1
|
Turner R, Quach H, Horvath N, Kerridge I, Lee E, Morris E, Kalff A, Khong T, Reynolds J, Spencer A. Response adaptive salvage with KTd and ASCT for functional high-risk multiple myeloma-The Australasian Leukemia and Lymphoma Group (ALLG) MM17 Trial. Br J Haematol 2023. [PMID: 37332079 DOI: 10.1111/bjh.18914] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
We evaluated re-induction incorporating carfilzomib-thalidomide-dexamethasone (KTd) and autologous stem cell transplantation (ASCT) for newly diagnosed multiple myeloma (NDMM) refractory, or demonstrating a suboptimal response, to non-IMID bortezomib-based induction. KTd salvage consisted of thalidomide 100 mg daily and dexamethasone 20 mg orally combined with carfilzomib 56 mg/m2 days 1, 2, 8, 9, 15 and 16, of each 28-day cycle. Following four cycles, patients achieving a stringent complete response proceeded to ASCT whereas those who did not received a further two cycles then ASCT. Consolidation consisted of two cycles of KTd then Td to a total of 12 months post-ASCT therapy. Primary end-point was the overall response rate (ORR) with KTd prior to ASCT. Fifty patients were recruited. The ORR was 78% with EuroFlow MRD negativity of 34% in the intention-to-treat population and 65% in the evaluable population at 12 months post-ASCT. With follow-up >38 months median PFS and OS have not been reached with PFS and OS at 36 months of 64% and 80%, respectively. KTd was well tolerated with grade 3 and grade ≥4 adverse events rates of 32% and 10%, respectively. Response adaptive utilisation of KTd with ASCT is associated with both high-quality responses and durable disease control in functional high-risk NDMM.
Collapse
Affiliation(s)
- R Turner
- Alfred Health, Melbourne, Victoria, Australia
| | - H Quach
- St Vincent's Hospital, Melbourne, Victoria, Australia
- Melbourne University, Melbourne, Victoria, Australia
| | - N Horvath
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - I Kerridge
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - E Lee
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - E Morris
- Townsville Cancer Centre, Townsville, Queensland, Australia
| | - A Kalff
- Alfred Health, Melbourne, Victoria, Australia
| | - T Khong
- Alfred Health, Melbourne, Victoria, Australia
| | - J Reynolds
- Alfred Health, Melbourne, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| | - A Spencer
- Alfred Health, Melbourne, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
| |
Collapse
|
2
|
Weber N, Mollee P, Augustson B, Brown R, Catley L, Gibson J, Harrison S, Ho PJ, Horvath N, Jaksic W, Joshua D, Quach H, Roberts AW, Spencer A, Szer J, Talaulikar D, To B, Zannettino A, Prince HM. Management of systemic AL amyloidosis: recommendations of the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2016; 45:371-82. [PMID: 25169210 DOI: 10.1111/imj.12566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 06/06/2014] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
Abstract
Systemic AL amyloidosis is a plasma cell dyscrasia with a characteristic clinical phenotype caused by multi-organ deposition of an amyloidogenic monoclonal protein. This condition poses a unique management challenge due to the complexity of the clinical presentation and the narrow therapeutic window of available therapies. Improved appreciation of the need for risk stratification, standardised use of sensitive laboratory testing for monitoring disease response, vigilant supportive care and the availability of newer agents with more favourable toxicity profiles have contributed to the improvement in treatment-related mortality and overall survival seen over the past decade. Nonetheless, with respect to the optimal management approach, there is a paucity of high-level clinical evidence due to the rarity of the disease, and enrollment in clinical trials is still the preferred approach where available. This review will summarise the Clinical Practice Guidelines on the Management of Systemic Light Chain (AL) Amyloidosis recently prepared by the Medical Scientific Advisory Group of the Myeloma Foundation of Australia. It is hoped that these guidelines will assist clinicians in better understanding and optimising the management of this difficult disease.
Collapse
Affiliation(s)
- N Weber
- Clinical Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Moore E, Bergin K, McQuilten Z, Wood E, Augustson B, Blacklock H, Ho P, Horvath N, King T, McNeil J, Mollee P, Quach H, Reid C, Rosengarten B, Walker P, Spencer A. Real world management of multiple myeloma: initial results from the Australia and New Zealand Myeloma and Related Diseases Registry. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.422] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
4
|
Quach H, Joshua D, Ho J, Szer J, Spencer A, Harrison S, Mollee P, Roberts A, Horvath N, Talaulikar D, To B, Zannettino A, Brown R, Catley L, Augustson B, Jaksic W, Gibson J, Prince HM. Treatment of patients with multiple myeloma who are not eligible for stem cell transplantation: position statement of the myeloma foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2015; 45:335-43. [DOI: 10.1111/imj.12688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 12/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- H. Quach
- Department of Haematology; St Vincent's Hospital; Melbourne Victoria Australia
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - D. Joshua
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - J. Ho
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - J. Szer
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - A. Spencer
- Department of Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. Harrison
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - P. Mollee
- Amyloidosis Centre and Department of Haematology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - A. Roberts
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - N. Horvath
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - D. Talaulikar
- Department of Haematology; Canberra Hospital; Canberra Australian Capital Territory Australia
- Australian National University; Canberra Australian Capital Territory Australia
| | - B. To
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - A. Zannettino
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - R. Brown
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - L. Catley
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Haematology; Mater Public Hospital; Brisbane Queensland Australia
- Mater Medical Research Institute; Brisbane Queensland Australia
| | - B. Augustson
- Department of Haematology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - W. Jaksic
- Department of Haematology; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - J. Gibson
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - H. M. Prince
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| |
Collapse
|
5
|
