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Nooka AK, Costa LJ, Gasparetto CJ, Richardson PG, Siegel DS, Chari A, Lentzsch S, Jagannath S, Mikhael J. Guidance for Use and dosing of Selinexor in Multiple Myeloma in 2021: Consensus From International Myeloma Foundation Expert Roundtable. Clin Lymphoma Myeloma Leuk 2022; 22:e526-e531. [PMID: 35361554 DOI: 10.1016/j.clml.2022.01.014] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
Abstract
Selinexor is a first in class selective inhibitor of nuclear export (SINE), blocks exportin 1 (XPO1), a protein transporter, that among other actions, shuttles cargo proteins such as tumor suppressor proteins (TSPs), the glucocorticoid receptor (GR), and oncoprotein messenger RNAs (mRNAs) across the nuclear membrane to cytoplasm. By blocking XPO1, selinexor facilitates nuclear preservation and activation of TSPs, and prevents mRNA translation of the oncoproteins leading to induction of apoptosis. The therapeutic value of selinexor in combination with dexamethasone has been successfully demonstrated in treating relapsed and/or refractory myeloma (RRMM), leading to the Food and Drug Administration (FDA) approval of selinexor in combination with dexamethasone in 2019 for the treatment of adult patients with RRMM who received at least 4 prior therapies and whose disease is refractory to at least 2 proteasome inhibitors, at least 2 immunomodulatory agents, and an anti-CD38 monoclonal antibody (mAb) - a pentarefractory myeloma. More recently, selinexor in combination with bortezomib and dexamethasone was approved by the FDA in December 2020, based on the BOSTON study among RRMM patients who had received at least one prior line of therapy. With more available safety and efficacy data supporting the increased interval between dosing of selinexor (and lesser cumulative weekly dosing) and schedule, contrary to the originally approved dose of 160 mg per week, the supportive care guidelines needed to be revisited. The current manuscript summarizes the supportive care solutions with weekly dosing of selinexor and identifies the ideal potential patient for selinexor treatment.
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Affiliation(s)
- A K Nooka
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
| | - L J Costa
- University of Alabama Blood and Marrow Transplantation Program, University of Alabama at Birmingham, Birmingham, AL
| | | | - P G Richardson
- Multiple Myeloma Program, Dana-Farber Cancer Institute, Boston, MA
| | - D S Siegel
- Division Chief, Multiple Myeloma, Hackensack Meridian Health, Hackensack, NJ
| | - A Chari
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - S Lentzsch
- Division of Hematology and Oncology, Department of Medicine, Columbia University, New York, NY
| | - S Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Mikhael
- Applied Cancer Research and Drug Discovery, Translational Genomics Research Institute (TGen), City of Hope Cancer Center, Phoenix, AZ
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Madduri D, Parekh S, Campbell T, Neumann F, Petrocca F, Jagannath S. Anti-BCMA-CAR-T-Zell-Therapie bei einem Patienten mit rezidiviertem und refraktärem Multiplen Myelom nach einer COVID-19-Infektion: ein Fallbericht. Kompass Onkol 2022. [PMCID: PMC9059054 DOI: 10.1159/000522435] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hintergrund: Über das Risiko einer Virusinfektion mit dem schweren akuten Atemwegssyndrom Coronavirus 2 (SARS-CoV-2) bei Krebspatienten, von denen viele immungeschwächt und damit anfälliger für eine Vielzahl von Infektionen sind, ist sehr wenig bekannt. Als Vorsichtsmaßnahme haben viele klinische Studien während der ersten Welle der weltweiten Pandemie des neuartigen Coronavirus (COVID-19) die Aufnahme von Patienten pausiert. In diesem Fallbericht beschreiben wir die erfolgreiche Behandlung eines Patienten mit rezidiviertem und refraktärem Multiplem Myelom (MM), der unmittelbar nach der klinischen Genesung von COVID-19 mit einer chimären Antigenrezeptor (CAR)-T-Zelltherapie mit Anti-B-Zellreifungsantigen (BCMA) behandelt wurde. Fallvorstellung: Der 57-jährige weiße männliche Patient war seit 4 Jahren an MM erkrankt und galt bei der Vorstellung zur CAR-T-Zelltherapie als pentarefraktär. Er hatte eine Immunsuppression in seiner medizinischen Vorgeschichte und er erhielt am Tag vor der COVID-19-Diagnose eine Dosis lymphdepletierender Chemotherapie (LDC). Dieser Patient konnte eine erhebliche Immunantwort gegen das SARS-CoV-2-Virus aufbauen, und antivirale Antikörper bleiben auch 2 Monate nach Erhalt einer Anti-BCMA-CAR-T-Zelltherapie noch nachweisbar. Die kürzliche SARS-CoV-2-Infektion bei diesem Patienten führte nicht zu einer Exazerbation des CAR-T-assoziierten Zytokin-Freisetzungssyndroms (CRS) und umgekehrt führte die CAR-T-Zelltherapie nicht zu Komplikationen im Zusammenhang mit COVID-19. Einen Monat nach der CAR-T-Zell-Infusion wurde bei dem Patienten ein unbestätigtes partielles Ansprechen nach den Kriterien der International Myeloma Working Group (IMWG) festgestellt. Schlussfolgerung: Unser Fall liefert einen wichtigen Kontext für die Wahl der Behandlung von MM-Patienten in Zeiten von COVID-19 sowie für die Frage, ob die CAR-T-Therapie auch bei Patienten verabreicht werden kann, die von COVID-19 genesen sind. Da die COVID-19-Pandemie weltweit anhält, ist eine umfangreiche Diskussion über die Entscheidung, ob mit der CAR-T-Zelltherapie fortgefahren werden soll, erforderlich, wobei die potenziellen Risiken und Vorteile der Therapie gegeneinander abgewogen werden müssen. Dieser Fall legt nahe, dass es möglich ist, die Anti-BCMA-CAR-T-Zelltherapie nach der Genesung von COVID-19 erfolgreich abzuschließen. Die Studie CRB-402 wurde am 6. September 2017 bei clinicaltrials.gov registriert (NCT03274219).
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Affiliation(s)
- D. Madduri
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- *D. Madduri,
| | - S. Parekh
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - F. Neumann
- bluebird bio, Cambridge, Massachusetts, USA
| | | | - S. Jagannath
- Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Usmani SZ, Berdeja JG, Jakubowiak A, Agha M, Cohen AD, Madduri D, Hari P, Yeh T, Olyslager Y, Banerjee A, Jackson CC, Allred A, Zudaire E, Deraedt W, Wu X, Pacaud L, Akram M, Lin Y, Martin T, Jagannath S. UPDATED RESULTS FROM THE CARTITUDE-1 STUDY OF CILTACABTAGENE AUTOLEUCEL, A B-CELL MATURATION ANTIGEN–DIRECTED CHIMERIC ANTIGEN RECEPTOR T CELL THERAPY, IN RELAPSED/REFRACTORY MULTIPLE MYELOMA. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Madduri D, Parekh S, Campbell TB, Neumann F, Petrocca F, Jagannath S. Anti-BCMA CAR T administration in a relapsed and refractory multiple myeloma patient after COVID-19 infection: a case report. J Med Case Rep 2021; 15:90. [PMID: 33608053 PMCID: PMC7894235 DOI: 10.1186/s13256-020-02598-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Very little is known about the risk that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection poses to cancer patients, many of whom are immune compromised causing them to be more susceptible to a host of infections. As a precautionary measure, many clinical studies halted enrollment during the initial surge of the global Novel Coronavirus Disease (COVID-19) pandemic. In this case report, we detail the successful treatment of a relapsed and refractory multiple myeloma (MM) patient treated with an anti-B cell maturation antigen (BCMA) chimeric antigen receptor (CAR) T cell therapy immediately following clinical recovery from COVID-19. CASE PRESENTATION The 57 year old Caucasian male patient had a 4-year history of MM and was considered penta-refractory upon presentation for CAR T cell therapy. He had a history of immunosuppression and received one dose of lymphodepleting chemotherapy (LDC) the day prior to COVID-19 diagnosis; this patient was able to mount a substantial immune response against the SARS-CoV-2 virus, and antiviral antibodies remain detectable 2 months after receiving anti-BCMA CAR T cell therapy. The recent SARS-CoV-2 infection in this patient did not exacerbate CAR T-associated cytokine release syndrome (CRS) and conversely the CAR T cell therapy did not result in COVID-19-related complications. One month after CAR T cell infusion, the patient was assessed to have an unconfirmed partial response per International Myeloma Working Group (IMWG) criteria. CONCLUSION Our case adds important context around treatment choice for MM patients in the era of COVID-19 and whether CAR T therapy can be administered to patients who have recovered from COVID-19. As the COVID-19 global pandemic continues, the decision of whether to proceed with CAR T cell therapy will require extensive discussion weighing the potential risks and benefits of therapy. This case suggests that it is possible to successfully complete anti-BCMA CAR T cell therapy after recovery from COVID-19. CRB-402 study registered 6 September 2017 at clinicaltrials.gov (NCT03274219).
