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Ceglédi A, Csukly Z, Fekete M, Kozma A, Szemlaky Z, Andrikovics H, Mikala G. Effective venetoclax-based treatment in relapsed/refractory multiple myeloma patients with translocation t(6;14). Pathol Oncol Res 2023; 29:1611375. [PMID: 38025905 PMCID: PMC10668022 DOI: 10.3389/pore.2023.1611375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023]
Abstract
Introduction: The selective Bcl-2 inhibitor venetoclax has shown promising therapeutic potential in multiple myeloma, particularly in cases associated with t(11;14) IGH::CCND1 translocation. However, the efficacy of venetoclax in myeloma patients with the t(6;14) IGH::CCND3 translocation remains less investigated. Methods: In this study, we conducted a retrospective analysis to investigate the efficacy of venetoclax-based therapy in relapsed/refractory myeloma patients with t(6;14) translocation. The treatment courses of three patients, that included previous therapies and responses to venetoclax, were assessed. Clinical data, laboratory results, and adverse events were analyzed to evaluate treatment outcomes. Results: Our findings demonstrated remarkable therapeutic responses in three consecutive patients with t(6;14) translocation-associated myeloma who received venetoclax-based therapy. Patient 1, a lenalidomide-bortezomib-daratumumab and alkylator treatment refractory patient, achieved sustained stringent complete remission (sCR) after combining carfilzomib-dexamethasone with venetoclax, which was his best response ever. Similarly, Patient 2, refractory to frontline bortezomib-thalidomide-dexamethasone therapy, attained CR following a transition to bortezomib-dexamethason-venetoclax treatment. Patient 3, who was immunomodulatory (IMID)-intolerant, showed a highly favorable response to venetoclax-dexamethasone therapy after his first relapse following autologous stem cell transplantation. No significant adverse effects were observed in any of the patients. Discussion: Our study provides compelling preliminary evidence for the efficacy of venetoclax in t(6;14) translocation-associated myeloma. The outcomes observed in our patients suggest that venetoclax-based therapy holds substantial promise as an effective treatment option for this specific genetic subgroup. Furthermore, the similarities in treatment response between t(11;14) and t(6;14) translocation subgroups highlight the importance of personalized approaches targeting specific genetic abnormalities to optimize therapeutic outcomes.
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Affiliation(s)
- Andrea Ceglédi
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute for Hematology and Infectious Diseases, Budapest, Hungary
| | - Zoltán Csukly
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute for Hematology and Infectious Diseases, Budapest, Hungary
| | - Mónika Fekete
- Department of Public Health, Semmelweis University, Budapest, Hungary
| | - András Kozma
- Laboratory of Molecular Genetics, Central Hospital of Southern Pest, National Institute for Hematology and Infectious Diseases, Budapest, Hungary
| | - Zsuzsanna Szemlaky
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute for Hematology and Infectious Diseases, Budapest, Hungary
| | - Hajnalka Andrikovics
- Laboratory of Molecular Genetics, Central Hospital of Southern Pest, National Institute for Hematology and Infectious Diseases, Budapest, Hungary
| | - Gábor Mikala
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute for Hematology and Infectious Diseases, Budapest, Hungary
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2
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Akagi Y, Yamashita Y, Kosako H, Furuya Y, Hosoi H, Mushino T, Murata S, Nishikawa A, Tamura S, Nakao T, Sonoki T. Administration of combined venetoclax and azacitidine in a patient with acute myeloid leukemia and multiple comorbidities undergoing dialysis: A case report. EJHAEM 2023; 4:841-843. [PMID: 37601888 PMCID: PMC10435694 DOI: 10.1002/jha2.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 08/22/2023]
Abstract
Patients with acute myeloid leukemia (AML) who have comorbidities have limited treatment options, thereby resulting in poor prognosis. Venetoclax, a specific B-cell lymphoma-2 inhibitor, has recently been approved for AML in combination with hypomethylating agents; however, only one report has described its use in patients undergoing dialysis. Herein, we report the effectiveness of combined venetoclax and azacitidine in a 73-year-old man with AML undergoing dialysis and who was ineligible for standard therapies. The safety of venetoclax and azacitidine in patients undergoing dialysis has been reported, and their combination may be a feasible option for patients with AML undergoing dialysis.
