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Buske C, Dreyling M, Alvarez-Larrán A, Apperley J, Arcaini L, Besson C, Bullinger L, Corradini P, Giovanni Della Porta M, Dimopoulos M, D'Sa S, Eich HT, Foà R, Ghia P, da Silva MG, Gribben J, Hajek R, Harrison C, Heuser M, Kiesewetter B, Kiladjian JJ, Kröger N, Moreau P, Passweg JR, Peyvandi F, Rea D, Ribera JM, Robak T, San-Miguel JF, Santini V, Sanz G, Sonneveld P, von Lilienfeld-Toal M, Wendtner C, Pentheroudakis G, Passamonti F. Managing hematological cancer patients during the COVID-19 pandemic: an ESMO-EHA Interdisciplinary Expert Consensus. ESMO Open 2022; 7:100403. [PMID: 35272130 PMCID: PMC8795783 DOI: 10.1016/j.esmoop.2022.100403] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has created enormous challenges for the clinical management of patients with hematological malignancies (HMs), raising questions about the optimal care of this patient group. METHODS This consensus manuscript aims at discussing clinical evidence and providing expert advice on statements related to the management of HMs in the COVID-19 pandemic. For this purpose, an international consortium was established including a steering committee, which prepared six working packages addressing significant clinical questions from the COVID-19 diagnosis, treatment, and mitigation strategies to specific HMs management in the pandemic. During a virtual consensus meeting, including global experts and lead by the European Society for Medical Oncology and the European Hematology Association, statements were discussed and voted upon. When a consensus could not be reached, the panel revised statements to develop consensual clinical guidance. RESULTS AND CONCLUSION The expert panel agreed on 33 statements, reflecting a consensus, which will guide clinical decision making for patients with hematological neoplasms during the COVID-19 pandemic.
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Affiliation(s)
- C Buske
- Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany.
| | - M Dreyling
- Department of Medicine III at LMU Hospital, Munich, Germany
| | - A Alvarez-Larrán
- Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - J Apperley
- Centre for Haematology, Imperial College London, Hammersmith Hospital, London, UK
| | - L Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - C Besson
- Service d'Hématologie Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France; UVSQ, Inserm, CESP, Villejuif, France
| | - L Bullinger
- Department of Hematology, Oncology, and Tumorimmunology, Campus Virchow Klinikum, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - P Corradini
- Hematology Division, University of Milan, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - M Giovanni Della Porta
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - M Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - S D'Sa
- UCLH Centre for Waldenström and Neurohaematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - H T Eich
- Department of Radiation Oncology, University of Muenster, Münster, Germany
| | - R Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - P Ghia
- Strategic Research Program on Chronic Lymphocytic Leukemia and Laboratory of B Cell Neoplasia, Division of Molecular Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - M G da Silva
- Department Of Hematology, Portuguese Institute of Oncology, Lisbon, Portugal
| | - J Gribben
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - R Hajek
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - C Harrison
- Clinical Director - Haematology, Haemostasis, Palliative Care, Cellular Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hanover, Germany
| | - B Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - J J Kiladjian
- Université de Paris, APHP, Hôpital Saint-Louis, Centre d'Investigations Cliniques, Paris, France
| | - N Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - P Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | - J R Passweg
- Hematology Division, Basel University Hospital, Basel, Switzerland
