Bortezomib retreatment in relapsed multiple myeloma - results from a retrospective multicentre survey in Germany and Switzerland

OBJECTIVES

This multicenter, retrospective survey evaluated the efficacy and safety of bortezomib retreatment in patients with relapsed multiple myeloma who had responded to initial bortezomib treatment.

METHODS

Clinical records of 94 patients receiving bortezomib retreatment in Germany and Switzerland were reviewed.

RESULTS

Sixty patients were included according to prespecified criteria. Patients had received a mean 3.7 ± 2.3 therapies prior to initial bortezomib. Overall response rate to bortezomib retreatment was 63.3%; 8 (13.3%), 3 (5.0%) and 27 (45.0%) patients achieved complete response (CR), near-CR and partial response, respectively. Response to retreatment was associated with response to initial treatment (75.0% of patients with CR to initial treatment responded to retreatment) and treatment-free interval (TFI) after initial treatment (76.9 vs. 38.1% overall response rate for patients with TFI >6 vs. ≤ 6 months). After retreatment, median time to progression was 9.3 months. Median TFI was 5.7 months; 31.7, 25.0 and 15.0% of patients experienced a TFI longer than 6, 9 and 12 months, respectively. Reported adverse drug reactions were consistent with the known safety profile of bortezomib and most resolved completely.

CONCLUSIONS

These results demonstrate that relapsed multiple myeloma patients who respond to initial bortezomib treatment have a sustained susceptibility to bortezomib and do not experience uncommon toxicity to retreatment.

Integrating novel agents into multiple myeloma treatment - current status in Switzerland and treatment recommendations

The treatment of multiple myeloma has undergone significant changes in the recent past. The arrival of novel agents, especially thalidomide, bortezomib and lenalidomide, has expanded treatment options and patient outcomes are improving significantly. This article summarises the discussions of an expert meeting which was held to debate current treatment practices for multiple myeloma in Switzerland concerning the role of the novel agents and to provide recommendations for their use in different treatment stages based on currently available clinical data. Novel agent combinations for the treatment of newly diagnosed, as well as relapsed multiple myeloma are examined. In addition, the role of novel agents in patients with cytogenetic abnormalities and renal impairment, as well as the management of the most frequent side effects of the novel agents are discussed. The aim of this article is to assist in treatment decisions in daily clinical practice to achieve the best possible outcome for patients with multiple myeloma.

[Painful shoulder in the elderly--not always of degenerative nature]

A 81-year-old man suffered, without any preceding trauma, from progressive pain of his left shoulder since 3 weeks. The left upper arm was warm and swollen with a palpable solid mass. Mild normocytic anemia and an increased erythrocyte sedimentation reaction were determined. X-ray showed an osteolytic lesion of left humerus with pathological fracture and involvement of soft tissue. Multiple myeloma was diagnosed from the biopsy of this lesion, detection of paraprotein IgA Kappa in the serum, and a 15-20% plasma cell infiltration of the bone marrow. The patient responded well to radio-therapy and intravenous application of biphosphonates--the fracture healed by conservative therapy. The treating physician--on the basis of clinical experience and by intuition--has to decide considering medical history and clinical findings whether musculoskeletal pain must be investigated further. Diagnosis of multiple myeloma requires monoclonal protein (paraprotein) in the serum or urine, plasma cell infiltration of the bone marrow, and evidence of end-organ damage (anemia, renal insufficiency, bone lesions or hypercalcemia).

Second-line high-dose chemotherapy in patients with mediastinal and retroperitoneal primary non-seminomatous germ cell tumors: the EBMT experience

BACKGROUND

Results of second-line chemotherapy in patients with extragonadal non-seminomatous germ cell tumor (NSGCT) appear inferior to results in testicular NSGCT. Patients with retroperitoneal NSGCT achieve a comparable long-term survival rate of 30%, but the salvage rates of patients with mediastinal primary are less than 10%. We conducted a retrospective analysis on patients with mediastinal and retroperitoneal NSGCT treated with second-line high-dose chemotherapy (HDCT) registered with the European Group for Blood and Marrow Transplantation (EBMT).

PATIENTS AND METHODS

Between 1987 and 1999, 59 registered patients with retroperitoneal (n=37) and mediastinal (n=22) primary NSGCT, median age 28 years (range 18-60), were treated with second-line HDCT. All had received cisplatin-containing chemotherapy as first-line treatment.

RESULTS

Toxic death occurred in three cases (5%). With a median follow-up of 58 months (range 14-114), 18/59 patients (30%) continue to be disease-free. Of three patients who had a disease recurrence after HDCT, one patient achieved a disease-free status with further chemotherapy and surgery. In total, 19 patients (32%) are currently disease-free. Sixteen of 37 patients (43%) with retroperitoneal NSGCT, and three of 22 patients (14%) with mediastinal NSGCT are currently alive and disease-free.

CONCLUSIONS

Second-line HDCT might represent a possible option for patients with retroperitoneal primary NSGCT. New salvage strategies are needed for patients with mediastinal NSGCT.

Eosinophilic pneumonia after administration of fludarabine for the treatment of non-Hodgkin's lymphoma

Fludarabine is a purine analogue which is effective in the treatment of patients with low-grade non-Hodgkin's lymphoma, including chronic lymphocytic leukemia. While pulmonary toxicity due to cytotoxic drugs is increasingly diagnosed, only few cases of interstitial pneumonitis have been described following fludarabine administration. Here we report the first case in the literature of an acute eosinophilic pneumonia associated with peripheral blood eosinophilia after the administration of fludarabine monotherapy for stage IV follicular lymphoma.

Fusion PET-CT imaging of neurolymphomatosis

In a patient suffering from peripheral neuropathy due to neurolymphomatosis, fused PET-CT imaging, performed on a novel in-line PET-CT system, showed multiple small nodular lesions extending along the peripheral nerves corresponding to an early relapse of a transformed B-cell non-Hodgkin's lymphoma.

Immunoblot analysis of antibody binding to polypeptides of Borrelia burgdorferi in children with different clinical manifestations of Lyme disease

We analyzed by means of immunoblot technique the patterns of antibodies binding to polypeptides of Borrelia burgdorferi B31 in the sera of 21 children with different stages of Lyme disease. All sera but one recognized the flagellar protein 41 kD and all but two the 83-kD protein. The number of proteins recognized rose from clinical stage I to stage III. The polypeptides of the mol wt 55 and 31 kD were exclusively bound by IgM and the proteins 66, 58, 39, and 36 kD exclusively by IgG. Based on the number of proteins visualized by single sera, IgM was the predominant isotype in stages I and II peaking in stage II, whereas in stage III IgG predominated. Considering the number of proteins recognized and the corresponding antibody isotype, a serologic differentiation between the three stages of the disease is feasible: within stage I and within stage III patients with different clinical signs had distinct antibody patterns. No clearcut pattern could be discriminated in stage II for patients with different settings. Immunoblotting yields a possible distinction between active infection and serological scar by the detection of specific antibody patterns.