Quach H, Joshua D, Ho J, Szer J, Spencer A, Harrison SJ, Mollee P, Roberts AW, Horvath N, Talulikar D, To B, Zannettino A, Brown R, Catley L, Augustson B, Jaksic W, Gibson J, Prince HM. Treatment of patients with multiple myeloma who are eligible for stem cell transplantation: position statement of the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2015; 45:94-105. [DOI: 10.1111/imj.12640] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 09/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- H. Quach
- Department of Haematology; St Vincent's Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - D. Joshua
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - J. Ho
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - J. Szer
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - A. Spencer
- Department of Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. J. Harrison
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - P. Mollee
- Amyloidosis Centre and Department of Haematology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - A. W. Roberts
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - N. Horvath
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - D. Talulikar
- Department of Haematology; Canberra Hospital; Canberra ACT Australia
- Australian National University; Canberra ACT Australia
| | - B. To
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - A. Zannettino
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - R. Brown
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - L. Catley
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Haematology; Mater Public Hospital; Brisbane Queensland Australia
- Mater Medical Research Institute; Brisbane Queensland Australia
| | - B. Augustson
- Department of Haematology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - W. Jaksic
- Department of Haematology; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - J. Gibson
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - H. M. Prince
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| |
Collapse
|
6
|
Chow AWS, Lee CHS, Hiwase DK, To LB, Horvath N. Relapsed multiple myeloma: who benefits from salvage autografts? Intern Med J 2013; 43:156-61. [DOI: 10.1111/j.1445-5994.2012.02867.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 06/07/2012] [Indexed: 11/27/2022]
Affiliation(s)
- A. W. S. Chow
- Royal Adelaide Hospital and SA Pathology; Adelaide; South Australia; Australia
| | - C. H. S. Lee
- Royal Adelaide Hospital and SA Pathology; Adelaide; South Australia; Australia
| | - D. K. Hiwase
- Royal Adelaide Hospital and SA Pathology; Adelaide; South Australia; Australia
| | - L. B. To
- Royal Adelaide Hospital and SA Pathology; Adelaide; South Australia; Australia
| | - N. Horvath
- Royal Adelaide Hospital and SA Pathology; Adelaide; South Australia; Australia
| |
Collapse
|
7
|
Joshua DE, Bashford J, Szer J, Horvath N, Spencer A, Hertzberg MS, Ashurst E, Wade J, Copeman MC, Prince HM. Response of newly diagnosed myeloma with 1q21 amplification to bortezomib-based PAD induction therapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
8
|
Quach H, Horvath N, Cannell P, Mikhael JR, Butcher BE, Prince HM. Safety and efficacy results from an international expanded access programme to bortezomib for patients with relapsed and/or refractory multiple myeloma: a subset analysis of the Australian and New Zealand data of 111 patients. Intern Med J 2009; 39:290-5. [PMID: 19371392 DOI: 10.1111/j.1445-5994.2008.01738.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bortezomib has been shown to be a safe and efficacious for the treatment of relapsed and refractory multiple myeloma (MM). Here we report a subset analysis of Australian and New Zealand data from the International Extended Access Programme for bortezomib. METHODS Patients with more than or equal to two prior lines of therapy were given bortezomib 1.3 mg/m(2) (i.v. bolus days 1, 4, 8, 11) for up to eight 21-day cycles (C). Dexamethasone, 20 mg/day p. o. on the day of, and day after, bortezomib was added after C2 for progressive disease or after C4 for stable disease. Efficacy was assessed using modified Southwest Oncology Group criteria in the intent-to-treat group. Results were compared between the Australian and New Zealand and international cohort. RESULTS One hundred and eleven patients from 16 centres (55% men, median age 61.9 years) had a median of 5.2 +/- 2.8 treatment cycles of bortezomib. Among them, 82% had > or =3 prior therapies. Grade 3-4 treatment-related adverse events were reported in 57 patients (52%); the most common were thrombocytopenia (25.7%), anaemia (8.3%), peripheral neuropathy (7.3%) and diarrhoea (7.3%). Responses were evaluable in 106 patients: 22% achieved a best response of complete response/response and 20% partial response (overall response rate of 42%). Median times to first and best responses were 42 days and 69 days, respectively. Compared with the international cohort, the cohorts from Australian and New Zealand showed inferior overall response rates (54 vs 42%, P = 0.001), possibly due to heavier pretreatment (82% greater than or equal to three prior therapies vs 68%, P < 0.001). CONCLUSION Our analysis confirms that bortezomib is safe and effective in relapsed and refractory MM in a real-life clinical setting.
Collapse
Affiliation(s)
- H Quach
- Department of Haematology and Clinical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Victoria.
| | | | | | | | | | | |
Collapse
|
9
|
Dickinson M, Prince HM, Kirsa S, Zannettino A, Gibbs SDJ, Mileshkin L, O'Grady J, Seymour JF, Szer J, Horvath N, Joshua DE. Osteonecrosis of the jaw complicating bisphosphonate treatment for bone disease in multiple myeloma: an overview with recommendations for prevention and treatment. Intern Med J 2008; 39:304-16. [PMID: 19220531 DOI: 10.1111/j.1445-5994.2008.01824.x] [Citation(s) in RCA: 37] [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: 12/01/2022]
Abstract
Osteonecrosis of the Jaw (ONJ) is a recently recognised and potentially highly morbid complication of bisphosphonate therapy in the setting of metastatic malignancy, including myeloma. Members of the Medical and Scientific Advisory Group of the Myeloma Foundation of Australia formulated guidelines for the management of bisphosphonates around the issue of ONJ, based on the best available evidence in June 2008. Prior to commencement of therapy, patients should have an oral health assessment and be educated about the risks of ONJ. Dental assessment should occur 6 monthly during therapy. If tooth extraction is required, sufficient time should be allowed for complete healing to occur prior to commencement of bisphosphonate. As the risk of ONJ increases with duration of bisphosphonate therapy, we recommend annual assessment of dose with modification to 3 monthly i.v. therapy or to oral therapy with clodronate for those with all but the highest risk of skeletal-related event. Established ONJ should be managed conservatively; a bisphosphonate "drug holiday" is usually indicated and invasive surgery should generally be avoided. These recommendations will assist with clinical decision making for myeloma patients who are at risk of bisphosphonate-associated ONJ.