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Affiliation(s)
- D. Madduri
- grid.59734.3c0000 0001 0670 2351Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1185, New York, NY 10029 USA
| | - S. Parekh
- grid.59734.3c0000 0001 0670 2351Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1185, New York, NY 10029 USA
| | | | - F. Neumann
- grid.434678.a0000 0004 0455 430Xbluebird bio, Cambridge, MA USA
| | - F. Petrocca
- grid.434678.a0000 0004 0455 430Xbluebird bio, Cambridge, MA USA
| | - S. Jagannath
- grid.59734.3c0000 0001 0670 2351Department of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1185, New York, NY 10029 USA
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Berdeja J, Madduri D, Usmani S, Singh I, Zudaire E, Yeh T, Allred A, Olyslager Y, Banerjee A, Goldberg J, Schecter J, Geng D, Wu X, Carrasco-Alfonso M, Rizvi S, Fan F, Jakubowiak A, Jagannath S. UPDATE OF CARTITUDE-1: A PHASE 1B/2 STUDY OF JNJ-68284528 (JNJ-4528), A B-CELL MATURATION ANTIGEN (BCMA)-DIRECTED CHIMERIC ANTIGEN RECEPTOR T (CAR-T) CELL THERAPY, IN RELAPSED/REFRACTORY MULTIPLE MYELOMA (MM). Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Background:
Nitrogen-containing heterocyclics are abundant in natural products and
also in synthetic drug molecules because of a variety of applications and superior pharmacological
profile action. Pyrazoles are the integral architects of many of the heterocyclic compounds with superior
biological activity.
Methods:
Two series of the pyrazole conjugated Benzothiazole derivatives were synthesized. The
pyrazoles were synthesized by the Vilsmeier-Haack reaction and then conjugated with benzothiazole
hydrazine and hydrazide by imine bond formation. The synthesized compounds were screened
for anti-mitotic activity using Allium assay.
Results:
Here, the anti-mitotic activity, the percentage of cell division and the percentage of inhibition
compared to the control were calculated. Compound 4b (-OMe), 4c (-OH), 5b (-OMe), 5c (-
OH) and 5d (-CH3) had electron donating groups which showed excellent activity, was followed by
4f and 5f where they contain p-Bromo substitution, showing moderate activity.
Conclusion:
In the two series, benzothiazole linked to pyrazole through the hydrazide bridging
(5a-5i) had superior to hydrazine bridging (4a-4i). The observed chromosomal aberrations are because
of the structural morphology and binding sites of the molecule with the chromosome.
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Affiliation(s)
- M. Bhat
- Environmental Chemistry Laboratory, Department of Studies in Environmental Science, University of Mysore, Manasagangothri, Mysore -570 006, Karnataka, India
| | - S.L. Belagali
- Environmental Chemistry Laboratory, Department of Studies in Environmental Science, University of Mysore, Manasagangothri, Mysore -570 006, Karnataka, India
| | - N.K.H. Kumar
- Department of Studies in Botany, University of Mysore, Manasagangothri, Mysore -570 006, Karnataka, India
| | - S. Jagannath
- Department of Studies in Botany, University of Mysore, Manasagangothri, Mysore -570 006, Karnataka, India
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Abonour R, Rifkin R, Gasparetto C, Toomey K, Durie B, Hardin J, Terebelo H, Jagannath S, Narang M, Ailawadhi S, Srinivasan S, Kitali A, Agarwal A, Wagner L. Impact of initial treatment (tx) on HRQoL and outcomes in patients (pts) with newly diagnosed multiple myeloma (NDMM) without intent for immediate transplant (SCT): Results from the Connect® MM registry. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy286.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Laganà A, Perumal D, Melnekoff D, Readhead B, Kidd BA, Leshchenko V, Kuo PY, Keats J, DeRome M, Yesil J, Auclair D, Lonial S, Chari A, Cho HJ, Barlogie B, Jagannath S, Dudley JT, Parekh S. Integrative network analysis identifies novel drivers of pathogenesis and progression in newly diagnosed multiple myeloma. Leukemia 2017. [DOI: 10.1038/leu.2017.197] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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9
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Lonial S, Ribeiro de Oliveira M, Yimer H, Mateos M, Rifkin R, Schjesvold F, San-Miguel J, Ghori R, Marinello P, Jagannath S. KEYNOTE-185: A randomized, open-label phase 3 study of pembrolizumab in combination with lenalidomide and low-dose dexamethasone in newly diagnosed and treatment-naive multiple myeloma (MM). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw525.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Mateos M, Blacklock H, Rocafiguera A, Iida S, Jagannath S, Lonial S, Kher U, Farooqui M, Marinello P, San-Miguel J. KEYNOTE-183: A randomized, open-label phase 3 study of pembrolizumab in combination with pomalidomide and low-dose dexamethasone in refractory or relapsed and refractory multiple myeloma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw525.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Palumbo A, Mateos MV, Miguel JS, Shah J, Thompson S, Marinello P, Jagannath S. Pembrolizumab in combination with lenalidomide and low-dose dexamethasone in newly diagnosed and treatment-naive multiple myeloma (MM): randomized, phase 3 KEYNOTE-185 study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw375.35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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12
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Ocio E, Shah J, Jagannath S, Mateos MV, Palumbo A, Kher U, Marinello P, Miguel JS. Pembrolizumab in combination with pomalidomide and low-dose dexamethasone in refractory or relapsed and refractory multiple myeloma (rrMM): Randomized, phase 3 KEYNOTE-183 study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw375.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jonsson F, Ou Y, Claret L, Siegel D, Jagannath S, Vij R, Badros A, Aggarwal S, Bruno R. A Tumor Growth Inhibition Model Based on M-Protein Levels in Subjects With Relapsed/Refractory Multiple Myeloma Following Single-Agent Carfilzomib Use. CPT Pharmacometrics Syst Pharmacol 2015; 4:711-9. [PMID: 26904385 PMCID: PMC4759707 DOI: 10.1002/psp4.12044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/27/2015] [Indexed: 11/10/2022]
Abstract
Change in tumor size estimated using longitudinal tumor growth inhibition (TGI) modeling is an early predictive biomarker of clinical outcomes for multiple cancer types. We present the application of TGI modeling for subjects with multiple myeloma (MM). Longitudinal time course changes in M‐protein data from relapsed and/or refractory MM subjects who received single‐agent carfilzomib in phase II studies (n = 456) were fit to a TGI model. The tumor growth rate estimate was similar to that of other anti‐myeloma agents, indicating that the model is robust and treatment‐independent. An overall survival model was subsequently developed, which showed that early change in tumor size (ECTS) at week 4, Eastern Cooperative Oncology Group performance status (ECOG PS), hemoglobin, sex, percent bone marrow cell involvement, and number of prior regimens were significant independent predictors for overall survival (P < 0.001). ECTS based on M‐protein modeling could be an early biomarker for survival in MM following exposure to single‐agent carfilzomib.