| | - F Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - D Rea
- University Medical Department of Hematology and Immunology, France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Hôpital Saint-Louis, Paris, France
| | - J-M Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - T Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - J F San-Miguel
- Clínica Universidad de Navarra (CUN), Centro de Investigación Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), CIBERONC, Pamplona, Spain
| | - V Santini
- MDS Unit, Hematology, DMSC, AOUC, University of Florence, Florence, Italy
| | - G Sanz
- Hematology Department, Hospital Univesitario y Politecnico La Fe, Valencia; CIBERONC, IS Carlos III, Madrid, Spain
| | - P Sonneveld
- Erasmus MC Cancer Institute, Department of Haematology, Rotterdam, The Netherlands
| | - M von Lilienfeld-Toal
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - C Wendtner
- Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilian University, Munich, Germany
| | - G Pentheroudakis
- Scientific and Medical Division, European Society for Medical Oncology, Lugano, Switzerland
| | - F Passamonti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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Ludwig H, Delforge M, Facon T, Einsele H, Gay F, Moreau P, Avet-Loiseau H, Boccadoro M, Hajek R, Mohty M, Cavo M, Dimopoulos MA, San-Miguel JF, Terpos E, Zweegman S, Garderet L, Mateos MV, Cook G, Leleu X, Goldschmidt H, Jackson G, Kaiser M, Weisel K, van de Donk NWCJ, Waage A, Beksac M, Mellqvist UH, Engelhardt M, Caers J, Driessen C, Sonneveld P. Prevention and management of adverse events of Novel agents in multiple myeloma: A consensus of the european myeloma network. Leukemia 2017:leu2017353. [PMID: 29251284 DOI: 10.1038/leu.2017.353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/23/2017] [Accepted: 11/30/2017] [Indexed: 11/08/2022]
Abstract
During the last few years, several new drugs have been introduced for treatment of patients with multiple myeloma, which have significantly improved treatment outcome. All of these novel substances differ at least in part in their mode of action from similar drugs of the same drug class, or are representatives of new drugs classes, and as such present with very specific side effect profiles. In this review, we summarize these adverse events, provide information on their prevention, and give practical guidance for monitoring of patients and for management of adverse events.Leukemia accepted article preview online, 18 December 2017. doi:10.1038/leu.2017.353.
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Affiliation(s)
- H Ludwig
- Wilhelminen Cancer Research Institute, Vienna, Austria
| | - M Delforge
- Stem Cell Biology and Embryology Unit, Department of Development and Regeneration, Catholic University Leuven, Leuven, Belgium
| | - T Facon
- Department of Hematology, Lille University Hospital, Lille, France
| | - H Einsele
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - F Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - P Moreau
- Department of Hematology, University Hospital, University of Nantes, Nantes, France
| | - H Avet-Loiseau
- Centre de Recherches en Cancerologie de Toulouse CRCT, Institut National de la Sante et de la Recherche Medicale, Université Toulouse, Toulouse, France
| | - M Boccadoro
- Division of Hematology, Citta della Salute e della Scienza, University of Torino, Torino, Italy
| | - R Hajek
- Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - M Mohty
- Department of Haematology, Saint Antoine Hospital, University Pierre and Marie Curie, and INSERM UMRs 938, Paris, France
| | - M Cavo
- a 'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - J F San-Miguel
- Department of Hematology, Clinica Universidad de Navarra, Centro de Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - S Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - L Garderet
- Department of Haematology, Saint Antoine Hospital, University Pierre and Marie Curie, and INSERM UMRs 938, Paris, France
| | - M-V Mateos