Collapse
Affiliation(s)
- M Dickinson
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Hui CH, Horvath N, Lewis I, To LB, Szabo F. Outcome of patients with myelodysplastic syndromes - experience from a single institution in South Australia. Intern Med J 2008; 38:824-8. [DOI: 10.1111/j.1445-5994.2007.01582.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
11
|
Sanborn SL, Cooney M, Gibbons J, Brell J, Savvides P, Krishnamurthi S, Bokar J, Horvath N, Ness A, Remick S. Phase I trial of daily lenalidomide and docetaxel given every three weeks in patients with advanced solid tumors. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3570] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3570 Background: Lenalidomide is a potent anti-angiogenic and immune modulating agent. This phase I trial of docetaxel and lenalidomide was undertaken to evaluate the maximal tolerated dose (MTD), dose-limiting toxicity (DLT), and secondarily, any tumor response for this novel combination. Methods: Patients with advanced solid tumors with adequate organ function were eligible. Lenalidomide was given orally days 1–14, and docetaxel was administered intravenously on day 1 of each 21-day cycle. DLT was defined as grade 3 or higher non-hematologic toxicity, grade 4 neutropenia with fever, and grade 4 anemia or thrombocytopenia. Results: Nineteen patients, 14 male and 5 female, with tumor types including prostate (7), sarcoma (3), head and neck (2), pancreatic, colon, melanoma, adenocarcinoma of unknown primary, gastric, bladder, and GIST have been enrolled. ECOG performance status was zero (10 patients) or one (9 patients). The median age was 59 years (range 35 to 86). Fourteen patients had zero or one prior treatment regimens (range 0 to 6). A total of 64 cycles have been administered (range 1 to 12). In the first nine evaluable patients, eight (89%) had grade 3 or 4 neutropenia. Docetaxel 75 mg/m2 given every 3 weeks with lenalidomide 5 mg on days 1–14 exceeded the MTD due to one grade 3 nausea/vomiting and one grade 4 neutropenia with fever. After the addition of pegfilgrastim on day 2, there has not been any neutropenia in the subsequent seven evaluable patients. Other grade 3 and 4 toxicities included leukopenia (31%), lymphopenia (19%), as well as nausea, vomiting, fatigue, anemia, infection, hyponatremia, and hypokalemia (6% each). Seven patients (44%) have had stable disease (range 3 to 12 cycles). One prostate cancer patient experienced a >95% reduction of PSA. Enrollment is ongoing and the current dose level is docetaxel 75 mg/m2, lenalidomide 10 mg days 1–14, and pegfilgrastim on day 2. Conclusions: The toxicity evaluation is ongoing. This trial will provide the MTD of docetaxel 75 mg/m2 given every 3 weeks with lenalidomide on days 1–14 in combination with pegfilgrastim support to avoid neutropenia. No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | | | | | - J. Brell
- Case Medical Center, Cleveland, OH
| | | | | | - J. Bokar
- Case Medical Center, Cleveland, OH
| | | | - A. Ness
- Case Medical Center, Cleveland, OH
| | | |
Collapse
|
12
|
Snell M, Koc ON, Bahlis NJ, Liu L, Lazarus HM, Gerson SL, Laughlin MJ, Jacobberger J, Horvath N, Remick S, Cooper BW. A phase I trial of PS-341 and fludarabine for relapsed and refractory indolent non-Hodgkin’s lymphoma and chronic lymphocytic leukemia. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7580 Background: The safety and efficacy of PS-341 (bortezomib) as a single agent in relapsed and refractory hematologic malignancies has been well documented. Fludarabine is known to be active in indolent non-Hodgkin’s lymphoma (NHL) and chronic lymphocytic leukemia (CLL). PS-341 may potentiate fludarabine activity by inhibiting DNA repair and inducing apoptosis in Bcl-2 over-expressing cells. The safety of this combination was evaluated in an ongoing phase I study. An additional dose level including rituxumab has been added to potentially improve efficacy without significant additional toxicity. Methods: Dose levels were as outlined in the table below. Each cycle was 21 days. Results: To date, 13 patients have received at least one cycle of treatment and are evaluable for toxicity. Diagnoses of patients included CLL, Waldenstom’s macroglobulinemia and MALT, lymphoplasmacytoid, mantle cell and follicular lymphomas. Patients received a median of 3 prior treatments (range 1–6). DLT’s were not observed in the first 4 dose levels, however the first patient on dose level 5 experienced grade 4 neutropenia. Three patients had doses of PS-341 held due to toxicity (2 due to neuropathy and one leukopenia; doses were held during cycles 3, 4 and 2 respectively) and two required dose reductions for grade 2 neuropathy (on cycles 2 and 3). One CRu has been documented (follicular lymphoma), 1 PR (mantle cell) and 6 patients with SD for 1.5 to 3 months. One patient was taken off the study with disease progression after 1 cycle (CLL) and two discontinued treatment due to prolonged cytopenias (MCL) and patient decision. The most 2 most recent patients are not yet evaluable for response. Conclusions: Combination PS-341 and fludarabine appears to be well-tolerated and active in relapsed and refractory NHL and CLL. Enrollment and follow-up of patients on level 5 (addition of rituxan) continues. Initiation of a phase II study of this regimen is anticipated shortly. [Table: see text] No significant financial relationships to disclose.
