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Furlan A, Cea M, Pavan L, Galli M, Clissa C, Mangiacavalli S, Cafro AM, Girlanda S, Patriarca F, Minotto C, Bertoldero G, Barilà G, Pascarella A, Lico A, Paolini R, Rabassi N, Pescosta N, Porrazzo M, De Sabbata G, Pompa A, Bega G, Cavallin S, Guidotti F, Marcatti M, Rupolo M, Belotti A, Gherlinzoni F, Zambello R. A real-world retrospective-prospective analysis of efficacy and safety of combined ixazomib, lenalidomide, and dexamethasone in relapsed/refractory multiple myeloma: The northern Italy experience. Cancer Med 2024; 13:e7071. [PMID: 38558233 PMCID: PMC10983806 DOI: 10.1002/cam4.7071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Ixazomib, lenalidomide, and dexamethasone (IRd) have been approved for the treatment of relapsed/refractory multiple myeloma (RRMM) based on the results of the TOURMALINE-MM1. OBJECTIVES AND METHODS We conducted a retrospective-prospective analysis of 106 RRMM patients (pts) treated with IRd in 21 centers in Northern Italy, with the aim to evaluate the efficacy and safety of IRd in real life. RESULTS At IRd initiation, 34% of pts were aged ≥75 (median 72.5), 8.5% had an ECOG performance status ≥2, 54.7% of evaluable pts carried high-risk cytogenetic abnormalities [del17p and/or t(4;14) and/or t(14;16) and/or 1 g gain/amp], 60.2% had received ≥2 prior lines of therapy (pLoT), 57.5% were lenalidomide (Len)-exposed (including both Len-sensitive and Len-refractory pts), and 22% were Len-refractory. Main G ≥3 adverse events (AEs) were thrombocytopenia (16%) and neutropenia (12.3%). G ≥3 non-hematologic AEs included infections (9.4%) and GI toxicity (diarrhea 5.7%, hepatotoxicity 2.8%), VTE, skin rash, and peripheral neuropathy were mainly G1-2. The overall response rate was 56.4% (≥VGPR 30%). With a median follow-up of 38 m, median PFS (mPFS) was 16 m and the 1-year OS rate was 73%. By subgroup analysis, an extended PFS was observed for pts achieving ≥VGPR (mPFS 21.2 m), time from diagnosis to IRd ≥5 years (26.2 m), 1 pLoT (34.4 m), Len-naïve (NR), age ≥70 (20 m). In pts exposed to Len, non-refractory in any prior line and immediately prior to IRd, mPFS was 16 and 18 m, respectively. An inferior PFS was seen in Len-refractory pts (4.6 m). By multivariate analysis, independent predictors of PFS were age ≥70 (HR 0.6), time from diagnosis ≥5 years (HR 0.32), refractoriness to Len in any prior line (HR 3.33), and immediately prior (HR 4.31). CONCLUSION IRd might be effective and safe in RRMM pts with an indolent disease, in early lines of treatment, and who proved Len-sensitive, independent of age, and cytogenetic risk.
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Affiliation(s)
- Anna Furlan
- Divisione di Ematologia Ospedale Ca' Foncello di Treviso, ASL 2TrevisoItaly
| | - Michele Cea
- Hematology Unit, Department of Internal Medicine (DiMI)University of Genoa, IRCSS Ospedale Policlinico San MartinoGenovaItaly
| | - Laura Pavan
- Padua University School of MedicineHematology and Clinical ImmunologyPadovaItaly
| | - Monica Galli
- Hematology Division, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Cristina Clissa
- Hematology Unit and Stem Cells Transplant CenterAzienda Ospedaliera Universitaria Integrata di VeronaVeronaItaly
| | | | | | - Stefania Girlanda
- Medical Oncology and Hematology UnitASST Fatebenefratelli Sacco, PO FatebenefratelliMilanoItaly
| | - Francesca Patriarca
- Hematology UnitAzienda Sanitaria Universitaria Friuli Centrale, DAME, Udine University School of MedicineUdineItaly
| | - Claudia Minotto
- Medical Oncology and Hematology UnitAzienda ULSS 3 SerenissimaMiranoItaly
| | | | - Gregorio Barilà
- Hematology UnitAzienda ULSS3 Serenissima, Ospedale dell'AngeloVenezia‐MestreItaly
| | - Anna Pascarella
- Hematology UnitAzienda ULSS3 Serenissima, Ospedale dell'AngeloVenezia‐MestreItaly
| | - Albana Lico
- Hematology UnitAzienda ULSS8 Berica, Ospedale San BortoloVicenzaItaly
| | - Rossella Paolini
- Hematology UnitOspedale Santa Maria della MisericordiaRovigoItaly
| | - Nicholas Rabassi
- Hematology Unit and Stem Cells Transplant CenterOspedale Provinciale BolzanoBolzanoItaly
| | - Norbert Pescosta
- Hematology Unit and Stem Cells Transplant CenterOspedale Provinciale BolzanoBolzanoItaly
| | | | | | - Alessandra Pompa
- Hematology UnitIRCCS Fondazione Ca' Granda, Ospedale Maggiore PoliclinicoMilanoItaly
| | - Giulia Bega
- Medical Oncology UnitOspedale G. Fracastoro, Azienda ULSS 9 ScaligeraVeronaItaly
| | - Stefania Cavallin
- Medical Oncology UnitOspedale di Vittorio Veneto, Azienda ULSS 2 Marca TrevigianaVittorio VenetoItaly
| | | | | | - Maurizio Rupolo
- SOSD OncoematologiaIstituto Nazionale Tumori AvianoAvianoItaly
| | - Angelo Belotti
- Hematology UnitASST Spedali Civili di BresciaBresciaItaly
| | | | - Renato Zambello
- Padua University School of MedicineHematology and Clinical ImmunologyPadovaItaly
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Barilà G, Quaglia FM, Furlan A, Pescosta N, Bonalumi A, Marcon C, Pascarella A, Tinelli M, De March E, Lico A, Sartori R, Clissa C, De Sabbata G, Nappi D, Porrazzo M, De Marchi R, Pavan L, Tosetto A, Gherlinzoni F, Krampera M, Bassan R, Patriarca F, Semenzato G, Zambello R. A real-life study of daratumumab-bortezomib-dexamethasone (D-VD) in lenalidomide exposed/refractory multiple myeloma patients: a report from the Triveneto Myeloma Working Group. Ann Hematol 2024; 103:125-132. [PMID: 37731147 PMCID: PMC10761376 DOI: 10.1007/s00277-023-05443-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
Treatment of lenalidomide refractory (Len-R) multiple myeloma (MM) patients still represents an unmet clinical need. In the last years, daratumumab-bortezomib-dexamethasone (D-VD) combination was extensively used in this setting, even though only a small fraction of Len-R patients was included in the pivotal trial. This real-life study aimed to evaluate the efficacy and safety of the D-VD regimen in a cohort that exclusively enrolled Len exposed or refractory MM patients. The study cohort included 57 patients affected by relapsed/refractory MM. All patients were previously exposed to Len, with 77.2% being refractory. The overall response rate (ORR) was 79.6% with 43% of cases obtaining at least a very good partial response (VGPR). The D-VD regimen showed a favorable safety profile, with low frequency of grade 3-4 adverse events, except for thrombocytopenia observed in 21.4% of patients. With a median follow-up of 13 months, median progression-free survival (PFS) was 17 months. No significant PFS differences were observed according to age, ISS, LDH levels, type of relapse, and high-risk FISH. Len exposed patients displayed a PFS advantage as compared to Len refractory patients (29 vs 16 months, p = 0.2876). Similarly, patients treated after Len maintenance showed a better outcome as compared to patients who had received a full-dose Len treatment (23 vs 13 months, p = 0.1728). In conclusion, our real-world data on D-VD combination showed remarkable efficacy in Len-R patients, placing this regimen as one of the standards of care to be properly taken into account in this MM setting.
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Affiliation(s)
| | | | - Anna Furlan
- Hematology Unit, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
| | - Norbert Pescosta
- Ematologia e Centro TMO, Ospedale Centrale Bolzano, Bozen, Italy
| | - Angela Bonalumi
- Hematology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Chiara Marcon
- Hematology and Transplant Center Unit, Udine University Hospital, DAME, University of Udine, Udine, Italy
| | - Anna Pascarella
- Hematology Unit, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Martina Tinelli
- Hematology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Elena De March
- Department of Medicine, Section of Hematology, Belluno Hospital, Belluno, Italy
| | - Albana Lico
- Hematology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Roberto Sartori
- Department of Clinical and Experimental Oncology, Onco-hematology Unit, Veneto Institute of Oncology, IOV-IRCCS, Castelfranco Veneto (TV), Italy
| | - Cristina Clissa
- Hematology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanni De Sabbata
- Struttura Complessa Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Davide Nappi
- Ematologia e Centro TMO, Ospedale Centrale Bolzano, Bozen, Italy
| | - Marika Porrazzo
- Struttura Complessa Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Roberta De Marchi
- Department of Clinical and Experimental Oncology, Onco-hematology Unit, Veneto Institute of Oncology, IOV-IRCCS, Castelfranco Veneto (TV), Italy
| | - Laura Pavan
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padova University School of Medicine, Via Giustiniani 2, 35128, Padua, Italy
| | | | | | - Mauro Krampera
- Hematology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Renato Bassan
- Hematology Unit, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Francesca Patriarca
- Hematology and Transplant Center Unit, Udine University Hospital, DAME, University of Udine, Udine, Italy
| | - Gianpietro Semenzato
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padova University School of Medicine, Via Giustiniani 2, 35128, Padua, Italy
| | - Renato Zambello
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padova University School of Medicine, Via Giustiniani 2, 35128, Padua, Italy.
