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Avivi I, Vesole DH, Davila-Valls J, Usnarska-Zubkiewicz L, Olszewska-Szopa M, Milunovic V, Baumert B, Osękowska B, Kopińska A, Gentile M, Puertas-Martinez B, Robak P, Crusoe E, Rodriguez-Lobato LG, Gajewska M, Varga G, Delforge M, Cohen Y, Gozzetti A, Pena C, Shustik C, Mikala G, Zalac K, Alexander HD, Barth P, Weisel K, Martínez-López J, Waszczuk-Gajda A, Krzystański M, Jurczyszyn A. Outcome of Second Primary Malignancies Developing in Multiple Myeloma Patients. Cancers (Basel) 2023; 15:4359. [PMID: 37686635 PMCID: PMC10487060 DOI: 10.3390/cancers15174359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND There is an increased risk of second primary malignancies (SMPs) in patients with multiple myeloma (MM). This multinational 'real-world' retrospective study analyzed the characteristics and outcomes of MM patients that developed SPMs. RESULTS 165 patients were analyzed: 62.4% males; 8.5% with a prior cancer; 113 with solid SPMs, mainly ≥stage 2; and 52 with hematological SPM (hemato-SPM), mainly MDS/AML. Patients with hemato-SPM were younger (p = 0.05) and more frequently had a prior AutoHCT (p = 0.012). The time to SPM was shorter in the older (>65 years) and more heavily pretreated patients. One hundred patients were actively treated at the time of SPM detection. Treatment was discontinued in 52, substituted with another anti-MM therapy in 15, and continued in 33 patients. Treatment discontinuation was predominant in the patients diagnosed with hemato-SPM (76%). The median OS following SPM detection was 8.5 months, and the main cause of death was SPM. A poor ECOG status predicted a shorter OS (PS 3 vs. 0, HR = 5.74, 2.32-14.21, p < 0.001), whereas a normal hemoglobin level (HR = 0.43, 0.19-0.95, p = 0.037) predicted longer OS. CONCLUSIONS With the continuing improvement in OS, a higher proportion of MM patients might develop SPM. The OS following SPM diagnosis is poor; hence, frequent surveillance and early detection are imperative to improve outcomes.
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Affiliation(s)
- Irit Avivi
- Department of Hematology, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - David H. Vesole
- Hackensack University Medical Center, New Jersey Medical School, Rutgers University, Hackensack, NJ 07601, USA
| | | | - Lidia Usnarska-Zubkiewicz
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Magdalena Olszewska-Szopa
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Vibor Milunovic
- Division of Hematology, Clinical Hospital Merkur, 10000 Zagreb, Croatia
| | - Bartłomiej Baumert
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland; (B.B.)
| | - Bogumiła Osękowska
- Department of General Pathology, Pomeranian Medical University, 70-111 Szczecin, Poland; (B.B.)
| | - Anna Kopińska
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, 40-032 Katowice, Poland
| | - Massimo Gentile
- Hematology Unit AO of Cosenza, Cosenza and Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
| | - Borja Puertas-Martinez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Cancer Research Center-IBMCC (USAL-CSIC), CIBERONC, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Paweł Robak
- Department of Hematology, Copernicus Memorial Hospital, Medical University of Lodz, 90-752 Lodz, Poland
| | - Edvan Crusoe
- Universidade Federal da Bahia, Hospital Universitário Professor Edgar Santos, Serviço de Hematologia, Salvador 40110-909, BA, Brazil
| | - Luis Gerardo Rodriguez-Lobato
- Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, IDIBAPS, 08036 Barcelona, Spain
| | - Małgorzata Gajewska
- Department of Internal Medicine and Hematology, Military Institute of Medicine, 04-141 Warsaw, Poland
| | - Gergely Varga
- Department of Internal Medicine and Haematology, Semmelweis University, 1085 Budapest, Hungary
| | | | - Yael Cohen
- Department of Hematology, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Alessandro Gozzetti
- Department of Medical Science, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Camila Pena
- Sección Hematología, Hospital del Salvador, Santiago 13123, Chile
| | - Chaim Shustik
- Royal Victoria Hospital, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Gabor Mikala
- Department of Hematology and Stem Cell Transplantation, National Institute for Hematology and Infectious Diseases, South Pest Central Hospital, 1097 Budapest, Hungary;
| | - Klara Zalac
- Department of Hematology, Clinics for Internal Medicine, University Hospital Center “Sestre Milosrdnice”, 10000 Zagreb, Croatia
| | - H. Denis Alexander
- Personalised Medicine Centre, School of Medicine, Ulster University, Derry/Londonderry BT47 6SB, UK;
| | - Peter Barth
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Katja Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical-Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | | | - Anna Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Diseases, Warsaw Medical University, 02-097 Warsaw, Poland
| | | | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, 31-155 Crakow, Poland;
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Buske C, Tedeschi A, Trotman J, García-Sanz R, MacDonald D, Leblond V, Mahe B, Herbaux C, Matous JV, Tam CS, Heffner LT, Varettoni M, Palomba ML, Shustik C, Kastritis E, Treon SP, Ping J, Hauns B, Arango-Hisijara I, Dimopoulos MA. Plain Language Summary of the iNNOVATE study: ibrutinib plus rituximab is well-tolerated and effective in people with Waldenström's macroglobulinemia. Future Oncol 2023; 19:345-353. [PMID: 36815271 DOI: 10.2217/fon-2022-1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This article provides a short summary of 5-year results from the iNNOVATE trial. The original paper was published in the Journal of Clinical Oncology in October 2021. People with Waldenström's macroglobulinemia (WM) were randomly divided into two groups of 75 people each. One group received a combination treatment composed of two drugs, ibrutinib plus rituximab, and the other group took placebo ("sugar pill") plus rituximab. Ibrutinib (also known by the brand name Imbruvica®) is a drug that reduces cancer cells' ability to multiply and survive. Ibrutinib is an FDA-approved drug for the treatment of WM. Rituximab is a drug that helps the immune system find and kill cancer cells. Participants in the trial were treated and their health monitored for up to 5 years (63 months). WHAT WERE THE RESULTS? During the 5 years of monitoring, more people who took ibrutinib plus rituximab experienced an improvement in their disease and lived longer without their disease getting worse compared to those who took placebo plus rituximab. Side effects from ibrutinib and rituximab were manageable and generally decreased over time. Participants in both study groups reported improvements in quality of life, but those who took ibrutinib plus rituximab reported significantly greater improvement in their quality of life (as measured by FACT-An score) compared to those who took placebo plus rituximab. WHAT DO THE RESULTS MEAN? These results show that ibrutinib plus rituximab is better than rituximab alone in people with WM and that ibrutinib plus rituximab is safe and effective in the long term. This information confirms the role of ibrutinib plus rituximab as a standard of care for WM. Clinical Trial Registration: NCT02165397 (ClinicalTrials.gov).
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Affiliation(s)
- Christian Buske
- Institute of Experimental Cancer Research, Comprehensive Cancer Center Ulm, University Hospital of Ulm, Ulm, Germany
| | | | - Judith Trotman
- Concord Hospital, University of Sydney, Sydney, Australia
| | - Ramón García-Sanz
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC & Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
| | | | - Veronique Leblond
- Département d'Hématologie Hôpital Pitié-Salpêtrière AP-HP, Sorbonne Université, Paris, France
| | - Beatrice Mahe
- Centre Hospitalier Universitaire de Nantes, Hôtel Dieu Hematologie Clinique, Nantes, France
| | - Charles Herbaux
- Centre Hospitalier Régional Universitaire de Lille, Institute of Hematology-Transfusion, Lille, France
| | | | - Constantine S Tam
- The Alfred Hospital & the University of Melbourne, Melbourne, Australia
| | | | | | - M Lia Palomba
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Chaim Shustik
- Royal Victoria Hospital at McGill University Health Centre, Montreal, Canada
| | | | | | - Jerry Ping
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA, USA
| | - Bernhard Hauns
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA, USA
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Cornell RF, Baz R, Richter JR, Rossi A, Vogl DT, Chen C, Shustik C, Alvarez MJ, Shen Y, Unger TJ, Ben-Shahar O, Wang H, Baloglu E, Senapedis W, Ma X, Landesman Y, Bai X, Bader J, Xu H, Marshall T, Chang H, Walker CJ, Shah J, Shacham S, Kauffman MG, Hofmeister CC. A phase 1 clinical trial of oral eltanexor in patients with relapsed or refractory multiple myeloma. Am J Hematol 2022; 97:E54-E58. [PMID: 34817872 DOI: 10.1002/ajh.26420] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/29/2021] [Accepted: 11/16/2021] [Indexed: 11/11/2022]
Affiliation(s)
| | - Rachid Baz
- Moffitt Cancer Center, Tampa, Florida, USA
| | - Joshua R Richter
- Hackensack University John Theurer Cancer Center, Hackensack, New Jersey, USA
| | - Adriana Rossi
- Weill Cornell Medical College Myeloma Center, New York, New York, USA
| | - Dan T Vogl
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christine Chen
- UHN Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Chaim Shustik
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Yao Shen
- DarwinHealth Inc., New York, New York, USA
| | - T J Unger
- Karyopharm Therapeutics Inc, Newton, Massachusetts, USA
| | | | - Hongwei Wang
- Karyopharm Therapeutics Inc, Newton, Massachusetts, USA
| | - Erkan Baloglu
- Karyopharm Therapeutics Inc, Newton, Massachusetts, USA
| | | | - Xiwen Ma
- Karyopharm Therapeutics Inc, Newton, Massachusetts, USA
| | | | - Xiang Bai
- Karyopharm Therapeutics Inc, Newton, Massachusetts, USA
| | - Justin Bader
- Karyopharm Therapeutics Inc, Newton, Massachusetts, USA
| | - Hongmei Xu
- Karyopharm Therapeutics Inc, Newton, Massachusetts, USA
| | | | - Hua Chang
- Karyopharm Therapeutics Inc, Newton, Massachusetts, USA
| | | | - Jatin Shah
- Karyopharm Therapeutics Inc, Newton, Massachusetts, USA
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Buske C, Tedeschi A, Trotman J, García-Sanz R, MacDonald D, Leblond V, Mahe B, Herbaux C, Matous JV, Tam CS, Heffner LT, Varettoni M, Palomba ML, Shustik C, Kastritis E, Treon SP, Ping J, Hauns B, Arango-Hisijara I, Dimopoulos MA. Ibrutinib Plus Rituximab Versus Placebo Plus Rituximab for Waldenström's Macroglobulinemia: Final Analysis From the Randomized Phase III iNNOVATE Study. J Clin Oncol 2022; 40:52-62. [PMID: 34606378 PMCID: PMC8683240 DOI: 10.1200/jco.21.00838] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The double-blind, randomized, placebo-controlled phase III iNNOVATE study showed sustained efficacy of ibrutinib-rituximab in Waldenström's macroglobulinemia (WM). Here, we present the final analysis from iNNOVATE. METHODS Patients had confirmed symptomatic WM, either previously untreated or previously treated; patients with prior rituximab had at least a minor response to their last rituximab-based regimen. Patients were randomly assigned to once-daily ibrutinib 420 mg plus rituximab or placebo plus rituximab (n = 75 per arm). The primary end point was progression-free survival (PFS). Secondary end points included response rate, time to next treatment, hemoglobin improvement, overall survival, and safety. RESULTS With a median follow-up of 50 (range, 0.5-63) months, median (95% CI) PFS was not reached (57.7 months to not evaluable) with ibrutinib-rituximab versus 20.3 months (13.0 to 27.6) with placebo-rituximab (hazard ratio, 0.250; P < .0001). PFS benefit was regardless of prior treatment status, MYD88 and CXCR4 mutation status, or key patient characteristics. Higher response rates (partial response or better) were observed with ibrutinib-rituximab (76% v 31% with placebo-rituximab; P < .0001) and were sustained over time. Median time to next treatment was not reached with ibrutinib-rituximab versus 18 months with placebo-rituximab. More patients receiving ibrutinib-rituximab versus placebo-rituximab had sustained hemoglobin improvement (77% v 43%; P < .0001). Median overall survival was not reached in either arm. Ibrutinib-rituximab maintained a manageable safety profile; the prevalence of grade ≥ 3 adverse events of clinical interest generally decreased over time. CONCLUSION In the final analysis of iNNOVATE with a median follow-up of 50 months, ibrutinib-rituximab showed ongoing superiority across clinical outcomes in patients with WM regardless of MYD88 or CXCR4 mutation status, prior treatment, and key patient characteristics.