Collapse
Affiliation(s)
- M. Snell
- Case Western Reserve University, Cleveland, OH; University of Calgary, Calgary, AB, Canada
| | - O. N. Koc
- Case Western Reserve University, Cleveland, OH; University of Calgary, Calgary, AB, Canada
| | - N. J. Bahlis
- Case Western Reserve University, Cleveland, OH; University of Calgary, Calgary, AB, Canada
| | - L. Liu
- Case Western Reserve University, Cleveland, OH; University of Calgary, Calgary, AB, Canada
| | - H. M. Lazarus
- Case Western Reserve University, Cleveland, OH; University of Calgary, Calgary, AB, Canada
| | - S. L. Gerson
- Case Western Reserve University, Cleveland, OH; University of Calgary, Calgary, AB, Canada
| | - M. J. Laughlin
- Case Western Reserve University, Cleveland, OH; University of Calgary, Calgary, AB, Canada
| | - J. Jacobberger
- Case Western Reserve University, Cleveland, OH; University of Calgary, Calgary, AB, Canada
| | - N. Horvath
- Case Western Reserve University, Cleveland, OH; University of Calgary, Calgary, AB, Canada
| | - S. Remick
- Case Western Reserve University, Cleveland, OH; University of Calgary, Calgary, AB, Canada
| | - B. W. Cooper
- Case Western Reserve University, Cleveland, OH; University of Calgary, Calgary, AB, Canada
| |
Collapse
|
13
|
Koc ON, Bahlis NJ, Liu L, Lazarus HM, Cooper BW, Gerson SL, Laughlin MJ, Jacobberger JW, Horvath N, Remick S. A phase I trial of bortezomib in combination with fludarabine in patients with lymphoproliferative neoplasms. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6647] [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)
- O. N. Koc
- Case Western Reserve Univ, Cleveland, OH
| | | | - L. Liu
- Case Western Reserve Univ, Cleveland, OH
| | | | | | | | | | | | - N. Horvath
- Case Western Reserve Univ, Cleveland, OH
| | - S. Remick
- Case Western Reserve Univ, Cleveland, OH
| |
Collapse
|
14
|
Spencer A, Horvath N, Gibson J, Prince HM, Herrmann R, Bashford J, Joske D, Grigg A, McKendrick J, Prosser I, Lowenthal R, Deveridge S, Taylor K. Prospective randomised trial of amifostine cytoprotection in myeloma patients undergoing high-dose melphalan conditioned autologous stem cell transplantation. Bone Marrow Transplant 2005; 35:971-7. [PMID: 15778725 DOI: 10.1038/sj.bmt.1704946] [Citation(s) in RCA: 57] [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: 11/08/2022]
Abstract
In this prospective multicentre trial, 90 patients undergoing autologous stem cell transplantation (ASCT) were randomised to receive (n=43) or not receive (n=47) amifostine 910 mg/m(2) prior to melphalan 200 mg/m(2). Patients were monitored for regimen-related toxicity, engraftment, supportive care, response and survival. Both groups underwent ASCT at a median of 8 months from diagnosis and were matched for disease characteristics, prior therapy and pre-ASCT disease responsiveness. Amifostine infusional side-effects were frequent, occurring in 65% of patients, but of mild severity. Amifostine use was associated with a reduction in the median grade of oral mucositis (1 vs 2, P=0.01) and the frequency of severe (WHO grades 3 or 4) mucositis (12 vs 33%, P=0.02), but no reduction in the requirement for parenteral nutrition or analgesic use. Conversion to complete remission post-ASCT occurred in 30 and 14% of the amifostine and control groups, respectively (P=0.09). With a median follow-up of 35 months, there was no statistically significant difference between the median progression-free or overall survival times for the two groups. We conclude that amifostine can be safely administered prior to high-dose melphalan and significantly reduces the frequency and severity of therapy-induced oral mucositis.
Collapse
Affiliation(s)
- A Spencer
- Clinical Haematology & BMT, The Alfred Hospital, Melbourne, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Ross DM, To LB, Horvath N. Assessment of early paraprotein response to vincristine-doxorubicin-dexamethasone chemotherapy may help guide therapy in multiple myeloma. Intern Med J 2004; 34:576-8. [PMID: 15482273 DOI: 10.1111/j.1445-5994.2004.00689.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: 10/26/2022]
Abstract
Vincristine, doxorubicin and dexamethasone (VAD) are commonly used as the initial chemotherapy in myeloma patients prior to high-dose therapy and autologous stem cell transplantation. We reviewed monoclonal protein responses and survival of 62 patients treated in this way. Among patients with IgG paraprotein, achievement of at least 50% reduction in paraprotein after the first cycle of VAD correlated with significantly better event-free survival at 3 years, compared with those having less than 50% response. We postulate that early paraprotein response may be used to identify high risk patients.