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Affiliation(s)
- Yuina Akagi
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
- Department of HematologyNaga Municipal HospitalWakayamaJapan
| | - Yusuke Yamashita
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
- Department of HematologyNaga Municipal HospitalWakayamaJapan
| | - Hideki Kosako
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
| | - Yoshiaki Furuya
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
- Department of HematologyNaga Municipal HospitalWakayamaJapan
| | - Hiroki Hosoi
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
| | - Toshiki Mushino
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
| | - Shogo Murata
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
| | - Akinori Nishikawa
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
| | - Shinobu Tamura
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
| | - Taisei Nakao
- Department of HematologyNaga Municipal HospitalWakayamaJapan
- Department of Internal MedicineNaga Municipal HospitalWakayamaJapan
| | - Takashi Sonoki
- Department of Hematology/OncologyWakayama Medical UniversityWakayamaJapan
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3
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Murphy P. A Case of Disseminated Systemic Light-Chain Amyloidosis with Coagulopathy. Am J Med 2023; 136:e51. [PMID: 36796957 DOI: 10.1016/j.amjmed.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 02/16/2023]
Affiliation(s)
- Philip Murphy
- Department of Haematology, Beaumont Hospital, Dublin, Ireland.
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Edahiro T, Ureshino H, Chishaki R, Fujino K, Mino T, Yoshida T, Fukushima N, Ichinohe T. Successful combination treatment with azacitidine and venetoclax for a patient with acute myeloid leukemia undergoing hemodialysis. Leuk Lymphoma 2022; 63:3511-3512. [PMID: 36098247 DOI: 10.1080/10428194.2022.2123230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Taro Edahiro
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Ureshino
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Ren Chishaki
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Keita Fujino
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tatsuji Mino
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tetsumi Yoshida
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Noriyasu Fukushima
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.,Department of Internal Medicine, Karatsu Red Cross Hospital, Karatsu, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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5
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Gandhi A, Andrick B, Darling J, Truong T, Signorelli J. Oral Antineoplastics in Acute Myeloid Leukemia: A Comprehensive Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e1033-e1049. [PMID: 36192350 DOI: 10.1016/j.clml.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 01/26/2023]
Abstract
AML is a biologically and clinically heterogeneous disease that is associated with poor overall long-term survival. The expanding knowledge of genomic landscape in AML as well as advancements in molecular and chemical biology over the pathway in AML. After 40 years of stagnancy, the recent approval of numerous novel oral anti-leukemic agents for the treatment of AML has changed both the armamentarium of medications and treatment paradigms. These agents have unique clinical considerations in terms of administration, adverse effects, and monitoring parameters which may differ from clinician's historical expectations. Understanding the data, indication and clinical considerations for such novel oral anti-leukemic agents is paramount for clinicians caring patients with AML.
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Affiliation(s)
- Arpita Gandhi
- Assistant Director, Hematology/Oncology Clinical Pharmacy Specialist, Emory Healthcare, Atlanta, GA.
| | - Benjamin Andrick
- Assistant Professor, Clinical Research, Center for Pharmacy Innovations and Outcomes, Geisinger Health, Hematology/Oncology Pharmacy, Danville, PA
| | - Julianne Darling
- Manger of Education, National Community Oncology Dispensing Association, Inc., Cazenovia, NY
| | - Tuyet Truong
- Northeastern University School of Pharmacy, Boston, MA
| | - Jessie Signorelli
- Clinical Pharmacist Specialist, Hematology, Massachusetts General Hospital, Boston, MA
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Sugiura H, Sezaki N, Ishikawa T, Kuroi T, Okamoto S, Nomura N, Masunari T, Nakasako Y, Kiguchi T, Tanimoto M. Successful treatment of relapsed chronic lymphocytic leukemia with venetoclax in a patient with severe chronic kidney disease. Clin Case Rep 2022; 10:e05735. [PMID: 35441018 PMCID: PMC9010727 DOI: 10.1002/ccr3.5735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/25/2022] [Indexed: 11/30/2022] Open
Abstract
Venetoclax is a promising new drug for relapsed or refractory chronic lymphocytic leukemia (CLL). However, venetoclax use had not been reported in severe chronic kidney disease (CKD) patients. We report the first case of relapsed CLL in a severe CKD patient that was successfully treated with venetoclax.