- Hospital Universitario de Salamanca, Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
| | - G Cook
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - X Leleu
- Service d'Hématologie et Thérapie Cellulaire, PRC, and Inserm CIC1402, Hospital de la Miléterie, Poitiers, France
| | - H Goldschmidt
- National Center for Tumor Diseases, Heidelberg Medical University, Heidelberg, Germany
| | - G Jackson
- Department of Hematology, Newcastle University, Newcastle, UK
| | - M Kaiser
- Myeloma Group, The Institute of Cancer Research ICR, London, UK
| | - K Weisel
- Department of Hematology and Oncology, University of Tuebingen, Tuebingen, Germany
| | - N W C J van de Donk
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - A Waage
- Department of Hematology, St Olavs Hospital, and IKOM, NTNU, Trondheim, Norway
| | - M Beksac
- Department of Medicine, Ankara University, Ankara, Turkey
| | - U H Mellqvist
- Department of Hematology Sahlgrenska Hospital, Gothenburg, Sweden
| | - M Engelhardt
- Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany
| | - J Caers
- Department of Hematology, University Hospital of Liège, Liège, Belgium
| | - C Driessen
- Department of Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - P Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Hájek R, Masszi T, Petrucci MT, Palumbo A, Rosiñol L, Nagler A, Yong KL, Oriol A, Minarik J, Pour L, Dimopoulos MA, Maisnar V, Rossi D, Kasparu H, Van Droogenbroeck J, Yehuda DB, Hardan I, Jenner M, Calbecka M, Dávid M, de la Rubia J, Drach J, Gasztonyi Z, Górnik S, Leleu X, Munder M, Offidani M, Zojer N, Rajangam K, Chang YL, San-Miguel JF, Ludwig H. A randomized phase III study of carfilzomib vs low-dose corticosteroids with optional cyclophosphamide in relapsed and refractory multiple myeloma (FOCUS). Leukemia 2016; 31:107-114. [PMID: 27416912 PMCID: PMC5220126 DOI: 10.1038/leu.2016.176] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/16/2016] [Accepted: 04/28/2016] [Indexed: 02/07/2023]
Abstract
This randomized, phase III, open-label, multicenter study compared carfilzomib monotherapy against low-dose corticosteroids and optional cyclophosphamide in relapsed and refractory multiple myeloma (RRMM). Relapsed and refractory multiple myeloma patients were randomized (1:1) to receive carfilzomib (10-min intravenous infusion; 20 mg/m2 on days 1 and 2 of cycle 1; 27 mg/m2 thereafter) or a control regimen of low-dose corticosteroids (84 mg of dexamethasone or equivalent corticosteroid) with optional cyclophosphamide (1400 mg) for 28-day cycles. The primary endpoint was overall survival (OS). Three-hundred and fifteen patients were randomized to carfilzomib (n=157) or control (n=158). Both groups had a median of five prior regimens. In the control group, 95% of patients received cyclophosphamide. Median OS was 10.2 (95% confidence interval (CI) 8.4-14.4) vs 10.0 months (95% CI 7.7-12.0) with carfilzomib vs control (hazard ratio=0.975; 95% CI 0.760-1.249; P=0.4172). Progression-free survival was similar between groups; overall response rate was higher with carfilzomib (19.1 vs 11.4%). The most common grade ⩾3 adverse events were anemia (25.5 vs 30.7%), thrombocytopenia (24.2 vs 22.2%) and neutropenia (7.6 vs 12.4%) with carfilzomib vs control. Median OS for single-agent carfilzomib was similar to that for an active doublet control regimen in heavily pretreated RRMM patients.
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Affiliation(s)
- R Hájek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - T Masszi
- St István and St László Hospital of Budapest, Budapest, Hungary
| | | | | | - L Rosiñol
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Nagler
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - K L Yong
- University College London Cancer Institute, London, UK
| | - A Oriol
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - J Minarik
- University Hospital Olomouc and Medical Faculty of Palacky, University Olomouc, Olomouc, Czech Republic
| | - L Pour
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - M A Dimopoulos