Collapse
Affiliation(s)
- D M Ross
- Division of Haematology, Institute of Medical and Veterinary Science, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | | |
Collapse
|
16
|
Horvath N, Hahn U, Joshua D, Dyson P, Gibson J, Stevens J, Rawling T, Barrow L, Brown R, Stephens S, Gower G, Norman J, Mills B, To LB. Long-term follow up of sequential mobilisation and autologous transplantation with CD34-selected cells in multiple myeloma: a multimodality approach. Intern Med J 2004; 34:167-75. [PMID: 15086696 DOI: 10.1111/j.1444-0903.2004.00552.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/30/2022]
Abstract
BACKGROUND Even after high dose chemotherapy (HDT) and autologous haemopoietic stem cell transplantation, the majority of patients with multiple myeloma eventually relapse. AIM The aim of the present study was to study the -feasibility and outcome of delivering a regimen including in vivo and in vitro purging and double HDT in patients with multiple myeloma. METHODS Thirty-four patients with advanced multiple myeloma were enrolled in a program of vincristine, doxorubicin and dexamethasone chemotherapy, high dose cyclophosphamide/granulocyte macrophage colony stimulating factor (GM-CSF) stem cell mobilisation, CD34 selection of harvested stem cells (in vitro purging), double HDT (cyclophosphamide/epirubicin in the first, busulphan/melphalan in the second) rescued by CD34(+)-selected cells, the second rescue using cells harvested following the first HDT (in vivo purging) and interferon maintenance. RESULTS Forty-four per cent of patients completed the program. Fifty-three per cent of withdrawals were as a result of insufficient stem cells. This correlated to previous chemotherapy. Therapy-related mortality was 6%. CD34(+) selection achieved more than a 2-log reduction of CD38(++) cells; in vivo purging achieved 80%. Although similar numbers of CD34(+) cells were reinfused at both HDT, platelet recovery was slower after the second HDT. Additional complete remissions were achieved after each phase of therapy, 3% at the end of vincristine, doxorubicin and dexamethasone and 33% after completing planned HDT. Factors associated with longer overall survival included age less than 60 years (P = 0.044), serum beta-2-microglobulin below 3 micro gamma/L at entry (P = 0.042) and less than 2 months between the two HDT (P = 0.024). The only factor associated with a longer event-free survival was less than 2 months between HDT on study (P = 0.038). CONCLUSIONS (i) dose intensification with two HDT delivered within 2 months might be associated with a better patient outcome, (ii) early mobilisation should be incorporated in multiple myeloma HDT programs and (iii) higher CD34(+) doses may be required for tandem transplants.
Collapse
Affiliation(s)
- N Horvath
- Department of Haematology, Institute of Medical and Veterinary Science, Adelaide, South Australia, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Roberts MM, Dyson P, Rawling C, Thorp D, Rawling T, White D, Horvath N, Bardy P, Hui CH, Dart GW, To LB, Hughes TP. Selected CD34 blood cell allografts for older patients: low transplant-related mortality, graft failure and acute GvHD. Cytotherapy 2003; 5:534-41. [PMID: 14660049 DOI: 10.1080/14653240310003594] [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: 10/26/2022]
Abstract
BACKGROUND Early transplant mortality is related to acute GvHD, which this study in older patients (40 to 60 years) decreased by reducing the graft T-cell number while maintaining a high CD34 cell number--by positive CD34 cell selection. Potential increased risk of relapse is addressed by giving donor leucocyte infusion (DLI) post-transplant. METHODS CD34 cells selected by Isolex devices from leukophereses obtained from Filgrastim-treated matched sibling donors were transplanted and DLI given later if there was no GvHD. RESULTS Selection of CD34 cells achieved a median of 5.2 million cells/kg, with minimum target for transplantation achieved in 17 of 21 donors. Median CD3 cell number was 0.24 million/kg. Engraftment was rapid and graft failure rare. Transplant-related mortality was low (6% at 3 months). Acute GvHD of >or=Grade 2 occurred in only two patients (12.5%). DLI were given to only six patients who had resolved Grade 1 or no GvHD. Eight of the 17 patients relapsed, including three of the six who had DLI. Extensive chronic GvHD developed in six of 12 evaluable patients, two of these had received DLI. Seven of the 17 patients (41%) are alive at median follow-up of 56 months. CONCLUSION CD34 selection allows transplantation of high numbers of CD34 cells with low CD3 cell count, reducing early mortality in patients 40-60 years old because of rapid hemopoietic reconstitution and low acute GvHD incidence. Administration of DLI was often precluded by low-grade acute GvHD.
Collapse
Affiliation(s)
- M M Roberts
- Division of Haematology, Hanson Centre for Cancer Research, Adelaide, South Australia
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Hui CH, Bardy P, Hughes T, Horvath N, To LB. Successful salvage of RAEB/AML relapsing early post allograft with FLAG-Ida conditioned mini-allograft: a report of two cases. Clin Lab Haematol 2001; 23:135-8. [PMID: 11488854 DOI: 10.1046/j.1365-2257.2001.00359.x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Management options are often limited for patients with AML or high grade myelodysplasia (MDS) relapsing within a year of allogeneic transplantation. We report, in two such patients, the use of re-induction with FLAG-Ida chemotherapy, followed by the infusion of GCSF-mobilized blood stem cells from the same HLA-matched donor. Both patients achieved durable complete remissions with good quality of life and longer disease-free survival than after the first myeloablative allografts. This mini-allograft approach offers a practical, well-tolerated salvage and a potentially curative treatment for relapsed AML/high grade MDS patients failing a first conventional myeloablative allogeneic transplants.
Collapse
Affiliation(s)
- C H Hui
- Clinical Haematology & Bone Marrow Transplant Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
| | | | | | | | | |
Collapse
|
19
|
|
20
|
Szabó F, Horvath N, Seimon S, Hughes T. Inappropriate antidiuretic hormone secretion, abdominal pain and disseminated varicella-zoster virus infection: an unusual triad in a patient 6 months post mini-allogeneic peripheral stem cell transplant for chronic myeloid leukemia. Bone Marrow Transplant 2000; 26:231-3. [PMID: 10918438 DOI: 10.1038/sj.bmt.1702486] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Severe abdominal pain followed by inappropriate antidiuretic hormone secretion (SIADH) preceding by several days the skin manifestation of varicella-zoster virus (VZV) infection in an immunocompromised patient is described. This is a rare presentation of a severe infection described previously only once in a chronic myeloid leukemia (CML) patient 5 months post allo-BMT during immunosuppressive treatment with cyclosporin A. This is the first case described in the setting of non-myeloablative preparation with fludarabine and melphalan and followed by donor leukocyte infusion (DLI) 2 and 4 months post allo-BMT. The influence of these factors on development of VZV virus infection is discussed. We also highlight the high incidence and high mortality in VZV infection in immunocompromised patients as well as the frequent atypical presentation.