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Affiliation(s)
- Christian Buske
- Institute of Experimental Cancer Research, Comprehensive Cancer Center Ulm, University Hospital of Ulm, Ulm, Germany,Christian Buske, MD, Institute of Experimental Cancer Research, Comprehensive Cancer Center Ulm, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; e-mail:
| | | | - Judith Trotman
- Concord Hospital, University of Sydney, Sydney, Australia
| | - Ramón García-Sanz
- Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), Salamanca, Spain
| | | | - Veronique Leblond
- Département d’Hématologie Hôpital Pitié-Salpêtrière AP-HP, Sorbonne Université, Paris, France
| | - Beatrice Mahe
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Charles Herbaux
- Centre Hospitalier Régional Universitaire de Lille, Institute of Hematology-Transfusion, Lille, France
| | | | - Constantine S. Tam
- Peter MacCallum Cancer Centre & St Vincent's Hospital and the University of Melbourne, Melbourne, Australia
| | | | | | | | - Chaim Shustik
- Royal Victoria Hospital at McGill University Health Centre, Montreal, Canada
| | - Efstathios Kastritis
- National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Jerry Ping
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
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5
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Belch A, Bahlis N, White D, Cheung M, Chen C, Shustik C, Song K, Tosikyan A, Dispenzieri A, Anderson K, Brown D, Robinson S, Srinivasan S, Facon T. Continuous lenalidomide and low-dose dexamethasone in patients with transplant-ineligible newly diagnosed MM: FIRST trial subanalysis of Canadian/US patients. Cancer Med 2020; 9:8923-8930. [PMID: 33049118 PMCID: PMC7724300 DOI: 10.1002/cam4.3511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/16/2020] [Accepted: 09/05/2020] [Indexed: 12/14/2022] Open
Abstract
The phase 3 FIRST trial demonstrated significant improvement in progression-free survival (PFS) and overall survival (OS) with an immune-stimulatory agent, lenalidomide, in combination with low-dose dexamethasone until disease progression (Rd continuous) vs melphalan +prednisone + thalidomide (MPT) in transplant-ineligible patients with newly diagnosed multiple myeloma (NDMM). Rd continuous similarly extended PFS vs fixed-duration Rd for 18 cycles (Rd18). Outcomes in the Canadian/US subgroup (104 patients per arm) are reported in this analysis. Rd continuous demonstrated a significant improvement in PFS vs MPT (median, 29.3 vs 20.2 months; HR, 0.69 [95% CI, 0.49-0.97]; p = 0.03326) and an improvement vs Rd18 (median, 21.9 months). Median OS was 56.9 vs 46.8 months with Rd continuous vs MPT (p = 0.15346) and 59.5 months with Rd18. The overall response rate was higher with Rd continuous and Rd18 (78.8% and 79.8%) vs MPT (65.4%). In the 49.0%, 52.9%, and 29.8% of patients with at least very good partial response in the Rd continuous, Rd18, and MPT arms, respectively, the median PFS was 56.0, 30.9, and 40.2 months, respectively. The most common grade 3/4 treatment-emergent adverse events were neutropenia (28.4%, 30.1%, and 52.0%), anemia (23.5%, 21.4%, and 23.5%), and infections (37.3%, 30.1%, and 24.5%) with Rd continuous, Rd18, and MPT, respectively. These results were consistent with those in the intent-to-treat population, confirming the benefit of Rd continuous vs MPT in the Canadian/US subgroup and supporting the role of Rd continuous as a standard of care for transplant-ineligible patients with NDMM.
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Affiliation(s)
| | | | - Darrell White
- Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | | | - Chaim Shustik
- McGill University Health Centre, Montréal, QC, Canada
| | - Kevin Song
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Axel Tosikyan
- Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | | | | | - Diane Brown
- Celgene, a Bristol-Myers Squibb Company, Mississauga, ON, Canada
| | | | | | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
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Chari A, Cornell RF, Gasparetto C, Karanes C, Matous JV, Niesvizky R, Lunning M, Usmani SZ, Anderson LD, Chhabra S, Girnius S, Shustik C, Stuart R, Lee Y, Salman Z, Liu E, Valent J. Final analysis of a phase 1/2b study of ibrutinib combined with carfilzomib/dexamethasone in patients with relapsed/refractory multiple myeloma. Hematol Oncol 2020; 38:353-362. [PMID: 32053229 PMCID: PMC7496325 DOI: 10.1002/hon.2723] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/31/2020] [Accepted: 02/08/2020] [Indexed: 01/10/2023]
Abstract
Patients with multiple myeloma (MM) inevitably relapse on initial treatment regimens, and novel combination therapies are needed. Ibrutinib is a first‐in‐class, once‐daily inhibitor of Bruton's tyrosine kinase, an enzyme implicated in growth and survival of MM cells. Preclinical data suggest supra‐additivity or synergy between ibrutinib and proteasome inhibitors (PIs) against MM. This phase 1/2b study evaluated the efficacy and safety of ibrutinib plus the PI carfilzomib and dexamethasone in patients with relapsed/refractory MM (RRMM). In this final analysis, we report results in patients who received the recommended phase 2 dose (RP2D; ibrutinib 840 mg and carfilzomib 36 mg/m2 with dexamethasone), which was determined in phase 1. The primary efficacy endpoint was overall response rate (ORR). Fifty‐nine patients with RRMM received the RP2D (18 in phase 1 and 41 in phase 2b). These patients had received a median of three prior lines of therapy; 69% were refractory to bortezomib, and 90% were refractory to their last treatment. ORR in the RP2D population was 71% (stringent complete response and complete response: 3% each). Median duration of clinical benefit and median duration of response were both 6.5 months. Median progression‐free survival (PFS) was 7.4 months, and median overall survival (OS) was 35.9 months. High‐risk patients had comparable ORR and median PFS (67% and 7.7 months, respectively) to non–high‐risk patients, whose ORR was 73% and median PFS was 6.9 months, whereas median OS in high‐risk patients was 13.9 months and not reached in non–high‐risk patients. The most common grade ≥3 hematologic treatment‐emergent adverse events (TEAEs) were anemia and thrombocytopenia (17% each); the most common grade ≥3 non‐hematologic TEAE was hypertension (19%). In patients with RRMM treated with multiple previous lines of therapy, ibrutinib plus carfilzomib demonstrated anticancer activity within the expected efficacy range. No new safety signals were identified and the combination was well‐tolerated.
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Affiliation(s)
- Ajai Chari
- Department of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, New York
| | - Robert F Cornell
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cristina Gasparetto
- Division of Hematologic Malignancies and Cellular Therapy, Duke University Health System, Durham, North Carolina
| | - Chatchada Karanes
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Jeffrey V Matous
- Department of Hematology/Oncology, Colorado Blood Cancer Institute, Denver, Colorado
| | - Ruben Niesvizky
- Department of Medical Oncology, Weill Cornell Medicine, New York, New York
| | - Matthew Lunning
- Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Saad Z Usmani
- Department of Hematologic Oncology & Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Larry D Anderson
- Division of Hematology Oncology, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saulius Girnius
- Department of Medicine, University of Cincinnati Cancer Institute, Cincinnati, Ohio
| | - Chaim Shustik
- Division of Hematology, Cedars Cancer Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Stuart
- Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Yihua Lee
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California
| | - Zeena Salman
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California
| | - Emily Liu
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, California
| | - Jason Valent
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
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Waller DD, Monczak Y, Michel RP, Shustik C, Sebag M. Spontaneous remission and clonal evolution in lenalidomide associated secondary AML. Leuk Lymphoma 2020; 61:1724-1727. [PMID: 32077352 DOI: 10.1080/10428194.2020.1725504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Daniel D Waller
- Department of Medicine, Division of Hematology, McGill University, Montreal, Canada
| | - Yury Monczak
- Department of Pathology, Jewish General Hospital, Montreal, Canada
| | - René P Michel
- Department of Pathology, McGill University, Montreal, Canada
| | - Chaim Shustik
- Department of Medicine, Division of Hematology, McGill University, Montreal, Canada
| | - Michael Sebag
- Department of Medicine, Division of Hematology, McGill University, Montreal, Canada
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Tedeschi A, Dimopoulos MA, Trotman J, Garcia-Sanz R, MacDonald D, Mahe B, Herbaux C, Heffner LT, Tam CSL, Varettoni M, Palomba ML, Matous J, Shustik C, Kastritis E, Treon SP, Li J, Poulsen E, Hauns B, Buske C, Leblond V. Patient-reported outcomes (PROs) with ibrutinib-rituximab in Waldenström macroglobulinemia (WM): Results from iNNOVATE. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8018] [Citation(s) in RCA: 1] [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
8018 Background: Anemia and fatigue can impair quality of life in patients (pts) with WM. Ibrutinib (ibr) as single agent or in combination with RTX is FDA-approved for WM. In pts with RTX-refractory WM, single-agent ibr induced meaningful improvements in PROs (Trotman, EHA 2017). In iNNOVATE, ibr-RTX (IR) produced higher rates of sustained hemoglobin improvement and meaningful improvements in PROs versus placebo-RTX (R; Dimopoulos NEJM 2018). Here, we report detailed PRO analyses from iNNOVATE. Methods: Pts with symptomatic WM requiring therapy were randomized to daily 420 mg oral ibr or placebo, both with RTX (375 mg/m2/week IV at weeks 1–4 and 17–20). PRO measures included FACIT-Fatigue (FACIT-F), FACT-An total score (TS) and anemia subscale score (AS), and EQ-5D-5L (EuroQol Research Foundation. EQ-5D is a trade mark of the EuroQol Research Foundation) visual analog scale (VAS), and utility score (US). Results: For 150 randomized pts (n=75/arm), most common reasons for initiating therapy were fatigue (61%), constitutional symptoms (32%), and anemia (32%). Baseline PRO scores were comparable in both arms. At a median follow-up of 26.5 mo, numerically more pts showed clinically meaningful improvement in FACIT-F, TS, and AS with IR than R (Table). Median time to PRO improvement was short (1-2 mo) in both arms. At week 25, the Pearson correlation coefficients were 0.28, 0.29, and 0.26 for changes in hemoglobin levels vs changes in FACIT-F, TS and AS, respectively, in the IR arm; no meaningful correlations were observed on R. The correlation coefficients were -0.32, -0.33, -0.35 and -0.26 for changes in IgM levels vs changes in FACIT-F, TS, AS, and EQ-VAS, respectively, for IR and 0.29 and 0.35 vs FACIT-F and TS for R. Conclusions: Clinical response and improvements in anemia with IR are consistent with more pts showing clinically meaningful improvement in PROs versus R. Changes in IgM correlate with improvements in PROs. Clinical trial information: NCT02165397. [Table: see text]
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Affiliation(s)
- Alessandra Tedeschi
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | | | - David MacDonald
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | | | - Charles Herbaux
- Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille, France
| | | | - Constantine Si Lun Tam
- Peter MacCallum Cancer Centre, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | | | | | | | - Chaim Shustik
- Royal Victoria Hospital at McGill University Health Centre, Montreal, QC, Canada
| | - Efstathios Kastritis
- National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Jianling Li
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Erik Poulsen
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | - Christian Buske
- Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, University Hospital of Ulm, Ulm, Germany
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Dimopoulos MA, Tedeschi A, Trotman J, García-Sanz R, Macdonald D, Leblond V, Mahe B, Herbaux C, Tam C, Orsucci L, Palomba ML, Matous JV, Shustik C, Kastritis E, Treon SP, Li J, Salman Z, Graef T, Buske C. Phase 3 Trial of Ibrutinib plus Rituximab in Waldenström's Macroglobulinemia. N Engl J Med 2018; 378:2399-2410. [PMID: 29856685 DOI: 10.1056/nejmoa1802917] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Single-agent ibrutinib has shown substantial activity in patients with relapsed Waldenström's macroglobulinemia, a rare form of B-cell lymphoma. We evaluated the effect of adding ibrutinib to rituximab in patients with this disease, both in those who had not received previous treatment and in those with disease recurrence. METHODS We randomly assigned 150 symptomatic patients to receive ibrutinib plus rituximab or placebo plus rituximab. The primary end point was progression-free survival, as assessed by an independent review committee. Key secondary end points were response rates, sustained hematologic improvement from baseline, and safety. The mutational status of MYD88 and CXCR4 was assessed in bone marrow samples. RESULTS At 30 months, the progression-free survival rate was 82% with ibrutinib-rituximab versus 28% with placebo-rituximab (hazard ratio for progression or death, 0.20; P<0.001). The benefit in the ibrutinib-rituximab group over that in the placebo-rituximab group was independent of the MYD88 or CXCR4 genotype. The rate of major response was higher with ibrutinib-rituximab than with placebo-rituximab (72% vs. 32%, P<0.001). More patients had sustained increases in hemoglobin level with ibrutinib-rituximab than with placebo-rituximab (73% vs. 41%, P<0.001). The most common adverse events of any grade with ibrutinib-rituximab included infusion-related reactions, diarrhea, arthralgia, and nausea. Events of grade 3 or higher that occurred more frequently with ibrutinib-rituximab than with placebo-rituximab included atrial fibrillation (12% vs. 1%) and hypertension (13% vs. 4%); those that occurred less frequently included infusion reactions (1% vs. 16%) and any grade of IgM flare (8% vs. 47%). The major hemorrhage rate was the same in the two trial groups (4%). CONCLUSIONS Among patients with Waldenström's macroglobulinemia, the use of ibrutinib-rituximab resulted in significantly higher rates of progression-free survival than the use of placebo-rituximab, both among those who had received no previous treatment and among those with disease recurrence. Atrial fibrillation and hypertension were more common with ibrutinib-rituximab, whereas infusion reactions and IgM flare were more common with placebo-rituximab. (Funded by Pharmacyclics and Janssen Research and Development; ClinicalTrials.gov number, NCT02165397 .).