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Affiliation(s)
- Hiroyuki Sugiura
- Department of Hematology Chugoku Central Hospital of Japan Mutual Aid Association of Public School Teachers Fukuyama Japan
| | - Nobuo Sezaki
- Department of Hematology Chugoku Central Hospital of Japan Mutual Aid Association of Public School Teachers Fukuyama Japan
| | - Tatsunori Ishikawa
- Department of Hematology Chugoku Central Hospital of Japan Mutual Aid Association of Public School Teachers Fukuyama Japan
| | - Taiga Kuroi
- Department of Hematology Chugoku Central Hospital of Japan Mutual Aid Association of Public School Teachers Fukuyama Japan
| | - Sachiyo Okamoto
- Department of Hematology Chugoku Central Hospital of Japan Mutual Aid Association of Public School Teachers Fukuyama Japan
| | - Naho Nomura
- Department of Hematology Chugoku Central Hospital of Japan Mutual Aid Association of Public School Teachers Fukuyama Japan
| | - Taro Masunari
- Department of Hematology Chugoku Central Hospital of Japan Mutual Aid Association of Public School Teachers Fukuyama Japan
| | - Yukio Nakasako
- Department of Diabetology and Nephrology Chugoku Central Hospital of Japan Mutual Aid Association of Public School Teachers Fukuyama Japan
| | - Toru Kiguchi
- Department of Diabetes Endocrinology and Hematology Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Mitsune Tanimoto
- Department of Hematology Chugoku Central Hospital of Japan Mutual Aid Association of Public School Teachers Fukuyama Japan
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Szita VR, Mikala G, Kozma A, Fábián J, Hardi A, Alizadeh H, Rajnics P, Rejtő L, Szendrei T, Váróczy L, Nagy Z, Illés Á, Vályi-Nagy I, Masszi T, Varga G. Targeted Venetoclax Therapy in t(11;14) Multiple Myeloma: Real World Data From Seven Hungarian Centers. Pathol Oncol Res 2022; 28:1610276. [PMID: 35295611 PMCID: PMC8918485 DOI: 10.3389/pore.2022.1610276] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/08/2022] [Indexed: 12/13/2022]
Abstract
Despite the introduction of novel agents, multiple myeloma remains incurable for most patients, necessitating further therapeutic options. Venetoclax, a selective BCL-2 inhibitor, had shown promising results in patients with translocation t(11;14), but questions remain open about its optimal use. We have contacted all Hungarian haematology centers for their experience treating t(11;14) myeloma patients with venetoclax. 58 patients were reported. 37 received venetoclax in the relapsed/refractory setting with few or no other therapeutic options available. 21 patients started venetoclax as salvage after failing to achieve satisfactory response to first line therapy. In the relapsed/refractory setting objective response rate (ORR) was 94%, median progression-free survival (PFS) 10.0 months and median overall survival (OS) 14.6 months. In reinduction patients, ORR was 100%, median PFS and OS were not reached. Importantly, we found no adverse effect of high risk features such as deletion 17p or renal failure, in fact renal failure ameliorated in 42% of the cases, including three patients who became dialysis independent. Our study also reports the highest number of plasma cell leukemia cases successfully treated with venetoclax published in literature, with refractory plasma cell leukemia patients achieving a median PFS of 10.0 and a median OS of 12.2 months.
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Affiliation(s)
- Virág Réka Szita
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Gábor Mikala
- Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute for Haematology and Infectious Diseases, Budapest, Hungary
| | - András Kozma
- Department of Molecular Genetics, South Pest Central Hospital, National Institute for Haematology and Infectious Diseases, Budapest, Hungary
| | - János Fábián
- Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute for Haematology and Infectious Diseases, Budapest, Hungary
| | - Apor Hardi
- Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute for Haematology and Infectious Diseases, Budapest, Hungary
| | - Hussain Alizadeh
- 1st Department of Internal Medicine, University of Pécs, Pécs, Hungary
| | - Péter Rajnics
- Department of Haematology, Teaching Hospital Mór Kaposi, Kaposvár, Hungary
- Faculty of Health Sciences, Institute of Diagnostics, University of Pécs, Pécs, Hungary
| | - László Rejtő
- Jósa András Teaching Hospital, Nyíregyháza, Hungary
| | | | - László Váróczy
- Department of Haematology, Faculty of Medicine, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Zsolt Nagy
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Árpád Illés
- Department of Haematology, Faculty of Medicine, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - István Vályi-Nagy
- Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute for Haematology and Infectious Diseases, Budapest, Hungary
| | - Tamás Masszi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Gergely Varga
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
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Sgherza N, Curci P, Rizzi R, Musto P. Novel Approaches Outside the Setting of Immunotherapy for the Treatment of Multiple Myeloma: The Case of Melflufen, Venetoclax, and Selinexor. Front Oncol 2021; 11:716751. [PMID: 34660279 PMCID: PMC8514936 DOI: 10.3389/fonc.2021.716751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Although the survival rate of patients with multiple myeloma has significantly improved in the last years thanks to the introduction of various classes of new drugs, such as proteasome inhibitors, immunomodulatory agents, and monoclonal antibodies, the vast majority of these subjects relapse with a more aggressive disease due to the acquisition of further genetic alterations that may cause resistance to current salvage therapies. The treatment of these often "triple" (or even more) refractory patients remains challenging, and alternative approaches are required to overcome the onset of that resistance. Immunotherapies with novel monoclonal, drug-conjugated, or bi-specific antibodies, as well as the use of chimeric antigen receptor T cells, have been recently developed and are currently investigated. However, other non-immunologic therapeutic regimens based on melfluflen, venetoclax, or selinexor, three molecules with new mechanisms of action, have also shown promising results in the setting of relapsed/refractory myeloma. Here we report the most recent literature data regarding these three drugs, focusing on their efficacy and safety in multiple myeloma.