- National and Kapodistrian University of Athens, Athens, Greece
| | - V Maisnar
- Charles University Teaching Hospital, Hradec Králové, Czech Republic
| | - D Rossi
- Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - H Kasparu
- Hospital Elisabethinen Linz, Linz, Austria
| | | | - D B Yehuda
- Hadassah Medical Center, Jerusalem, Israel
| | - I Hardan
- Meir Medical Center, Kfar-Saba, Israel
| | - M Jenner
- Southampton General Hospital, Hampshire, UK
| | - M Calbecka
- Nicolaus Copernicus Hospital, Toruń, Poland
| | - M Dávid
- University of Pécs, Pécs, Hungary
| | - J de la Rubia
- University Hospital La Fe and Universidad Católica de València 'San Vicente Mártir', València, Spain
| | - J Drach
- Medical University of Vienna, Vienna, Austria
| | - Z Gasztonyi
- Petz Aladár Megyei Oktató Kórház, Vasvári Pál, Hungary
| | - S Górnik
- Zamojski Szpital Niepubliczny, Zamosc, Poland
| | - X Leleu
- Hopital Huriez, CHRU, Lille, France
| | - M Munder
- University Medicine Mainz, Mainz, Germany
| | - M Offidani
- Clinica di Ematologia Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - N Zojer
- Center for Oncology, Hematology with Outpatient Department and Palliative Care, Wilhelminenspital, Vienna, Austria
| | - K Rajangam
- Onyx Pharmaceuticals, Inc., an Amgen subsidiary, South San Francisco, CA, USA
| | - Y-L Chang
- Onyx Pharmaceuticals, Inc., an Amgen subsidiary, South San Francisco, CA, USA
| | - J F San-Miguel
- Clínica Universidad de Navarra-CIMA-IDISNA, Navarra, Spain
| | - H Ludwig
- Wilhelminen Cancer Research Institute, Vienna, Austria
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Puig N, Conde I, Jiménez C, Sarasquete ME, Balanzategui A, Alcoceba M, Quintero J, Chillón MC, Sebastián E, Corral R, Marín L, Gutiérrez NC, Mateos MV, González-Díaz M, San-Miguel JF, García-Sanz R. The predominant myeloma clone at diagnosis, CDR3 defined, is constantly detectable across all stages of disease evolution. Leukemia 2015; 29:1435-7. [DOI: 10.1038/leu.2015.7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Paíno T, Paiva B, Sayagués JM, Mota I, Carvalheiro T, Corchete LA, Aires-Mejía I, Pérez JJ, Sanchez ML, Barcena P, Ocio EM, San-Segundo L, Sarasquete ME, García-Sanz R, Vidriales MB, Oriol A, Hernández MT, Echeveste MA, Paiva A, Blade J, Lahuerta JJ, Orfao A, Mateos MV, Gutiérrez NC, San-Miguel JF. Phenotypic identification of subclones in multiple myeloma with different chemoresistant, cytogenetic and clonogenic potential. Leukemia 2014; 29:1186-94. [DOI: 10.1038/leu.2014.321] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/31/2014] [Accepted: 11/04/2014] [Indexed: 01/06/2023]
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Durie BG, Morgan G, San-Miguel JF, Orlowski RZ, Lonial S, Niesvizky R, Yu Z, Anderson KC. Long-term safety of lenalidomide (LEN) in relapsed/refractory multiple myeloma (RRMM) patients (Pts): Analysis of pooled data. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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San-Miguel JF, Lonial S, Hungria V, Moreau P, Einsele H, Lee JH, Yoon S, Corradini P, Jedrzejczak WW, Tan DC, Yong K, Guenther A, Wroclawska-Swacha MM, Weber HJ, Bourquelot PM, Richardson PGG. PANORAMA1: A randomized, double-blind, placebo controlled phase III study of panobinostat in combination with bortezomib and dexamethasone in patients with relapsed multiple myeloma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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San-Miguel JF, Richardson PGG, Sezer O, Guenther A, Siegel DSD, Blade J, LeBlanc R, Sutherland HJ, Mateos M, Gramatzki M, Hazell KM, Bengoudifa B, Bourquelot PM, Anderson KC. A phase lb study of oral panobinostat and IV bortezomib in relapsed or relapsed and refractory multiple myeloma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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García-Sanz R, Ocio EM, Caballero A, Magalhães RJP, Alonso J, López-Anglada L, Villaescusa T, Puig N, Hernández JM, Fernández-Calvo J, Aguilar A, Martín A, López R, Paiva B, Orfao A, Vidriales B, San-Miguel JF, del Carpio D. Post-Treatment Bone Marrow Residual Disease > 5% by Flow Cytometry Is Highly Predictive of Short Progression-Free and Overall Survival in Patients With Waldenström's Macroglobulinemia. Clinical Lymphoma Myeloma and Leukemia 2011; 11:168-71. [DOI: 10.3816/clml.2011.n.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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10