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D’Agostino M, Belotti A, Zamagni E, Auclair D, Zambello R, Arigoni M, Spadano A, Cea M, Pescosta N, Ronconi S, Olivero M, Musolino C, Genuardi E, Molica S, Pavone V, Patriarca F, Fabritiis PD, Gamberi B, Calogero RA, Offidani M, Galli M, Musto P, Boccadoro M, Gay F. OAB-055: Gain and amplification of 1q induce transcriptome deregulation and worsen the outcome of newly diagnosed Multiple Myeloma patients. Clinical Lymphoma Myeloma and Leukemia 2021. [DOI: 10.1016/s2152-2650(21)02127-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tacchetti P, Pantani L, Patriarca F, Petrucci MT, Zamagni E, Dozza L, Galli M, Di Raimondo F, Crippa C, Boccadoro M, Barbato S, Tosi P, Narni F, Montefusco V, Testoni N, Spadano A, Terragna C, Pescosta N, Marzocchi G, Cellini C, Galieni P, Ronconi S, Gobbi M, Catalano L, Lazzaro A, De Sabbata G, Cangialosi C, Ciambelli F, Musto P, Elice F, Cavo M. Bortezomib, thalidomide, and dexamethasone followed by double autologous haematopoietic stem-cell transplantation for newly diagnosed multiple myeloma (GIMEMA-MMY-3006): long-term follow-up analysis of a randomised phase 3, open-label study. Lancet Haematol 2020; 7:e861-e873. [PMID: 33242443 DOI: 10.1016/s2352-3026(20)30323-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/03/2020] [Accepted: 09/16/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND The phase 3 GIMEMA-MMY-3006 trial, which compared bortezomib, thalidomide, and dexamethasone (VTD) combination therapy with thalidomide and dexamethasone (TD) as induction therapy before and consolidation therapy after double autologous haematopoietic stem-cell transplantation (HSCT) for newly diagnosed multiple myeloma, showed the superiority of the triplet regimen over the doublet in terms of increased complete response rate and improved progression-free survival. We report the results from the final analysis of the study. METHODS In this randomised, open-label, phase 3 study, patients aged 18-65 years with previously untreated symptomatic multiple myeloma and a Karnofsky Performance Status of 60% or higher were enrolled at 73 centres in Italy. Patients were randomised (1:1) by a web-based system to receive three 21-day cycles of thalidomide (100 mg daily orally for the first 14 days and 200 mg daily thereafter) plus dexamethasone (total 320 mg per cycle; 40 mg on days 1-2, 4-5, 8-9, and 11-12 in the VTD regimen, and 40 mg on days 1-4 and 9-12 in the TD regimen), either alone (TD group) or with bortezomib (1·3 mg/m2 intravenously on days 1, 4, 8, and 11; VTD group). After double autologous HSCT, patients received two 35-day cycles of either the VTD or TD regimen, according to random assignment, as consolidation therapy. The primary outcome was the rate of complete response and near complete response after induction (already reported). In this updated analysis we assessed long-term progression-free survival and overall survival (secondary endpoints of the study) with an extended 10-year median follow-up, and analysed the variables influencing survival. Analysis was by intention to treat. The study is registered with ClinicalTrials.gov, NCT01134484. FINDINGS Between May 10, 2006, and April 30, 2008, 480 patients were enrolled and randomly assigned to receive VTD (241 patients) or TD (239 patients). Six patients withdrew consent before start of treatment. 236 (99 [42%] women) in the VTD group and 238 (102 [43%] women) in the TD group were included in the intention-to-treat analysis. The data cutoff date for this analysis was May 31, 2018. Median follow-up for surviving patients was 124·1 months (IQR 117·2-131·7). The 10-year progression-free survival estimate for patients in the VTD group was 34% (95% CI 28-41) compared with 17% (13-23) for the TD group (hazard ratio [HR] 0·62 [95% CI 0·50-0·77]; p<0·0001). 60% (95% CI 54-67) of patients in the VTD group were alive at 10 years versus 46% (40-54) of patients in the TD group (HR 0·68 [95% CI 0·51-0·90]; p=0·0068). VTD was an independent predictor of improved progression-free survival (HR 0·60 [95% CI 0·48-0·76]; p<0·0001) and overall survival (HR 0·68 [0·50-0·91]; p=0·010). The incidence of second primary malignancies per 100 person-years was 0·87 (95% CI 0·49-1·44) in the VTD group compared with 1·41 (0·88-2·13) in the TD group. INTERPRETATION Incorporation of VTD into double autologous HSCT resulted in clinically meaningful improvements in long-term progression-free survival and overall survival, confirming that a regimen including bortezomib and an immunomodulatory drug is the gold standard treatment for patients with newly diagnosed myeloma who are fit for high-dose chemotherapy. FUNDING Seràgnoli Institute of Haematology, University of Bologna, and BolognAIL.
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Affiliation(s)
- Paola Tacchetti
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Lucia Pantani
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Francesca Patriarca
- Clinical Hematology and Bone Marrow Transplant Centre, S Maria della Misericordia University Hospital, DAME, University of Udine, Udine, Italy
| | - Maria Teresa Petrucci
- Hematology Unit, and Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Elena Zamagni
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Luca Dozza
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Monica Galli
- Hematology and Bone Marrow Transplant Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Di Raimondo
- Division of Hematology, Azienda Ospedaliero-Universitaria Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Claudia Crippa
- Unità Operativa Complessa di Ematologia, Spedali Civili Brescia, Brescia, Italy
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Cittàdella Salute e della Scienza, Turin, Italy
| | - Simona Barbato
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Patrizia Tosi
- Unità Operativa, Ematologia, Ospedale Infermi di Rimini, Rimini, Italy
| | - Franco Narni
- Programma Trapianti Cellule Staminali Emopoietiche, Università di Modena e Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Vittorio Montefusco
- Department of Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nicoletta Testoni
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Antonio Spadano
- Unità Operativa Complessa, Ematologia Clinica, Azienda Sanitaria Locale di Pescara, Pescara, Italy
| | - Carolina Terragna
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Norbert Pescosta
- Reparto di Ematologia e Centro Trapianto Midollo Osseo, Ospedale Centrale, Bolzano, Italy
| | - Giulia Marzocchi
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Claudia Cellini
- Unità Operativa Complessa Ematologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Piero Galieni
- Unità Operativa Complessa Ematologia e Terapia cellulare, Ospedale Costanzo e Giacomo Mazzoni, Ascoli Piceno, Italy
| | - Sonia Ronconi
- IRCCS, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Marco Gobbi
- Dipartimento di Medicina interna, Clinica Ematologica, Policlinico Ospedale San Martino, Genoa, Italy
| | - Lucio Catalano
- Unità Operativa Ematologia, Azienda Ospedaliero-Universitaria Federico II, Napoli, Italy
| | - Antonio Lazzaro
- Division of Hematology and Bone Marrow Transplant Center, Department of Oncology-Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Giovanni De Sabbata
- Struttura Complessa Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Clotilde Cangialosi
- Divisione di Ematologia ad indirizzo oncologico con Trapianto, Azienda Ospedali Riuniti "Villa Sofia Cervello", Presidio Ospedaliero "V Cervello", Palermo, Italy
| | - Fabrizio Ciambelli
- Struttura Complessa di Ematologia, Azienda Socio Sanitaria Territoriale della Valle Olona, Busto Arsizio, Italy
| | - Pellegrino Musto
- "Aldo Moro" University School of Medicine, Unit of Hematology and Stem Cell Transplantation, AOUCPoliclinico, Bari, Italy; Unit of Hematology and Stem Cell Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Francesca Elice
- Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Michele Cavo
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy.