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Affiliation(s)
- Nicola Sgherza
- Unit of Hematology and Stem Cell Transplantation, Azienda Ospedaliero Universitaria Consorziale (AOUC) Policlinico, Bari, Italy
| | - Paola Curci
- Unit of Hematology and Stem Cell Transplantation, Azienda Ospedaliero Universitaria Consorziale (AOUC) Policlinico, Bari, Italy
| | - Rita Rizzi
- Unit of Hematology and Stem Cell Transplantation, Azienda Ospedaliero Universitaria Consorziale (AOUC) Policlinico, Bari, Italy
- Department of Emergency and Organ Transplantation, “Aldo Moro” University School of Medicine, Bari, Italy
| | - Pellegrino Musto
- Unit of Hematology and Stem Cell Transplantation, Azienda Ospedaliero Universitaria Consorziale (AOUC) Policlinico, Bari, Italy
- Department of Emergency and Organ Transplantation, “Aldo Moro” University School of Medicine, Bari, Italy
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9
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Clinical features and survival outcomes in IgD myeloma: a study by Asia Myeloma Network (AMN). Leukemia 2020; 35:1797-1802. [PMID: 33082513 PMCID: PMC8179848 DOI: 10.1038/s41375-020-01060-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/21/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
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Dual targeting of BCL2 and MCL1 rescues myeloma cells resistant to BCL2 and MCL1 inhibitors associated with the formation of BAX/BAK hetero-complexes. Cell Death Dis 2020; 11:316. [PMID: 32371863 PMCID: PMC7200824 DOI: 10.1038/s41419-020-2505-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 11/08/2022]
Abstract
Multiple myeloma is a plasma cell malignancy that escapes from apoptosis by heterogeneously over-expressing anti-apoptotic BCL2 proteins. Myeloma cells with a t(11;14) translocation present a particular vulnerability to BCL2 inhibition while a majority of myeloma cells relies on MCL1 for survival. The present study aimed to determine whether the combination of BCL2 and MCL1 inhibitors at low doses could be of benefit for myeloma cells beyond the single selective inhibition of BCL2 or MCL1. We identified that half of patients were not efficiently targeted neither by BCL2 inhibitor nor MCL1 inhibitor. Seventy percent of these myeloma samples, either from patients at diagnosis or relapse, presented a marked increase of apoptosis upon low dose combination of both inhibitors. Interestingly, primary cells from a patient in progression under venetoclax treatment were not sensitive ex vivo to neither venetoclax nor to MCL1 inhibitor, whereas the combination of both efficiently induced cell death. This finding suggests that the combination could overcome venetoclax resistance. The efficacy of the combination was also confirmed in U266 xenograft model resistant to BCL2 and MCL1 inhibitors. Mechanistically, we demonstrated that the combination of both inhibitors favors apoptosis in a BAX/BAK dependent manner. We showed that activated BAX was readily increased upon the inhibitor combination leading to the formation of BAK/BAX hetero-complexes. We found that BCLXL remains a major resistant factor of cell death induced by this combination. The present study supports a rational for the clinical use of venetoclax/S63845 combination in myeloma patients with the potential to elicit significant clinical activity when both single inhibitors would not be effective but also to overcome developed in vivo venetoclax resistance.
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