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Paiva B, Pérez-Andrés M, Vídriales MB, Almeida J, de las Heras N, Mateos MV, López-Corral L, Gutiérrez NC, Blanco J, Oriol A, Hernández MT, de Arriba F, de Coca AG, Terol MJ, de la Rubia J, González Y, Martín A, Sureda A, Schmidt-Hieber M, Schmitz A, Johnsen HE, Lahuerta JJ, Bladé J, San-Miguel JF, Orfao A. Competition between clonal plasma cells and normal cells for potentially overlapping bone marrow niches is associated with a progressively altered cellular distribution in MGUS vs myeloma. Leukemia 2011; 25:697-706. [PMID: 21252988 DOI: 10.1038/leu.2010.320] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Disappearance of normal bone marrow (BM) plasma cells (PC) predicts malignant transformation of monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM) into symptomatic multiple myeloma (MM). The homing, behavior and survival of normal PC, but also CD34(+) hematopoietic stem cells (HSC), B-cell precursors, and clonal PC largely depends on their interaction with stromal cell-derived factor-1 (SDF-1) expressing, potentially overlapping BM stromal cell niches. Here, we investigate the distribution, phenotypic characteristics and competitive migration capacity of these cell populations in patients with MGUS, SMM and MM vs healthy adults (HA) aged >60 years. Our results show that BM and peripheral blood (PB) clonal PC progressively increase from MGUS to MM, the latter showing a slightly more immature immunophenotype. Of note, such increased number of clonal PC is associated with progressive depletion of normal PC, B-cell precursors and CD34(+) HSC in the BM, also with a parallel increase in PB. In an ex vivo model, normal PC, B-cell precursors and CD34(+) HSC from MGUS and SMM, but not MM patients, were able to abrogate the migration of clonal PC into serial concentrations of SDF-1. Overall, our results show that progressive competition and replacement of normal BM cells by clonal PC is associated with more advanced disease in patients with MGUS, SMM and MM.
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Affiliation(s)
- B Paiva
- Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
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San-Miguel JF, Sezer O, Siegel DS, Guenther A, Blade J, Prosser IW, Bengoudifa B, Klebsattel M, Bourquelot PM, Anderson KC. Phase Ib study of oral panobinostat (LBH589) plus intravenous bortezomib in patients (Pts) with relapsed (Rel) or Rel and refractory (Ref) multiple myeloma (MM). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mateos M, Spencer A, Taylor K, Lonial S, De La Rubia J, Facon T, Bengoudifa B, Hazell K, Bourquelot PM, San-Miguel JF. Phase Ib study of oral panobinostat (LBH589) plus lenalidomide (LEN) plus dexamethasone (DEX) in patients (Pts) with relapsed (Rel) or Rel and refractory (Ref) multiple myeloma (MM). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lopez-Villar O, Garcia JL, Sanchez-Guijo FM, Robledo C, Villaron EM, Hernández-Campo P, Lopez-Holgado N, Diez-Campelo M, Barbado MV, Perez-Simon JA, Hernández-Rivas JM, San-Miguel JF, del Cañizo MC. Both expanded and uncultured mesenchymal stem cells from MDS patients are genomically abnormal, showing a specific genetic profile for the 5q− syndrome. Leukemia 2009; 23:664-72. [DOI: 10.1038/leu.2008.361] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Stadtmauer EA, Weber D, Dimopoulos MA, Borrello I, San-Miguel JF, Hellmann A, Marta Olesnyckyj M, Yu Z, Zeldis JB, Knight RD. Lenalidomide (Len) in combination with dexamethasone (Dex) is more effective than Dex alone at first relapse and provides better outcomes when used early rather than as later salvage therapy in relapsed multiple myeloma (MM). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7600 Background: High-dose Dex remains a standard therapy for relapsed or refractory MM. Lenalidomide is a novel, oral, immunomodulatory drug (IMiD) that has activity against MM with additive effects when combined with Dex. At the interim analysis of MM-009/010, Len/Dex achieved a significant benefit over Dex, providing a longer median TTP, higher response rates, and higher CR rates. Aim: This prospective subgroup analysis was performed to determine the potential benefit of starting Len/Dex at first relapse by analyzing outcomes versus Dex among patients (pts) who had received only 1 versus >1 prior line of therapy. Methods: Pts who had received 1–3 prior treatments and were not refractory to Dex were randomized to either oral lenalidomide (25 mg daily for 3 weeks every 4 weeks) plus Dex (40 mg on Days 1–4, 9–12, 17–20 every 4 weeks for 4 months, then 40 mg on Days 1–4 every cycle thereafter) or placebo plus Dex. The EBMT criteria were used for response. Randomization was stratified at entry by number of prior therapies (1 versus > 1). Results: Of 692 randomized pts, 241 pts (34%) received only 1 prior therapy. Those receiving 2nd-line Len/Dex had a significantly longer median TTP (66 vs. 20 wks) and a higher RR (CR + PR); (63% vs. 26%) versus those receiving 2nd-line Dex. After a median follow-up of 12.1 mos for all pts, 2nd-line Len/Dex provided significantly improved overall survival (OS) (hazard ratio 1.85, P = 0.03) versus 2nd-line Dex. Among the 451 pts who had received > 1 prior line of therapy, the median TTP (44 vs. 20 wks), RR (57% vs. 20%), and OS (hazard ratio 1.50, P = 0.03) were higher with Len/Dex vs. Dex. Response to Len/Dex was superior to that of Dex regardless of the type of prior therapy. Comparing pts who received Len/Dex as 2nd-line versus later salvage therapy, the median TTP was longer and response rates higher in pts treated in second-line. Conclusions: Len/Dex provided higher response rates and improved TTP compared with Dex at first relapse and beyond. TTP and response rates were superior when Len/Dex was administered earlier at first relapse compared with its use as later salvage therapy. These data support the use of Len/Dex for pts as 2nd-line therapy for relapsed MM. [Table: see text]
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Affiliation(s)
- E. A. Stadtmauer
- Abramson Cancer Center, Philadelphia, PA; M. D. Anderson Cancer Center, Houston, TX; General Alexandras Hospital, Athens, Greece; Johns Hopkins University, Baltimore, MD; Hospital Universitario de Salamanca, Salamanca, Spain; University of Medicine, Gdansk, Poland; Celgene Corporation, Summit, NJ
| | - D. Weber
- Abramson Cancer Center, Philadelphia, PA; M. D. Anderson Cancer Center, Houston, TX; General Alexandras Hospital, Athens, Greece; Johns Hopkins University, Baltimore, MD; Hospital Universitario de Salamanca, Salamanca, Spain; University of Medicine, Gdansk, Poland; Celgene Corporation, Summit, NJ
| | - M. A. Dimopoulos
- Abramson Cancer Center, Philadelphia, PA; M. D. Anderson Cancer Center, Houston, TX; General Alexandras Hospital, Athens, Greece; Johns Hopkins University, Baltimore, MD; Hospital Universitario de Salamanca, Salamanca, Spain; University of Medicine, Gdansk, Poland; Celgene Corporation, Summit, NJ
| | - I. Borrello
- Abramson Cancer Center, Philadelphia, PA; M. D. Anderson Cancer Center, Houston, TX; General Alexandras Hospital, Athens, Greece; Johns Hopkins University, Baltimore, MD; Hospital Universitario de Salamanca, Salamanca, Spain; University of Medicine, Gdansk, Poland; Celgene Corporation, Summit, NJ
| | - J. F. San-Miguel
- Abramson Cancer Center, Philadelphia, PA; M. D. Anderson Cancer Center, Houston, TX; General Alexandras Hospital, Athens, Greece; Johns Hopkins University, Baltimore, MD; Hospital Universitario de Salamanca, Salamanca, Spain; University of Medicine, Gdansk, Poland; Celgene Corporation, Summit, NJ
| | - A. Hellmann