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Mina R, Belotti A, Petrucci MT, Zambello R, Capra A, Di Lullo G, Ronconi S, Pescosta N, Grasso M, Monaco F, Cellini C, Gobbi M, Ballanti S, de Fabritiis P, Mosca-Siez ML, Marchetti M, Liberati AM, Offidani M, Giuliani N, Ria R, Musto P, Romano A, Sonneveld P, Boccadoro M, Larocca A. Bortezomib-dexamethasone as maintenance therapy or early retreatment at biochemical relapse versus observation in relapsed/refractory multiple myeloma patients: a randomized phase II study. Blood Cancer J 2020; 10:58. [PMID: 32424154 PMCID: PMC7234990 DOI: 10.1038/s41408-020-0326-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Roberto Mina
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Angelo Belotti
- Division of Hematology, Spedali Civili di Brescia, Brescia, Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Renato Zambello
- Padova University School of Medicine, Hematology and Clinical Immunology, Padova, Italy
| | - Andrea Capra
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Giacomo Di Lullo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Sonia Ronconi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Norbert Pescosta
- Reparto di Ematologia e Centro TMO, Ospedale Centrale, Bolzano, Italy
| | - Mariella Grasso
- S.C. Ematologia, Azienda Ospedaliera Santa Croce - Carle, Cuneo, Italy
| | - Federico Monaco
- Dipartimento di Ematologia e Medicina Trasfusionale, Azienda Ospedaliera 'SS. Antonio e Biagio e Cesare Arrigo', Alessandria, Italy
| | - Claudia Cellini
- U.O.C. EMATOLOGIA, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Marco Gobbi
- Clinical Hematology, Ospedale Policlinico S. Martino, Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Stelvio Ballanti
- Ematologia con TMO, Ospedale Santa Maria della Misericordia di Perugia, Perugia, Italy
| | | | | | - Monia Marchetti
- Day Hospital Ematologico, Ospedale Cardinal Massaia, Asti, Italy.,Unità di Ematologia, Azienda Sanitaria Ospedaliera 'Ss. Antonio e Biagio e Cesare Arrigo', Alessandria, Italy
| | - Anna Marina Liberati
- Università degli Studi di Perugia - Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Massimo Offidani
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Nicola Giuliani
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Roberto Ria
- Internal Medicine "G. Baccelli", Department of Biomedical Science, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Pellegrino Musto
- Hematology, IRCCS CROB, Rionero in Vulture (Pz), Italy.,Unit of Hematology and Stem Cell Transplantation, AOU Policlinico Giovanni XXIII, School of Medicine, Aldo Moro University, Bari, Italy
| | - Alessandra Romano
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - Pieter Sonneveld
- Department of Hematology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
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Bringhen S, D'Agostino M, Paris L, Ballanti S, Pescosta N, Spada S, Pezzatti S, Grasso M, Rota-Scalabrini D, De Rosa L, Pavone V, Gazzera G, Aquino S, Poggiu M, Santoro A, Gentile M, Baldini L, Petrucci MT, Tosi P, Marasca R, Cellini C, Palumbo A, Falco P, Hájek R, Boccadoro M, Larocca A. Lenalidomide-based induction and maintenance in elderly newly diagnosed multiple myeloma patients: updated results of the EMN01 randomized trial. Haematologica 2019; 105:1937-1947. [PMID: 31582542 PMCID: PMC7327625 DOI: 10.3324/haematol.2019.226407] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 05/20/2019] [Accepted: 09/26/2019] [Indexed: 01/01/2023] Open
Abstract
n the EMN01 trial, the addition of an alkylator (melphalan or cyclophosphamide) to lenalidomide-steroid induction therapy was prospectively evaluated in transplant-ineligible patients with multiple myeloma. After induction, patients were randomly assigned to maintenance treatment with lenalidomide alone or with prednisone continuously. The analysis presented here (median follow-up of 71 months) is focused on maintenance treatment and on subgroup analyses defined according to the International Myeloma Working Group Frailty Score. Of the 654 evaluable patients, 217 were in the lenalidomide-dexamethasone arm, 217 in the melphalan-prednisone-lenalidomide arm and 220 in the cyclophosphamide-prednisone-lenalidomide arm. With regards to the Frailty Score, 284 (43%) patients were fit, 205 (31%) were intermediate-fit and 165 (25%) were frail. After induction, 402 patients were eligible for maintenance therapy (lenalidomide arm, n=204; lenalidomide-prednisone arm, n=198). After a median duration of maintenance of 22.0 months, progression-free survival from the start of maintenance was 22.2 months with lenalidomide-prednisone vs. 18.6 months with lenalidomide (hazard ratio 0.85, P=0.14), with no differences across frailty subgroups. The most frequent grade ≥3 toxicity was neutropenia (10% of lenalidomide-prednisone and 21% of lenalidomide patients; P=0.001). Grade ≥3 non-hematologic adverse events were rare (<15%). In fit patients, melphalan-prednisone-lenalidomide significantly prolonged progression-free survival compared to cyclophosphamide-prednisone-lenalidomide (hazard ratio 0.72, P=0.05) and lenalidomide-dexamethasone (hazard ratio 0.72, P=0.04). Likewise, a trend towards a better overall survival was noted for patients treated with melphalan-prednisone-lenalidomide or cyclophosphamide-prednisone-lenalidomide, as compared to lenalidomide-dexamethasone. No differences were observed in intermediate-fit and frail patients. This analysis showed positive outcomes of maintenance with lenalidomide-based regimens, with a good safety profile. For the first time, we showed that fit patients benefit from a full-dose triplet regimen, while intermediate-fit and frail patients benefit from gentler regimens. ClinicalTrials.gov registration number: NCT01093196.
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Affiliation(s)
- Sara Bringhen
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mattia D'Agostino
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Laura Paris
- Hematology and Bone Marrow Transplant Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Stelvio Ballanti
- Sezione di Ematologia e Immunologia Clinica, Ospedale Santa Maria della Misericordia, località Sant'Andrea delle Fratte, Perugia, Italy
| | - Norbert Pescosta
- Reparto Ematologia e Centro TMO, Ospedale Centrale, Bolzano, Italy
| | - Stefano Spada
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Sara Pezzatti
- Divisione di Ematologia, Ospedale S. Gerardo, Monza, Italy
| | | | | | - Luca De Rosa
- Hematology and Stem Cell Transplantation Unit, Az. Osp. S. Camillo-Forlanini, Rome, Italy
| | - Vincenzo Pavone
- UOC Ematologia e Trapianto, Az. Osp. C. Panico, Tricase (Lecce), Italy
| | - Giulia Gazzera
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Sara Aquino
- Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marco Poggiu
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Armando Santoro
- Istituto Clinico Humanitas, Humanitas University, Rozzano-Milano, Italy
| | | | - Luca Baldini
- UOC Ematologia, Università degli Studi di Milano, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Patrizia Tosi
- UO Ematologia, Ospedale di Rimini, AUSL della Romagna, Rimini, Italy
| | - Roberto Marasca
- Hematology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Cellini
- U.O. Ematologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Patrizia Falco
- SSD Ematologia, ASLTO4, Ospedali di Chivasso Cirié Ivrea, Italy
| | - Roman Hájek
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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7
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Mian M, Pescosta N, Badiali S, Cappelletto PC, Marcheselli L, Luminari S, Patriarca F, Zambello R, Pascarella A, Tagariello G, Marabese A, Mondello P, Billio A, Cortelazzo S. Phase II trial to investigate efficacy and safety of bendamustine, dexamethasone and thalidomide in relapsed or refractory multiple myeloma patients after treatment with lenalidomide and bortezomib. Br J Haematol 2018; 185:944-947. [PMID: 30478966 DOI: 10.1111/bjh.15645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michael Mian
- Department of Haematology & CBMT, Hospital of Bolzano, Bolzano, Italy.,Internal Medicine V, Haematology & Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Norbert Pescosta
- Department of Haematology & CBMT, Hospital of Bolzano, Bolzano, Italy
| | | | | | | | - Stefano Luminari
- Haematology, Santa Maria Nuova Hospital, IRCCS, Reggio Emilia, Italy
| | - Francesca Patriarca
- ClinicaEmatologica e Unita' di TerapieCellulari "Carlo Melzi", Azienda Ospedaliera-Universitaria, Udine, Italy
| | | | | | - Giuseppe Tagariello
- Transfusion Service, Haemophilia Centre and Haematology, Laboratory Analysis, Castelfranco Veneto Hospital, Castelfranco Veneto, Italy
| | | | - Patrizia Mondello
- Department of Human Pathology, University of Messina, Messina, Italy.,Department of Biological and Environmental Sciences, University of Messina, Messina, Italy.,Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Atto Billio
- Department of Haematology & CBMT, Hospital of Bolzano, Bolzano, Italy
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Mina R, Petrucci MT, Corradini P, Spada S, Patriarca F, Cerrato C, De Paoli L, Pescosta N, Ria R, Malfitano A, Musto P, Baldini L, Guglielmelli T, Gamberi B, Mannina D, Benevolo G, Zambello R, Falcone AP, Palumbo A, Nagler A, Calafiore V, Hájek R, Spencer A, Boccadoro M, Bringhen S. Treatment Intensification With Autologous Stem Cell Transplantation and Lenalidomide Maintenance Improves Survival Outcomes of Patients With Newly Diagnosed Multiple Myeloma in Complete Response. Clinical Lymphoma Myeloma and Leukemia 2018; 18:533-540. [DOI: 10.1016/j.clml.2018.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/08/2018] [Accepted: 05/21/2018] [Indexed: 11/28/2022]
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Oliva S, Gambella M, Gilestro M, Muccio VE, Gay F, Drandi D, Ferrero S, Passera R, Pautasso C, Bernardini A, Genuardi M, Patriarca F, Saraci E, Petrucci MT, Pescosta N, Liberati AM, Caravita T, Conticello C, Rocci A, Musto P, Boccadoro M, Palumbo A, Omedè P. Minimal residual disease after transplantation or lenalidomide-based consolidation in myeloma patients: a prospective analysis. Oncotarget 2018; 8:5924-5935. [PMID: 27779105 PMCID: PMC5351601 DOI: 10.18632/oncotarget.12641] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 09/21/2016] [Indexed: 11/25/2022] Open
Abstract
We analyzed 50 patients who achieved at least a very good partial response in the RV-MM-EMN-441 study. Patients received consolidation with autologous stem-cell transplantation (ASCT) or cyclophosphamide-lenalidomide-dexamethasone (CRD), followed by Lenalidomide-based maintenance. We assessed minimal residual disease (MRD) by multi-parameter flow cytometry (MFC) and allelic-specific oligonucleotide real-time quantitative polymerase chain reaction (ASO-RQ-PCR) after consolidation, after 3 and 6 courses of maintenance, and thereafter every 6 months until progression. By MFC analysis, 19/50 patients achieved complete response (CR) after consolidation, and 7 additional patients during maintenance. A molecular marker was identified in 25/50 patients, 4/25 achieved molecular-CR after consolidation, and 3 additional patients during maintenance. A lower MRD value by MFC was found in ASCT patients compared with CRD patients (p=0.0134). Tumor burden reduction was different in patients with high-risk vs standard-risk cytogenetics (3.4 vs 5.2, ln-MFC; 3 vs 6 ln-PCR, respectively) and in patients who relapsed vs those who did not (4 vs 5, ln-MFC; 4.4 vs 7.8 ln-PCR). MRD progression anticipated clinical relapse by a median of 9 months while biochemical relapse by a median of 4 months. MRD allows the identification of a low-risk group, independently of response, and a better characterization of the activity of treatments.