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Affiliation(s)
- Meletios A Dimopoulos
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Alessandra Tedeschi
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Judith Trotman
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Ramón García-Sanz
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - David Macdonald
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Veronique Leblond
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Beatrice Mahe
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Charles Herbaux
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Constantine Tam
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Lorella Orsucci
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - M Lia Palomba
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Jeffrey V Matous
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Chaim Shustik
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Efstathios Kastritis
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Steven P Treon
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Jianling Li
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Zeena Salman
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Thorsten Graef
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
| | - Christian Buske
- From the National and Kapodistrian University of Athens School of Medicine, Athens (M.A.D., E.K.); ASST Grande Ospedale Metropolitano Niguarda, Milan (A.T.), and Città della Salute Hospital and University, Turin (L.O.) - both in Italy; Concord Hospital, University of Sydney, Concord, NSW (J.T.), and Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, VIC (C.T.) - both in Australia; Hospital Universitario de Salamanca, Salamanca, Spain (R.G.-S.); Ottawa Hospital, University of Ottawa, Ottawa (D.M.), and Royal Victoria Hospital at McGill University Health Centre, Montreal (C.S.) - both in Canada; Département d'Hématologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris (V.L.), Centre Hospitalier Universitaire de Nantes, Nantes (B.M.), and Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille (C.H.) - all in France; Memorial Sloan Kettering Cancer Center, New York (M.L.P.); Colorado Blood Cancer Institute, Denver (J.V.M.); Dana-Farber Cancer Institute, Boston (S.P.T.); Pharmacyclics, Sunnyvale, CA (J.L., Z.S., T.G.); and Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany (C.B.)
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Dimopoulos MA, Tedeschi A, Trotman J, Garcia-Sanz R, MacDonald D, Leblond V, Mahe B, Herbaux C, Tam C, Palomba ML, Matous J, Shustik C, Kastritis E, Treon SP, Li J, Salman Z, Graef T, Buske C. Randomized phase 3 trial of ibrutinib/rituximab vs placebo/rituximab in Waldenström's macroglobulinemia. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.8003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
| | | | - Judith Trotman
- Concord Hospital, University of Sydney, Concord, Australia
| | | | - David MacDonald
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Veronique Leblond
- Département d’ Hématologie Hôpital Pitié-Salpêtrière APHP, UPMC Université Paris, Paris, France
| | - Beatrice Mahe
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Charles Herbaux
- Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille, France
| | - Constantine Tam
- Peter MacCallum Cancer Centre and St. Vincent's Hospital, Melbourne, Australia
| | | | | | - Chaim Shustik
- Royal Victoria Hospital at McGill University Health Centre, Montreal, QC, Canada
| | - Efstathios Kastritis
- National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Jianling Li
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | - Zeena Salman
- Pharmacyclics LLC, an AbbVie Company, Sunnyvale, CA
| | | | - Christian Buske
- Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, University Hospital of Ulm, Ulm, Germany
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Kumar S, Moreau P, Hari P, Mateos MV, Ludwig H, Shustik C, Masszi T, Spencer A, Hájek R, Romeril K, Avivi I, Liberati AM, Minnema MC, Einsele H, Lonial S, Berg D, Lin J, Gupta N, Esseltine DL, Richardson PG. Management of adverse events associated with ixazomib plus lenalidomide/dexamethasone in relapsed/refractory multiple myeloma. Br J Haematol 2017; 178:571-582. [PMID: 28485007 PMCID: PMC5574012 DOI: 10.1111/bjh.14733] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/06/2017] [Indexed: 12/30/2022]
Abstract
The oral proteasome inhibitor ixazomib is approved in the United States, European Union and other countries, in combination with oral lenalidomide and dexamethasone (Rd), for the treatment of patients with multiple myeloma who have received at least one prior therapy. Approval was based on the global, randomised, double‐blind, placebo‐controlled Phase III TOURMALINE‐MM1 study of ixazomib‐Rd (IRd) versus placebo‐Rd in patients with relapsed/refractory multiple myeloma. IRd resulted in a significant improvement in progression‐free survival versus placebo‐Rd (median: 20·6 vs. 14·7 months; hazard ratio 0·74). Common toxicities observed more commonly with IRd versus placebo‐Rd were thrombocytopenia, nausea, vomiting, diarrhoea, constipation, rash, peripheral neuropathy, peripheral oedema and back pain; these were generally grade 1/2 in severity except for thrombocytopenia (19% vs. 9% grade 3/4), which appeared manageable and reversible, with no differences between arms in significant bleeding or dose discontinuations. No cumulative toxicities were observed, indicating the potential feasibility of long‐term IRd treatment. Safety data from TOURMALINE‐MM1 are reviewed and guidance for managing clinically relevant adverse events associated with IRd is provided. Most toxicities were manageable with supportive care and dose delays or reductions as needed. Clinicians should be aware of and understand these potential side effects to optimise and prolong patient benefit.
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Affiliation(s)
- Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Parameswaran Hari
- Division of Hematology and Oncology, Froedtert Hospital and the Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Heinz Ludwig
- Wilhelminenspital der Stadt Wien, Vienna, Austria
| | - Chaim Shustik
- McGill University Health Center, Royal Victoria Hospital, Montreal, Canada
| | - Tamas Masszi
- Department of Haematology and Stem Cell Transplantation, St István and St László Hospital, Semmelweis University, Budapest, Hungary
| | | | - Roman Hájek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Kenneth Romeril
- Wellington Blood and Cancer Centre, Wellington Regional Hospital, Wellington, New Zealand
| | - Irit Avivi
- Department of Haematology and Bone Marrow Transplantation, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Anna M Liberati
- University of Perugia, SC Oncoematologia AO S. Maria di Terni, Terni, Italy
| | - Monique C Minnema
- Department of Haematology, UMC Utrecht Cancer Centre, Utrecht, The Netherlands
| | - Hermann Einsele
- Universitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Deborah Berg
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Jianchang Lin
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Neeraj Gupta
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Dixie-Lee Esseltine
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
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Dimopoulos MA, Trotman J, Tedeschi A, Matous JV, Macdonald D, Tam C, Tournilhac O, Ma S, Oriol A, Heffner LT, Shustik C, García-Sanz R, Cornell RF, de Larrea CF, Castillo JJ, Granell M, Kyrtsonis MC, Leblond V, Symeonidis A, Kastritis E, Singh P, Li J, Graef T, Bilotti E, Treon S, Buske C. Ibrutinib for patients with rituximab-refractory Waldenström's macroglobulinaemia (iNNOVATE): an open-label substudy of an international, multicentre, phase 3 trial. Lancet Oncol 2017; 18:241-250. [DOI: 10.1016/s1470-2045(16)30632-5] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/30/2016] [Accepted: 10/13/2016] [Indexed: 12/16/2022]
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Hulin C, Belch A, Shustik C, Petrucci MT, Dührsen U, Lu J, Song K, Rodon P, Pégourié B, Garderet L, Hunter H, Azais I, Eek R, Gisslinger H, Macro M, Dakhil S, Goncalves C, LeBlanc R, Romeril K, Royer B, Doyen C, Leleu X, Offner F, Leupin N, Houck V, Chen G, Ervin-Haynes A, Dimopoulos MA, Facon T. Updated Outcomes and Impact of Age With Lenalidomide and Low-Dose Dexamethasone or Melphalan, Prednisone, and Thalidomide in the Randomized, Phase III FIRST Trial. J Clin Oncol 2016; 34:3609-3617. [DOI: 10.1200/jco.2016.66.7295] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This analysis of the FIRST trial in patients with newly diagnosed multiple myeloma (MM) ineligible for stem-cell transplantation examined updated outcomes and impact of patient age. Patients and Methods Patients with untreated symptomatic MM were randomly assigned at a one-to-one-to-one ratio to lenalidomide plus low-dose dexamethasone until disease progression (Rd continuous), Rd for 72 weeks (18 cycles; Rd18), or melphalan, prednisone, and thalidomide (MPT; 72 weeks), stratified by age (≤ 75 v > 75 years), disease stage (International Staging System stage I/II v III), and country. The primary end point was progression-free survival. Rd continuous and MPT were primary comparators. Results Between August 21, 2008, and March 7, 2011, 1,623 patients were enrolled (Rd continuous, n = 535; Rd18, n = 541; MPT, n = 547), including 567 (35%) age older than 75 years. Higher rates of advanced-stage disease and renal impairment were observed in patients older than 75 versus 75 years of age or younger. Rd continuous reduced the risk of progression or death compared with MPT by 31% (hazard ratio [HR], 0.69; 95% CI, 0.59 to 0.80; P < .001) overall, 36% (HR, 0.64; 95% CI, 0.53 to 0.77; P < .001) in patients age 75 years or younger, and 20% (HR, 0.80; 95% CI, 0.62 to 1.03; P = .084) in those age older than 75 years. Median overall survival was longer with Rd continuous than with MPT, including a 14-month difference in patients age older than 75 years. Progression-free survival with Rd18 was similar to that with MPT, and overall survival with Rd18 was marginally inferior to that with Rd continuous. Rates of grade 3 to 4 treatment-emergent adverse events were similar for Rd continuous–treated patients age 75 years or older and those age older than 75 years; however, older patients had more frequent lenalidomide dose reductions. Conclusion Results support Rd continuous treatment as a new standard of care for stem-cell transplantation–ineligible patients with newly diagnosed MM of all ages.
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Affiliation(s)
- Cyrille Hulin
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Andrew Belch
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Chaim Shustik
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Maria Teresa Petrucci
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Ulrich Dührsen
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Jin Lu
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Kevin Song
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Philippe Rodon
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Brigitte Pégourié
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Laurent Garderet
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Hannah Hunter
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Isabelle Azais
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Richard Eek
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Heinz Gisslinger
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Margaret Macro
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Shaker Dakhil
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Cristina Goncalves
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Richard LeBlanc
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Ken Romeril
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Bruno Royer
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Chantal Doyen
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Xavier Leleu
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Fritz Offner
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Nicolas Leupin
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Vanessa Houck
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Guang Chen
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Annette Ervin-Haynes
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Meletios A. Dimopoulos
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
| | - Thierry Facon
- Cyrille Hulin, Bordeaux Hospital University Center, Bourdeaux; Philippe Rodon, Centre Hospitalier de Périgueux, Périgueux; Brigitte Pégourié, Centre Hospitalier Regional Universitaire, Grenoble; Laurent Garderet, Centre Hospitalier Universitaire (CHU) Hôpital St-Antoine, Paris; Isabelle Azais, CHU Institut National de la Santé et de la Recherche Médicale (INSERM); Xavier Leleu, Hôpital de la Milétrie, CHU INSERM, Poitiers; Margaret Macro, CHU de Caen, Caen; Bruno Royer, University Hospital, Amiens
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14
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Jurczyszyn A, Grzasko N, Gozzetti A, Czepiel J, Cerase A, Hungria V, Crusoe E, Silva Dias ALM, Vij R, Fiala MA, Caers J, Rasche L, Nooka AK, Lonial S, Vesole DH, Philip S, Gangatharan S, Druzd-Sitek A, Walewski J, Corso A, Cocito F, Vekemans MCM, Atilla E, Beksac M, Leleu X, Davila J, Badros A, Aneja E, Abildgaard N, Kastritis E, Fantl D, Schutz N, Pika T, Butrym A, Olszewska-Szopa M, Usnarska-Zubkiewicz L, Usmani SZ, Nahi H, Chim CS, Shustik C, Madry K, Lentzsch S, Swiderska A, Helbig G, Guzicka-Kazimierczak R, Lendvai N, Waage A, Andersen KT, Murakami H, Zweegman S, Castillo JJ. Central nervous system involvement by multiple myeloma: A multi-institutional retrospective study of 172 patients in daily clinical practice. Am J Hematol 2016; 91:575-80. [PMID: 26955792 DOI: 10.1002/ajh.24351] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/26/2016] [Accepted: 02/29/2016] [Indexed: 11/06/2022]
Abstract
The multicenter retrospective study conducted in 38 centers from 20 countries including 172 adult patients with CNS MM aimed to describe the clinical and pathological characteristics and outcomes of patients with multiple myeloma (MM) involving the central nervous system (CNS). Univariate and multivariate analyses were performed to identify prognostic factors for survival. The median time from MM diagnosis to CNS MM diagnosis was 3 years. Thirty-eight patients (22%) were diagnosed with CNS involvement at the time of initial MM diagnosis and 134 (78%) at relapse/progression. Upon diagnosis of CNS MM, 97% patients received initial therapy for CNS disease, of which 76% received systemic therapy, 36% radiotherapy and 32% intrathecal therapy. After a median follow-up of 3.5 years, the median overall survival (OS) from the onset of CNS involvement for the entire group was 7 months. Untreated and treated patients had median OS of 2 and 8 months, respectively (P < 0.001). At least one previous line of therapy for MM before the diagnosis of CNS disease and >1 cytogenetic abnormality detected by FISH were independently associated with worse OS. The median OS for patients with 0, 1 and 2 of these risk factors were 25 months, 5.5 months and 2 months, respectively (P < 0.001). Neurological manifestations, not considered chemotherapy-related, observed at any time after initial diagnosis of MM should raise a suspicion of CNS involvement. Although prognosis is generally poor, the survival of previously untreated patients and patients with favorable cytogenetic profile might be prolonged due to systemic treatment and/or radiotherapy. Am. J. Hematol. 91:575-580, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Norbert Grzasko
- Department of Hematooncology and Bone Marrow Transplantation; Medical University of Lublin; Lublin Poland
- Department of Hematology; St. John's Cancer Center; Lublin Poland
| | | | - Jacek Czepiel
- Jagiellonian University Medical College; Cracow Poland
| | | | | | | | | | - Ravi Vij
- Washington University School of Medicine; St. Louis Missouri
| | - Mark A. Fiala
- Washington University School of Medicine; St. Louis Missouri
| | - Jo Caers
- Centre Hospitalier Universitaire de Liege; Liege Belgium
| | - Leo Rasche
- University Hospital Wuerzburg; Wuerzburg Germany
| | - Ajay K. Nooka
- Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Sagar Lonial
- Winship Cancer Institute; Emory University; Atlanta Georgia
| | - David H. Vesole
- John Theurer Cancer Center at Hackensack UMC, New Jersey and Georgetown University; Washington DC
| | - Sandhya Philip
- John Theurer Cancer Center at Hackensack UMC, New Jersey and Georgetown University; Washington DC
| | | | | | - Jan Walewski
- Maria Sklodowska-Curie Institute - Oncology Center; Warsaw Poland
| | - Alessandro Corso
- Fondazione IRCCS Policlinico San Matteo, University of Pavia; Pavia Italy
| | - Federica Cocito
- Fondazione IRCCS Policlinico San Matteo, University of Pavia; Pavia Italy
| | | | | | | | | | - Julio Davila
- Hospital Universitario de Salamanca; Salamanca Spain
| | - Ashraf Badros
- University of Maryland Medical Center; Baltimore Maryland
| | - Ekta Aneja
- Weill Cornell Medical College; New York New York
| | | | | | - Dorotea Fantl
- Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - Natalia Schutz
- Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - Tomas Pika
- University Hospital Olomouc; Olomouc Czech Republic
| | | | | | | | - Saad Z. Usmani
- Levine Cancer Institute/Carolinas HealthCare System; Charlotte NC
| | - Hareth Nahi
- Karolinska University Hospital; Stockholm Sweden
| | - Chor S Chim
- Queen Mary Hospital; University of Hong Kong; Hong Kong
| | - Chaim Shustik
- Royal Victoria Hospital; McGill University; Montreal Canada
| | | | | | | | | | | | | | - Anders Waage
- Norwegian University of Science and Technology; Trondheim Norway
| | | | | | | | - Jorge J. Castillo
- Dana-Farber Cancer Institute; Harvard Medical School; Boston Massachusetts
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15
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Lachance S, Christofides A, Lee J, Sehn L, Ritchie B, Shustik C, Stewart D, Toze C, Haddad E, Vinh D. A Canadian perspective on the use of immunoglobulin therapy to reduce infectious complications in chronic lymphocytic leukemia. Curr Oncol 2016; 23:42-51. [PMID: 26966403 PMCID: PMC4754059 DOI: 10.3747/co.23.2810] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Infections are a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (cll), who typically have increased susceptibility because of hypogammaglobulinemia (hgg) related to their disease and its treatment. Immunoglobulin replacement therapy (igrt) has been shown to reduce the frequency of bacterial infections and associated hospitalizations in patients with hgg or a history of infection, or both. However, use of igrt in cll is contentious. Studies examining such treatment were conducted largely before the use of newer chemoimmunotherapies, which can extend lifespan, but do not correct the hgg inherent to the disease. Thus, the utility of igrt has to be re-evaluated in the current setting. Here, we discuss the evidence for the use of igrt in cll and provide a practical approach to its use in the prevention and management of infections.
