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Bountziouka C, Kastritis E, Schmelz M, Theodorakakou F, Fotiou D, Kokotis P. HP57 : Peripheral nerve involvement in AL Amyloidosis : A long prospective follow up study. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2021.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Makris N, Laina A, Georgiopoulos G, Gavriatopoulou M, Papanagnou E, Eleutherakis-Papaiakovou E, Fotiou D, Dialoupi I, Migkou M, Roussou M, Terpos E, Trougakos I, Dimopoulos MA, Kastritis E, Stamatelopoulos K. Global deterioration of cardiovascular mechanics by carfilzomib treatment is associated with proteasome activity in patients with relapsed multiple myeloma. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Carfilzomib (CFZ) is a second generation irreversible proteasome inhibitor that has been shown to improve overall survival in patients with relapsed or refractory multiple myeloma (MM) but is associated with cardiac toxicity in MM. Because ubiquitin-proteasome system (UPS) is involved in cardiovascular homeostasis exploring the effects of proteasome inhibition on cardiac mechanics, in a clinical setting, would provide novel insight of the clinical role of UPS in cardiovascular disease.
Aim
To gain a thorough understanding of proteasome inhibition on myocardial mechanics in a clinical setting.
Methods
We prospectively evaluated 48 patients with relapsed or refractory MM and an indication to receive CFZ treatment [median age: 67.5, interquartile range (64–73), 66.7% men]. All patients underwent cardiac ultrasonography at an initial visit, at the first day of the 3rd month (C3D1, n=25) and at the last day of cycle 6 (C6D16, n=48). Pulse wave velocity (PWV) was used to assess arterial stiffness and calculate arterial-ventricular coupling (VAC) by the ratio (PWV/global longitudinal strain (GLS)). Carfilzomib was administered at 27mg/m2 on days 1 (C1D1) and 2 (C1D2) of cycle 1 and at 56mg/m2 thereafter. Blood was drawn at baseline, C3D1 and C6D16 to measure proteasome activity (PrA). Patients were followed up for carfilzomib–related cardiovascular adverse events.
Results
Regarding systolic function, between baseline and C6D16, we noticed deterioration in left ventricular ejection fraction (LVEF) (57.7±5.4% vs 56.1±7.19%, p=0.022), GLS (−20.51±2.78 vs −18.88±3.45%, p=0.003), S wave of LV longitudinal strain rate and radial strain (p<0.05 for both). Markers of LV diastolic function also deteriorated at 6 months including early diastolic (Ea) mitral annular velocity (7.27±1.83cm/sec vs 6.7±1.64cm/sec, p=0.008) and E wave of LV longitudinal strain rate (1.1±0.37sec-1 vs 0.95±0.36sec-1, p=0.010). Left atrial volume (LAV) and index (LAVi) increased both at 3 and 6 months (p<0.05). Peak LA strain at reservoir phase (peak atrial longitudinal strain, PALS) was also decreased at 6th and 3rd month measurements (p<0.05), whereas LA strain rate at reservoir function (s wave) was decreased, compared to baseline, only at 6th month (p=0.001). RV longitudinal strain also decreased between 3rd and 6th month (p=0.039). Furthermore, PWV/GLS also deteriorated at 6 months (−0.56±0.13 vs −0.64±0.21, p=0.001). By linear mixed models analysis, we found that changes in proteasome activity were associated with changes in PWV/GLS (p=0.017), LAV (p=0.015) and LAVi (p=0.009), and PALS (p=0.014).
Conclusion
CFZ treatment was associated with global deterioration of markers of myocardial systolic and diastolic function and VAC. The observed association of changes in proteasome activity with VAC and left atrial function and structure supports a direct effect of proteasome inhibition on the cross-talk between LV and arterial function and LV diastolic function.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Amgen
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Affiliation(s)
- N Makris
- Alexandra University Hospital, Athens, Greece
| | - A Laina
- Alexandra University Hospital, Athens, Greece
| | | | | | - E.D Papanagnou
- National & Kapodistrian University of Athens, Department of Cell Biology and Biophysics, Faculty of Biology, Athens, Greece
| | | | - D Fotiou
- Alexandra University Hospital, Athens, Greece
| | - I Dialoupi
- Alexandra University Hospital, Athens, Greece
| | - M Migkou
- Alexandra University Hospital, Athens, Greece
| | - M Roussou
- Alexandra University Hospital, Athens, Greece
| | - E Terpos
- Alexandra University Hospital, Athens, Greece
| | - I.P Trougakos
- National & Kapodistrian University of Athens, Department of Cell Biology and Biophysics, Faculty of Biology, Athens, Greece
| | | | - E Kastritis
- Alexandra University Hospital, Athens, Greece
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Laina A, Georgiopoulos G, Makris N, Gavriatopoulou M, Papanagnou E, Eleutherakis-Papaiakovou E, Fotiou D, Dialoupi I, Migkou M, Roussou M, Terpos E, Trougakos I, Dimopoulos MA, Kastritis E, Stamatelopoulos K. Aortic hemodynamic parameters as predictors of incident or deteriorating hypertension during carfilzomib therapy in patients with relapsed multiple myeloma. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Carfilzomib (CFZ) improves survival in relapsed/refractory multiple myeloma but is associated with cardiovascular adverse events, among which hypertension is commonly reported.