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Affiliation(s)
- Stefania Oliva
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Manuela Gambella
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Milena Gilestro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Vittorio Emanuele Muccio
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniela Drandi
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Pautasso
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Annalisa Bernardini
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mariella Genuardi
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Patriarca
- Azienda Ospedaliera-Universitaria di Udine, DISM Università di Udine, Udine, Italy
| | - Elona Saraci
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maria Teresa Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Norbert Pescosta
- Ematologia e Centro TMO, Ospedale Centrale Bolzano, Bozen, Italy
| | | | | | - Concetta Conticello
- Divisione di Ematologia, Azienda Policlinico-OVE, Università di Catania, Catania, Italy
| | - Alberto Rocci
- Department of Haematology, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paola Omedè
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospeadliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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Mian M, Tinelli M, DE March E, Turri G, Meneghini V, Pescosta N, Berno T, Marabese A, Mondello P, Patriarca F, Pizzolo G, Semenzato G, Cortelazzo S, Zambello R. Bortezomib, Thalidomide and Lenalidomide: Have They Really Changed the Outcome of Multiple Myeloma? Anticancer Res 2016; 36:1059-1065. [PMID: 26976998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Treatment of multiple myeloma (MM) has significantly improved, although the disease remains incurable. Prospective clinical trials evaluating the impact on outcome of new drugs such as proteasome inhibitors or immunomodulating agents are limited since they are not able to reflect the clinical routine and available retrospective data are not detailed enough to directly evaluate the value of new drugs. To address these information gaps, we performed a retrospective real-life analysis. We retrospectively assessed 949 patients treated for multiple myeloma or plasma cell leukemia at three Italian cancer centers in the years 1979-2014. Clinical features at the time of diagnosis were consistent with what was observed in clinical routine. A total of 39% of patients underwent high-dose chemotherapy followed by autologous stem cell transplantation (ASCT). The median overall survival (OS) of the whole group was 5.4 years and ranged from 3.4 years for patients who did not receive at least one of the new drugs compared to 5.9 years in the other patients (p<0.001). The improvement in OS due to administration of new drugs was also observed among different prognostic sub-groups such as age, Durie and Salmon stage, international staging system and renal impairment. Availability of new drugs significantly improved survival of patients who underwent ASCT and also those who did not. In conclusion, we provided evidence that the advent of the new drugs drastically improved the outcome of patients with MM, also in cases with poor risk at the time of diagnosis. ASCT is still of major importance in the treatment of this disease. Nevertheless, MM remains incurable and new therapeutic approaches are warranted.
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Affiliation(s)
- Michael Mian
- Department of Hematology & Center of Bone Marrow Transplantation, Ospedale di Bolzano, Bolzano, Italy Department of Internal Medicine V (Haematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - Martina Tinelli
- Department of Medicine, Section of Hematology, University Hospital of Verona, Verona, Italy
| | - Elena DE March
- Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy
| | - Gloria Turri
- Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy
| | - Vittorio Meneghini
- Department of Medicine, Section of Hematology, University Hospital of Verona, Verona, Italy
| | - Norbert Pescosta
- Department of Hematology & Center of Bone Marrow Transplantation, Ospedale di Bolzano, Bolzano, Italy
| | - Tamara Berno
- Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy
| | - Alessandra Marabese
- Department of Hematology & Center of Bone Marrow Transplantation, Ospedale di Bolzano, Bolzano, Italy
| | - Patrizia Mondello
- Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Giovanni Pizzolo
- Department of Medicine, Section of Hematology, University Hospital of Verona, Verona, Italy
| | - Gianpietro Semenzato
- Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy
| | - Sergio Cortelazzo
- Unit of Medical Oncology and Hematology, Clinical Institute Humanitas-Gavazzeni, Bergamo, Italy
| | - Renato Zambello
- Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy
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Gay F, Oliva S, Petrucci MT, Conticello C, Catalano L, Corradini P, Siniscalchi A, Magarotto V, Pour L, Carella A, Malfitano A, Petrò D, Evangelista A, Spada S, Pescosta N, Omedè P, Campbell P, Liberati AM, Offidani M, Ria R, Pulini S, Patriarca F, Hajek R, Spencer A, Boccadoro M, Palumbo A. Chemotherapy plus lenalidomide versus autologous transplantation, followed by lenalidomide plus prednisone versus lenalidomide maintenance, in patients with multiple myeloma: a randomised, multicentre, phase 3 trial. Lancet Oncol 2015; 16:1617-29. [PMID: 26596670 DOI: 10.1016/s1470-2045(15)00389-7] [Citation(s) in RCA: 238] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/04/2015] [Accepted: 10/01/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND High-dose melphalan plus autologous stem-cell transplantation (ASCT) is the standard approach in transplant-eligible patients with newly diagnosed myeloma. Our aims were to compare consolidation with high-dose melphalan plus ASCT versus chemotherapy (cyclophosphamide and dexamethasone) plus lenalidomide, and maintenance with lenalidomide plus prednisone versus lenalidomide alone. METHODS We did an open-label, randomised, multicentre, phase 3 study at 59 centres in Australia, Czech Republic, and Italy. We enrolled transplant-eligible patients with newly diagnosed myeloma aged 65 years or younger. Patients received a common induction with four 28-day cycles of lenalidomide (25 mg, days 1-21) and dexamethasone (40 mg, days 1, 8, 15, and 22) and subsequent chemotherapy with cyclophosphamide (3 g/m(2)) followed by granulocyte colony-stimulating factor for stem-cell mobilisation and collection. Using a 2 × 2 partial factorial design, we randomised patients to consolidation with either chemotherapy plus lenalidomide (six cycles of cyclophosphamide [300 mg/m(2), days 1, 8, and 15], dexamethasone [40 mg, days 1, 8, 15, and 22], and lenalidomide [25 mg, days 1-21]) or two courses of high-dose melphalan (200 mg/m(2)) and ASCT. We also randomised patients to maintenance with lenalidomide (10 mg, days 1-21) plus prednisone (50 mg, every other day) or lenalidomide alone. A simple randomisation sequence was used to assign patients at enrolment into one of the four groups (1:1:1:1 ratio), but the treatment allocation was disclosed only when the patient reached the end of the induction and confirmed their eligibility for consolidation. Both the patient and the treating clinician did not know the consolidation and maintenance arm until that time. The primary endpoint was progression-free survival assessed by intention-to-treat. The trial is ongoing and some patients are still receiving maintenance. This study is registered at ClinicalTrials.gov, number NCT01091831. FINDINGS 389 patients were enrolled between July 6, 2009, and May 6, 2011, with 256 eligible for consolidation (127 high-dose melphalan and ASCT and 129 chemotherapy plus lenalidomide) and 223 eligible for maintenance (117 lenalidomide plus prednisone and 106 lenalidomide alone). Median follow-up was 52·0 months (IQR 30·4-57·6). Progression-free survival during consolidation was significantly shorter with chemotherapy plus lenalidomide compared with high-dose melphalan and ASCT (median 28·6 months [95% CI 20·6-36·7] vs 43·3 months [33·2-52·2]; hazard ratio [HR] for the first 24 months 2·51, 95% CI 1·60-3·94; p<0·0001). Progression-free survival did not differ between maintenance treatments (median 37·5 months [95% CI 27·8-not evaluable] with lenalidomide plus prednisone vs 28·5 months [22·5-46·5] with lenalidomide alone; HR 0·84, 95% CI 0·59-1·20; p=0·34). Fewer grade 3 or 4 adverse events were recorded with chemotherapy plus lenalidomide than with high-dose melphalan and ASCT; the most frequent were haematological (34 [26%] of 129 patients vs 107 [84%] of 127 patients), gastrointestinal (six [5%] vs 25 [20%]), and infection (seven [5%] vs 24 [19%]). Haematological serious adverse events were reported in two (2%) patients assigned chemotherapy plus lenalidomide and no patients allocated high-dose melphalan and ASCT. Non-haematological serious adverse events were reported in 13 (10%) patients assigned chemotherapy plus lenalidomide and nine (7%) allocated high-dose melphalan and ASCT. During maintenance, adverse events did not differ between groups. The most frequent grade 3 or 4 adverse events were neutropenia (nine [8%] of 117 patients assigned lenalidomide plus prednisone vs 14 [13%] of 106 allocated lenalidomide alone), infection (eight [8%] vs five [5%]), and systemic toxicities (seven [6%] vs two [2%]). Non-haematological serious adverse events were reported in 13 (11%) patients assigned lenalidomide plus prednisone versus ten (9%) allocated lenalidomide alone. Four patients died because of adverse events, three from infections (two during induction and one during consolidation) and one because of cardiac toxic effects. INTERPRETATION Consolidation with high-dose melphalan and ASCT remains the preferred option in transplant-eligible patients with multiple myeloma, despite a better toxicity profile with chemotherapy plus lenalidomide. FUNDING Celgene.