Collapse
MESH Headings
- Abdominal Pain/etiology
- Abdominal Pain/virology
- Chickenpox/complications
- Chickenpox/etiology
- Chickenpox/virology
- Hematopoietic Stem Cell Transplantation/adverse effects
- Herpes Zoster/complications
- Herpes Zoster/etiology
- Herpes Zoster/virology
- Herpesvirus 3, Human
- Humans
- Immunocompromised Host
- Inappropriate ADH Syndrome/etiology
- Inappropriate ADH Syndrome/virology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/virology
- Leukocyte Transfusion
- Male
- Middle Aged
- Transplantation, Homologous/adverse effects
Collapse
Affiliation(s)
- F Szabó
- Royal Adelaide Hospital, Department of Haematology and Bone Marrow Transplantation, Australia
| | | | | | | |
Collapse
|
21
|
Dyson PG, Horvath N, Joshua D, Barrow L, Van Holst NG, Brown R, Gibson J, To LB. CD34+ selection of autologous peripheral blood stem cells for transplantation following sequential cycles of high-dose therapy and mobilization in multiple myeloma. Bone Marrow Transplant 2000; 25:1175-84. [PMID: 10849530 DOI: 10.1038/sj.bmt.1702408] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A potential problem of autologous transplantation in the treatment of multiple myeloma (MM) is the infusion of tumor cells. CD34+ selection has been used to purge autografts in MM and it is also possible to reduce tumour cell contamination of autografts by cytotoxic drug therapy prior to peripheral blood stem cell (PBSC) collection. To evaluate the effectiveness of a protocol combining multiple cycles of high-dose therapy and CD34+ selection to reduce tumour contamination of PBSC autografts, 34 MM patients were entered on a treatment schedule comprising two sequential cycles of mobilisation, CD34+ selection, and transplantation following high-dose therapy. In the second cycle of mobilisation there was a five-fold reduction in tumour contamination of the stem cell harvest (0.5 x 106/kg) compared with the first cycle (2.5 x 106/kg). In the 97 CD34+ selection procedures performed a median of 185 x 108 mononuclear cells (MNC) were processed yielding a median of 0.98 x 108 CD34+-enriched cells. CD34+ cells were enriched 68-fold from 1. 3% to 88.6%. The median yield of CD34+ cells was 42.2%. Following CD34+ selection the tumour cell contamination of the leukapheresis product was reduced by a median of 2.7 logs. This study demonstrates that in multiple myeloma a significant reduction in the malignant contamination of stem cell autografts can be achieved by combining the in vivo purging effect of cytotoxic therapy with in vitro purging by CD34+ selection.
Collapse
Affiliation(s)
- P G Dyson
- Division of Haematology, Hanson Centre for Cancer Research, Institute of Medical and Veterinary Science, Adelaide, South Australia
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Parry EJ, Stevens SR, Gilliam AC, Horvath N, el-Charif M, Spiro TP, Adler LP, Shina D, Kinsella T, Heyman EN, Cooper KD, Wood GS. Management of cutaneous lymphomas using a multidisciplinary approach. Arch Dermatol 1999; 135:907-11. [PMID: 10456338 DOI: 10.1001/archderm.135.8.907] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- E J Parry
- Salford Royal Hospitals, National Health Service Trust, Manchester, England
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Atopic dermatitis is a common skin disease characterized by severely pruritic eczematous patches, papular and lichenified plaques, excoriations, cracks, and erosions. Photopheresis has been shown to ameliorate the signs and symptoms of atopic dermatitis in some patients. We describe successful results with photopheresis for refractory disease in a patient who chronicled his quality of life weekly for more than 15 years before and during extracorporeal photochemotherapy.
Collapse
Affiliation(s)
- G Mohla
- Photopheresis Service, University Hospitals of Cleveland, Ireland Cancer Center, Case Western Reserve University, Ohio 44106-5028, USA
| | | | | |
Collapse
|
24
|
Lie AK, Hui CH, Rawling T, Dyson PG, Thorp D, Benic J, Rawling CM, Toogood I, Horvath N, Simmons PJ, To LB. Granulocyte colony-stimulating factor (G-CSF) dose-dependent efficacy in peripheral blood stem cell mobilization in patients who had failed initial mobilization with chemotherapy and G-CSF. Bone Marrow Transplant 1998; 22:853-7. [PMID: 9827812 DOI: 10.1038/sj.bmt.1701463] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [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: 11/08/2022]
Abstract
For 10 consecutive patients in our unit who did not show a significant rise in blood progenitor cells within 14 days following chemotherapy and G-CSF, we increased the G-CSF dose from 5 to 10 microg/kg/day (n = 9) or from 10 to 15 microg/kg/day (n = 1). As a result, there were significant increases in total yield as well as yield per apheresis of mononuclear cells, CD34+ cells and CFU-GM (P < 0.025, <0.01 and <0.005, respectively). After G-CSF dose escalation, six of the 10 patients had sufficient CD34+ cells for performing transplantation. These results demonstrate a dose-dependent response of progenitor cell mobilization by G-CSF when used in combination with chemotherapy. Moreover, increasing the dose of G-CSF as late as the third week of mobilization may still provide sufficient cell yield even with patients who did not show a significant mobilization with conventional doses of G-CSF.