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Affiliation(s)
- F Jonsson
- Pharsight, a Certara company St. Louis Missouri USA
| | - Y Ou
- Onyx Pharmaceuticals, Inc., an Amgen subsidiary South San Francisco California USA
| | - L Claret
- Pharsight, a Certara company St. Louis Missouri USA
| | - D Siegel
- John Theurer Cancer Center Hackensack New Jersey USA
| | - S Jagannath
- Mount Sinai Medical Center New York New York USA
| | - R Vij
- Washington University School of Medicine St. Louis Missouri USA
| | - A Badros
- Greenebaum Cancer Center University of Maryland Baltimore Maryland USA
| | - S Aggarwal
- Onyx Pharmaceuticals, Inc., an Amgen subsidiary South San Francisco California USA
| | - R Bruno
- Pharsight, a Certara company St. Louis Missouri USA
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Richardson P, Bensinger W, Huff C, Costello C, Lendvai N, Berdeja J, Anderson L, Siegel D, Jagannath S, Laubach J, Stockerl-Goldstein K, Knapp L, Kwei L, Clow F, Graef T, Bilotti E, Vij R. Ibrutinib in combination with low-dose dexamethasone in patients with relapsed or relapsed and refractory multiple myeloma: results from a multicenter phase 2 trial. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Richardson PG, Delforge M, Beksac M, Wen P, Jongen JL, Sezer O, Terpos E, Munshi N, Palumbo A, Rajkumar SV, Harousseau JL, Moreau P, Avet-Loiseau H, Lee JH, Cavo M, Merlini G, Voorhees P, Chng WJ, Mazumder A, Usmani S, Einsele H, Comenzo R, Orlowski R, Vesole D, Lahuerta JJ, Niesvizky R, Siegel D, Mateos MV, Dimopoulos M, Lonial S, Jagannath S, Bladé J, Miguel JS, Morgan G, Anderson KC, Durie BGM, Sonneveld P, Sonneveld P. Management of treatment-emergent peripheral neuropathy in multiple myeloma. Leukemia 2012; 26:595-608. [PMID: 22193964 DOI: 10.1038/leu.2011.346] [Citation(s) in RCA: 189] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Peripheral neuropathy (PN) is one of the most important complications of multiple myeloma (MM) treatment. PN can be caused by MM itself, either by the effects of the monoclonal protein or in the form of radiculopathy from direct compression, and particularly by certain therapies, including bortezomib, thalidomide, vinca alkaloids and cisplatin. Clinical evaluation has shown that up to 20% of MM patients have PN at diagnosis and as many as 75% may experience treatment-emergent PN during therapy. The incidence, symptoms, reversibility, predisposing factors and etiology of treatment-emergent PN vary among MM therapies, with PN incidence also affected by the dose, schedule and combinations of potentially neurotoxic agents. Effective management of treatment-emergent PN is critical to minimize the incidence and severity of this complication, while maintaining therapeutic efficacy. Herein, the state of knowledge regarding treatment-emergent PN in MM patients and current management practices are outlined, and recommendations regarding optimal strategies for PN management during MM treatment are provided. These strategies include early and regular monitoring with neurological evaluation, with dose modification and treatment discontinuation as indicated. Areas requiring further research include the development of MM-specific, patient-focused assessment tools, pharmacogenomic analysis of patient DNA, and trials to assess the efficacy of pharmacological interventions.
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Kumar SK, Lee JH, Lahuerta JJ, Morgan G, Richardson PG, Crowley J, Haessler J, Feather J, Hoering A, Moreau P, LeLeu X, Hulin C, Klein SK, Sonneveld P, Siegel D, Bladé J, Goldschmidt H, Jagannath S, Miguel JS, Orlowski R, Palumbo A, Sezer O, Rajkumar SV, Durie BGM. Risk of progression and survival in multiple myeloma relapsing after therapy with IMiDs and bortezomib: a multicenter international myeloma working group study. Leukemia 2011; 26:149-57. [PMID: 21799510 DOI: 10.1038/leu.2011.196] [Citation(s) in RCA: 593] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Promising new drugs are being evaluated for treatment of multiple myeloma (MM), but their impact should be measured against the expected outcome in patients failing current therapies. However, the natural history of relapsed disease in the current era remains unclear. We studied 286 patients with relapsed MM, who were refractory to bortezomib and were relapsed following, refractory to or ineligible to receive, an IMiD (immunomodulatory drug), had measurable disease, and ECOG PS of 0, 1 or 2. The date patients satisfied the entry criteria was defined as time zero (T(0)). The median age at diagnosis was 58 years, and time from diagnosis to T(0) was 3.3 years. Following T(0), 213 (74%) patients had a treatment recorded with one or more regimens (median=1; range 0-8). The first regimen contained bortezomib in 55 (26%) patients and an IMiD in 70 (33%). A minor response or better was seen to at least one therapy after T(0) in 94 patients (44%) including ≥ partial response in 69 (32%). The median overall survival and event-free survival from T(0) were 9 and 5 months, respectively. This study confirms the poor outcome, once patients become refractory to current treatments. The results provide context for interpreting ongoing trials of new drugs.
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Affiliation(s)
- S K Kumar
- Divison of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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Siegel DSD, Martin T, Wang M, Vij R, Lonial S, Kukreti V, Bahlis NJ, Alsina M, Somlo G, Buadi F, Reu FJ, Song KW, Kunkel LA, Wong A, Vallone M, Orlowski RZ, Stewart AK, Singhal S, Jagannath S, Jakubowiak AJ. PX-171-003-A1, an open-label, single-arm, phase (Ph) II study of carfilzomib (CFZ) in patients (pts) with relapsed and refractory multiple myeloma (R/R MM): Long-term follow-up and subgroup analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Stewart AK, Kaufman JL, Jakubowiak AJ, Jagannath S, Kukreti V, McDonagh KT, Alsina M, Bahlis NJ, Belch A, Gabrail NY, Reu FJ, Matous J, Vesole DH, Orlowski RZ, Kunkel LA, Le M, Lee P, Sebag M, Wang M, Vij R. The effect of carfilzomib (CFZ) in patients (Pts) with bortezomib (BTZ)-naive relapsed or refractory multiple myeloma (MM): Updated results from the PX-171-004 study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Lonial S, Vij R, Facon T, Moreau P, Leleu X, Mazumder A, Kaufman JL, Westland C, Tsao C, Singhal AK, Jagannath S. Phase I trial of elotuzumab, lenalidomide, and low-dose dexamethasone in patients with relapsed or refractory multiple myeloma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Richardson PGG, Moreau P, Jakubowiak AJ, Facon T, Jagannath S, Vij R, Reece DE, White D, Raab M, Benboubker L, Rossi J, Tsao C, Parli T, Berman DM, Singhal AK, Lonial S. Elotuzumab with lenalidomide and low-dose dexamethasone in patients with relapsed multiple myeloma: A randomized phase II study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Anderson KC, Weller E, Lonial S, Jakubowiak AJ, Jagannath S, Raje NS, Avigan D, Knight RD, Esseltine D, Richardson PG. Lenalidomide, bortezomib, and dexamethasone in patients with newly diagnosed multiple myeloma (MM): Final results of a multicenter phase I/II study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jagannath S, Siegel DS, Hajek R, Dimopoulos MA, Yoon S, Lonial S, Graef T, Lupinacci L, Reiser D, Anderson KC. Update on vantage program to assess combined vorinostat (V) and bortezomib (B) in patients (pts) with relapsed and/or refractory (RR) multiple myeloma (MM). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lonial S, Vij R, Harousseau J, Facon T, Moreau P, Leleu X, Westland C, Singhal AK, Jagannath S. Elotuzumab in combination with lenalidomide and low-dose dexamethasone in relapsed or refractory multiple myeloma: A phase I/II study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wolf JL, Vij R, Lonial S, Wang M, Jagannath S, Singhal S, Le MH, Kirk C, Arastu-Kapur S, Siegel DS. Neurotoxic and peripheral neuropathic effects in preclinical and clinical studies of carfilzomib (CFZ), a novel proteasome inhibitor (PI). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vij R, Siegel DS, Kaufman JL, Jakubowiak AJ, Stewart AK, Jagannath S, Kukreti V, Le MH, Bennett MK, Wang M. Results of an ongoing open-label, phase II study of carfilzomib in patients with relapsed and/or refractory multiple myeloma (R/R MM). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kaufman J, Wang M, Siegel D, Stewart A, Jakubowiak A, Kukreti V, McDonagh K, Jagannath S, Alsina M, Vij R. 9201 Tolerability profile of carfilzomib enables full-dose anti-tumor treatment for up to 12 months. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Giralt S, Stadtmauer EA, Harousseau JL, Palumbo A, Bensinger W, Comenzo RL, Kumar S, Munshi NC, Dispenzieri A, Kyle R, Merlini G, San Miguel J, Ludwig H, Hajek R, Jagannath S, Blade J, Lonial S, Dimopoulos MA, Einsele H, Barlogie B, Anderson KC, Gertz M, Attal M, Tosi P, Sonneveld P, Boccadoro M, Morgan G, Sezer O, Mateos MV, Cavo M, Joshua D, Turesson I, Chen W, Shimizu K, Powles R, Richardson PG, Niesvizky R, Rajkumar SV, Durie BGM. International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100). Leukemia 2009; 23:1904-12. [PMID: 19554029 DOI: 10.1038/leu.2009.127] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multiple myeloma is the most common indication for high-dose chemotherapy with autologous stem cell support (ASCT) in North America today. Stem cell procurement for ASCT has most commonly been performed with stem cell mobilization using colony-stimulating factors with or without prior chemotherapy. The target CD34+ cell dose to be collected as well as the number of apheresis performed varies throughout the country, but a minimum of 2 million CD34+ cells/kg has been traditionally used for the support of one cycle of high-dose therapy. With the advent of plerixafor (AMD3100) (a novel stem cell mobilization agent), it is pertinent to review the current status of stem cell mobilization for myeloma as well as the role of autologous stem cell transplantation in this disease. On June 1, 2008, a panel of experts was convened by the International Myeloma Foundation to address issues regarding stem cell mobilization and autologous transplantation in myeloma in the context of new therapies. The panel was asked to discuss a variety of issues regarding stem cell collection and transplantation in myeloma especially with the arrival of plerixafor. Herein, is a summary of their deliberations and conclusions.