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Affiliation(s)
- Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefania Oliva
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Maria Teresa Petrucci
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Concetta Conticello
- Divisione di Ematologia, Azienda Policlinico-OVE, Università di Catania, Catania, Italy
| | | | - Paolo Corradini
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Valeria Magarotto
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luděk Pour
- Department of Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Alessandra Malfitano
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Daniela Petrò
- Hematology Department, Niquarda Ca'Granda Hospital, Milan, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Turin, Italy
| | - Stefano Spada
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Norbert Pescosta
- Ematologia e Centro TMO Ospedale Centrale Bolzano, Bolzano, Italy
| | - Paola Omedè
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Philip Campbell
- Haematology Department, Cancer Services, Barwon Health, Geelong, VIC, Australia
| | | | | | - Roberto Ria
- University of Bari Aldo Moro Medical School, Department of Biomedical Science, Internal Medicine G Baccelli Policlinico, Bari, Italy
| | - Stefano Pulini
- Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, U O Ematologia Clinica, Ospedale Civile Spirito Santo, Pescara, Italy
| | | | - Roman Hajek
- Department of Haematooncology, University Hospital Ostrava and University of Ostrava, Ostrava, Czech Republic
| | - Andrew Spencer
- Department of Clinical Haematology, Alfred Health, Monash University, Melbourne, VIC, Australia
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
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Abstract
We report on the case of a young woman with a diagnosis of amyloidosis who developed severe portal and splenic venous thrombosis shortly after hormonal follicle stimulation therapy for oocyte preservation. The clinical implications are discussed.
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Affiliation(s)
- Andrea Piccin
- Haematology Department, San Maurizio Regional Hospital , Bolzano, South Tyrol , Italy
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Mian M, Farsad M, Pescosta N, Casini M, Cavattoni IM, Deola S, Cortelazzo S. Bendamustine salvage for the treatment of relapsed Hodgkin’s lymphoma after allogeneic bone marrow transplantation. Ann Hematol 2012; 92:121-3. [DOI: 10.1007/s00277-012-1525-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/08/2012] [Indexed: 11/28/2022]
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Palumbo A, Cavo M, Bringhen S, Zamagni E, Romano A, Patriarca F, Rossi D, Gentilini F, Crippa C, Galli M, Nozzoli C, Ria R, Marasca R, Montefusco V, Baldini L, Elice F, Callea V, Pulini S, Carella AM, Zambello R, Benevolo G, Magarotto V, Tacchetti P, Pescosta N, Cellini C, Polloni C, Evangelista A, Caravita T, Morabito F, Offidani M, Tosi P, Boccadoro M. Aspirin, Warfarin, or Enoxaparin Thromboprophylaxis in Patients With Multiple Myeloma Treated With Thalidomide: A Phase III, Open-Label, Randomized Trial. J Clin Oncol 2011; 29:986-93. [DOI: 10.1200/jco.2010.31.6844] [Citation(s) in RCA: 249] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose In patients with myeloma, thalidomide significantly improves outcomes but increases the risk of thromboembolic events. In this randomized, open-label, multicenter trial, we compared aspirin (ASA) or fixed low-dose warfarin (WAR) versus low molecular weight heparin (LMWH) for preventing thromboembolism in patients with myeloma treated with thalidomide-based regimens. Patients and Methods A total of 667 patients with previously untreated myeloma who received thalidomide-containing regimens and had no clinical indication or contraindication for a specific antiplatelet or anticoagulant therapy were randomly assigned to receive ASA (100 mg/d), WAR (1.25 mg/d), or LMWH (enoxaparin 40 mg/d). A composite primary end point included serious thromboembolic events, acute cardiovascular events, or sudden deaths during the first 6 months of treatment. Results Of 659 analyzed patients, 43 (6.5%) had serious thromboembolic events, acute cardiovascular events, or sudden death during the first 6 months (6.4% in the ASA group, 8.2% in the WAR group, and 5.0% in the LMWH group). Compared with LMWH, the absolute differences were +1.3% (95% CI, −3.0% to 5.7%; P = .544) in the ASA group and +3.2% (95% CI, −1.5% to 7.8%; P = .183) in the WAR group. The risk of thromboembolism was 1.38 times higher in patients treated with thalidomide without bortezomib. Three major (0.5%) and 10 minor (1.5%) bleeding episodes were recorded. Conclusion In patients with myeloma treated with thalidomide-based regimens, ASA and WAR showed similar efficacy in reducing serious thromboembolic events, acute cardiovascular events, and sudden deaths compared with LMWH, except in elderly patients where WAR showed less efficacy than LMWH.
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Affiliation(s)
- Antonio Palumbo
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Michele Cavo
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Sara Bringhen
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Elena Zamagni
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Alessandra Romano
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Francesca Patriarca
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Davide Rossi
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Fabiana Gentilini
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Claudia Crippa
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Monica Galli
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Chiara Nozzoli
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Roberto Ria
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Roberto Marasca
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Vittorio Montefusco
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Luca Baldini
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Francesca Elice
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Vincenzo Callea
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Stefano Pulini
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Angelo M. Carella
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Renato Zambello
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Giulia Benevolo
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Valeria Magarotto
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Paola Tacchetti
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Norbert Pescosta
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Claudia Cellini
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Claudia Polloni
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Andrea Evangelista
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Tommaso Caravita
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Fortunato Morabito
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Massimo Offidani
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Patrizia Tosi
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
| | - Mario Boccadoro
- From the University of Torino, Azienda Ospedaliero-Universitaria (AOU) San Giovanni Battista, Torino; “Seràgnoli” Institute of Hematology, Bologna University School of Medicinew, Bologna University Hospital, Bologna; University of Catania, Catania; AOU di Udine, Udine; Università del Piemonte Orientale Amedeo Avogadro, Novara; “Sapienza” University of Rome; Università Tor Vergata, Ospedale S Eugenio, Rome; Spedali Civili Brescia, Brescia; Ospedali Riuniti, Bergamo; AOU Careggi, Firenze; Università degli
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Cavo M, Tacchetti P, Patriarca F, Petrucci MT, Pantani L, Galli M, Di Raimondo F, Crippa C, Zamagni E, Palumbo A, Offidani M, Corradini P, Narni F, Spadano A, Pescosta N, Deliliers GL, Ledda A, Cellini C, Caravita T, Tosi P, Baccarani M. Bortezomib with thalidomide plus dexamethasone compared with thalidomide plus dexamethasone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma: a randomised phase 3 study. Lancet 2010; 376:2075-85. [PMID: 21146205 DOI: 10.1016/s0140-6736(10)61424-9] [Citation(s) in RCA: 650] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Thalidomide plus dexamethasone (TD) is a standard induction therapy for myeloma. We aimed to assess the efficacy and safety of addition of bortezomib to TD (VTD) versus TD alone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma. METHODS Patients (aged 18-65 years) with previously untreated symptomatic myeloma were enrolled from 73 sites in Italy between May, 2006, and April, 2008, and data collection continued until June 30, 2010. Patients were randomly allocated (1:1 ratio) by a web-based system to receive three 21-day cycles of thalidomide (100 mg daily for the first 14 days and 200 mg daily thereafter) plus dexamethasone (40 mg daily on 8 of the first 12 days, but not consecutively; total of 320 mg per cycle), either alone or with bortezomib (1·3 mg/m(2) on days 1, 4, 8, and 11). The randomisation sequence was computer generated by the study coordinating team and was stratified by disease stage. After double autologous stem-cell transplantation, patients received two 35-day cycles of their assigned drug regimen, VTD or TD, as consolidation therapy. The primary endpoint was the rate of complete or near complete response to induction therapy. Analysis was by intention to treat. Patients and treating physicians were not masked to treatment allocation. This study is still underway but is not recruiting participants, and is registered with ClinicalTrials.gov, number NCT01134484, and with EudraCT, number 2005-003723-39. FINDINGS 480 patients were enrolled and randomly assigned to receive VTD (n=241 patients) or TD (n=239). Six patients withdrew consent before start of treatment, and 236 on VTD and 238 on TD were included in the intention-to-treat analysis. After induction therapy, complete or near complete response was achieved in 73 patients (31%, 95% CI 25·0-36·8) receiving VTD, and 27 (11%, 7·3-15·4) on TD (p<0·0001). Grade 3 or 4 adverse events were recorded in a significantly higher number of patients on VTD (n=132, 56%) than in those on TD (n=79, 33%; p<0·0001), with a higher occurrence of peripheral neuropathy in patients on VTD (n=23, 10%) than in those on TD (n=5, 2%; p=0·0004). Resolution or improvement of severe peripheral neuropathy was recorded in 18 of 23 patients on VTD, and in three of five patients on TD. INTERPRETATION VTD induction therapy before double autologous stem-cell transplantation significantly improves rate of complete or near complete response, and represents a new standard of care for patients with multiple myeloma who are eligible for transplant. FUNDING Seràgnoli Institute of Haematology at the University of Bologna, Bologna, Italy.