Collapse
Affiliation(s)
- A K Lie
- Division of Hematology, Hanson Center for Cancer Research, Institute of Medical and Veterinary Science, Adelaide, Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
To LB, Horvath N, Dyson P, Henry J, Sykes P, Brisco M, Morley A, Bennetts B. Myeloma stem cells in autografting in multiple myeloma. J Hematother 1996; 5:557-9. [PMID: 8938529 DOI: 10.1089/scd.1.1996.5.557] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Autologous transplantation has been used increasingly over the last 10 years for the treatment of multiple myeloma. As is the case in other cancers treated by high-dose therapy and stem cell rescue, the contribution of occult tumor cells in the graft to relapse posttransplant remains to be resolved. In this report, we review the biology and differentiation of plasma cells in the context of their significance as an origin of relapse in multiple myeloma.
Collapse
Affiliation(s)
- L B To
- Division of Haematology, Hanson Centre for Cancer Research, Adelaide, S. Australia
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Hawkins T, Horvath N, Rawling C, Bayly J, Andary C, Dyson P, Ho J, Dart G, Juttner C, To B. An incremental response to high-dose therapy in multiple myeloma. Bone Marrow Transplant 1996; 17:929-35. [PMID: 8807096] [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: 02/02/2023]
Abstract
Results of conventional chemotherapy for multiple myeloma are disappointing. High-dose chemoradiotherapy with auto-transplantation is increasingly reported and some results are encouraging. We report the results of peripheral blood stem cell transplantation (PBSCT) for multiple myeloma at a single institution over a 6-year period. Forty patients, including 18 de novo patients, received debulking chemotherapy consisting of vincristine, adriamycin, and dexamethasone or methyl-prednisolone followed by stem cell mobilization with high-dose cyclophosphamide. Twenty-nine patients received PBSCT following high-dose chemoradiotherapy. Following PBSCT 92% of evaluable patients obtained at least a partial remission and 29% reached complete remission. Objective treatment responses, defined as at least a 50% reduction in serum paraprotein or marrow plasma cells, were observed following each treatment step of debulking chemotherapy, mobilization and PBSCT in 50, 42 and 71% of patients, respectively. The median overall survival from diagnosis in patients transplanted was 50 months and the median overall and progression-free survivals following transplant were 26 and 18 months, respectively. Median follow-up was 28 months. Overall treatment-related mortality was 20% but was significantly lower in de novo vs previously treated patients at 6 and 33% respectively (P = 0.027). De novo patients were more likely to obtain complete remission and had a longer overall survival following transplant but overall survival from diagnosis was similar to previously treated patients. A low serum B2M before mobilization predicted a longer progression-free survival. PBSCT needs to be considered early following diagnosis to maximise treatment response and reduce the high treatment-related mortality seen in heavily pretreated patients. In this treatment program a dose response effect in multiple myeloma was observed possibly suggesting that more intensive therapy than a single transplant may effect greater disease response.
Collapse
Affiliation(s)
- T Hawkins
- Hanson Centre for Cancer Research, Institute of Medical and Veterinary Science, Adelaide, SA, Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Winter JN, Lazarus HM, Rademaker A, Villa M, Mangan C, Tallman M, Jahnke L, Gordon L, Newman S, Byrd K, Cooper BW, Horvath N, Crum E, Stadtmauer EA, Conklin E, Bauman A, Martin J, Goolsby C, Gerson SL, Bender J, O'Gorman M. Phase I/II study of combined granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor administration for the mobilization of hematopoietic progenitor cells. J Clin Oncol 1996; 14:277-86. [PMID: 8558209 DOI: 10.1200/jco.1996.14.1.277] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [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: 01/31/2023] Open
Abstract
PURPOSE To study the toxicity and efficacy of combined granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) administration for mobilization of hematopoietic progenitor cells (HPCs). MATERIALS AND METHODS Cohorts of a minimum of five patients each were treated subcutaneously as follows: G-CSF 5 micrograms/kg on days 1 to 12 and GM-CSF at .5, 1, or 5 micrograms/kg on days 7 to 12 (cohorts 1, 2, and 3); GM-CSF 5 micrograms/kg on days 1 to 12 and G-CSF 5 micrograms/kg on days 7 to 12 (cohort 4); and G-CSF and GM-CSF 5 micrograms/kg each on days 1 to 12 (cohort 5). Ten-liter aphereses were performed on days 1 (baseline, pre-CSF), 5, 7, 11, and 13. Colony assays for granulocyte-macrophage colony-forming units (CFU-GM) and erythroid burst-forming units (BFU-E) were performed on each harvest. RESULTS The principal toxicities were myalgias, bone pain, fever, nausea, and mild thrombocytopenia, but none was dose-limiting. Four days of treatment with either G-CSF or GM-CSF resulted in dramatic and sustained increases in the numbers of CFU-GM per kilogram collected per harvest that represented 35.6 +/- 8.9- and 33.7 +/- 13.0-fold increases over baseline, respectively. This increment was attributable both to increased numbers of mononuclear cells collected per 10-L apheresis and to increased concentrations of progenitors within each collection. The administration of G-CSF to patients already receiving GM-CSF (cohort 4) caused the HPC content to surge to nearly 80-fold the baseline (P = .024); the reverse sequence, ie, the addition of GM-CSF to G-CSF, was less effective. The CFU-GM content of the baseline aphereses correlated with the maximal mobilization achieved (r = .74, P = .001). CONCLUSION Combined G-CSF and GM-CSF administration effectively and predictably mobilizes HPCs and facilitates apheresis.