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Affiliation(s)
- S Giralt
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
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Jagannath S, Vij R, Stewart K, Somlo G, Jakubowiak A, Trudel S, Schwartz R, Siegel D, Kunkel L. Final results of PX-171–003-A0, part 1 of an open-label, single-arm, phase II study of carfilzomib (CFZ) in patients (pts) with relapsed and refractory multiple myeloma (MM). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8504] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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
8504 Background: CFZ is a novel proteasome inhibitor of the epoxyketone class that exhibits a high level of proteasome selectivityand demonstrates antitumor activity in bortezomib (BTZ)-resistant MM pts in phase I studies. Methods: PX-171–003-A0 was an open-label, multicenter study that enrolled MM pts who relapsed from >2 prior therapies, failed BTZ and at least 1 immunomodulatory agent [thalidomide (THAL) or lenalidomide (LEN)], and were refractory to last treatment [progressing on or within 60 d of last therapy or <25% response to last therapy]. Pts received CFZ 20 mg/m2 IV d 1, 2, 8, 9, 15 and 16 every 28 d for up to 12 cycles (C). Clinical benefit response (CBR) was defined as MR or better. Results: 46 pts were enrolled, including 78% with progression on or within 60 d of last therapy and 22% with no response to last therapy. 39 pts completed at least 1 C of CFZ, had measurable M-protein, and were evaluable for response. Median prior therapies was 5 (range 2–15). 100% of pts received prior BTZ, 91% prior THAL, 89% prior LEN, and 83% prior stem cell transplant (SCT) and all had failed combinations including anthracyclines (80%) and/or alkylating agents (94%). Pts received a median of 3 C (range 1–12); 13 pts completed ≥6 C. CBR was 26% (10/39 eval pts), including 5 pts achieving PR and 5 pts achieving MR. 5 BTZ-refractory pts achieved MR or PR. Median TTP was 6.2 mo, the median DOR for the MR + PR was 7.4 mo. 8/10 pts achieved response during C1. 16 additional pts achieved SD for at least 6 wks. The most common adverse events were fatigue, anemia, thrombocytopenia, nausea, upper respiratory infection, increased creatinine and diarrhea. Peripheral neuropathy occured in < 10% of pts with 1 Gr 3 in a pt with pre-existing Gr 2. Conclusions: Single-agent CFZ achieved a TTP of > 6 mo in relapsed and refractory MM pts who failed available therapies. 26% of patients had at least an MR and median duration of >7 mo with this steroid- and anthracycline-sparing regimen. CFZ toxicities were manageable and importantly, exacerbation of pre-existing PN was rare. The study has been expanded to enroll an additional 250 pts in this unmet medical need population at an escalated dose, and treatment has been extended beyond a year. [Table: see text]
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Affiliation(s)
- S. Jagannath
- St. Vincent's Comprehensive Cancer Center, New York, NY; Washington University School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ; City of Hope, Duarte, CA; University of Michigan, Ann Arbor, MI; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - R. Vij
- St. Vincent's Comprehensive Cancer Center, New York, NY; Washington University School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ; City of Hope, Duarte, CA; University of Michigan, Ann Arbor, MI; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - K. Stewart
- St. Vincent's Comprehensive Cancer Center, New York, NY; Washington University School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ; City of Hope, Duarte, CA; University of Michigan, Ann Arbor, MI; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - G. Somlo
- St. Vincent's Comprehensive Cancer Center, New York, NY; Washington University School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ; City of Hope, Duarte, CA; University of Michigan, Ann Arbor, MI; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - A. Jakubowiak
- St. Vincent's Comprehensive Cancer Center, New York, NY; Washington University School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ; City of Hope, Duarte, CA; University of Michigan, Ann Arbor, MI; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - S. Trudel
- St. Vincent's Comprehensive Cancer Center, New York, NY; Washington University School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ; City of Hope, Duarte, CA; University of Michigan, Ann Arbor, MI; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - R. Schwartz
- St. Vincent's Comprehensive Cancer Center, New York, NY; Washington University School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ; City of Hope, Duarte, CA; University of Michigan, Ann Arbor, MI; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - D. Siegel
- St. Vincent's Comprehensive Cancer Center, New York, NY; Washington University School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ; City of Hope, Duarte, CA; University of Michigan, Ann Arbor, MI; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - L. Kunkel
- St. Vincent's Comprehensive Cancer Center, New York, NY; Washington University School of Medicine, St. Louis, MO; Mayo Clinic, Scottsdale, AZ; City of Hope, Duarte, CA; University of Michigan, Ann Arbor, MI; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
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Anderson KC, Jagannath S, Jakubowiak A, Lonial S, Raje N, Alsina M, Ghobrial I, Knight R, Esseltine D, Richardson P. Lenalidomide, bortezomib, and dexamethasone in relapsed/refractory multiple myeloma (MM): Encouraging outcomes and tolerability in a phase II study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8536] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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
8536 Background: Lenalidomide (Revlimid, Len), bortezomib (VELCADE, Bz; maximum tolerated dose [MTD] 15 mg/1.0 mg/m2) ± dexamethasone (Dex; 20–40 mg; RVD) was well tolerated in a phase I study in relapsed/refractory MM patients (pts), with 58% ≥MR. This multicenter phase 2 study evaluated RVD efficacy and safety at the MTD. Methods: Patients received up to eight 21-day cycles of Len 15 mg (days 1–14), Bz 1.0 mg/m2 (days 1, 4, 8, 11), and Dex 40/20 mg (cycles 1–4/5–8, days of/after Bz dosing). After cycle 8, patients with stable/responding disease received maintenance (Len, days 1–14; Bz, days 1, 8; doses per end of cycle 8; Dex 10 mg, days 1, 2, 8, 9) until progression or unacceptable toxicity. Pts with significant peripheral neuropathy were excluded. Results: Among 64 pts, 38 (59%) had relapsed and 26 (41%) refractory/relapsed MM. Median number of prior therapies was two, including Len (8%), Bz (55%), Dex (92%), thalidomide (77%), and stem cell transplant (SCT, 36%). Forty-one pts (64%) completed 8 cycles, 33 continue on maintenance, 22 discontinued early (11 due to progressive disease). Toxicities were manageable, primarily grade (G) 1/2 myelosuppression; 2 developed DVT on aspirin, 2 G3 atrial fibrillation, 1 G3 peripheral neuropathy. One pt died on-study (fungal pneumonia, possibly due to Dex). Overall response rate (62 evaluable patients) was 84% ≥MR, including 21% CR/nCR, 68% ≥PR, which was independent of high-risk features and prior treatment ( Table ). Median duration of response is 24 weeks (range 6–81). Time-to-events data including median time to progression, progression-free survival, and 1-year survival rates will be presented. Conclusions: RVD is active and well tolerated in pts with relapsed/refractory MM, including pts who have received prior Len, Bz, thalidomide, and SCT. Durable responses have been observed and appear independent of adverse cytogenetics and other recognized risk factors. [Table: see text] [Table: see text]
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Affiliation(s)
- K. C. Anderson
- Dana-Farber Cancer Institute, Boston, MA; St. Vincent's Comprehensive Cancer Center, New York, NY; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Winship Cancer Institute, Atlanta, GA; Massachusetts General Hospital, Boston, MA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Celgene, Inc, Summit, NJ; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - S. Jagannath
- Dana-Farber Cancer Institute, Boston, MA; St. Vincent's Comprehensive Cancer Center, New York, NY; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Winship Cancer Institute, Atlanta, GA; Massachusetts General Hospital, Boston, MA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Celgene, Inc, Summit, NJ; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - A. Jakubowiak
- Dana-Farber Cancer Institute, Boston, MA; St. Vincent's Comprehensive Cancer Center, New York, NY; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Winship Cancer Institute, Atlanta, GA; Massachusetts General Hospital, Boston, MA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Celgene, Inc, Summit, NJ; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - S. Lonial
- Dana-Farber Cancer Institute, Boston, MA; St. Vincent's Comprehensive Cancer Center, New York, NY; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Winship Cancer Institute, Atlanta, GA; Massachusetts General Hospital, Boston, MA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Celgene, Inc, Summit, NJ; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - N. Raje