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Affiliation(s)
- Michele Cavo
- Istituto di Ematologia Seràgnoli, Università degli Studi di Bologna, Bologna, Italy.
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Palumbo A, Gay F, Falco P, Crippa C, Montefusco V, Patriarca F, Rossini F, Caltagirone S, Benevolo G, Pescosta N, Guglielmelli T, Bringhen S, Offidani M, Giuliani N, Petrucci MT, Musto P, Liberati AM, Rossi G, Corradini P, Boccadoro M. Bortezomib as induction before autologous transplantation, followed by lenalidomide as consolidation-maintenance in untreated multiple myeloma patients. J Clin Oncol 2010; 28:800-7. [PMID: 20048187 DOI: 10.1200/jco.2009.22.7561] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [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
PURPOSE To evaluate the effect of bortezomib as induction therapy before autologous transplantation, followed by lenalidomide as consolidation-maintenance in myeloma patients. PATIENTS AND METHODS Newly diagnosed patients age 65 to 75 years were eligible. Induction (bortezomib, doxorubicin, and dexamethasone [PAD]) included four 21-day cycles of bortezomib (1.3 mg/m(2) on days 1, 4, 8, and 11), pegylated liposomal doxorubicin (30 mg/m(2) on day 4), and dexamethasone (40 mg/d; cycle 1: days 1 to 4, 8 to 11, and 15 to 18; cycles 2 to 4: days 1 to 4). Autologous transplantation was tandem melphalan 100 mg/m(2) (MEL100) and stem-cell support. Consolidation included four 28-day cycles of lenalidomide (25 mg/d on days 1 to 21 every 28 days) plus prednisone (50 mg every other day), followed by maintenance with lenalidomide (LP-L; 10 mg/d on days 1 to 21) until relapse. Primary end points were safety (incidence of grade 3 to 4 adverse events [AEs]) and efficacy (response rate). Results A total of 102 patients were enrolled. In a per-protocol analysis, after PAD, 58% of patients had very good partial response (VGPR) or better, including 13% with complete response (CR); after MEL100, 82% of patients had at least VGPR and 38% had CR; and after LP-L, 86% of patients had at least VGPR and 66% had CR. After median follow-up time of 21 months, the 2-year progression-free survival rate was 69%, and the 2-year overall survival rate was 86%. During induction, treatment-related mortality was 3%; grade 3 to 4 AEs included thrombocytopenia (17%), neutropenia (10%), peripheral neuropathy (16%), and pneumonia (10%). During consolidation-maintenance, grade 3 to 4 AEs were neutropenia (16%), thrombocytopenia (6%), pneumonia (5%), and cutaneous rash (4%). CONCLUSION Bortezomib as induction before autologous transplantation, followed by lenalidomide as consolidation-maintenance, is an effective regimen.
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Affiliation(s)
- Antonio Palumbo
- Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliero-Universitaria San Giovanni Battista, Via Genova 3, 10126 Torino, Italy.
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Galli M, Salmoiraghi S, Golay J, Gozzini A, Crippa C, Pescosta N, Rambaldi A. A phase II multiple dose clinical trial of histone deacetylase inhibitor ITF2357 in patients with relapsed or progressive multiple myeloma. Ann Hematol 2009; 89:185-90. [DOI: 10.1007/s00277-009-0793-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
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Palumbo A, Gay F, Bringhen S, Falcone A, Pescosta N, Callea V, Caravita T, Morabito F, Magarotto V, Ruggeri M, Avonto I, Musto P, Cascavilla N, Bruno B, Boccadoro M. Bortezomib, doxorubicin and dexamethasone in advanced multiple myeloma. Ann Oncol 2008; 19:1160-5. [DOI: 10.1093/annonc/mdn018] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Palumbo AP, Ambrosini MT, Benevolo G, Pescosta N, Callea V, Cangialosi C, Caravita T, Morabito F, Gay F, Boccadoro M. Factors predictive of outcome in relapsed, refractory multiple myeloma patients treated with bortezomib, melphalan, prednisone, and thalidomide (VMPT). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
8048 Background: In relapsed/refractory multiple myeloma (MM) patients, the addition of thalidomide and bortezomib to the standard oral melphalan/prednisone (VMPT) significantly increased response rate and progression-free survival (PFS) (Blood. 2006 Dec 5; [Epub ahead of print]). Baseline parameters which may predict outcome after VMPT have been investigated to identify which patient subgroups most benefit from this drug combination. Methods: Thirty patients with relapsed or refractory MM after 1 or 2 lines of treatment, were treated with six 35-days courses of bortezomib (3 dose levels: 1.0,1.3 and 1.6 mg/m2) on days 1,4,15,22, plus melphalan (6 mg/m2) and prednisone (60 mg/m2) on days 1–5 and thalidomide (50 mg) on days 1–35. Several parameters such as age, β2-microglobulin, C-reactive protein, chromosome 13 abnormalities, albumin, haemoglobin, stage, creatinine, bone marrow plasmacytosis, line of therapy and dosage of bortezomib were analyzed in association with response rate and PFS, using χ2 and Cox model. Results: At least a very good partial response was achieved in 43% of patients and at least a partial response in 67%. The 1-year PFS was 61%, and the 1- year overall survival was 84%. Subgroup analyses did not show any statistical difference between responses and either age, β2 microglobulin, C-reactive protein, chromosome 13 abnormalities, line of treatment or dosage of bortezomib. Serum albumin <3.5 mg/dL was loosely associated with a lower response rate (p=0.09). Factors predictive of shorter PFS were C-reactive protein = 6 mg/L (p=0.02) and 3rd line of therapy (p=0.009). Factors loosely associated with shorter PFS were β2-microglobulin = 3.5 mg/L (p=0.06) and creatinine = 2 mg/dL (p=0.09). No difference in PFS was observed between patients with or without chromosome 13 abnormalities. Conclusions: VMPT induced a high proportion of responses and appeared to overcome the poor prognosis of patients with chromosome 13q deletion. [Table: see text]
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Affiliation(s)
- A. P. Palumbo
- Italian Multiple Myeloma Network, GIMEMA; Az. Osp. San Giovanni Battista, Torino, Italy; Ospedale Centrale, Bolzano, Italy; Opedali Riuniti, Reggio Calabria, Italy; Az. Osp. Cervello, Palermo, Italy; Università TorVergata, Ospedale San Eugenio, Roma, Italy; Az. Osp. di Cosenza, Cosenza, Italy
| | - M. T. Ambrosini
- Italian Multiple Myeloma Network, GIMEMA; Az. Osp. San Giovanni Battista, Torino, Italy; Ospedale Centrale, Bolzano, Italy; Opedali Riuniti, Reggio Calabria, Italy; Az. Osp. Cervello, Palermo, Italy; Università TorVergata, Ospedale San Eugenio, Roma, Italy; Az. Osp. di Cosenza, Cosenza, Italy
| | - G. Benevolo
- Italian Multiple Myeloma Network, GIMEMA; Az. Osp. San Giovanni Battista, Torino, Italy; Ospedale Centrale, Bolzano, Italy; Opedali Riuniti, Reggio Calabria, Italy; Az. Osp. Cervello, Palermo, Italy; Università TorVergata, Ospedale San Eugenio, Roma, Italy; Az. Osp. di Cosenza, Cosenza, Italy
| | - N. Pescosta
- Italian Multiple Myeloma Network, GIMEMA; Az. Osp. San Giovanni Battista, Torino, Italy; Ospedale Centrale, Bolzano, Italy; Opedali Riuniti, Reggio Calabria, Italy; Az. Osp. Cervello, Palermo, Italy; Università TorVergata, Ospedale San Eugenio, Roma, Italy; Az. Osp. di Cosenza, Cosenza, Italy
| | - V. Callea
- Italian Multiple Myeloma Network, GIMEMA; Az. Osp. San Giovanni Battista, Torino, Italy; Ospedale Centrale, Bolzano, Italy; Opedali Riuniti, Reggio Calabria, Italy; Az. Osp. Cervello, Palermo, Italy; Università TorVergata, Ospedale San Eugenio, Roma, Italy; Az. Osp. di Cosenza, Cosenza, Italy
| | - C. Cangialosi