Purpose
To evaluate aortic hemodynamics as possible predictors for CFZ-associated hypertension.
Methods
In a prospective study of 48 patients treated with Kd (CFZ 20/56 mg/m2 and dexamethasone) followed until disease progression or cycle 6 for a median of 10 months, patients underwent peripheral hemodynamic assessment, including applanation tonometry, which allows estimation of aortic blood pressure and arterial wave reflections and assessment of pulse wave velocity, which allows estimation of aortic stiffness. Hemodynamic parameters were examined at baseline and at pre-specified time points before and 24 hours after drug infusion.
Results
Thirteen patients (27.1%) developed hypertension or merited more intensive anti-hypertensive treatment (grade I or II: 6.25%, grade III: 20.8%). Patients with new onset or worsening hypertension had increased aortic [130±12.9 mmHg versus 115±16.7 mmHg, p=0.004] and peripheral systolic blood pressure (SBP) [145±15.7 mmHg versus 130±19.5 mmHg, p=0.001] at baseline. Patients distributed at highest tertile of baseline aortic SBP (log-rank test p=0.0001, Figure) or baseline peripheral SBP (log-rank test p=0.002) had significantly higher risk for CFZ associated hypertension as compared to those distributed at lower tertiles. After adjustment for age, gender and baseline hypertension, increased aortic [HR=8.0, 95% CIs 2.4–26.6, p=0.001] and peripheral SBP [HR=4.85, 95% CIs 1.53–15.4, p=0.007] remained significantly associated with hypertension. After adjustment for both baseline peripheral and aortic SBP in the same multivariable core model, aortic SBP was the only independent predictor of the study outcome (p=0.041). Accordingly, baseline aortic SBP was associated with higher discriminative value as compared to peripheral SBP [AUC: 0.819, 95% CIs 0.722–0.916 versus 0.724, 95% CIs 0.570–0.878, respectively]. Further adjustment for all cardiotoxicity risk factors using forced inclusion in non-parsimonious multivariable Cox regression models, revealed that increased aortic and peripheral SBP remained independent predictors of hypertensive events (p<0.05 for both).
Conclusion
Baseline aortic hemodynamics are associated with hypertension during CFZ treatment. Aortic SBP at baseline was the strongest predictor of CFZ-associated hypertensive adverse events, suggesting that an initial assessment of aortic blood pressure may facilitate discrimination of patients in need of close monitoring during treatment.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Funding from the Hellenic Foundation for Research and Innovation (HFRI) and the General Secretariat for Research and Technology (GSRT), under grant agreement No [1285].
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Affiliation(s)
- A Laina
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - N Makris
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M Gavriatopoulou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Papanagnou
- National & Kapodistrian University of Athens, Department of Cell Biology and Biophysics, Faculty of Biology, Athens, Greece
| | | | - D Fotiou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Dialoupi
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M Migkou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M Roussou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Terpos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Trougakos
- National & Kapodistrian University of Athens, Department of Cell Biology and Biophysics, Faculty of Biology, Athens, Greece
| | - M A Dimopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Kastritis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
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Terpos E, Symeonidis A, Delimpasi S, Zamagni E, Katodritou E, Rivolti E, Kyrtsonis M, Fotiou D, Kanellias N, Migkou M, Roussou M, Gavriatopoulou M, Hatjiharissi E, Cavo M, Dimopoulos M. Efficacy and safety of daratumumab with dexamethasone in patients with relapsed/refractory multiple myeloma and severe renal impairment: results of the phase 2 dare study. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kastritis E, Karatrasoglou E, Dialoupi I, Gavriatopoulou M, Roussou M, Fotiou D, Kanellias N, Ntanasis-Stathopoulos I, Eleutherakis-Papaiakovou E, Manios E, Migkou M, Papanota AM, Papadopoulou E, Stamatelopoulos K, Ntalianis A, Papanikolaou A, Psimenou E, Gakiopoulou C, Tsitsilonis O, Tselegkidi M, Trougakos I, Kostopoulos I, Terpos E, Dimopoulos M. PS1378 AN EARLY, WITHIN THE FIRST MONTH, AND DEEP RESPONSE, SHOULD BE THE GOAL OF THERAPY IN AL AMYLOIDOSIS. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000563788.88142.a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fotiou D, Papageorgiou L, Salta S, Terpos E, Fareed J, VanDreden P, Lefkou E, Larsen A, Elalamy I, Dimopoulos M, Gerotziafas G. Prospective Assessment of Clinical Risk Factors and Biomarkers of Hypercoagulability for the Identification of Newly diagnosed chemotherapy Naïve Patients with Multiple Myeloma at Risk for Cancer-associated Thrombosis. The Observational ROADMAP-CAT-MM Study. Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kastritis E, Gavriatopoulou M, Roussou M, Fotiou D, Ziogas DC, Migkou M, Eleutherakis-Papaiakovou E, Panagiotidis I, Kanellias N, Psimenou E, Papadopoulou E, Pamboucas C, Manios E, Gakiopoulou H, Ntalianis A, Tasidou A, Giannouli S, Terpos E, Dimopoulos MA. Addition of cyclophosphamide and higher doses of dexamethasone do not improve outcomes of patients with AL amyloidosis treated with bortezomib. Blood Cancer J 2017; 7:e570. [PMID: 28622303 PMCID: PMC5520394 DOI: 10.1038/bcj.2017.47] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/05/2017] [Accepted: 02/15/2017] [Indexed: 01/11/2023] Open