- Dana-Farber Cancer Institute, Boston, MA; St. Vincent's Comprehensive Cancer Center, New York, NY; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Winship Cancer Institute, Atlanta, GA; Massachusetts General Hospital, Boston, MA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Celgene, Inc, Summit, NJ; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - M. Alsina
- Dana-Farber Cancer Institute, Boston, MA; St. Vincent's Comprehensive Cancer Center, New York, NY; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Winship Cancer Institute, Atlanta, GA; Massachusetts General Hospital, Boston, MA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Celgene, Inc, Summit, NJ; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - I. Ghobrial
- Dana-Farber Cancer Institute, Boston, MA; St. Vincent's Comprehensive Cancer Center, New York, NY; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Winship Cancer Institute, Atlanta, GA; Massachusetts General Hospital, Boston, MA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Celgene, Inc, Summit, NJ; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - R. Knight
- Dana-Farber Cancer Institute, Boston, MA; St. Vincent's Comprehensive Cancer Center, New York, NY; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Winship Cancer Institute, Atlanta, GA; Massachusetts General Hospital, Boston, MA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Celgene, Inc, Summit, NJ; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - D. Esseltine
- Dana-Farber Cancer Institute, Boston, MA; St. Vincent's Comprehensive Cancer Center, New York, NY; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Winship Cancer Institute, Atlanta, GA; Massachusetts General Hospital, Boston, MA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Celgene, Inc, Summit, NJ; Millennium Pharmaceuticals, Inc., Cambridge, MA
| | - P. Richardson
- Dana-Farber Cancer Institute, Boston, MA; St. Vincent's Comprehensive Cancer Center, New York, NY; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Winship Cancer Institute, Atlanta, GA; Massachusetts General Hospital, Boston, MA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; Celgene, Inc, Summit, NJ; Millennium Pharmaceuticals, Inc., Cambridge, MA
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Vij R, Wang M, Orlowski R, Stewart AK, Jagannath S, Kukreti V, Le MH, Kunkel L, Siegel D. PX-171–004, a multicenter phase II study of carfilzomib (CFZ) in patients with relapsed myeloma: An efficacy update. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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
8537 Background: Carfilzomib (CFZ) is a proteasome inhibitor, active against hematologic malignancies. Preclinically, CFZ overcomes bortezomib (BTZ) resistance in multiple tumors, including myeloma (MM). PX-171–004 is an ongoing Phase II study evaluating safety and efficacy of CFZ in MM patients with relapsed disease after 1–3 prior therapies. Overall Response Rate (ORR) of 35.5% for all subjects was previously reported (ASH 2008); updated data are now available. Methods: Patients were divided into two cohorts: BTZ-naïve and BTZ-exposed. CFZ 20 mg/m2 was administered Days 1, 2, 8, 9, 15 and 16 in a 28-day cycle, for up to 12 cycles. Dexamethasone 4 mg po was administered prior to each dose in Cycle 1. The primary endpoint was ORR, defined as Partial Response (PR) or better. Secondary endpoints included Duration Of Response (DOR) and Time To Progression (TTP). Results: 31 patients were enrolled; 14 (45%) BTZ-naïve and 17 (55%) BTZ-exposed. Of the BTZ-exposed cohort, 2 subjects received BTZ exclusively as a single agent, 6 had BTZ in a chemotherapy combination, and 9 received BTZ in a transplant regime. Overall, 23 (74%) subjects had > 1 prior therapy and 27 (87%) received transplant. In BTZ-naïve patients, CFZ achieved an ORR of 57%; median DOR of 8.6 mos (range >1.9 to >9.7 mos). To date, 7 patients (50%) remain progression free and 3 patients have completed 12 cycles. The median follow-up was 10 mos and the median TTP has not been reached. For the BTZ- exposed group, CFZ achieved an ORR of 18%; median DOR not yet reached (>8.5 mos) (range >1 d to >8.5 mos). 7 patients (41%) are progression free and 3 patients have completed 12 cycles. Median follow-up and TTP were 9.2 and 8.9 mos, respectively. Conclusions: These preliminary results demonstrate that single-agent CFZ is tolerable for at least 1 yr and achieves sustained responses in relapsed MM. Prior BTZ mono/combination therapy does not preclude durable response with CFZ. These data support continuing evaluation of CFZ in the treatment of relapsed MM. [Table: see text] [Table: see text]
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Affiliation(s)
- R. Vij
- Washington University School of Medicine, St Louis, MO; University of Texas M. D. Anderson Cancer Center, Houston, TX; Mayo Clinic, Scottsdale, AZ; St. Vincent's Comprehensive Cancer Center, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - M. Wang
- Washington University School of Medicine, St Louis, MO; University of Texas M. D. Anderson Cancer Center, Houston, TX; Mayo Clinic, Scottsdale, AZ; St. Vincent's Comprehensive Cancer Center, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - R. Orlowski
- Washington University School of Medicine, St Louis, MO; University of Texas M. D. Anderson Cancer Center, Houston, TX; Mayo Clinic, Scottsdale, AZ; St. Vincent's Comprehensive Cancer Center, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - A. K. Stewart
- Washington University School of Medicine, St Louis, MO; University of Texas M. D. Anderson Cancer Center, Houston, TX; Mayo Clinic, Scottsdale, AZ; St. Vincent's Comprehensive Cancer Center, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - S. Jagannath
- Washington University School of Medicine, St Louis, MO; University of Texas M. D. Anderson Cancer Center, Houston, TX; Mayo Clinic, Scottsdale, AZ; St. Vincent's Comprehensive Cancer Center, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - V. Kukreti
- Washington University School of Medicine, St Louis, MO; University of Texas M. D. Anderson Cancer Center, Houston, TX; Mayo Clinic, Scottsdale, AZ; St. Vincent's Comprehensive Cancer Center, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - M. H. Le
- Washington University School of Medicine, St Louis, MO; University of Texas M. D. Anderson Cancer Center, Houston, TX; Mayo Clinic, Scottsdale, AZ; St. Vincent's Comprehensive Cancer Center, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - L. Kunkel
- Washington University School of Medicine, St Louis, MO; University of Texas M. D. Anderson Cancer Center, Houston, TX; Mayo Clinic, Scottsdale, AZ; St. Vincent's Comprehensive Cancer Center, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
| | - D. Siegel
- Washington University School of Medicine, St Louis, MO; University of Texas M. D. Anderson Cancer Center, Houston, TX; Mayo Clinic, Scottsdale, AZ; St. Vincent's Comprehensive Cancer Center, New York, NY; Princess Margaret Hospital, Toronto, ON, Canada; Proteolix, Inc., South San Francisco, CA; Hackensack University Medical Center, Hackensack, NJ
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Voorhees PM, Manges RF, Somlo G, Lentzsch S, Jagannath S, Sonneveld P, Frank RC, Zweegman S, Wijermans PW, Thomas S. A phase II multicenter study of CNTO 328, an anti-IL-6 monoclonal antibody, in patients (pts) with relapsed or refractory multiple myeloma (MM). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8527 Background: Relapsed/refractory MM constitutes a specific and unmet medical need with poor overall response and survival. Interleukin-6 (IL-6) plays an important role in MM cell proliferation, survival, and corticosteroid resistance and previous studies have shown clinical benefit from anti-IL-6 therapy. We therefore evaluated the combination of CNTO328, a chimeric monoclonal antibody with high affinity for human IL-6, and dexamethasone (dex) in pts with relapsed/refractory MM. Methods: Pts were treated with 6 mg/kg CNTO328 IV Q2 weeks. Oral dex (40mg) was given once daily, days 1–4, 9–12, and 17–20 for a max of 4 cycles; and on days 1–4 for subsequent cycles. Inclusion criteria were > 2 prior lines of systemic therapy, creatinine clearance >20 ml/min, platelets >50,000/mm3, and neutrophils >1000/mm3. Primary endpoint was overall response with secondary endpoints of time to progression, incidence of AEs and SAEs. Results: Thirty-nine pts received at least 1 infusion of CNTO328 in combination with dex - median age 66 yrs (range 43–89), median disease duration 4.2 yrs (1–13), median lines of prior therapy 5 (2–9) including bortezomib (100%), IMIDs (87%), and ASCT (59%). The median duration of therapy was 3.3 months (0.5–21+). Of the 36 pts who were evaluable, the overall response rate (CR+PR+MR) using EBMT criteria was 31% (7PR, 4MR). An additional 4 uMR and 4 SD lasting ≥3 months have been reported. PRs were durable; 6 out of 7 pts had responses ranging from 3 months to up to more than 1 year (with 1 still ongoing for more than 1 year). Duration of MRs ranged from 2–5 months. Responses were seen in pts relapsing after and refractory to at least one other prior treatment including bortezomib, IMIDs, or steroids. Median time to disease progression (PD) was 3.7 months (0.3–18+). Main reasons for treatment discontinuation were PD (24) and AEs (6). Hematologic toxicities Grade ≥ 3 were common though not dose-limiting. Three pts had Grade ≥ 3 infections considered reasonably related to CNTO328. Conclusions: CNTO 328 in combination with dex shows promising preliminary activity in this heavily pretreated patient population with an acceptable safety profile. Further investigation is ongoing. No significant financial relationships to disclose.