- Italian Multiple Myeloma Network, GIMEMA; Az. Osp. San Giovanni Battista, Torino, Italy; Ospedale Centrale, Bolzano, Italy; Opedali Riuniti, Reggio Calabria, Italy; Az. Osp. Cervello, Palermo, Italy; Università TorVergata, Ospedale San Eugenio, Roma, Italy; Az. Osp. di Cosenza, Cosenza, Italy
| | - T. Caravita
- Italian Multiple Myeloma Network, GIMEMA; Az. Osp. San Giovanni Battista, Torino, Italy; Ospedale Centrale, Bolzano, Italy; Opedali Riuniti, Reggio Calabria, Italy; Az. Osp. Cervello, Palermo, Italy; Università TorVergata, Ospedale San Eugenio, Roma, Italy; Az. Osp. di Cosenza, Cosenza, Italy
| | - F. Morabito
- Italian Multiple Myeloma Network, GIMEMA; Az. Osp. San Giovanni Battista, Torino, Italy; Ospedale Centrale, Bolzano, Italy; Opedali Riuniti, Reggio Calabria, Italy; Az. Osp. Cervello, Palermo, Italy; Università TorVergata, Ospedale San Eugenio, Roma, Italy; Az. Osp. di Cosenza, Cosenza, Italy
| | - F. Gay
- Italian Multiple Myeloma Network, GIMEMA; Az. Osp. San Giovanni Battista, Torino, Italy; Ospedale Centrale, Bolzano, Italy; Opedali Riuniti, Reggio Calabria, Italy; Az. Osp. Cervello, Palermo, Italy; Università TorVergata, Ospedale San Eugenio, Roma, Italy; Az. Osp. di Cosenza, Cosenza, Italy
| | - M. Boccadoro
- Italian Multiple Myeloma Network, GIMEMA; Az. Osp. San Giovanni Battista, Torino, Italy; Ospedale Centrale, Bolzano, Italy; Opedali Riuniti, Reggio Calabria, Italy; Az. Osp. Cervello, Palermo, Italy; Università TorVergata, Ospedale San Eugenio, Roma, Italy; Az. Osp. di Cosenza, Cosenza, Italy
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Palumbo A, Ambrosini MT, Benevolo G, Pregno P, Pescosta N, Callea V, Cangialosi C, Caravita T, Morabito F, Musto P, Bringhen S, Falco P, Avonto I, Cavallo F, Boccadoro M. Bortezomib, melphalan, prednisone, and thalidomide for relapsed multiple myeloma. Blood 2006; 109:2767-72. [PMID: 17148584 DOI: 10.1182/blood-2006-08-042275] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [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: 12/22/2022] Open
Abstract
AbstractIn multiple myeloma (MM), the addition of thalidomide or bortezomib to the standard oral melphalan/prednisone combination significantly increased response rate and event-free survival. In this multicenter phase 1/2 trial, dosing, safety, and efficacy of the 4-drug combination, bortezomib, melphalan, prednisone, and thalidomide (VMPT) was determined. Bortezomib was administered at 3 dose levels (1.0 mg/m2, 1.3 mg/m2, or 1.6 mg/m2) on days 1, 4, 15, and 22; melphalan was given at a dose of 6 mg/m2 on days 1 through 5 and prednisone at 60 mg/m2 on days 1 through 5. Thalidomide was delivered at 50 mg on days 1 through 35. Each course was repeated every 35 days. The maximum tolerated dose of bortezomib was 1.3 mg/m2. Thirty patients with relapsed or refractory MM were enrolled; 20 patients (67%) achieved a partial response (PR) including 13 patients (43%) who achieved at least a very good PR. Among 14 patients who received VMPT as second-line treatment, the PR rate was 79% and the immunofixation-negative complete response rate 36%. The 1-year progression-free survival was 61%, and the 1-year survival from study entry was 84%. Grade 3 nonhematologic adverse events included infections (5 patients), fatigue (1), vasculitis (1), and peripheral neuropathy (2); no grade 4 toxicities were recorded. Initial results showed that VMPT is an effective salvage therapy with a very high proportion of responses. The incidence of neurotoxicities was unexpectedly low.
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Affiliation(s)
- Antonio Palumbo
- Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera (AO) S. Giovanni Battista, Turin, Italy.
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Palumbo A, Bringhen S, Bertola A, Cavallo F, Falco P, Massaia M, Bruno B, Rus C, Barbui A, Caravita T, Musto P, Pescosta N, Rossini F, Vignetti M, Boccadoro M. Multiple myeloma: comparison of two dose-intensive melphalan regimens (100 vs 200 mg/m2). Leukemia 2003; 18:133-8. [PMID: 14586481 DOI: 10.1038/sj.leu.2403196] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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: 11/08/2022]
Abstract
Several trials have shown the superior impact of high-dose melphalan (usually 200 mg/m(2), MEL200) vs standard therapy in myeloma patients. Intermediate-dose melphalan (100 mg/m(2), MEL100) is also superior to the standard dose, but has not been clinically compared with MEL200. A total of 90 patients at diagnosis were treated with two MEL100 courses. Their clinical outcome was compared with that of a control group of 90 pair mates matched for serum beta2-microglobulin levels and Durie and Salmon clinical stage. These patients were treated at diagnosis with two MEL200 courses. Patient characteristics were similar in both groups except that the median age of the MEL100 group was significantly higher (P<0.0001). Complete remission was 35% after MEL100 and 48% after MEL200 (P=0.08). Median event-free survival (EFS) was 32 months in the MEL100 group and 42 months in the MEL200 group (P<0.005), but overall survival (OS) was not different. Transplant-related mortality was not significantly different. Haematological and extra-haematological toxicity was significantly reduced after MEL100. Despite the significant age difference, tandem MEL100 was less toxic than tandem MEL200, and MEL100 was inferior to MEL200 in terms of EFS but not in terms of OS. The intensified nonmyeloablative MEL100 regimen is an effective first-line treatment.
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Affiliation(s)
- A Palumbo
- Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S Giovanni Battista, Torino, Italy
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Svaldi M, Lanthaler AJ, Dugas M, Lohse P, Pescosta N, Straka C, Mitterer M. T-cell receptor excision circles: a novel prognostic parameter for the outcome of transplantation in multiple myeloma patients. Br J Haematol 2003; 122:795-801. [PMID: 12930391 DOI: 10.1046/j.1365-2141.2003.04482.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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: 11/20/2022]
Abstract
This study investigated whether T-cell receptor excision circles (TRECs) are a prognostic marker for the outcome of myeloma patients undergoing a tandem autologous peripheral blood stem cell transplantation (PBSCT). Twenty-five patients were enrolled. Samples were obtained at study enrollment, after conventional therapy, between first and second transplantation and 3, 6, 12 and 24 months after the second PBSCT. TRECs were quantified using real-time polymerase chain reaction. A high variation in TREC levels was found at diagnosis (median TREC level 136/10(5) peripheral blood mononuclear cells (PBMCs); range 1-1729), suggesting individual differences in thymic output of naive T cells. Patients with more than 136 TRECs/10(5) P BMCs at diagnosis had a statistically significant better overall survival (P=0.05) and event-free survival (P=0.045), whereas low TREC levels correlated with a higher incidence of infectious complications. Median TREC values were lowest after the first PBSCT (52/10(5) PBMCs) and reached the baseline 12 months after the second transplantation. Patients with high TREC levels after the second PBSCT had a significantly higher probability of being in complete or partial remission 30 months after the second PBSCT. TREC levels were not correlated with beta2-microglobulin and C-reactive protein levels at diagnosis. These data suggest that TRECs could be a relevant prognostic factor for patients who receive high-dose chemotherapy and autologous PBSCT.
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Affiliation(s)
- Mirija Svaldi
- Department of Hematology and Bone Marrow Transplantation Centre, Regional Hospital, Bozen, Italy.