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Affiliation(s)
| | | | - J.K. Lee
- Canadian Society of Allergy and Clinical Immunology, Toronto, ON
| | | | | | - C. Shustik
- McGill University Health Centre, Montreal, QC
| | | | - C.L. Toze
- Leukemia/Bone Marrow Transplant Program of BC, Vancouver General Hospital, BC Cancer Agency, and University of British Columbia, Vancouver, BC
| | - E. Haddad
- chu Sainte-Justine, Departments of Pediatrics and of Microbiology, Immunology, and Infectiology, Université de Montréal, Montreal, QC
| | - D.C. Vinh
- McGill University Health Centre, Montreal, QC
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16
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Jurczyszyn A, Olszewska-Szopa M, Hungria V, Crusoe E, Pika T, Delforge M, Leleu X, Rasche L, Nooka AK, Druzd-Sitek A, Walewski J, Davila J, Caers J, Maisnar V, Gertz M, Gentile M, Fantl D, Mele G, Vesole DH, Yee AJ, Shustik C, Lentzsch S, Zweegman S, Gozzetti A, Skotnicki AB, Castillo JJ. Cutaneous involvement in multiple myeloma: a multi-institutional retrospective study of 53 patients. Leuk Lymphoma 2016; 57:2071-6. [PMID: 26726867 DOI: 10.3109/10428194.2015.1128542] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Skin infiltration in multiple myeloma (skin MM) is a rare clinical problem. Only a few cases of skin involvement have been reported, primarily in single case reports. We analyzed and present the clinical outcomes, immunohistochemistry and cytogenetic features, and relevant laboratory data on 53 biopsy-proven skin MM cases. The median time from MM diagnosis to skin involvement was 2 years. There appears to be an overrepresentation of immunoglobulin class A (IgA) and light chain disease in skin MM. We found no correlation between CD56 negative MM and skin infiltration. We found that skin MM patients presented in all MM stages (i.e. ISS stages I to III), and there was no preferential cytogenetic abnormality. Patients with skin MM carry a very poor prognosis with a median overall survival (OS) of 8.5 months as time from skin involvement. Moreover, patients with IgA disease and plasmablastic morphology appear to have a worse OS.
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Affiliation(s)
| | | | | | - Edvan Crusoe
- c Santa Casa Medical School , Sao Paulo , Brazil
| | - Tomas Pika
- d University Hospital Olomouc , Olomouc , Czech Republic
| | - Michel Delforge
- e Department of Hematology University Hospitals Leuven , Belgium
| | | | - Leo Rasche
- g Department of Internal Medicine II , University Hospital Wuerzburg , Wuerzburg , Germany
| | - Ajay K Nooka
- h Winship Cancer Institute, Emory University , Atlanta , GA , USA
| | - Agnieszka Druzd-Sitek
- i Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology , Warsaw , Poland
| | - Jan Walewski
- i Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology , Warsaw , Poland
| | - Julio Davila
- j Hospital Universitario De Salamanca , Salamanca , Spain
| | - Jo Caers
- k Centre Hospitalier Universitaire De Liege , Liege , Belgium
| | - Vladimir Maisnar
- l Department of Medicine - Haematology , Hradec Kralove , Czech Republic
| | - Morie Gertz
- m Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Massimo Gentile
- n Hematology Unit, Department of Onco-Hematology , A.O. of Cosenza , Cosenza , Italy
| | - Dorotea Fantl
- o Hospital Italiano De Buenos Aires , Buenos Aires , Argentina
| | - Giuseppe Mele
- p Haematology, Ospedale A. Perrino , Brindisi , Italy
| | - David H Vesole
- q John Theurer Cancer Center at Hackensack University Medical Center , Hackensack , NJ , USA
| | - Andrew J Yee
- r Massachusetts General Hospital Cancer Center , Harvard Medical School , Boston , MA , USA
| | - Chaim Shustik
- s Royal Victoria Hospital, McGill University , Montreal , Canada
| | | | - Sonja Zweegman
- u VU University Medical Center , Amsterdam , the Netherlands
| | | | | | - Jorge J Castillo
- w Dana-Farber Cancer Institute, Harvard Medical School , Boston , MA , USA
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17
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Hulin C, Shustik C, Belch A, Petrucci M, Dührsen U, Lu J, Song K, Rodon P, Garderet L, Hunter H, Azais I, Eek R, Macro M, Dakhil S, Houck V, Chen G, Ervin-Haynes A, Offner F, Dimopoulos M, Facon T. Continuous Treatment With Lenalidomide and Low-Dose Dexamethasone for Patients With Transplant-Ineligible Newly Diagnosed Multiple Myeloma in the First Trial: Impact of Age. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.324] [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: 11/17/2022]
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18
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Dimopoulos MA, Leleu X, Matous J, MacDonald D, Trotman J, Oriol A, Shustik C, Tedeschi A, Garcia-Sanz R, Heffner LT, Ma S, Mahe B, Tam C, Tournilhac O, Li J, Singh P, Bilotti E, Graef T, Treon SP, Buske C. A randomized, double-blind, placebo-controlled, phase 3 study of rituximab with or without ibrutinib for Waldenstrom’s macroglobulinemia (PCYC-1127-CA). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps8599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- Meletios A. Dimopoulos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece
| | - Xavier Leleu
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | - David MacDonald
- Division of Hematology, Dalhousie University, Halifax, NS, Canada
| | - Judith Trotman
- Department of Haematology, Concord Hospital, Sydney, Australia
| | - Albert Oriol
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | | | - Ramon Garcia-Sanz
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Leonard T. Heffner
- Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Shuo Ma
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Constantine Tam
- Peter MacCallum Cancer Centre and St. Vincent's Hospital, East Melbourne, Australia
| | - Olivier Tournilhac
- CREaT, EA3846, INSERM CIC-501, UFR médecine, Université d’Auvergne, Clermont-Ferrand, France
| | | | | | | | | | - Steven P. Treon
- Bing Center for Waldenstrom's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Christian Buske
- Institute of Experimental Cancer Research, University of Ulm, Ulm, Germany
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19
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Hay AE, Trudel S, Bahlis NJ, White D, Sabry W, Belch A, Reiman TJ, Roy J, Shustik C, Kovacs MJ, Sussman J, Reece DE, Lacy M, Meyer RM, Shepherd LE, Whelan K, Zhu L, Chapman JAW, Stewart AK. A randomized phase 3 trial of thalidomide and prednisone (TP) as maintenance therapy following autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM): An updated analysis of the NCIC Clinical Trials Group MY10 trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
| | | | | | - Darrell White
- Queen Elizabeth II Health Sciences Centre, Division of Hematology, Halifax, NS, Canada
| | | | - Andrew Belch
- University of Alberta Cross Cancer Institute, Edmonton, AB, Canada
| | | | - Jean Roy
- Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Chaim Shustik
- Royal Victoria Hospital; McGill University Health Centre, Montreal, QC, Canada
| | | | | | | | | | | | - Lois E. Shepherd
- NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada
| | - Kate Whelan
- NCIC Clinical Trials Group, Kingston, ON, Canada
| | - Liting Zhu
- NCIC Clinical Trials Group, Kingston, ON, Canada
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20
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Richardson PG, Siegel DS, Vij R, Hofmeister CC, Baz R, Jagannath S, Chen C, Lonial S, Jakubowiak A, Bahlis N, Song K, Belch A, Raje N, Shustik C, Lentzsch S, Lacy M, Mikhael J, Matous J, Vesole D, Chen M, Zaki MH, Jacques C, Yu Z, Anderson KC. Pomalidomide alone or in combination with low-dose dexamethasone in relapsed and refractory multiple myeloma: a randomized phase 2 study. Blood 2014; 123:1826-32. [PMID: 24421329 PMCID: PMC3962162 DOI: 10.1182/blood-2013-11-538835] [Citation(s) in RCA: 285] [Impact Index Per Article: 28.5] [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] [Received: 11/15/2013] [Accepted: 01/02/2014] [Indexed: 01/04/2023] Open
Abstract
This multicenter, open-label, randomized phase 2 study assessed the efficacy and safety of pomalidomide (POM) with/without low-dose dexamethasone (LoDEX) in patients with relapsed/refractory multiple myeloma (RRMM). Patients who had received ≥2 prior therapies (including lenalidomide [LEN] and bortezomib [BORT]) and had progressed within 60 days of their last therapy were randomized to POM (4 mg/day on days 1-21 of each 28-day cycle) with/without LoDEX (40 mg/week). The primary end point was progression-free survival (PFS). In total, 221 patients (median 5 prior therapies, range 1-13) received POM+LoDEX (n = 113) or POM (n = 108). With a median follow-up of 14.2 months, median PFS was 4.2 and 2.7 months (hazard ratio = 0.68, P = .003), overall response rates (ORRs) were 33% and 18% (P = .013), median response duration was 8.3 and 10.7 months, and median overall survival (OS) was 16.5 and 13.6 months, respectively. Refractoriness to LEN, or resistance to both LEN and BORT, did not affect outcomes with POM+LoDEX (median PFS 3.8 months for both; ORRs 30% and 31%; and median OS 16 and 13.4 months). Grade 3-4 neutropenia occurred in 41% (POM+LoDEX) and 48% (POM); no grade 3-4 peripheral neuropathy was reported. POM+LoDEX was effective and generally well tolerated and provides an important new treatment option for RRMM patients who have received multiple prior therapies. This trial was registered at www.clinicaltrials.gov as #NCT00833833.
