A ∼5000 year multiproxy record of summer climate in NE Greenland

The High Arctic plays a vital role in Earth's climate system, and its ecosystems are highly sensitive to global climate change. High Arctic lakes are valuable sentinels of climate change, as their sediments integrate long-term natural climatic fluctuations and anthropogenic influences. Here, we present a high-resolution ∼5000 year-reconstruction of NE Greenland climate variability from Aucella Lake (74°N, 20°E) based on physical, chemical, and biological properties of lake sediments. We use CT-scans, hyperspectral imaging, organic matter, XRD, and diatom analyses to show that changing air temperatures were controlled by a mix of regional climatic changes and local landscape feedbacks. The latest Mid-Holocene (∼5.0-3.8 cal. ka BP) was characterized by relatively warmer conditions, while the onset of the Late-Holocene was marked by abrupt temperature decreases that coincided with the beginning of glacial advances elsewhere (∼3.8-3.4 cal. ka BP). From ∼3.4-2.4 cal. ka BP, the sedimentary record indicated progressive warming, with temperature peaking during the Medieval Climate Anomaly, although temperature rises were punctuated by abrupt, short-lived cold periods. From ∼1.1-0.05 cal. ka BP, the influence of landscape factors over the system diminished. Sedimentary indicators suggested a transition towards a colder, more humid climate, coinciding with the beginning of the Little Ice Age, that was characterized by a marked decrease in air temperature that reached minimum values at the end of this period. The last 50 years at Aucella Lake were marked by abrupt temperature rises, consistent with recently observed anthropogenic global warming. Our results illustrate the importance of high-resolution multiproxy studies for accurately characterizing lake linkages to their environment and climate.

The vanishing and the establishment of a new ecosystem on an oceanic island - Anthropogenic impacts with no return ticket

A multiproxy approach was applied to a sediment core retrieved from the deep crater Lake Funda, located in the middle of the North Atlantic Ocean on Flores Island, Azores archipelago (Portugal). The purpose of this study was to determine how this ecosystem responded to natural and anthropogenic forces over the last millennium. We distinguished three main phases in lake evolution using multiproxy reconstructions and documentary sources. (A) Climate and lake catchment processes, as well as internal ones, were the main drivers of ecosystem variability before 1335 CE, when human disturbances were absent in the Lake Funda catchment. (B) The second phase is marked by unprecedented changes in all studied proxies between 1335 and 1560 CE, including abrupt changes in the composition and diversity of diatom and chironomid assemblages. Synergistic effects from high climate variability and the onset of human disturbances in the catchment (e.g., introduction of livestock) during the Medieval Climate Anomaly-Little Ice Age transition, led to an increase in lake trophic state from mesotrophic to eutrophic conditions. (C) In the last phase (1560 CE to the present), the eutrophic conditions in Lake Funda were maintained through a positive feedback loop between lake productivity and in-lake phosphorous recycling. Variability within the lake ecosystem was mainly associated with climate variability and internal lake dynamics (e.g., phosphorus remobilization). Our results show that a paleoecological approach is crucial to understanding lake ecological states in the present-day in order to develop locally adapted management and restoration strategies. A long-term perspective enables us to understand the harmful consequences of ongoing climate change and human disturbances on lake ecosystems.

Processes driving seagrass soils composition along the western Mediterranean: The case of the southeast Iberian Peninsula

Seagrasses are distributed all along the coast of the Mediterranean Sea being Posidonia oceanica and Cymodocea nodosa the most common species. They promote sedimentation, leading to the formation of well-structured soils. Over the last decade, a growing attention has been paid to their role as CO₂ sinks in the form of organic carbon (C_org) and to their use as environmental archives. However, most of the knowledge about pedogenetic processes in these soils refer to the rhizosphere. This study aims to understand seagrass soils biogeochemistry in the rhizosphere and below, which in turn can help to understand their long term formation processes. Fifteen cores were strategically sampled along a 350 km stretch of the Southeast Iberian coast, and analyzed for elemental composition (XRF core-scanning), magnetic susceptibility, C_org content and gran size distribution. The cores were dated by ²¹⁰Pb and ¹⁴C-AMS techniques to estimate soil accretion. Principal component analysis was used to explore the main geochemical processes linked to soil formation. The results showed that terrestrial runoff plays a key role in meadow soil composition. Furthermore, C_org accumulation did not follow any general depth trend in our soil records, suggesting that temporal variation in C_org inputs is an important factor in determining carbon depth distribution within the soil. We obtained evidence that the establishment of well-developed, stable C. nodosa meadows in the Mediterranean Sea may be promoted by adverse environmental conditions to P. oceanica settlement. Metal's behavior within the meadow deposit and their interaction with organic matter and carbonates is unclear. The results presented in this paper highlight the importance of the influence of land-based inputs in the characteristics of seagrass meadow deposits, highly determining their C_org content, as well as the need for further studies on metal behavior, to understand their full potential as environmental records.