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Mead GM, Sydes MR, Walewski J, Grigg A, Hatton CS, Pescosta N, Guarnaccia C, Lewis MS, McKendrick J, Stenning SP, Wright D, Norbert P. An international evaluation of CODOX-M and CODOX-M alternating with IVAC in adult Burkitt's lymphoma: results of United Kingdom Lymphoma Group LY06 study. Ann Oncol 2002; 13:1264-74. [PMID: 12181251 DOI: 10.1093/annonc/mdf253] [Citation(s) in RCA: 246] [Impact Index Per Article: 11.2] [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: 01/21/2023] Open
Abstract
BACKGROUND Burkitt's lymphoma (BL) is a rare and rapidly progressive form of B-cell non-Hodgkin's lymphoma. Cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate (CODOX-M)/ifosfamide, etoposide and high-dose cytarabine (IVAC) is a highly effective alternating non-cross-resistant regimen developed by Magrath et al. (Magrath I., Adde M., Shad A. et al. J Clin Oncol 1996; 14: 925-934) at the US National Cancer Institute. The aim was to confirm these results in a larger, international, multi-centre study using International Prognostic Index-based criteria to assign prognostic groups, whilst slightly simplifying the protocol. PATIENTS AND METHODS A phase II study where: (i) low risk (LR) patients were treated with three cycles of modified CODOX-M; and (ii) high risk (HR) patients received treatment with four cycles of alternating modified CODOX-M and IVAC chemotherapy. Target of 60 patients, fit for protocol treatment, from 16 to 60 years of age with locally diagnosed, non-HIV-related, non-organ-transplant-related BL. RESULTS Results are given for 52 of 72 registered patients whose pathological eligibility was confirmed by central pathology review: 12 LR plus 40 HR. The majority of patients (n = 41) completed protocol treatment, but toxicity was severe, especially myelosuppression and mucositis. Overall, 2-year event-free survival (EFS) was 64.6% (95% CI 50.4% to 78.9%) and 2-year overall survival (OS) was 72.8% (95% CI 59.4% to 86.3%). For LR, 2-year EFS was 83.3% and OS was 81.5%. For HR, 2-year EFS was 59.5% and OS was 69.9%. CONCLUSIONS This study confirms high cure rates with this CODOX-M/IVAC approach.
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Affiliation(s)
- G M Mead
- Wessex Medical Oncology Unit, Royal South Hants Hospital, Southampton, UK
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Billio A, Venturi R, Morello E, Rosanelli C, Pescosta N, Coser P. Chronic neutrophilic leukemia evolving from polycythemia vera with multiple chromosome rearrangements: a case report. Haematologica 2001; 86:1225-6. [PMID: 11694412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Billio A, Moeseneder C, Donazzan G, Triani A, Pescosta N, Coser P. Hermansky-Pudlak syndrome: clinical presentation and confirmation of the value of the mepacrine-based cytofluorimetry test in the diagnosis of delta granule deficiency. Haematologica 2001; 86:220. [PMID: 11224500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Abstract
We report the case of a 14-month-old child with Kasabach-Merritt Syndrome, due to a giant liver hemangioma. The therapeutic approach consisted of peripheral transcatheter embolisation of the right hepatic artery with Ivalon microspheres without the addition of thrombogenic material. This procedure brought to a sensible permanent reduction of the size of the liver hemangioma with normalisation of the previous altered coagulation parameters after 6 years of follow-up.
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Affiliation(s)
- A Billio
- Reparto Ematologia, Ospedale Regionale San Maurizio, Bolzano, Italy
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Billio A, Pescosta N, Rosanelli C, Fabris P, Coser P. A brief intensive chemotherapy in T-prolymphocytic leukemia. Haematologica 2000; 85:438-9. [PMID: 10756378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Mitterer M, Pescosta N, McQuain C, Gebert U, Oberkofler F, Coser P, Knecht H. Epstein-Barr virus related hemophagocytic syndrome in a T-cell rich B-cell lymphoma. Ann Oncol 1999; 10:231-4. [PMID: 10093694 DOI: 10.1023/a:1008212516595] [Citation(s) in RCA: 13] [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: 11/12/2022] Open
Abstract
We report the case of a 30-year-old woman who presented with an EBV related hemophagocytic syndrome. After a few months she developed a T-cell rich B-cell non-Hodgkin's lymphoma with liver involvement. Serological data demonstrated a reactivation of the EBV infection. Tumor progression with liver involvement occurred during treatment with conventional chemotherapy. Tumor reduction and disappearance of all masses was seen after starting high-dose sequential chemotherapy, followed by an autologous peripheral blood progenitor transplantation LMP-1 could be amplified in the tumor material by PCR technology, but no LMP-1 expression could be found in the few malignant B-cells with Reed-Sternberg morphology. Sequence analysis of the carboxy terminal of the LMP-1 region revealed the naturally occurring 30 bp deletion variant of the LMP-1 with multiple point mutations within the NF kb region. Since LMP-1 was not expressed in the malignant tumor cells, no evidence could be found, that EBV participated in the tumorigenesis of this case.
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Affiliation(s)
- M Mitterer
- Department of Hematology and Bone Marrow Transplantation, Bozen, Italy.
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Santini G, Salvagno L, Leoni P, Chisesi T, De Souza C, Sertoli MR, Rubagotti A, Congiu AM, Centurioni R, Olivieri A, Tedeschi L, Vespignani M, Nati S, Soracco M, Porcellini A, Contu A, Guarnaccia C, Pescosta N, Majolino I, Spriano M, Vimercati R, Rossi E, Zambaldi G, Mangoni L, Rizzoli V. VACOP-B versus VACOP-B plus autologous bone marrow transplantation for advanced diffuse non-Hodgkin's lymphoma: results of a prospective randomized trial by the non-Hodgkin's Lymphoma Cooperative Study Group. J Clin Oncol 1998; 16:2796-802. [PMID: 9704732 DOI: 10.1200/jco.1998.16.8.2796] [Citation(s) in RCA: 173] [Impact Index Per Article: 6.7] [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: 11/20/2022] Open
Abstract
PURPOSE The aim of this multicenter randomized study was to compare conventional therapy with conventional plus high-dose therapy (HDT) and autologous bone marrow transplantation (ABMT) as front-line treatment for poor-prognosis non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS Between October 1991 and June 1995, 124 patients, aged 15 to 60 years, with diffuse intermediate- to high-grade NHL (Working Formulation criteria), stages II bulky (> or = 10 cm), III, or IV were enrolled. Sixty-one patients were randomized to receive etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (VACOP-B) for 12 weeks and cisplatin, cytarabine, and dexamethasone (DHAP) as a salvage regimen (arm A), and 63 to receive VACOP-B for 12 weeks plus HDT and ABMT (Arm B). RESULTS There was no significant difference in terms of complete remissions (CRS) in the two groups: 75% in arm A, and 73% in arm B. The median follow-up observation time was 42 months. The 6-year survival probability was 65% in both arms. There was no difference in disease-free survival (DFS) or progression-free survival (PFS) between the two groups. DFS was 60% and 80% (P = .1) and PFS was 48% and 60% (P = .4) for arms A and B, respectively. Procedure feasibility was the major problem. In arm B, 29% of enrolled patients did not undergo HDT and ABMT. A statistical improvement in terms of DFS (P = .008) and a favorable trend in terms of PFS (P = .08) for intermediate-/high- plus high-risk group patients assigned to HDT and ABMT was observed. CONCLUSION In this study, conventional chemotherapy followed by HDT and ABMT as front-line therapy seems no more successful than conventional treatment in terms of overall results. However, our results suggest that controlled studies of HDT plus ABMT should be proposed for higher risk patients.
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Affiliation(s)
- G Santini
- Department of Haematology, San Martino Hospital, Genova, Italy.
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Billio A, Pescosta N, Rosanelli C, Amaddii G, Fontanella F, Coser P. Successful short-term oral surgery prophylaxis with rFVIIa in severe congenital factor VII deficiency. Blood Coagul Fibrinolysis 1997; 8:249-50. [PMID: 9199823 DOI: 10.1097/00001721-199706000-00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Mitterer M, Pescosta N, Fend F, Larcher C, Prang N, Schwarzmann F, Coser P, Huemer HP. Chronic active Epstein-Barr virus disease in a case of persistent polyclonal B-cell lymphocytosis. Br J Haematol 1995; 90:526-31. [PMID: 7646989 DOI: 10.1111/j.1365-2141.1995.tb05579.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [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: 01/26/2023]
Abstract
Persistent polyclonal B-cell lymphocytosis (PPBL) is a rare haematological disorder. It is characterized by activated and morphologically atypical B lymphocytes and polyclonal IgM production and has been associated with female sex, cigarette smoking, and HLA-DR7 expression. We report a case of PPBL with intermitting symptoms compatible with a chronic fatigue syndrome, recurrent erythema nodosum and multiforme. Serological findings suggested a chronic active Epstein-Barr virus (EBV) infection. Messenger RNA of EBV immediate early gene transactivation BZLF1 was detected in peripheral blood lymphocytes by reverse transcriptase PCR indicating a persistent replication of the virus. Over 2 years of observation we detected varying numbers of atypical lymphocytes. These cells hybridized with a probe specific for the EBV internal repeat region (BamHI W) which indicates a productive infection. Of interest, no reaction was observed with a probe specific for the latency-associated small RNAs (EBERs). The immunological phenotype of the polyclonal B cells was similar to B-cell lines immortalized by EBV in vitro, expressing a number of activation molecules (CD23, CD25, CD54) and the bcl-2 protein. In summary, our findings suggest that persistent EBV replication might be crucial in the development of lymphoproliferative disorders such as PPBL.
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Affiliation(s)
- M Mitterer
- Department of Haematology, General Hospital, Bozen, Italy
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Mitterer M, Pescosta N, Vogetseder W, Mair M, Coser P. Two episodes of aseptic meningitis during intravenous immunoglobulin therapy of idiopathic thrombocytopenic purpura. Ann Hematol 1993; 67:151-2. [PMID: 8373906 DOI: 10.1007/bf01701743] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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