Abstract
Bortezomib, in combination with dexamethasone (VD) or with the addition of cyclophosphamide (VCD), is highly effective in patients with amyloid light-chain (AL) amyloidosis. Currently, VCD is considered as a primary regimen for patients with AL, but it is not clear whether the addition of cyclophosphamide to VD further and significantly improves efficacy, given the substantial activity of bortezomib itself. We retrospectively compared the outcomes of 101 patients with AL amyloidosis who received VD (n=59) or VCD (n=42) in two consecutive periods. Early mortality after adjustment for Mayo stage was similar. On intent to treat, a hematologic response rate was 68% for patients treated with VD and 78% for VCD (P=0.26), while complete response+very good partial response (CR+VGPR) rate was 47.5% and 35%, respectively. Higher doses of dexamethasone or twice-weekly bortezomib were not associated with significantly higher CR+VGPR rates. Organ responses occurred in similar rates between the two groups. Median survival was similar (33 vs 36 months, P=0.45) even after adjustment for Mayo stage and dose and schedule of bortezomib and dexamethasone. In conclusion, bortezomib even with low doses of dexamethasone is effective for the treatment of AL amyloidosis; higher doses of dexamethasone and addition of cyclophosphamide do not seem to have a profound effect on efficacy and survival.
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Affiliation(s)
- E Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M Roussou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D Fotiou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D C Ziogas
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M Migkou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - E Eleutherakis-Papaiakovou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - I Panagiotidis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - N Kanellias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - E Psimenou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - E Papadopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - C Pamboucas
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - E Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - H Gakiopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Ntalianis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Tasidou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - S Giannouli
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - E Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Kaltsatou A, Grigoriou S, Karatzaferi C, Fotiou D, Stefanidis I, Sakkas G. SP456AUTONOMIC NERVOUS SYSTEM ACTIVITY ASSESSMENT USING PUPILLOMETRY AND HEART RATE VARIABILITY DURING INTRADIALYTIC EXERCISE TRAINING IN HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv194.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tsamis K, Mytilinaios D, Njau S, Fotiou D, Glaftsi S, Costa V, Baloyannis S. Properties of CA3 Dendritic Excrescences in Alzheimers Disease. Curr Alzheimer Res 2010; 7:84-90. [DOI: 10.2174/156720510790274482] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 05/02/2009] [Indexed: 11/22/2022]
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Tsiptsios D, Fotiou D, Stergiou V. The pupil light reflex test as a possible diagnostic index of central cholinergic dysfunction. Int J Psychophysiol 2008. [DOI: 10.1016/j.ijpsycho.2008.05.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tsiptsios D, Fotiou D, Stergiou V, Partsafillidis D, Keivanidou A, Karlovasitou A. Evaluation of pupillary size and mobility in patients with Myasthenia Gravis. Int J Psychophysiol 2008. [DOI: 10.1016/j.ijpsycho.2008.05.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Keivanidou A, Fotiou D, Arnaoutoglou C, Arnaoutoglou N, Tsiptsios D, Partsafyllidis D, Stergiou V, Karatasios G, Karamitrou A, Karlovasitou A. Changes in pupillary size and mobility in patients with heart failure. Int J Psychophysiol 2008. [DOI: 10.1016/j.ijpsycho.2008.05.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Partsafyllidis D, Fotiou D, Tsiptsios D, Keivanidou A, Stergiou V, Karamitrou A, Karatasios G, Karlovasitou A. Evaluation of pupillary size and mobility in patients with schizophrenia. Int J Psychophysiol 2008. [DOI: 10.1016/j.ijpsycho.2008.05.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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