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21
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Siegel DSD, Richardson PGG, Vij R, Hofmeister CC, Baz RC, Jagannath S, Chen C, Lonial S, Jakubowiak AJ, Bahlis NJ, Song KW, Belch A, Raje NS, Shustik C, Lentzsch S, Chen M, Zaki MH, Anderson KC. Long-term safety and efficacy of pomalidomide (POM) with or without low-dose dexamethasone (LoDEX) in relapsed and refractory multiple myeloma (RRMM) patients enrolled in the MM-002 phase II trial. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.8588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
8588 Background: MM-002 is a randomized, open-label, multicenter phase II trial evaluating the safety and efficacy of POM with or without LoDEX in advanced RRMM pts. Methods: Pts who had received ≥ 2 prior therapies, including lenalidomide (LEN) and bortezomib (BORT), and were refractory to their last treatment were randomized to POM+LoDEX (POM 4 mg/day, days 1–21 of a 28-day cycle; LoDEX 40 mg/week) or POM alone. End points included progression-free survival (PFS), response rate (according to EBMT criteria and investigator assessment), response duration, overall survival (OS), and safety. The efficacy outcomes are based on the intent-to-treat population (POM+LoDEX, n = 113; POM, n = 108). Results: The median number of prior therapies in each group was 5 (range 1–13). In the POM+LoDEX arm, 30 (27%) pts had high-risk cytogenetics, including del(17p13) and/or t(4p16/14q32). The overall response rate (≥ partial response) was 34% and 15% with POM+LoDEX and POM, respectively, with a median duration of 8.3 (95% CI: 5.8–10.1) and 8.8 (95% CI: 5.5–11.4) mos, respectively. At least minimal response was observed in 45% and 31% of pts, respectively. Median PFS was 4.6 (95% CI: 3.6–5.5) and 2.6 (95% CI: 1.9–2.8) mos with POM+LoDEX and POM, respectively, with a median follow-up of 16.0 and 12.2 mos. Median OS was 16.5 (95% CI: 12.4–18.5) and 13.6 (95% CI: 9.6–18.1) mos, respectively. The most common treatment emergent Gr 3/4 adverse events (AEs) reported in the safety population (n = 219) were neutropenia (44%), anemia (23%), thrombocytopenia (21%), and pneumonia (18%); there were no reports of Gr 3/4 peripheral neuropathy. The incidence of deep-vein thrombosis was low (2%). AEs were managed through dose reductions or interruptions, and supportive care with G-CSF (52%), RBC transfusions (47%), and platelet transfusions (17%). Discontinuations due to AEs were 10%. Conclusions: POM with or without LoDEX is clinically effective and generally well tolerated in RRMM pts who have received multiple prior treatments, including LEN and BORT. AEs were predictable and manageable. Updated data will be presented at the meeting. Clinical trial information: NCT00833833.
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Affiliation(s)
| | | | - Ravi Vij
- Washington University in St. Louis, St Louis, MO
| | | | - Rachid C. Baz
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | | | - Sagar Lonial
- Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | | | - Chaim Shustik
- Royal Victoria Hospital; McGill University Health Centre, Montreal, QC, Canada
| | - Suzanne Lentzsch
- College of Physicians and Surgeons of Columbia University, New York, NY
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22
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Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Wells WA, Winter JN, Horning SJ, Dar AR, Shustik C, Stewart DA, Crump M, Djurfeldt MS, Chen BE, Shepherd LE. ABVD alone versus radiation-based therapy in limited-stage Hodgkin's lymphoma. N Engl J Med 2012; 366:399-408. [PMID: 22149921 PMCID: PMC3932020 DOI: 10.1056/nejmoa1111961] [Citation(s) in RCA: 251] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chemotherapy plus radiation treatment is effective in controlling stage IA or IIA nonbulky Hodgkin's lymphoma in 90% of patients but is associated with late treatment-related deaths. Chemotherapy alone may improve survival because it is associated with fewer late deaths. METHODS We randomly assigned 405 patients with previously untreated stage IA or IIA nonbulky Hodgkin's lymphoma to treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) alone or to treatment with subtotal nodal radiation therapy, with or without ABVD therapy. Patients in the ABVD-only group, both those with a favorable risk profile and those with an unfavorable risk profile, received four to six cycles of ABVD. Among those assigned to subtotal nodal radiation therapy, patients who had a favorable risk profile received subtotal nodal radiation therapy alone and patients with an unfavorable risk profile received two cycles of ABVD plus subtotal nodal radiation therapy. The primary end point was 12-year overall survival. RESULTS The median length of follow-up was 11.3 years. At 12 years, the rate of overall survival was 94% among those receiving ABVD alone, as compared with 87% among those receiving subtotal nodal radiation therapy (hazard ratio for death with ABVD alone, 0.50; 95% confidence interval [CI], 0.25 to 0.99; P=0.04); the rates of freedom from disease progression were 87% and 92% in the two groups, respectively (hazard ratio for disease progression, 1.91; 95% CI, 0.99 to 3.69; P=0.05); and the rates of event-free survival were 85% and 80%, respectively (hazard ratio for event, 0.88; 95% CI, 0.54 to 1.43; P=0.60). Among the patients randomly assigned to ABVD alone, 6 patients died from Hodgkin's lymphoma or an early treatment complication and 6 died from another cause; among those receiving radiation therapy, 4 deaths were related to Hodgkin's lymphoma or early toxic effects from the treatment and 20 were related to another cause. CONCLUSIONS Among patients with Hodgkin's lymphoma, ABVD therapy alone, as compared with treatment that included subtotal nodal radiation therapy, was associated with a higher rate of overall survival owing to a lower rate of death from other causes. (Funded by the Canadian Cancer Society and the National Cancer Institute; HD.6 ClinicalTrials.gov number, NCT00002561.).
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Affiliation(s)
- Ralph M Meyer
- Cancer Research Institute, Queen's University, Kingston, ON, Canada.
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23
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Skamene S, Rotondo RL, Shustik C, Roberge D. Necrosis following skull base irradiation and stem cell transplant for multiple myeloma. Am J Hematol 2010; 85:713-4. [PMID: 20645432 DOI: 10.1002/ajh.21781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sonia Skamene
- Department of Radiation Oncology McGill University Health Centre, 1650 Cedar Avenue, Montreal, Quebec, Canada
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Reece DE, Sullivan D, Lonial S, Mohrbacher AF, Chatta G, Shustik C, Burris H, Venkatakrishnan K, Neuwirth R, Riordan WJ, Karol M, von Moltke LL, Acharya M, Zannikos P, Keith Stewart A. Pharmacokinetic and pharmacodynamic study of two doses of bortezomib in patients with relapsed multiple myeloma. Cancer Chemother Pharmacol 2010; 67:57-67. [PMID: 20306195 DOI: 10.1007/s00280-010-1283-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 02/09/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE Characterize bortezomib pharmacokinetics/pharmacodynamics in relapsed myeloma patients after single and repeat intravenous administration at two doses. METHODS Forty-two patients were randomized to receive bortezomib 1.0 or 1.3 mg/m(2), days 1, 4, 8, 11, for up to eight 21-day treatment cycles (n = 21, each dose group). Serial blood samples for pharmacokinetic/pharmacodynamic analysis were taken on days 1 and 11, cycles 1 and 3. Observational efficacy and safety data were collected. RESULTS Twelve patients in each dose group were evaluable for pharmacokinetics/pharmacodynamics. Plasma clearance decreased with repeat dosing (102-112 L/h for first dose; 15-32 L/h following repeat dosing), with associated increases in systemic exposure and terminal half-life. Systemic exposures of bortezomib were similar between dose groups considering the relatively narrow dose range and the observed pharmacokinetic variability, although there was no readily apparent deviation from dose-proportionality. Blood 20S proteasome inhibition profiles were similar between groups with mean maximum inhibition ranging from 70 to 84% and decreasing toward baseline over the dosing interval. Response rate (all 42 patients) was 50%, including 7% complete responses. The safety profile was consistent with the predictable and manageable profile previously established; data suggested milder toxicity in the 1.0 mg/m(2) group. CONCLUSIONS Bortezomib pharmacokinetics change with repeat dose administration, characterized by a reduction in plasma clearance and associated increase in systemic exposure. Bortezomib is pharmacodynamically active and tolerable at 1.0 and 1.3 mg/m(2) doses, with recovery toward baseline blood proteasome activity over the dosing interval following repeat dose administration, supporting the current clinical dosing regimen.
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Affiliation(s)
- Donna E Reece
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
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Van Der Jagt R, Robinson KS, Belch A, Yetisir E, Wells G, Larratt L, Shustik C, Gluck S, Stewart K, Sheridan D. Sequential response-adapted induction and consolidation regimens idarubicin/cytarabine and mitoxantrone/etoposide in adult acute myelogenous leukemia: 10 year follow-up of a study by the Canadian Leukemia Studies Group. Leuk Lymphoma 2007; 47:697-706. [PMID: 16690529 DOI: 10.1080/10428190500467917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The Canadian Leukemia Studies Group (CLSG) sought to test the safety and efficacy of response-adapted, non-cross resistant chemotherapy in de novo acute myeloid leukemia (AML). The combinations of idarubicin 12 mg/m(2)/d on days 1 - 3 and Ara-C (200 mg/m(2)/d) on days 1 - 7 (IDAC) followed by mitoxantrone 10 mg/m(2)/day, and etoposide 100 mg/m(2)/day, on days 1 - 5 (NOVE) were used according to patient response to induction and consolidation. PATIENTS AND METHODS In this multi-centre open-label phase II study, 140 patients up to age 80 were given induction with IDAC. Patients were entered between March 1993 and August 1995. If patients had persistent blasts at day 14 or on recovery, they were given NOVE. As consolidation, patients achieving complete remission (CR) with IDAC were given 1 further cycle of IDAC and 1 cycle of NOVE. Patients achieving CR after NOVE were given 2 further cycles of NOVE. RESULTS 76% of all patients achieved remission after IDAC +/- NOVE, 81% in patients aged < or =60 years and 67% in patients aged >60. Overall, induction mortality was 11% and toxicity was similar to other cooperative group studies. Median follow-up was 104.0 months with 95% CI: (100.0, 105.2). Median overall survival (OS) in responding patients < or =60 was not reached: of the 79 responders < or =60, 35 died. The median disease free survival (DFS) in these responding patients was 22.7 (14.9, na) months. Median OS and DFS in responding patients >60 was 10.0 (7.3, 15.2) months and 7.5 (6.2, 15.2) months, respectively. CONCLUSION The results of this trial are very encouraging and suggest that there may be long-term benefit to this method. On the basis of these results, a randomized phase III trial has been performed.
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Roberge D, Muanza T, Blake G, Shustik C, Vuong T, Freeman CR. Does adjuvant alpha-interferon improve outcome when combined with total skin irradiation for mycosis fungoides? Br J Dermatol 2007; 156:57-61. [PMID: 17199567 DOI: 10.1111/j.1365-2133.2006.07559.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with mycosis fungoides (MF) experience frequent disease recurrences following total skin electron irradiation (TSEI) and may benefit from adjuvant therapy. OBJECTIVES To review the McGill experience with adjuvant alpha-interferon (IFN) in the treatment of MF. METHODS From 1990 to 2000, 50 patients with MF were treated with TSEI: 31 with TSEI alone and 19 with TSEI + IFN. Median TSEI dose was 35 Gy. In the TSEI + IFN group, IFN was given subcutaneously at 3 x 10(6) units three times per week starting 2 weeks prior to start of TSEI, continued concurrently with the radiation and for an additional 12 months following TSEI. The TSEI alone group included 16 men and 15 women with a median age of 61 years (range 31-84). The TSEI + IFN group included 14 men and five women with a median age of 51 years (range 24-83). Clinical stage was IA, IB, IIA, IIB, III and IVA in 2, 9, 4, 8, 1 and 7 patients of the TSEI group and 0, 3, 3, 7, 4 and 2 patients of the TSEI + IFN group. RESULTS Median follow up for living patients was 70 months. All patients responded to treatment. Complete response (CR) rate was 65% following TSEI and 58% following TSEI + IFN (P = 0.6). Median overall survival (OS) was 61 months following TSEI and 38 months following TSEI + IFN (P = 0.4). Acute grade II-III dermatitis was seen in all patients. Fever, chills or myalgia were seen in 32% of patients treated with TSEI + IFN. CONCLUSIONS Concurrent IFN and TSEI is feasible, with acceptable toxicity. Even when controlling for disease stage, the addition of IFN did not appear to increase CR rate, disease-free survival or OS.
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Affiliation(s)
- D Roberge
- Department of Radiation Oncology and Division of Hematology, Department of Medicine, McGill University Health Centre, Montreal, Quebec H3G 1A4, Canada.
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Shustik C, Belch A, Robinson S, Rubin SH, Dolan SP, Kovacs MJ, Grewal KS, Walde D, Barr R, Wilson J, Gill K, Vickars L, Rudinskas L, Sicheri DA, Wilson K, Djurfeldt M, Shepherd LE, Ding K, Meyer RM. A randomised comparison of melphalan with prednisone or dexamethasone as induction therapy and dexamethasone or observation as maintenance therapy in multiple myeloma: NCIC CTG MY.7. Br J Haematol 2007; 136:203-11. [PMID: 17233817 DOI: 10.1111/j.1365-2141.2006.06405.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The effectiveness of melphalan plus dexamethasone (M-Dex) with melphalan plus prednisone (MP) as induction therapy and dexamethasone with observation as maintenance therapy was compared in 585 older patients with multiple myeloma. Randomization to the M-Dex arm was stopped as a result of an analysis performed which met a predetermined event-related criterion. Of 466 patients randomised to MP or M-Dex, no differences were detected in the respective median progression-free survivals (PFS) [1.8 vs. 1.9 years; Hazard Ratio (HR) = 0.88, 95% CI 0.72-1.07; P = 0.2] or overall survivals (OS) (2.5 vs. 2.7 years; HR = 0.91, 95% CI 0.74-1.11; P = 0.3). Of the initial 585 patients, 292 remained evaluable for maintenance therapy. Patients randomised to maintenance dexamethasone had a superior median PFS (2.8 years vs. 2.1 years; HR = 0.61, 95% CI 0.47-0.79; P = 0.0002). No difference in median OS was detected (4.1 years vs. 3.8 years; HR = 0.88, 95% CI 0.65-1.18; P = 0.4). The maintenance therapy results were robust when analysed by using two additional methodologies. Dexamethasone did not improve clinical outcome when combined with melphalan during induction; maintenance dexamethasone improved PFS, but this did not translate into a detectable survival advantage.
