2018-0539-0073).
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Affiliation(s)
- Li Bao
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Yu-Tong Wang
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Min-Qiu Lu
- Department of Hematology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Jun-Ling Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Zhang
- Department of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Zhong-Jun Xia
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhen-Ling Li
- Department of Hematology, China-Japan Friendship Hospital, Beijing, China
| | - Ying Yang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhen-Yu Yan
- Department of Hematology, Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Hong-Mei Jing
- Department of Hematology, Third Hospital of Peking University, Beijing, China
| | - Fei Dong
- Department of Hematology, Third Hospital of Peking University, Beijing, China
| | - Wen-Ming Chen
- Department of Hematology, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Yin Wu
- Department of Hematology, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - He-Bing Zhou
- Department of Hematology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu-Ping Gong
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Rong Huang
- Department of Hematology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Yong-Qing Zhang
- Department of Hematology, The Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
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Carmichael J, Seymour F, McIlroy G, Tayabali S, Amerikanou R, Feyler S, Popat R, Pratt G, Parrish C, Ashcroft AJ, Jackson GH, Cook G. Delayed diagnosis resulting in increased disease burden in multiple myeloma: the legacy of the COVID-19 pandemic. Blood Cancer J 2023; 13:38. [PMID: 36922489 PMCID: PMC10015143 DOI: 10.1038/s41408-023-00795-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/11/2023] [Accepted: 01/30/2023] [Indexed: 03/17/2023] Open
Abstract
The COVID-19 pandemic has had global healthcare impacts, including high mortality from SARS-CoV-2 infection in cancer patients; individuals with multiple myeloma (MM) are especially susceptible to poor outcomes. However, even for MM patients who avoided severe infection, the ramifications of the pandemic have been considerable. The consequences of necessary socio-geographical behavior adaptation, including prolonged shielding and interruptions in delivery of non-pandemic medical services are yet to be fully understood. Using a real-world dataset of 323 consecutive newly diagnosed MM patients in England, we investigated the impact of the COVID-19 pandemic on routes to myeloma diagnosis, disease stage at presentation and relevant clinical outcomes. We demonstrate increasing MM presentations via emergency services and increased rates of bony and extra-medullary disease. Differences were seen in choice of induction therapy and the proportion of eligible patients undertaking autologous stem cell transplantation. Whilst survival was statistically inferior for emergency presentations, significant survival differences have yet to be demonstrated for the entire cohort diagnosed during the pandemic, making extended follow-up critical in this group. This dataset highlights wide-ranging issues facing MM patients consequent of the COVID-19 pandemic, with full impacts for clinicians and policy-makers yet to be elucidated.
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Affiliation(s)
- Jonathan Carmichael
- Leeds Institute of Clinical Trial research & Leeds Cancer Centre, University of Leeds, Leeds, UK
- NIHR Medtech & In Vitro Diagnostics Cooperative (Leeds), Leeds, UK
- Dept of Haematology, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Frances Seymour
- Dept of Haematology, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Graham McIlroy
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarrah Tayabali
- Dept of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rosie Amerikanou
- Dept of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sylvia Feyler
- Dept of Haematology, Calderdale & Huddersfield Foundation Trust, Huddersfield, UK
| | - Rakesh Popat
- Dept of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher Parrish
- Leeds Institute of Clinical Trial research & Leeds Cancer Centre, University of Leeds, Leeds, UK
- Dept of Haematology, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - A John Ashcroft
- Dept of Haematology, Pinderfields Hospital, Mid Yorkshire NHS Trust, Wakefield, UK
| | - Graham H Jackson
- Department of Haematology, Newcastle University, Newcastle, UK
- College of Myeloma (UK), London, UK
| | - Gordon Cook
- Leeds Institute of Clinical Trial research & Leeds Cancer Centre, University of Leeds, Leeds, UK.
- NIHR Medtech & In Vitro Diagnostics Cooperative (Leeds), Leeds, UK.
- Dept of Haematology, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, UK.
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Nie C, Lee H, Tay J, Duggan P, McCulloch S, Neri P, Bahlis NJ, Jimenez-Zepeda VH. Real-world Outcomes With Cumulative Bortezomib Dose and Efficacy in the Treatment of Transplant-ineligible Multiple Myeloma With Cyclophosphamide, Bortezomib, and Dexamethasone. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:104-111. [PMID: 36396582 DOI: 10.1016/j.clml.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Higher cumulative dose of bortezomib, a key component of Multiple Myeloma (MM) treatment regimens, has been shown to improve outcomes in MM patients, but must be balanced with toxicities including peripheral neuropathy. In this study, we studied the effect of cumulative bortezomib dose on survival, depth of response, and discontinuation rate in transplant ineligible MM patients. PATIENTS AND METHODS Data from 70 patients treated with Cyclophsophamide, Bortezomib, and Dexamethasone (CyBorD) in a single Canadian center were grouped according to above vs below median cumulative bortezomib dose and analyzed for progression-free survival (PFS), overall survival (OS), depth of response, and discontinuation rate. RESULTS There was a trend for lower discontinuation rate (45.7% vs. 68.6%, P = .052) and significantly lower rate of neuropathy-related discontinuation (5.7% vs. 22.9%, P = .035) in patients who received higher than 43.1 mg/m² of bortezomib. The higher-dose group showed a trend for higher rate of complete response (14.3% vs. 5.7%, P = .225) and significantly higher rate of very good partial response or better (77.1% vs. 51.4%, P = .024). There was significantly longer PFS (24.3 vs. 9.1 months, P = .012) and a trend for longer OS (22.4 vs. 61.3 months, P = .061) in the higher-dose group. In landmark analysis after 180 days, PFS (23.5 vs. 24.3 months, P = .941) and OS were similar in both groups. CONCLUSION Higher cumulative bortezomib dose showed a lower rate of discontinuation, longer survival, and deeper response. Determining risk of treatment intolerance remains important for treatment.
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Affiliation(s)
- Chunpeng Nie
- Tom Baker Cancer Center, Department of Medical Oncology and Hematology, Calgary, Alberta, Canada
| | - Holly Lee
- Tom Baker Cancer Center, Department of Medical Oncology and Hematology, Calgary, Alberta, Canada
| | - Jason Tay
- Tom Baker Cancer Center, Department of Medical Oncology and Hematology, Calgary, Alberta, Canada; Charbonneau Cancer Research Institute, Calgary, Alberta, Canada
| | - Peter Duggan
- Tom Baker Cancer Center, Department of Medical Oncology and Hematology, Calgary, Alberta, Canada
| | - Sylvia McCulloch
- Tom Baker Cancer Center, Department of Medical Oncology and Hematology, Calgary, Alberta, Canada
| | - Paola Neri
- Tom Baker Cancer Center, Department of Medical Oncology and Hematology, Calgary, Alberta, Canada; Charbonneau Cancer Research Institute, Calgary, Alberta, Canada
| | - Nizar J Bahlis
- Tom Baker Cancer Center, Department of Medical Oncology and Hematology, Calgary, Alberta, Canada; Charbonneau Cancer Research Institute, Calgary, Alberta, Canada
| | - Victor H Jimenez-Zepeda
- Tom Baker Cancer Center, Department of Medical Oncology and Hematology, Calgary, Alberta, Canada; Charbonneau Cancer Research Institute, Calgary, Alberta, Canada.
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