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Affiliation(s)
- P. M. Voorhees
- University of North Carolina, Chapel Hill, NC; Investigative Clinical Research of Indiana, L.L.C., Indianapolis, IN; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Pittsburg Cancer Institute, ittsburgh, PA; St. Vincent's Comprehensive Cancer Center, New York, NY; Erasmus Medical Center, Rotterdam, Netherlands; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; VU University Medical Center, Amsterdam, Netherlands; Haga Hospital, The Hague, Netherlands; University of Texas M
| | - R. F. Manges
- University of North Carolina, Chapel Hill, NC; Investigative Clinical Research of Indiana, L.L.C., Indianapolis, IN; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Pittsburg Cancer Institute, ittsburgh, PA; St. Vincent's Comprehensive Cancer Center, New York, NY; Erasmus Medical Center, Rotterdam, Netherlands; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; VU University Medical Center, Amsterdam, Netherlands; Haga Hospital, The Hague, Netherlands; University of Texas M
| | - G. Somlo
- University of North Carolina, Chapel Hill, NC; Investigative Clinical Research of Indiana, L.L.C., Indianapolis, IN; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Pittsburg Cancer Institute, ittsburgh, PA; St. Vincent's Comprehensive Cancer Center, New York, NY; Erasmus Medical Center, Rotterdam, Netherlands; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; VU University Medical Center, Amsterdam, Netherlands; Haga Hospital, The Hague, Netherlands; University of Texas M
| | - S. Lentzsch
- University of North Carolina, Chapel Hill, NC; Investigative Clinical Research of Indiana, L.L.C., Indianapolis, IN; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Pittsburg Cancer Institute, ittsburgh, PA; St. Vincent's Comprehensive Cancer Center, New York, NY; Erasmus Medical Center, Rotterdam, Netherlands; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; VU University Medical Center, Amsterdam, Netherlands; Haga Hospital, The Hague, Netherlands; University of Texas M
| | - S. Jagannath
- University of North Carolina, Chapel Hill, NC; Investigative Clinical Research of Indiana, L.L.C., Indianapolis, IN; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Pittsburg Cancer Institute, ittsburgh, PA; St. Vincent's Comprehensive Cancer Center, New York, NY; Erasmus Medical Center, Rotterdam, Netherlands; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; VU University Medical Center, Amsterdam, Netherlands; Haga Hospital, The Hague, Netherlands; University of Texas M
| | - P. Sonneveld
- University of North Carolina, Chapel Hill, NC; Investigative Clinical Research of Indiana, L.L.C., Indianapolis, IN; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Pittsburg Cancer Institute, ittsburgh, PA; St. Vincent's Comprehensive Cancer Center, New York, NY; Erasmus Medical Center, Rotterdam, Netherlands; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; VU University Medical Center, Amsterdam, Netherlands; Haga Hospital, The Hague, Netherlands; University of Texas M
| | - R. C. Frank
- University of North Carolina, Chapel Hill, NC; Investigative Clinical Research of Indiana, L.L.C., Indianapolis, IN; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Pittsburg Cancer Institute, ittsburgh, PA; St. Vincent's Comprehensive Cancer Center, New York, NY; Erasmus Medical Center, Rotterdam, Netherlands; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; VU University Medical Center, Amsterdam, Netherlands; Haga Hospital, The Hague, Netherlands; University of Texas M
| | - S. Zweegman
- University of North Carolina, Chapel Hill, NC; Investigative Clinical Research of Indiana, L.L.C., Indianapolis, IN; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Pittsburg Cancer Institute, ittsburgh, PA; St. Vincent's Comprehensive Cancer Center, New York, NY; Erasmus Medical Center, Rotterdam, Netherlands; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; VU University Medical Center, Amsterdam, Netherlands; Haga Hospital, The Hague, Netherlands; University of Texas M
| | - P. W. Wijermans
- University of North Carolina, Chapel Hill, NC; Investigative Clinical Research of Indiana, L.L.C., Indianapolis, IN; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Pittsburg Cancer Institute, ittsburgh, PA; St. Vincent's Comprehensive Cancer Center, New York, NY; Erasmus Medical Center, Rotterdam, Netherlands; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; VU University Medical Center, Amsterdam, Netherlands; Haga Hospital, The Hague, Netherlands; University of Texas M
| | - S. Thomas
- University of North Carolina, Chapel Hill, NC; Investigative Clinical Research of Indiana, L.L.C., Indianapolis, IN; City of Hope Comprehensive Cancer Center, Duarte, CA; University of Pittsburg Cancer Institute, ittsburgh, PA; St. Vincent's Comprehensive Cancer Center, New York, NY; Erasmus Medical Center, Rotterdam, Netherlands; Whittingham Cancer Center at Norwalk Hospital, Norwalk, CT; VU University Medical Center, Amsterdam, Netherlands; Haga Hospital, The Hague, Netherlands; University of Texas M
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Lonial S, Singhal A, Jagannath S, Vij R. A129 Phase Ib Study of Elotuzumab (HuLuc63) inCombination with Lenalidomide in Relapsed Multiple Myeloma. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1557-9190(11)70470-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mazumder A, Vesole D, Jagannath S. Salvage and Hematopoietic Recovery With Bortezomib and Melphalan In Cytopenic Recurrent and Refractory Multiple Myeloma. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Weber DM, Badros A, Jagannath S, Siegel D, Richon V, Rizvi S, Garcia-Vargas J, Reiser D, Anderson KC. A242 Vorinostat and Bortezomib in Relapsed/Refractory MM. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1557-9190(11)70519-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Richardson PG, San-Miguel J, Lonial S, Reece D, Jakubowiak A, Hussein M, Jagannath S, Mitsiades CS, Raje N, Kaufman J, Avigan D, Ghobrial I, Schlossman RL, Munshi N, Dalton W, Anderson KC. The research mission in myeloma. Leukemia 2009; 23:422-3; author reply 423-4. [DOI: 10.1038/leu.2008.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jagannath S, Vij R, Stewart AK, Somlo G, Jakubowiak A, Reiman T, Trudel S, Taylor J, Fuhrman D, Cruickshank S, Schwartz R, Kunkel L, Siegel D. A377 Phase II Study of Carfilzomib in Patients with Relapsed and Refractory Multiple Myeloma (PX-171-003). ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1557-9190(11)70562-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sullivan K, Jagannath S, Mazumder A, Vesole DH. Plasma exchange after hematopoietic stem cell transplantation in multiple myeloma to reduce renal insufficiency. Bone Marrow Transplant 2008; 42:767. [DOI: 10.1038/bmt.2008.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jagannath S, Puri K, Kantsevoy S, Thuluvath PJ. Endoscopic ultrasound and fine needle aspiration for the diagnosis of hepatocellular carcinoma. MINERVA GASTROENTERO 2008; 54:125-130. [PMID: 18319685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Liver cancer is one of the most frequent solid cancers. The major risk factor associated with the development of hepatocellular carcinoma (HCC) is cirrhosis caused by hepatitis B, hepatitis C virus or chronic alcohol consumption. The overall prognosis of patients with HCC is very poor and this is mainly due to the advanced stages of cancer at presentation and also because of underlying cirrhosis. When HCC is diagnosed at early stages, prognosis is better with five-year disease free survival of around 50% with resection, or local ablative treatments such as radio-frequency ablation or percutaneous ethanol injection, and 70-80% with liver transplantation. Therefore, systematic screening of all the high-risk patients is the key to an early diagnosis of small HCC and the use of an appropriate treatment modality. The currently available tools for the screening, surveillance and diagnosis of HCC in the presence of cirrhosis remain sub-optimal. The advancements made in the past 10 years, however, have made HCC a potentially curable disease in a highly selected group of patients. This review will briefly discuss the current guidelines for surveillance and diagnosis of HCC in high-risk subjects and then review the potential role of endoscopic ultrasound and fine needle aspiration for the diagnosis of small HCC.