Collapse
Affiliation(s)
- J N Winter
- Robert Lurie Cancer Center, Northwestern University, Chicago, IL 60611, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
To LB, Roberts MM, Haylock DN, Dyson PG, Branford AL, Thorp D, Ho JQ, Dart GW, Horvath N, Davy ML. Comparison of haematological recovery times and supportive care requirements of autologous recovery phase peripheral blood stem cell transplants, autologous bone marrow transplants and allogeneic bone marrow transplants. Bone Marrow Transplant 1992; 9:277-84. [PMID: 1350938] [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: 03/25/2023]
Abstract
The haematological recovery time, infection rate and supportive care requirements of patients receiving recovery phase autologous peripheral blood stem cell transplants (APBSCT) (n = 38), autologous bone marrow transplants (autoBMT) (n = 13) and allogeneic bone marrow transplants (alloBMT) (n = 14) were compared with respect to the time post-transplant to reach 0.1, 0.5 and 2.0 x 10(9) neutrophils/l and 50 and 150 x 10(9) platelets/l, the length of hospitalization, fever and antibiotic use, the incidence of documented infection and the number of red cell and platelet transfusions. The APBSCT group had a significantly more rapid recovery of neutrophils and platelets and their supportive care requirements were significantly less than the autoBMT and the alloBMT groups. There was no difference between the latter two groups. The most significant variables contributing to the differences in haematological recovery times were the granulocyte-macrophage progenitor (CFU-GM) dose infused and, to a lesser extent, patient age. The APBSCT group received a higher CFU-GM dose of 87 +/- 12 x 10(4)/kg BW compared with 12 +/- 5 and 17 +/- 3 x 10(4)/kg BW in the autoBMT and the alloBMT groups, respectively (p = 0.0001). Patient age showed a negative correlation with the rate of recovery because the APBSCT group, which recovered faster was also older (48 +/- 2 years, compared with 33 +/- 3 and 31 +/- 2, respectively, p = 0.0001). On multivariate analysis, CFU-GM dose was the only variable to show a significant correlation with all the haematological recovery endpoints studied in these 65 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- L B To
- Division of Haematology, Institute of Medical and Veterinary Science, Adelaide, Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Juttner CA, To LB, Roberts MM, Haylock D, Dyson PG, Branford AL, Thorp D, Ho JQK, Dart GW, Horvath N, Davy MLJ, Olweny CLM, Abdi E. Comparison of haematological recovery, toxicity and supportive care of autologous PBSC, autologous BM and allogeneic BM transplants. ACTA ACUST UNITED AC 1992. [DOI: 10.1002/stem.5530100753] [Citation(s) in RCA: 14] [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: 11/11/2022]
|
30
|
Juttner CA, To LB, Haylock DN, Dyson PG, Thorp D, Dart GW, Ho JQ, Horvath N, Bardy P. Autologous blood stem cell transplantation. Transplant Proc 1989; 21:2929-31. [PMID: 2565063] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- C A Juttner
- Leukaemia Research Unit, Institute of Medical Science, Adelaide, South Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
To LB, Haylock DN, Thorp D, Dyson PG, Branford AL, Ho JQ, Dart GD, Roberts MM, Horvath N, Bardy P. The optimization of collection of peripheral blood stem cells for autotransplantation in acute myeloid leukaemia. Bone Marrow Transplant 1989; 4:41-7. [PMID: 2564287] [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: 01/01/2023]
Abstract
Between November 1982 and November 1986 31 patients with acute myeloid leukaemia underwent peripheral blood stem cell apheresis during haemopoietic regeneration following induction chemotherapy. A retrospective analysis of the factors affecting the efficacy of stem cell harvest and of the clinical outcome of these patients was performed. The mean number of myeloid progenitor cells (CFU-GM) collected was significantly higher in the complete remission group (n = 22) than in the partial remission group (n = 9). Fifty x 10(4) CFU-GM/kg body weight or more, which produced rapid, complete and sustained haemopoietic reconstitution after autografting in our patients, were collected from six of nine patients who underwent three or four 7-litre aphereses over 5-7 days using a lymphocyte collection procedure on the Fenwal CS3000 [Protocol B] but only from two of 12 patients who underwent three or four 5-litre aphereses over 3-5 days using the Aminco Celltrifuge [Protocol A] (p less than 0.05). No adverse effects on the rates of neutrophil, platelet and lymphocyte recovery after induction chemotherapy or on long-term disease-free survival for patients who achieved a complete remission could be attributed to apheresis when compared with a historical control group of 39 patients who achieved complete remission following the same induction chemotherapy but did not undergo apheresis. We conclude that sufficient numbers of peripheral blood stem cells to produce safe and rapid haemopoietic reconstitution can be collected from most patients who achieve complete remission using apheresis Protocol B without impairment of haemopoietic recovery or adversely affecting the length of complete remission.
Collapse
Affiliation(s)
- L B To
- Leukaemia Research Unit, Institute of Medical and Veterinary Science, Adelaide, Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Roberts MM, Juttner CA, Blunden RW, Horvath N, To LB, Ho JQ, Dart GW, Kimber RJ. Consolidation therapy without maintenance for acute non-lymphoblastic leukaemia. Med J Aust 1988; 148:181-3. [PMID: 3340044] [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: 01/05/2023]
Abstract
The most effective therapy to prolong remission and to increase cure rates in patients with acute non-lymphoblastic leukaemia is uncertain, and approaches vary from one course of consolidation to two years of maintenance and intensification therapy. We report the results of brief intensive therapy with daunorubicin, cytosine arabinoside and thioguanine, and no maintenance therapy, in 72 patients with a minimum follow-up period of two years. The complete remission rate was 67%, the median duration of remission was 11 months, and 23% of patients whose leukaemias went into remission, have remained in remission for three years and longer. These results are equivalent to those that have been reported with long-term chemotherapy.
Collapse
Affiliation(s)
- M M Roberts
- Division of Haematology, Institute of Medical and Veterinary Science, Adelaide, SA
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Horvath N, Howat P. Towards health education. A critique of the AMA policy on preventive medicine. Med J Aust 1983; 1:177-9. [PMID: 6843470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|