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Assouline S, Sylvestre MP, Carriere P, Shustik C, Laneuville P. Comparison of peripheral blood progenitor cell yield from standard chemotherapy used in the treatment of lymphoid malignancies and high-dose cyclophosphamide: a retrospective review of 141 patients. Transfusion 2006; 46:174-9. [PMID: 16441591 DOI: 10.1111/j.1537-2995.2006.00695.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/29/2022]
Abstract
BACKGROUND Peripheral blood progenitor cells (PBPCs) are often collected after mobilization with high-dose cyclophosphamide (HDC) combined with growth factors. HDC may not be needed for PBPC mobilization, and patients with lymphoid malignancies can be harvested with treatment regimens of chemotherapy. STUDY DESIGN AND METHODS A retrospective analysis was performed on 141 patients with lymphoma or multiple myeloma whose PBPCs were harvested after chemotherapy. The PBPC yield and time to mobilization was compared between patients who received HDC (n = 51) and other chemotherapy regimens (n = 90) including high-dose cyclophosphamide and etoposide (HDC plus VP-16; n = 41), CHOP, ESHAP, ABVD, VAD, and others (n = 49). A multiple linear regression model and proportional hazards model determined factors influencing yield and time to mobilization, respectively. RESULTS The difference in mean yield between HDC and all non-HDC regimens was significant, with HDC plus VP-16 resulting in the highest yields. The proportion of patients achieving a CD34 count in excess of 5 x 10(6) per kg did not differ significantly between the regimens. In a multiple linear regression model, HDC plus VP-16 resulted in a higher PBPC yield than HDC but all other regimens did not. In addition, patients exposed to more than one prior chemotherapy regimen had lower yield regardless of the mobilization regimen. The mean number of days to mobilization with HDC was 10.2 days, 17.1 days for HDC plus VP-16, and 14.2 days for all other regimens. The timing of mobilization was influenced by the chemotherapy used and the number of prior regimens in a proportional hazards model. CONCLUSION These results demonstrate a higher mean yield of PBPCs with HDC plus VP-16 but no difference in yield between non-HDC plus VP-16 regimens used for first-line or relapse therapy and HDC, suggesting that HDC may be an unnecessary additional therapy.
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Affiliation(s)
- Sarit Assouline
- Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Friedenberg WR, Rue M, Blood EA, Dalton WS, Shustik C, Larson RA, Sonneveld P, Greipp PR. Phase III study of PSC-833 (valspodar) in combination with vincristine, doxorubicin, and dexamethasone (valspodar/VAD) versus VAD alone in patients with recurring or refractory multiple myeloma (E1A95). Cancer 2006; 106:830-8. [PMID: 16419071 DOI: 10.1002/cncr.21666] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [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
BACKGROUND Preliminary studies have shown valspodar (PSC-833: Novartis Pharmaceuticals, East Hanover, NJ) to be a potent inhibitor of multidrug resistance (MDR), one cause of resistance to chemotherapy. An international randomized control study (Phase III) evaluated the use of vincristine, doxorubicin, and dexamethasone (VAD) with (n = 46) and without (n = 48) valspodar in the treatment of patients with recurring or refractory multiple myeloma. METHODS Patients with documented recurrence or refractory myeloma were stratified based on prior treatment exposure and creatinine and randomized. Because of interaction of valspodar with vincristine and doxorubicin, the doses of these drugs were reduced compared with the VAD-alone arm, and the doxorubicin was further reduced in the last 15 patients when given with valspodar based on pharmacokinetic and toxicity studies. RESULTS There were no complete or near-complete responses. There were 29% partial responses (PRs) in the VAD-alone arm and 44% with valspodar (P = 0.2). Median progression-free survival was 7 months with VAD alone and 4.9 months with valspodar (P = 0.50). Subjective response was 19% with VAD alone and 17% with valspodar (P = 1.0). Median survival with VAD alone was 18.5 months and 15.3 with the addition of valspodar (P = 0.055). Toxicity of Grade 3 or greater was higher (P < 0.0001) in the valspodar arm (89%) compared with the VAD-alone arm (58%). The reduction of doxorubicin dose reduced toxicity but not significantly (P = 0.11). CONCLUSION The addition of the MDR-modulating agent valspodar to VAD did not improve treatment outcome. Toxicity was increased in the valspodar-treated group compared with VAD alone.
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Affiliation(s)
- William R Friedenberg
- Department of Hematology/Oncology, Guthrie Foundation for Education & Research, Sayre, Pennsylvania, USA.
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Al-Asmi A, Jansen AC, Badhwar A, Dubeau F, Tampieri D, Shustik C, Mercho S, Savard G, Dobson-Stone C, Monaco AP, Andermann F, Andermann E. Familial temporal lobe epilepsy as a presenting feature of choreoacanthocytosis. Epilepsia 2005; 46:1256-63. [PMID: 16060937 DOI: 10.1111/j.1528-1167.2005.65804.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [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: 12/01/2022]
Abstract
PURPOSE Choreoacanthocytosis (ChAc) is an autosomal recessive disorder caused by mutations in VPS13A on chromosome 9q21 and characterized by neurodegeneration and red cell acanthocytosis. Seizures are not uncommon in ChAc but have not been well characterized in the literature. We report two ChAc families in which patients presented with temporal lobe epilepsy. METHODS Detailed medical and family histories were obtained. EEG, video-telemetry, brain magnetic resonance imaging (MRI) with volumetric studies of amygdala and hippocampus, as well as neuropsychological testing were performed. Blood smears were examined for acanthocytosis. Mutation analysis of VPS13A was carried out in five patients. RESULTS Six patients in three sibships were initially seen with seizures. Age at seizure onset ranged from 22 to 38 years. Seizures preceded other clinical manifestations of ChAc by < or = 15 years. The epileptic aura consisted of a sensation of déjà-vu, fear, hallucinations, palpitations, or vertigo. EEG with video-telemetry showed epileptiform discharges originating either from one or both temporal lobes. Epilepsy was generally well controlled, but some patients had periods of increased seizure frequency requiring treatment with multiple antiepileptic drugs (AEDs). Both families shared a deletion of exons 70-73 of VPS13A, extending to exons 6-7 of GNA14. CONCLUSIONS Temporal lobe epilepsy may be the presenting feature of ChAc and may delay its diagnosis. Epilepsy in ChAc patients represents a challenge, because seizures may at times be difficult to control, and some AEDs may worsen the involuntary movements. Mutations in VPS13A or GNA14 or both may be associated with clinical features of temporal lobe epilepsy.
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Affiliation(s)
- Abdullah Al-Asmi
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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Greipp PR, San Miguel J, Durie BGM, Crowley JJ, Barlogie B, Bladé J, Boccadoro M, Child JA, Avet-Loiseau H, Harousseau JL, Kyle RA, Lahuerta JJ, Ludwig H, Morgan G, Powles R, Shimizu K, Shustik C, Sonneveld P, Tosi P, Turesson I, Westin J. International staging system for multiple myeloma. J Clin Oncol 2005; 23:3412-20. [PMID: 15809451 DOI: 10.1200/jco.2005.04.242] [Citation(s) in RCA: 1891] [Impact Index Per Article: 99.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE There is a need for a simple, reliable staging system for multiple myeloma that can be applied internationally for patient classification and stratification. PATIENTS AND METHODS Clinical and laboratory data were gathered on 10,750 previously untreated symptomatic myeloma patients from 17 institutions, including sites in North America, Europe, and Asia. Potential prognostic factors were evaluated by univariate and multivariate techniques. Three modeling approaches were then explored to develop a staging system including two nontree and one tree survival assessment methodologies. RESULTS Serum beta2-microglobulin (Sbeta2M), serum albumin, platelet count, serum creatinine, and age emerged as powerful predictors of survival and were then used in the tree analysis approach. A combination of Sbeta2M and serum albumin provided the simplest, most powerful and reproducible three-stage classification. This new International Staging System (ISS) was validated in the remaining patients and consists of the following stages: stage I, Sbeta2M less than 3.5 mg/L plus serum albumin > or = 3.5 g/dL (median survival, 62 months); stage II, neither stage I nor III (median survival, 44 months); and stage III, Sbeta2M > or = 5.5 mg/L (median survival, 29 months). The ISS system was further validated by demonstrating effectiveness in patients in North America, Europe, and Asia; in patients less than and > or = 65 years of age; in patients with standard therapy or autotransplantation; and in comparison with the Durie/Salmon staging system. CONCLUSION) The new ISS is simple, based on easy to use variables (Sbeta2M and serum albumin), and recommended for early adoption and widespread use.
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Affiliation(s)
- Philip R Greipp
- Mayo Clinic College of Medicine and Eastern Cooperative Oncology Group, Rochester, MN, USA
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Stewart AK, Chen CI, Howson-Jan K, White D, Roy J, Kovacs MJ, Shustik C, Sadura A, Shepherd L, Ding K, Meyer RM, Belch AR. Results of a Multicenter Randomized Phase II Trial of Thalidomide and Prednisone Maintenance Therapy for Multiple Myeloma after Autologous Stem Cell Transplant. Clin Cancer Res 2004; 10:8170-6. [PMID: 15623591 DOI: 10.1158/1078-0432.ccr-04-1106] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a multicenter, randomized phase II trial conducted to assess the tolerability of combined thalidomide and prednisone maintenance in multiple myeloma. Eligibility required administration of melphalan (200 mg/m2) with blood stem cell support within 1 year of treatment onset and initiation of maintenance within 60 to 100 days after stem cell infusion. All patients received 50 mg of prednisone by mouth on alternate days and thalidomide at a starting dose of either 200 or 400 mg daily by mouth. The primary end point was the incidence of dropout or dose reduction due to treatment toxicity within 6 months. Sixty-seven patients were enrolled. Median follow-up is 36.8 months. The primary end point was reached by 31% of patients on the 200 mg of thalidomide arm and 64% of patients on the 400 mg of thalidomide arm. Allowing for dose reduction, 76% of patients assigned to the 200 mg of thalidomide arm and 41% of patients assigned to the 400 mg of thalidomide arm remained on any maintenance therapy 18 months after registration. Eighty-eight percent of all patients dose-reduced thalidomide and 72% of all patients dose-reduced prednisone within 2 years of beginning maintenance. The median progression-free survival post-transplant is 32.3 months, or 42.2 months from diagnosis. Only the 200 mg of thalidomide arm of this trial met our definition of a tolerable maintenance therapy, defined as no dose reductions or discontinuation due to toxicity in at least 65% of patients for a minimum of 6 months, thus establishing a dosing schedule for phase III trials.
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Shustik C, Belch A, Robinson S, Rubin S, Dolan S, Kovacs M, Djurfeldt M, Shepherd L, Ding K, Meyer RM. Dexamethasone (dex) maintenance versus observation (obs) in patients with previously untreated multiple myeloma: A National Cancer Institute Of Canada Clinical Trials Group Study: MY.7. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6510] [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)
- C. Shustik
- Royal Victoria Hospital, Montreal, PQ, Canada; Cross Cancer Institute, Edmonton, AB, Canada; QEII Health Sciences Centre, Halifax, NS, Canada; Moncton Hospital, Moncton, NB, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; London Health Sciences Centre, London, ON, Canada; Queen's University, Kingston, ON, Canada; Hamilton Regional Cancer Centre, Hamilton, ON, Canada
| | - A. Belch
- Royal Victoria Hospital, Montreal, PQ, Canada; Cross Cancer Institute, Edmonton, AB, Canada; QEII Health Sciences Centre, Halifax, NS, Canada; Moncton Hospital, Moncton, NB, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; London Health Sciences Centre, London, ON, Canada; Queen's University, Kingston, ON, Canada; Hamilton Regional Cancer Centre, Hamilton, ON, Canada
| | - S. Robinson
- Royal Victoria Hospital, Montreal, PQ, Canada; Cross Cancer Institute, Edmonton, AB, Canada; QEII Health Sciences Centre, Halifax, NS, Canada; Moncton Hospital, Moncton, NB, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; London Health Sciences Centre, London, ON, Canada; Queen's University, Kingston, ON, Canada; Hamilton Regional Cancer Centre, Hamilton, ON, Canada
| | - S. Rubin
- Royal Victoria Hospital, Montreal, PQ, Canada; Cross Cancer Institute, Edmonton, AB, Canada; QEII Health Sciences Centre, Halifax, NS, Canada; Moncton Hospital, Moncton, NB, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; London Health Sciences Centre, London, ON, Canada; Queen's University, Kingston, ON, Canada; Hamilton Regional Cancer Centre, Hamilton, ON, Canada
| | - S. Dolan
- Royal Victoria Hospital, Montreal, PQ, Canada; Cross Cancer Institute, Edmonton, AB, Canada; QEII Health Sciences Centre, Halifax, NS, Canada; Moncton Hospital, Moncton, NB, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; London Health Sciences Centre, London, ON, Canada; Queen's University, Kingston, ON, Canada; Hamilton Regional Cancer Centre, Hamilton, ON, Canada
| | - M. Kovacs
- Royal Victoria Hospital, Montreal, PQ, Canada; Cross Cancer Institute, Edmonton, AB, Canada; QEII Health Sciences Centre, Halifax, NS, Canada; Moncton Hospital, Moncton, NB, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; London Health Sciences Centre, London, ON, Canada; Queen's University, Kingston, ON, Canada; Hamilton Regional Cancer Centre, Hamilton, ON, Canada
| | - M. Djurfeldt
- Royal Victoria Hospital, Montreal, PQ, Canada; Cross Cancer Institute, Edmonton, AB, Canada; QEII Health Sciences Centre, Halifax, NS, Canada; Moncton Hospital, Moncton, NB, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; London Health Sciences Centre, London, ON, Canada; Queen's University, Kingston, ON, Canada; Hamilton Regional Cancer Centre, Hamilton, ON, Canada
| | - L. Shepherd
- Royal Victoria Hospital, Montreal, PQ, Canada; Cross Cancer Institute, Edmonton, AB, Canada; QEII Health Sciences Centre, Halifax, NS, Canada; Moncton Hospital, Moncton, NB, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; London Health Sciences Centre, London, ON, Canada; Queen's University, Kingston, ON, Canada; Hamilton Regional Cancer Centre, Hamilton, ON, Canada
| | - K. Ding
- Royal Victoria Hospital, Montreal, PQ, Canada; Cross Cancer Institute, Edmonton, AB, Canada; QEII Health Sciences Centre, Halifax, NS, Canada; Moncton Hospital, Moncton, NB, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; London Health Sciences Centre, London, ON, Canada; Queen's University, Kingston, ON, Canada; Hamilton Regional Cancer Centre, Hamilton, ON, Canada
| | - R. M. Meyer
- Royal Victoria Hospital, Montreal, PQ, Canada; Cross Cancer Institute, Edmonton, AB, Canada; QEII Health Sciences Centre, Halifax, NS, Canada; Moncton Hospital, Moncton, NB, Canada; Atlantic Health Sciences Corporation, Saint John, NB, Canada; London Health Sciences Centre, London, ON, Canada; Queen's University, Kingston, ON, Canada; Hamilton Regional Cancer Centre, Hamilton, ON, Canada
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Turcotte K, Gauthier S, Mitsos LM, Shustik C, Copeland NG, Jenkins NA, Fournet JC, Jolicoeur P, Gros P. Genetic control of myeloproliferation in BXH-2 mice. Blood 2003; 103:2343-50. [PMID: 14630819 DOI: 10.1182/blood-2003-06-1852] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
While studying the unique Nramp1 (Slc11a1)-independent susceptibility to Mycobacterium bovis (BCG) infection of BXH-2 mice, we noted that these mice develop important splenomegaly and enlargement of lymph nodes. Segregation analyses in several F2 crosses showed that splenomegaly segregates as a single recessive trait caused by a novel mutation in BXH-2, independent of the infection. Histologic and fluorescence-activated cell sorter (FACS) analyses indicated that splenomegaly is associated with a large increase in Mac1+/GR1+ (macrophage antigen-1+/granulocyte differentiation antigen 1+) granulocyte precursors in spleen, lymph nodes, and bone marrow, resembling a myeloproliferative syndrome. This is concomitant to extramedullary erythropoiesis in the spleen, as measured by proportion of Ter119+ erythroid cells. The locus controlling this myeloproliferative syndrome and splenomegaly was designated Myls and maps to an 18 centimorgan (cM) region of chromosome 8, which also contains an integrated copy of an N-ecotropic murine leukemia virus (MuLV) provirus (Emv2). The relationship between Myls, expansion of Mac1+/GR1+ cells, and Emv2 was investigated. Homozygosity at Myls is necessary but not sufficient for B-ecotropic virus replication in splenocytes, the extent of which appears to be under separate genetic control. Our results suggest a model in which Myls-dependent myeloproliferation in BXH-2 acts as a predisposing factor for the subsequent development of virally induced myeloid leukemia characteristic of this strain.