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Affiliation(s)
- S Jagannath
- Department of Medicine, The Johns Hopkins Hospital, 1830 Monument Street, Baltimore, MD 21287, USA
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Anderson KC, Jagannath S, Jakubowiak A, Lonial S, Raje N, Schlossman R, Munshi N, Knight R, Esseltine D, Richardson PG. Phase II study of lenalidomide (Len), bortezomib (Bz), and dexamethasone (Dex) in patients (pts) with relapsed or relapsed and refractory multiple myeloma (MM). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Voorhees PM, Manges RF, Sonneveld P, Somlo G, Jagannath S, Zweegman S, Munteanu M, Vermeulen JT, Xie H, Orlowski RZ. Phase II study evaluating the efficacy and safety of CNTO328 in combination with dexamethasone for patients with relapsed/refractory multiple myeloma (MM). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Galili N, Marionneaux S, Lascher S, Mazumder A, Vesole D, Mumtaz M, Mehdi M, Jagannath S, Raza A. C-reactive protein (CRP) associated with higher risk patients with myelodysplastic syndromes (MDS). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.18009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hussein MA, Richardson PG, Jagannath S, Singhal S, Bensinger W, Knight R, Zeldis JB, Yu Z, Olesnyckyj M, Anderson KC. Final analysis of MM-014: Single-agent lenalidomide in patients with relapsed and refractory multiple myeloma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Richardson PG, Lonial S, Jakubowiak A, Jagannath S, Raje N, Avigan D, Ghobrial IM, Knight R, Esseltine D, Anderson KC. Safety and efficacy of lenalidomide (Len), bortezomib (Bz), and dexamethasone (Dex) in patients (pts) with newly diagnosed multiple myeloma (MM): A phase I/II study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8520] [Citation(s) in RCA: 12] [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] [Indexed: 11/20/2022] Open
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Jagannath S, Richardson PG, Zeldenrust S, Alsina M, Wride K, Zeldis JB, Knight R, Olesnyckyj M, Anderson KC. Long-term responses observed with lenalidomide therapy for patients with relapsed or refractory multiple myeloma. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
8102 Background: Thalidomide or bortezomib combined with dexamethasone (TD or BD respectively) are now being increasingly used as induction regimens for newly diagnosed multiple myeloma. There are conflicting reports on the effects of T on stem cell mobilization. Since we have used both these regimens at our center, we performed a retrospective analysis of stem cell mobilization after induction therapy with either TD (n = 22) or BD (n = 18). Methods: The patients were balanced with respect to initial Durie-Salmon stage, median number of cycles of induction therapy prior to collection, response to induction therapy, bone marrow cellularity and involvement, and time from end of therapy to collection. All patients were mobilized with G-CSF 10mcg/kg and collected in a large volume pheresis, with a goal of at least 6x10(6) CD34+ cells/kg (for tandem transplant). Results: To achieve our stem cell goal, the number of patients who required 3 or more phereses in the TD group was 17/22 whereas it was only 4/18 in the BD group. (p<0.005). 3/3 patients who had received lenalidomide also required 3 or more phereses. Also, the number of CD34+ cells/kg obtained in the TD group was less–mean of 2.8x10(6) per pheresis, as compared to a mean of 5.2x10(6) per pheresis in the BD group (p<0.01). Time to neutrophil engraftment was similar in both groups. However in the TD group there was a 1 day delay in platelets > 20,000/ul (p<0.05). Conclusions: Thus, thalidomide induction led to a lower yield of stem cells when compared to bortezomib. Differences in stem cell markers are being investigated. This may become especially important when limiting numbers of stem cells are available from elderly patients, those with prior radiation or bulk disease and when used for in vitro manipulation. It is possible that agents such as bortezomib may alter the bone marrow microenviroment differently from imids such as thalidomide. No significant financial relationships to disclose.
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Gibson MK, Mezzadra H, Kleinberg L, Jagannath S, Brock M, Abdallah N, Rudek M, Berman D, Forastiere A, Altiok S. Predicting and monitoring tumor response to epidermal growth factor receptor inhibitor gefitinib in patients with locally advanced esophageal adenocarcinoma. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14112] [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
14112 Background: This study aimed to validate an ex vivo chemosensitivity assay to measure the pharmacodynamic effect of gefitinib on esophageal adenocarcinoma (EAC) prior to treatment with pre-operative concomitant chemoradiotherapy (CRT). Methods: A 14 day run-in period with 250 mg/day of gefitinib preceded CRT. Endoscopic biopsies (D 0 and 14) in 4 patients with T2–3N0/1M0/1a EAC were analyzed by ex vivo chemosensitivity assay. Day 0 tissue was exposed to gefitinib ex vivo, then tumor was exposed to gefitinib for 14 days in vivo (ie in the patient). Phosphorylation of the EGFR, raf/MEK/ERK and PI3/AKT pathways was measured by Western blot. Profiles were compared for correlation between ex vivo and in vivo exposure, and patterns were correlated with response to CRT. The effects were also characterized by immunohistochemistry (IHC). EGFR, K-Ras, and PI3K mutations, serum concentrations of gefitinib and PTEN status were measured as potential confounders. Results: One patient with stage T3N1 died of unexplained hemorrhage during surgery. Three had clinical and path stages of: T3N1/T0N0, T3N0/T3N0, T3N1/T2N1. Gefitinib levels were constant, confirming exposure of target tissue to the drug. Ex vivo exposure yielded four distinct pathway patterns. The exact same patterns were seen after in vivo exposure. No mutations were identified in exons 18–21 of the EGFR, exons 2/3 of K-ras or exons 9/22 of PI3K. PTEN levels were similar in all tumors. PCNA expression correlated with raf/MEK/ERK pathway inhibition, but not with inhibition of EGFR activity. IHC correlated with Western blot for expression of EGFR, and phospho- and total ERK levels. No correlation was observed between gefitinib effect and pathologic response to CRT. Conclusions: This study used a novel ex vivo chemosensitivity assay to demonstrate the activity of gefitinib to inhibit target in tumor tissue obtained from patients with EAC. The exact correlation of pre- and post-treatment profiles suggests potential use in the pre-treatment setting to predict in vivo effects of targeted therapies. This approach may facilitate the further refinement of patient selection to maximize potential benefit while sparing patients unlikely to respond to a given agent. No significant financial relationships to disclose.
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Affiliation(s)
- M. K. Gibson
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; The Johns Hopkins University, Baltimore, MD
| | - H. Mezzadra
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; The Johns Hopkins University, Baltimore, MD
| | - L. Kleinberg
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; The Johns Hopkins University, Baltimore, MD
| | - S. Jagannath
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; The Johns Hopkins University, Baltimore, MD
| | - M. Brock
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; The Johns Hopkins University, Baltimore, MD
| | - N. Abdallah
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; The Johns Hopkins University, Baltimore, MD
| | - M. Rudek
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; The Johns Hopkins University, Baltimore, MD
| | - D. Berman
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; The Johns Hopkins University, Baltimore, MD
| | - A. Forastiere
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; The Johns Hopkins University, Baltimore, MD
| | - S. Altiok
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; The Johns Hopkins University, Baltimore, MD
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Jagannath S, Richardson PG, Sonneveld P, Schuster MW, Irwin D, Stadtmauer EA, Facon T, Harousseau JL, Cowan JM, Anderson KC. Bortezomib appears to overcome the poor prognosis conferred by chromosome 13 deletion in phase 2 and 3 trials. Leukemia 2006; 21:151-7. [PMID: 17096017 DOI: 10.1038/sj.leu.2404442] [Citation(s) in RCA: 213] [Impact Index Per Article: 11.8] [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: 11/09/2022]
Abstract
In multiple myeloma, deletion of chromosome 13 (del(13)) is associated with poor prognosis regardless of treatment. This study analyzed the impact of del(13) status on response and survival following treatment with either bortezomib or high-dose dexamethasone in patients in the SUMMIT and APEX trials. Additionally, matched-pairs subset analyses were conducted of patients with and without del(13), balanced for age and International Staging System parameters. In both SUMMIT and APEX, prognosis appeared to be poorer in bortezomib-treated patients with del(13) compared with patients with no del(13) by metaphase cytogenetics. In the SUMMIT and APEX matched-pairs analysis, response and survival appeared comparable in bortezomib-treated patients with or without del(13) by metaphase cytogenetics. However, patients with del(13) receiving dexamethasone in APEX appeared to have markedly decreased survival compared with those without del(13) by metaphase cytogenetics. These matched-pairs analyses suggest that bortezomib may overcome some of the poor impact of del(13) as an independent prognostic factor. However, sample sizes were very small; these findings require confirmation from further studies.
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Affiliation(s)
- S Jagannath
- Department of Medical Oncology, St Vincent's Comprehensive Cancer Center, New York, NY 10011-8202, USA.
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Neelapu SS, Munshi NC, Jagannath S, Watson TM, Pennington R, Reynolds C, Barlogie B, Kwak LW. Tumor antigen immunization of sibling stem cell transplant donors in multiple myeloma. Bone Marrow Transplant 2005; 36:315-23. [PMID: 15968284 DOI: 10.1038/sj.bmt.1705057] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The unique antigenic determinants (idiotype (Id)) of the immunoglobulin secreted by myeloma tumor can serve as a tumor-specific antigen for active immunotherapy. Our objective was to induce tumor-specific T-cell immunity in bone marrow transplant (BMT) donors to enhance antitumor effects of allografts. We vaccinated five HLA-matched sibling donors with myeloma Id proteins isolated from recipient plasma before bone marrow harvest. Recipients were administered booster Id immunizations following transplantation. Vaccination induced donor Id and carrier-specific cellular and/or humoral immune responses. Two recipients died within 30 days of BMT from transplant-related complications. Id and carrier-specific T-cell responses were detected in all three remaining patients post-, but not pre-BMT and persisted for 18 months. All three surviving patients converted from partial to complete responses following BMT. Two of the three patients remain disease-free 7 years and 8 years after BMT, and the third died of renal failure after 5.5 years while in complete remission from myeloma. Our results suggest that myeloma Id vaccination induces specific T-cell immunity in healthy donors which may be transferable by BMT, is associated with prolonged disease-free survival of recipients, and may represent a general strategy to enhance graft-versus-tumor effect in other malignancies for which defined tumor-specific antigens exist.