- Abramson Cancer Center, Philadelphia, PA; M. D. Anderson Cancer Center, Houston, TX; General Alexandras Hospital, Athens, Greece; Johns Hopkins University, Baltimore, MD; Hospital Universitario de Salamanca, Salamanca, Spain; University of Medicine, Gdansk, Poland; Celgene Corporation, Summit, NJ
| | - M. Marta Olesnyckyj
- Abramson Cancer Center, Philadelphia, PA; M. D. Anderson Cancer Center, Houston, TX; General Alexandras Hospital, Athens, Greece; Johns Hopkins University, Baltimore, MD; Hospital Universitario de Salamanca, Salamanca, Spain; University of Medicine, Gdansk, Poland; Celgene Corporation, Summit, NJ
| | - Z. Yu
- Abramson Cancer Center, Philadelphia, PA; M. D. Anderson Cancer Center, Houston, TX; General Alexandras Hospital, Athens, Greece; Johns Hopkins University, Baltimore, MD; Hospital Universitario de Salamanca, Salamanca, Spain; University of Medicine, Gdansk, Poland; Celgene Corporation, Summit, NJ
| | - J. B. Zeldis
- Abramson Cancer Center, Philadelphia, PA; M. D. Anderson Cancer Center, Houston, TX; General Alexandras Hospital, Athens, Greece; Johns Hopkins University, Baltimore, MD; Hospital Universitario de Salamanca, Salamanca, Spain; University of Medicine, Gdansk, Poland; Celgene Corporation, Summit, NJ
| | - R. D. Knight
- Abramson Cancer Center, Philadelphia, PA; M. D. Anderson Cancer Center, Houston, TX; General Alexandras Hospital, Athens, Greece; Johns Hopkins University, Baltimore, MD; Hospital Universitario de Salamanca, Salamanca, Spain; University of Medicine, Gdansk, Poland; Celgene Corporation, Summit, NJ
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San-Miguel JF, Bartram C, Campana D, Andreeff M. Minimal residual disease in hematologic malignancies. Rev Invest Clin 1994; Suppl:147-52. [PMID: 7886299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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16
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Ruiz-Argüelles GJ, Lobato-Mendizábal E, San-Miguel JF, González M, Caballero MD, Ruiz-Argüelles A, Orfao A, Gómez-Almaguer D, Vidriales B, Ruiz-Reyes G. Long-term treatment results for acute megakaryoblastic leukaemia patients: a multicentre study. Br J Haematol 1992; 82:671-5. [PMID: 1482653 DOI: 10.1111/j.1365-2141.1992.tb06942.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The prognosis and long-term results of a group of 57 acute megakaryoblastic leukaemia (M7-AML) patients was analysed from a multicentre perspective. Ages ranged from 4 to 83 years, median 49 years; 30 were males and 27 were females. The median follow-up time was 7 months, range 1-24 months. Early exits occurred in 12 cases, their median age being 71 years. Forty-five patients were treated with combined aggressive chemotherapy (CT) (n = 26) or low-dose cytarabine (LD-AraC) (n = 19). The following results were obtained with combined CT or AraC, respectively. Complete remission (CR) rates were 73% and 84%, 12-month survival (SV) were 37% and 26%, 24-month SV were 12% and 11%, median SV 10 and 4 months, and relapse rates (RR) were 68% and 94%. These differences were not statistically significant. Irrespective of the treatment modality, the results were better for children (n = 10) than for adults (n = 35): RR rates were 90% and 74%, median SV: 7 and 5 months, 12-month SV: 40% and 22%, 24-month SV; 30% and 9%, and RR: 78% and 81%, respectively; these differences also were not statistically significant. In addition, a literature review of 42 patients from 18 previous reports is presented, including seven cases treated with allogeneic bone marrow transplantation (BMT). The best results were obtained with BMT: 12 and 24 month SV was 86% and the RR was 0%. On the above-mentioned basis, we feel that children and young adults with M7-AML should be offered BMT. In patients over 60 years old or not eligible for aggressive chemotherapy or BMT, an interesting possibility would be the use of LD-AraC which allows a high CR rate, followed by a classical consolidation regimen in order to prevent early relapses.
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