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Affiliation(s)
- Karine Turcotte
- Department of Biochemistry, McGill University, Montreal, QC, Canada H3G 1Y6
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Klasa RJ, Meyer RM, Shustik C, Sawka CA, Smith A, Guévin R, Maksymiuk A, Rubinger M, Samosh M, Laplante S, Grenier JF. Randomized phase III study of fludarabine phosphate versus cyclophosphamide, vincristine, and prednisone in patients with recurrent low-grade non-Hodgkin's lymphoma previously treated with an alkylating agent or alkylator-containing regimen. J Clin Oncol 2002; 20:4649-54. [PMID: 12488409 DOI: 10.1200/jco.2002.11.068] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To compare in a phase III study the safety and efficacy of fludarabine to that of cyclophosphamide, vincristine, and prednisone (CVP) in recurrent, low-grade, non-Hodgkin's lymphoma after previous response to systemic treatment. PATIENTS AND METHODS Patients were randomized to fludarabine (25 mg/m(2) intravenously on days 1 to 5, every 28 days) or CVP (cyclophosphamide 750 mg/m(2) and vincristine 1.2 mg/m(2) both intravenously on day 1 and prednisone 40 mg/m(2) orally on days 1 to 5, every 21 days). The primary outcome assessed was progression-free survival (PFS); secondary outcomes included treatment-free survival (TFS), overall survival (OS), treatment-related toxicity, and quality of life (QoL) according to the European Organization for Research and Treatment of Cancer's Quality of Life Questionnaire C-30 version 1.0 instrument. RESULTS Ninety-one patients were randomized, 47 to fludarabine and 44 to CVP. There was no difference in response rates, with 64% (complete response [CR], 9%) for fludarabine versus 52% (CR, 7%) for CVP (P =.72). With a median follow-up of 42 months, median PFS (11 months v 9.1 months; P =.03) and TFS (15 months v 11 months; P =.02) were superior in patients receiving fludarabine. No difference in median overall survival was detected (57 months for fludarabine v 44 months for CVP; P =.95). Three patients receiving fludarabine died of treatment-related toxicity compared with none of the patients receiving CVP. Peripheral neuropathy and alopecia were more common with CVP. Patients receiving fludarabine had higher scores for social function (P =.008); no other differences in QoL were detected. CONCLUSION In recurrent low-grade lymphoma, fludarabine improves PFS, TFS, and social function scores in comparison with CVP but does not improve OS.
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Affiliation(s)
- Richard J Klasa
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada.
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Po JL, Mak A, Ginsberg D, Huerta P, Manoukian R, Shustik C, Jensen GS. Mitotic separation of daughter cells in the human lymphoma B cell line Daudi involves L-selectin engagement and shedding. Haematologica 1999; 84:785-93. [PMID: 10477450] [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: 02/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVE A novel role for shedding of the surface molecule L-selectin has been proposed as an adjunctive phenomenon during cell detachment from marrow stroma or vessel endothelium. We wished to examine whether variations in expression of L-selectin on a lymphoma B cell line were linked to shedding. DESIGN AND METHODS Mapping of L-selectin expression on the surface of Daudi lymphoma cells was performed by flow cytometry, fluorescence microscopy, and electron microscopy. Levels of shed L-selectin were evaluated by Western blotting of culture supernatants. Evaluation of cell cycle and proliferative activity was performed by flow cytometry. RESULTS Large Daudi cells in S+G(2)/M phases were L-selectin positive, whereas small Daudi cells in G(0)/G(1) phase were L-selectin negative. During mitosis, L-selectin was distributed along the cleavage furrow, and gradually lost. Electron microscopy revealed that separating Daudi cells were negative for L-selectin on the entire surface, except minute aggregates of L-selectin within the cleavage furrow. Addition of agents known to interfere with the ligand-binding portion of L-selectin (sulfatides, MoAbs: Lam1.3 and TQ1) results in loss of L-selectin. Removal of L-selectin by digestion with chymotrypsin inhibits Daudi proliferation. The MoAb FMC46 did not interfere with proliferation. Proliferating Daudi cells produced large quantities of shed L-selectin. Inhibition of Daudi proliferation resulted in levels of shed L-selectin below the limit of detection. INTERPRETATION AND CONCLUSIONS L-selectin is re-distributed on the cell surface of Daudi cells during the last phase of mitosis, in which plasma membrane invagination occurs between newly formed daughter cells. Shedding of L-selectin is involved in the cytokinesis of Daudi cells.
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Affiliation(s)
- J L Po
- Dept. Surgery, Royal Victoria Hospital, Montreal, PQ, Canada
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Skillings JR, Rogers-Melamed I, Nabholtz JM, Sawka C, Gwadry-Sridhar F, Moquin JP, Rubinger M, Ganguly P, Burnell M, Shustik C, Dryer D, McLaughlin M, White D. An epidemiological review of red cell transfusions in cancer chemotherapy. Cancer Prev Control 1999; 3:207-12. [PMID: 10474769] [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] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE The objective of this chart review was to determine the frequency of transfusion and prevalence of anemia (hemoglobin result < 100 g/L) in patients receiving chemotherapy. DESIGN This study was a retrospective review of medical charts. SETTING Patients receiving chemotherapy were included from 12 tertiary care comprehensive cancer centres across Canada. MAIN OUTCOME MEASURE The primary study outcome measure was red blood cell transfusion rate, controlling for patient variables. RESULTS The 616 patients included had started chemotherapy in January-June 1992. For each subject, data collection finished 4 weeks after the end of the first regimen or after a maximum follow-up period of 26 weeks. Seventy-two patients (12%; 95% confidence interval 9.5% to 14.5%) were transfused for anemia (reasons other than blood loss), and 28% (95% confidence interval 24.5% to 31.5%) of the subjects were anemic during treatment. The univariate analyses of transfusion for anemia yielded significant associations with prognostic factors. In the multivariate analyses, platinum (odds ratio [OR] = 6.69) and anthracycline (OR = 3.56) chemotherapy, baseline hemoglobin (OR = 0.96) and disease stage (OR = 1.72) were statistically significant contributors. CONCLUSION In this patient cohort, red blood cell transfusion was infrequent (12%). However, patient groups at high risk of transfusion could be identified, with platinum-based chemotherapy being the most significant contributing factor. The information obtained from this multicentre study may prove helpful in developing supportive care guidelines for the management of chemotherapy-related anemia requiring transfusion.
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Abstract
BACKGROUND Iron deficiency anemia is a common complication of gastric bypass. The authors assessed the value of taking vitamin C with oral iron in correcting deficiencies in iron stores and anemia postoperatively. MATERIALS AND METHODS Iron absorption tests were performed on 55 patients 3.2+/-2.0 years after isolated gastric bypass to identify those at higher risk for the late development of anemia. Twenty-nine of this group agreed to a therapeutic trial of iron alone or with vitamin C over a 2-month period. All 55 patients were followed up for 27.1+/-1.0 months following the study. RESULTS The iron absorption test identified patients with low iron stores, as indicated by low serum ferritin, and those with sufficient absorption surface to benefit from oral iron. The addition of vitamin C appears to enhance the therapeutic effect of iron by correcting ferritin deficits (P < 0.01) and anemia (P < 0.05). Differences in intestine length bypassed by the operation (10 vs. 100 cm) did not affect late ferritin and hemoglobin values. CONCLUSION This study suggests but does not prove that the addition of vitamin C to iron therapy after gastric bypass is more effective in restoring ferritin and hemoglobin than iron alone. These results are in contrast with the outcome 22.8 months later, when approximately 50% of study patients were again anemic. Closer follow-up of patients is urgently needed.
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Affiliation(s)
- B M Rhode
- Department of Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
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Abstract
BACKGROUND: The role of interferon (IFN) in the treatment of multiple myeloma has been investigated for nearly two decades. The mechanisms underlying antitumor activity of IFN may be mediated by antiproliferative and immunomodulatory effects. The benefits of treatment remain controversial, and guidelines for the use of IFN in myeloma are needed. This review evaluates available data on the impact of IFN therapy on multiple myeloma. METHODS: A MEDLINE search of published prospective, randomized trials of IFN in multiple myeloma provided the data included in this review, as well as selected abstracts presented at international meetings. RESULTS: IFN has complex and pleiotropic effects on human myeloma lines and ex vivo myeloma cells. An antiproliferative effect with disruption of the IL-6-mediated growth loop may be crucial, but biologic heterogeneity in myeloma may have important clinical implications for response to IFN. IFN has demonstrable antitumor activity in multiple myeloma but appears to have a modest effect on overall survival when combined with chemotherapy during induction or when used as maintenance therapy. Most studies have shown a prolongation of the plateau phase of disease with IFN of variable duration of between four and 12 months. CONCLUSIONS: A reliable estimate of the benefit of IFN in the overall population of patients with myeloma is difficult to determine with discordant results from different trials. Possible sources of heterogeneity in randomized trials need to be identified, and recognition of subsets of patients who may benefit is important. Cost-benefit analyses with integration of quality-of-life data are essential for developing guidelines for the use of IFN in myeloma.
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Affiliation(s)
- C Shustik
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Connors JM, Klimo P, Adams G, Burns BF, Cooper I, Meyer RM, O'Reilly SE, Pater J, Quirt I, Sadura A, Shustik C, Skillings J, Sutcliffe S, Verma S, Yoshida S, Zee B. Treatment of Advanced Hodgkin's Disease With Chemotherapy—Comparison of MOPP/ABV Hybrid Regimen With Alternating Courses of MOPP and ABVD. J Clin Oncol 1997. [DOI: 10.1200/jco.1997.15.7.2762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The institution affiliation section on page 1638 of the April 1997 article entitled, "Treatment of Advanced Hodgkin's Disease With Chemotherapy—Comparison of MOPP/ABV Hybrid Regimen With Alternating Courses of MOPP and ABVD: A Report From the National Cancer Institute of Canada Clinical Trials Group" by Connors, et al (J Clin Oncol 15:1638–1645, 1997) was incomplete. The "London Regional Cancer Centre, London, Ontario, Canada" should have been included in the listing of author-affiliated institutions.