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Affiliation(s)
- S S Neelapu
- Experimental and Transplantation Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Lonial S, Waller EK, Richardson PG, Jagannath S, Orlowski RZ, Giver CR, Jaye DL, Barlogie B, Heffner LT, Anderson KC. Bortezomib-associated transient and cyclical thrombocytopenia: evidence for lack of marrow cytotoxicity. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Lonial
- Emory Univ, Atlanta, GA; Dana-Farber Cancer Inst, Boston, MA; St Vincent’s Comprehensive Cancer Ctr, New York, NY; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Myeloma and Transplant Research Ctr, Little Rock, AR
| | - E. K. Waller
- Emory Univ, Atlanta, GA; Dana-Farber Cancer Inst, Boston, MA; St Vincent’s Comprehensive Cancer Ctr, New York, NY; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Myeloma and Transplant Research Ctr, Little Rock, AR
| | - P. G. Richardson
- Emory Univ, Atlanta, GA; Dana-Farber Cancer Inst, Boston, MA; St Vincent’s Comprehensive Cancer Ctr, New York, NY; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Myeloma and Transplant Research Ctr, Little Rock, AR
| | - S. Jagannath
- Emory Univ, Atlanta, GA; Dana-Farber Cancer Inst, Boston, MA; St Vincent’s Comprehensive Cancer Ctr, New York, NY; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Myeloma and Transplant Research Ctr, Little Rock, AR
| | - R. Z. Orlowski
- Emory Univ, Atlanta, GA; Dana-Farber Cancer Inst, Boston, MA; St Vincent’s Comprehensive Cancer Ctr, New York, NY; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Myeloma and Transplant Research Ctr, Little Rock, AR
| | - C. R. Giver
- Emory Univ, Atlanta, GA; Dana-Farber Cancer Inst, Boston, MA; St Vincent’s Comprehensive Cancer Ctr, New York, NY; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Myeloma and Transplant Research Ctr, Little Rock, AR
| | - D. L. Jaye
- Emory Univ, Atlanta, GA; Dana-Farber Cancer Inst, Boston, MA; St Vincent’s Comprehensive Cancer Ctr, New York, NY; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Myeloma and Transplant Research Ctr, Little Rock, AR
| | - B. Barlogie
- Emory Univ, Atlanta, GA; Dana-Farber Cancer Inst, Boston, MA; St Vincent’s Comprehensive Cancer Ctr, New York, NY; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Myeloma and Transplant Research Ctr, Little Rock, AR
| | - L. T. Heffner
- Emory Univ, Atlanta, GA; Dana-Farber Cancer Inst, Boston, MA; St Vincent’s Comprehensive Cancer Ctr, New York, NY; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Myeloma and Transplant Research Ctr, Little Rock, AR
| | - K. C. Anderson
- Emory Univ, Atlanta, GA; Dana-Farber Cancer Inst, Boston, MA; St Vincent’s Comprehensive Cancer Ctr, New York, NY; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Myeloma and Transplant Research Ctr, Little Rock, AR
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Jagannath S, Richardson PG, Sonneveld P, Irwin D, Schuster MW, Stadtmauer EA, Facon T, Harousseau JL, Cowan JM, Anderson KC. Bortezomib appears to overcome poor prognosis conferred by chromosome 13 deletion in phase 2 and 3 trials. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6501] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Jagannath
- St. Vincent’s Catholic Medcl Ctr, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Univ Hosp Rotterdam, Rotterdam, The Netherlands; Alta Bates Cancer Ctr, Berkeley, CA; New York-Presbyterian Hosp, New York, NY; Univ of Pennsylvania Cancer Ctr, Philadelphia, PA; Hosp Claude Huriez, Lille, France; Hotel Dieu Hosp, Nantes, France; Tufts-New England Medcl Ctr, Boston, MA
| | - P. G. Richardson
- St. Vincent’s Catholic Medcl Ctr, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Univ Hosp Rotterdam, Rotterdam, The Netherlands; Alta Bates Cancer Ctr, Berkeley, CA; New York-Presbyterian Hosp, New York, NY; Univ of Pennsylvania Cancer Ctr, Philadelphia, PA; Hosp Claude Huriez, Lille, France; Hotel Dieu Hosp, Nantes, France; Tufts-New England Medcl Ctr, Boston, MA
| | - P. Sonneveld
- St. Vincent’s Catholic Medcl Ctr, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Univ Hosp Rotterdam, Rotterdam, The Netherlands; Alta Bates Cancer Ctr, Berkeley, CA; New York-Presbyterian Hosp, New York, NY; Univ of Pennsylvania Cancer Ctr, Philadelphia, PA; Hosp Claude Huriez, Lille, France; Hotel Dieu Hosp, Nantes, France; Tufts-New England Medcl Ctr, Boston, MA
| | - D. Irwin
- St. Vincent’s Catholic Medcl Ctr, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Univ Hosp Rotterdam, Rotterdam, The Netherlands; Alta Bates Cancer Ctr, Berkeley, CA; New York-Presbyterian Hosp, New York, NY; Univ of Pennsylvania Cancer Ctr, Philadelphia, PA; Hosp Claude Huriez, Lille, France; Hotel Dieu Hosp, Nantes, France; Tufts-New England Medcl Ctr, Boston, MA
| | - M. W. Schuster
- St. Vincent’s Catholic Medcl Ctr, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Univ Hosp Rotterdam, Rotterdam, The Netherlands; Alta Bates Cancer Ctr, Berkeley, CA; New York-Presbyterian Hosp, New York, NY; Univ of Pennsylvania Cancer Ctr, Philadelphia, PA; Hosp Claude Huriez, Lille, France; Hotel Dieu Hosp, Nantes, France; Tufts-New England Medcl Ctr, Boston, MA
| | - E. A. Stadtmauer
- St. Vincent’s Catholic Medcl Ctr, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Univ Hosp Rotterdam, Rotterdam, The Netherlands; Alta Bates Cancer Ctr, Berkeley, CA; New York-Presbyterian Hosp, New York, NY; Univ of Pennsylvania Cancer Ctr, Philadelphia, PA; Hosp Claude Huriez, Lille, France; Hotel Dieu Hosp, Nantes, France; Tufts-New England Medcl Ctr, Boston, MA
| | - T. Facon
- St. Vincent’s Catholic Medcl Ctr, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Univ Hosp Rotterdam, Rotterdam, The Netherlands; Alta Bates Cancer Ctr, Berkeley, CA; New York-Presbyterian Hosp, New York, NY; Univ of Pennsylvania Cancer Ctr, Philadelphia, PA; Hosp Claude Huriez, Lille, France; Hotel Dieu Hosp, Nantes, France; Tufts-New England Medcl Ctr, Boston, MA
| | - J. L. Harousseau
- St. Vincent’s Catholic Medcl Ctr, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Univ Hosp Rotterdam, Rotterdam, The Netherlands; Alta Bates Cancer Ctr, Berkeley, CA; New York-Presbyterian Hosp, New York, NY; Univ of Pennsylvania Cancer Ctr, Philadelphia, PA; Hosp Claude Huriez, Lille, France; Hotel Dieu Hosp, Nantes, France; Tufts-New England Medcl Ctr, Boston, MA
| | - J. M. Cowan
- St. Vincent’s Catholic Medcl Ctr, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Univ Hosp Rotterdam, Rotterdam, The Netherlands; Alta Bates Cancer Ctr, Berkeley, CA; New York-Presbyterian Hosp, New York, NY; Univ of Pennsylvania Cancer Ctr, Philadelphia, PA; Hosp Claude Huriez, Lille, France; Hotel Dieu Hosp, Nantes, France; Tufts-New England Medcl Ctr, Boston, MA
| | - K. C. Anderson
- St. Vincent’s Catholic Medcl Ctr, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Univ Hosp Rotterdam, Rotterdam, The Netherlands; Alta Bates Cancer Ctr, Berkeley, CA; New York-Presbyterian Hosp, New York, NY; Univ of Pennsylvania Cancer Ctr, Philadelphia, PA; Hosp Claude Huriez, Lille, France; Hotel Dieu Hosp, Nantes, France; Tufts-New England Medcl Ctr, Boston, MA
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