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Connors JM, Klimo P, Adams G, Burns BF, Cooper I, Meyer RM, O'Reilly SE, Pater J, Quirt I, Sadura A, Shustik C, Skillings J, Sutcliffe S, Verma S, Yoshida S, Zee B. Treatment of advanced Hodgkin's disease with chemotherapy--comparison of MOPP/ABV hybrid regimen with alternating courses of MOPP and ABVD: a report from the National Cancer Institute of Canada clinical trials group. J Clin Oncol 1997; 15:1638-45. [PMID: 9193364 DOI: 10.1200/jco.1997.15.4.1638] [Citation(s) in RCA: 126] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE This randomized, prospective trial compares outcomes for patients with advanced Hodgkin's disease treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP)/doxorubicin, bleomycin, and vinblastine (ABV) hybrid regimen or alternating MOPP/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). METHODS Three hundred one patients with advanced Hodgkin's disease were randomized to receive MOPP/ ABV hybrid regimen or alternating MOPP/ABVD after stratification for prior treatment, B symptoms, and treatment center. Eligible patients were either previously untreated and found to have stage IIIB, IVA, or IVB disease or previously treated with wide-field irradiation. Responding patients received a minimum of eight cycles of chemotherapy. Those with residual disease in a localized region received irradiation between the sixth and seventh cycle of treatment. RESULTS Response rates to the two regimens were similar. Five-year overall survival rates were 81% and 83% for MOPP/ABV hybrid and alternating MOPP/ ABVD, respectively (P = .74; 95% confidence interval [CI] for the difference, -11% to 7%). Five-year failure-free survivals were 71% and 67% for MOPP/ABV hybrid and alternating MOPP/ABVD, respectively (P = .87; 95% CI for the difference, -9% to 17%). Significantly more episodes of febrile neutropenia and stomatitis were observed with the MOPP/ABV hybrid regimen; there was no significant difference in fatal toxicity. Patients with predefined, high-quality partial responses (PR-1s) had results similar to those with complete responses (CRs). Planned subset analysis showed no significant difference in outcome between the two arms of the trial for patients with newly diagnosed disease (5-year failure-free survival rates were 70% for MOPP/ABV hybrid and 59% for alternating MOPP/ABVD; P = .180), but superiority of alternating MOPP/ABVD for patients with prior irradiation (5-year failure-free survival 94% v 73%; P = .017). CONCLUSION MOPP/ABV hybrid and alternating MOPP/ABVD regimens are equally effective for patients with advanced Hodgkin's disease.
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Affiliation(s)
- J M Connors
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada.
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Cellier M, Shustik C, Dalton W, Rich E, Hu J, Malo D, Schurr E, Gros P. Expression of the human NRAMP1 gene in professional primary phagocytes: studies in blood cells and in HL-60 promyelocytic leukemia. J Leukoc Biol 1997; 61:96-105. [PMID: 9000542 DOI: 10.1002/jlb.61.1.96] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.5] [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: 02/03/2023] Open
Abstract
In the mouse, mutations at the natural resistance-associated macrophage protein 1 (Nramp1) gene abrogate resistance to infection with antigenically unrelated intracellular parasites such as Mycobacterium, Salmonella, and Leishmania. Nramp1 expression is restricted to reticuloendothelial organs and peripheral blood leukocytes, where the protein may function as a membrane transporter of an as yet to be identified substrate. To identify the human blood cell type(s) expressing NRAMP1 mRNA and determine how Nramp1 expression is regulated in these cells, we have examined separated populations of peripheral blood leukocytes and in vitro cell lines. We observed that polymorphonuclear leukocytes (PMN) are the major site of NRAMP1 expression, followed to a lesser degree by monocytes (MN). Migration of MN to tissues (alveolar macrophages) or maturation in vitro (long-term culture) was associated with a higher level of NRAMP1 expression compared with blood MN. Northern analyses of RNA from model cultured cells showed absence of NRAMP1 expression in transformed cell lines from either erythroid or lymphoid T or B lineages as well as progenitors of the monocyte/macrophage pathway (KG1, U937, THP1), and the HL-60 promyelocytic leukemia. Induction of differentiation of HL-60 cells toward either the monocyte/macrophage (vitamin D3, phorbol ester) or the granulocyte pathways (DMF, DMSO), as measured by induction of IL8-Rb, c-FMS, and CD14 marker gene expression, was concomitant with a strong induction of NRAMP1 expression. These results suggest that NRAMP1 expression is specific to the myeloid lineage and is acquired during the maturation of PMN and MN. The possibility that NRAMP1 may be a component of the phagosomal/endosomal apparatus common to PMN and MN is discussed.
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Affiliation(s)
- M Cellier
- Department of Biochemistry, McGill University, Montreal, Canada
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Glass J, Shustik C, Hochberg FH, Cher L, Gruber ML. Therapy of primary central nervous system lymphoma with pre-irradiation methotrexate, cyclophosphamide, doxorubicin, vincristine, and dexamethasone (MCHOD). J Neurooncol 1996; 30:257-65. [PMID: 8943101 DOI: 10.1007/bf00177277] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prior studies have suggested that pre-irradiation methotrexate (MTX)-based chemotherapy improves duration of response and survival in primary central nervous system lymphoma (PCNSL). To circumvent the potential emergence of drug resistance, we combined high-dose MTX with agents highly active against systemic lymphoma. Patients received three week cycles of CHOD (cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and vincristine 1.4 mg/m2 [2 mg maximum] on day 1; dexamethasone 10 mg/m2 days 1-5), and MTX (3.5 gm/m2) with leucovorin rescue on day 8 (or on recovery from the CHOD nadir). Whole brain irradiation (WBRT) was planned after at least three cycles. Eighteen patients were treated. Complete responses were seen in eleven patients, and partial responses in three. Four progressed during therapy, three succumbing to progressive disease and one subsequently responding to WBRT. Response duration was 37.5 months in those responding to therapy. The time to progression for all eighteen patients was 19.5 months. Medial survival was 25.5 months. Disease-free survival was 50% at 38 months in MCHOD responders. Grade 3 or 4 myelotoxicity was seen in 19 of 50 cycles. There were three instances of neutropenic fever, three of azotemia, two of deep vein thrombosis, and one each of community-acquired pneumonia, intracranial hemorrhage, superior vena cava syndrome, and hepatotoxicity. Late radiation-related toxicities were seen in two patients. Pre-irradiation MCHOD has activity against PCNSL, but appears to be no better than MTX monotherapy and has greater toxicity.
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Affiliation(s)
- J Glass
- Massachusetts General Hospital, Boston
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Newkirk MM, Shiroky JB, Johnson N, Danoff D, Isenberg DA, Shustik C, Pearson GR. Rheumatic disease patients, prone to Sjögren's syndrome and/or lymphoma, mount an antibody response to BHRF1, the Epstein-Barr viral homologue of BCL-2. Br J Rheumatol 1996; 35:1075-81. [PMID: 8948292 DOI: 10.1093/rheumatology/35.11.1075] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The IgG response to Epstein-Barr virus (EBV) early antigens [BHRF1 (p 17.1), the viral homologue of bcl-2, and BMRF1 (p50.10), a DNA binding protein] was measured in patients with rheumatic disease to see whether there was any association with lymphoma. Patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), rheumatic disease patients with lymphoma, patients with lymphoma who did not have a rheumatic disease and normal individuals were tested for the presence of anti-EA peptide antibodies by ELISA. Whereas antibodies to early EBV peptides were detected only in one normal individual, patients with rheumatic diseases, especially those with either SS and/or lymphoma, had a much higher frequency of antibody detection. Antibodies to BMRF1 p50.10 were found in 7-50% of patients, and to BHRF1 p17.1 in 4-27%, depending on the group studied. Patients with lymphoma lacking a rheumatic disease had a 2-fold lower frequency of anti-BHRF1 antibodies, compared to the lymphoma plus rheumatic disease group. The increased immune response to the EBV EA proteins in the rheumatic diseases probably reflects the presence of reactivated virus, and the BHRF1 protein (the viral homologue to bcl-2) could, via inhibiting apoptosis, contribute to the lymphoproliferative nature of these diseases.
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Affiliation(s)
- M M Newkirk
- Department of Medicine, Montreal General Hospital Research Institute, Quebec, Canada
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Abstract
PURPOSE To determine whether parathyroid-hormone-related peptide (PTHRP) is an important pathogenetic mediator of hypercalcemia in patients with hematologic malignancies. PATIENTS AND METHODS We conducted a cohort analytic study in 76 consecutive patients with non-Hodgkin's lymphoma (NHL), Hodgkin's disease, multiple myeloma, and Waldenstrom's macroglobulinemia, 14 of which were hypercalcemic. Thirty normal subjects served as a control group. RESULTS Using the NH2 -terminal radioimmunoassay, PTHRP concentrations in heavy controls were undetectable (<7.5 pmol equivalents of PTHRP [fragment 1-34] per liter). The majority of hypercalcemic patients (8/14) had non-Hodgkin's lymphoma, and 62.5% of these (5/8) had significant elevations of circulating PTHRP concentrations (mean 70.5 +/- 38.5 pmol equivalents of PTHRP per liter) (P <0.01). In non-Hodgkin's lymphoma, 11 of 30 patients with advanced disease (stage IV) had elevated PTHRP concentrations, and of these, 8 of 11 had high-grade pathology. In contrast, only 3 or 21 patients with less advanced disease (stage I to III) had elevated PTHRP concentrations. In 4 NHL patients with less advance PTHRP concentrations sampled prior to cytotoxic chemotherapy, tumor response was associated with a decrease in PTHRP. Concomitant suppression of 1,25(OH)2D3 concentrations was observed in 66% of hypercalcemic patients with non-Hodgkin's lymphoma. CONCLUSIONS These results suggest that PTHRP may be an important pathogenetic factor in the development of hypercalcemia in hematologic malignancies, notably in non-Hodgkin's lymphoma.
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Affiliation(s)
- R Kremer
- Department of Medicine, Royal Victoria Hospital, Montreal, Quebec, Canada
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Skillings J, Rogers-Melamed I, Nabholtz JM, Sawka C, Gwadry-Sridhar F, Moquin JP, Rubinger M, Ganguly P, Burnell M, Shustik C, Dryer D, McLaughlin M, White D, Mertens W. 879 An epidemiological review of anaemia in cancer chemotherapy in Canada. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96128-z] [Citation(s) in RCA: 13] [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: 11/30/2022]
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Abstract
Allotransplantation of solid organs transfers passenger leucocytes which may give rise to a state of persistent microchimaerism. In this report we describe the case of a patient who developed a solitary plasmacytoma in a transplanted kidney more than 10 years after allografting. The diagnosis was established on the basis of the presence of a monoclonal IgG kappa peak in the serum, and light chain proteinuria, the plasmacytoid features of tumour cells including cell surface expression of IgG, kappa light chains, CD20, CD38 and CD56, the absence of lytic bone lesions and a normal bone marrow biopsy, and the disappearance of the monoclonal IgG peak after graft nephrectomy. A donor origin of the tumour was established by HLA DNA typing of tumour, tumour-free kidney tissue, and peripheral blood leucocytes, respectively.
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Affiliation(s)
- C Shustik
- Department of Medicine, Royal Victoria Hospital, Montreal, Quebec, Canada
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Browman GP, Bergsagel D, Sicheri D, O'Reilly S, Wilson KS, Rubin S, Belch A, Shustik C, Barr R, Walker I. Randomized trial of interferon maintenance in multiple myeloma: a study of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1995; 13:2354-60. [PMID: 7666094 DOI: 10.1200/jco.1995.13.9.2354] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To determine whether interferon maintenance therapy improves overall survival and response duration in patients with multiple myeloma who have responded to induction therapy with melphalan and prednisone. PATIENTS AND METHODS In a multicenter trial, patients with symptomatic clinical stage I and stage II and III multiple myeloma were registered at diagnosis and those who responded to melphalan-prednisone (MP) were randomized either to receive interferon (2 mU/m2) subcutaneously three times per week or no maintenance. MP was discontinued in both groups once a stable response plateau of the monoclonal protein was reached. Interferon was continued until relapse, and then was restarted on subsequent response to MP. Interferon toxicity was recorded using a self-report diary. Survival and response duration were calculated using life-table methods, and were adjusted in the analysis for imbalances in baseline prognostic factors. RESULTS Four hundred two patients were registered and 176 responders were randomized (85 to interferon and 91 to control). At a median follow-up time of 43 months, the median survival duration was 43 months for interferon and 35 months for control (P = .16), but when adjusted for chance imbalances in baseline prognostic factors (mainly performance status), the median survival duration was 44 months and 33 months for interferon and control, respectively (P = .049). Progression-free survival from randomization to first relapse also favored interferon (unadjusted P < .002; adjusted P < .003). Interferon toxicity caused 58% of patients to reduce their dose, of which 84% were able to return to the initial dose; 14% had to discontinue interferon treatment. CONCLUSION Interferon maintenance therapy improves progression-free and overall survival of patients with multiple myeloma who respond to melphalan and prednisone. Toxicity is substantial and must be weighed by patients against the potential benefits in response duration and survival.
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Affiliation(s)
- G P Browman
- National Cancer Institute of Canada Clinical Trials Group, Queen's University, Kingston
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Jensen GS, Po JL, Huerta P, Shustik C. Circulating B-cells in follicular non-Hodgkin's lymphoma show variant expression of L-selectin epitopes. Curr Top Microbiol Immunol 1995; 194:171-7. [PMID: 7534668 DOI: 10.1007/978-3-642-79275-5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- G S Jensen
- Department of Surgery, Royal Victoria Hospital, McGill University, Montreal, Canada
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Affiliation(s)
- C Shustik
- Department of Medicine, McGill Cancer Center, Royal Victoria Hospital, Montreal, Quebec, Canada
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