Ecology of the collapse of Rapa Nui society

Collapses of food producer societies are recurrent events in prehistory and have triggered a growing concern for identifying the underlying causes of convergences/divergences across cultures around the world. One of the most studied and used as a paradigmatic case is the population collapse of the Rapa Nui society. Here, we test different hypotheses about it by developing explicit population dynamic models that integrate feedbacks between climatic, demographic and ecological factors that underpinned the socio-cultural trajectory of these people. We evaluate our model outputs against a reconstruction of past population size based on archaeological radiocarbon dates from the island. The resulting estimated demographic declines of the Rapa Nui people are linked to the long-term effects of climate change on the island's carrying capacity and, in turn, on the ‘per-capita food supply’.

Fast deep water warming of a subtropical crater lake

Water temperature of deep lakes is often used to evaluate climate variability over long periods. Santa Maria del Oro Lake is a sub-tropical crater-lake (60 m maximum depth) almost confined by surrounding mountains, which only receives seasonal fresh water input. In order to evaluate lake thermal variations, we measured water temperatures at bottom, 4 m, 10 m, 25 m, and 32 m depth. To study lake vertical mixing process, we implemented a 3D high-resolution model forced with atmospheric variables. Field data analysis indicate an hypolimnetic warming rate of 0.1136 ± 0.0001 °C y^-1, about ten times larger than the mean global warming rate, and model results indicated that this was mainly caused by thermal diffusion between surface and bottom water layers. The lake presents a stable temperature stratification, which can reach 40 m depth during the windiest and coolest nights, indicating that the lake is oligomictic (i.e. mixes only occasionally). Inter-annual climate variability and global warming can alter the frequency of full vertical water mixing and, therefore, deep water warming. The used methodology can be useful to evaluate bottom trend temperature of subtropical lakes worldwide, and results may contribute to the use of deep lake waters as sentinels of multi-annual climate variability. As deep water mixing affects water quality, this may also be useful to better manage lake environmental services.

Management of relapsed and refractory multiple myeloma: novel agents, antibodies, immunotherapies and beyond

Despite enormous advances, management of multiple myeloma (MM) remains challenging. Multiple factors impact the decision to treat or which regimen to use at MM relapse/progression. Recent major randomized controlled trials (RCTs) showed widely varying progression-free survivals (PFS), ranging from a median of 4 months (MM-003) to 23.6 months (ASPIRE). Based on these RCTs, next-generation proteasome inhibitors (carfilzomib and ixazomib), next-generation immunomodulatory agent (pomalidomide), and monoclonal antibodies (elotuzumab and daratumumab) were approved for relapsed and refractory MM. Daratumumab, targeting CD38, has multiple mechanisms of action including modulation of the immunosuppressive bone marrow micro-environment. In addition to the remarkable single agent activity in refractory MM, daratumumab produced deep responses and superior PFS in MM when combined with lenalidomide/dexamethasone, or bortezomib/dexamethasone. Other anti-CD38 antibodies, such as isatuximab and MOR202, are undergoing assessment. Elotuzumab, targeting SLAMF7, yielded superior response rates and PFS when combined with lenalidomide/dexamethasone. New combinations of these next generation novel agents and/or antibodies are undergoing clinical trials. Venetoclax, an oral BH3 mimetic inhibiting BCL2, showed single agent activity in MM with t(11;14), and is being studied in combination with bortezomib/dexamethasone. Selinexor, an Exportin-1 inhibitor, yielded promising results in quad- or penta-refractory MM including patients resistant to daratumumab. Pembrolizumab, an anti-PD1 check-point inhibitor, is being tested in combination with lenalidomide/dexamethasone or pomalidomide/dexamethasone. Chimeric antigen receptor-T cells targeting B-cell maturation antigen have yielded deep responses in RRMM. Finally, salvage autologous stem cell transplantation (ASCT) remains an important treatment in MM relapsing/progressing after a first ASCT. Herein, the clinical trial data of these agents are summarized, cautious interpretation of RCTs highlighted, and algorithm for salvage treatment of relapse/refractory MM proposed.

Potential ash impact from Antarctic volcanoes: Insights from Deception Island's most recent eruption

Ash emitted during explosive volcanic eruptions may disperse over vast areas of the globe posing a threat to human health and infrastructures and causing significant disruption to air traffic. In Antarctica, at least five volcanoes have reported historic activity. However, no attention has been paid to the potential socio-economic and environmental consequences of an ash-forming eruption occurring at high southern latitudes. This work shows how ash from Antarctic volcanoes may pose a higher threat than previously believed. As a case study, we evaluate the potential impacts of ash for a given eruption scenario from Deception Island, one of the most active volcanoes in Antarctica. Numerical simulations using the novel MMB-MONARCH-ASH model demonstrate that volcanic ash emitted from Antarctic volcanoes could potentially encircle the globe, leading to significant consequences for global aviation safety. Results obtained recall the need for performing proper hazard assessment on Antarctic volcanoes, and are crucial for understanding the patterns of ash distribution at high southern latitudes with strong implications for tephrostratigraphy, which is pivotal to synchronize palaeoclimatic records.

Free-to-play: About addicted Whales, at risk Dolphins and healthy Minnows. Monetarization design and Internet Gaming Disorder

INTRODUCTION

Video games are not only changing due to technical innovation, but also because of new game design and monetization approaches. Moreover, elite gamer groups with financial in-game-investments co-finance all users of free-to-play-games. Besides questions on youth protection, the growing popularity of free-to-play games has fostered discussions on supposed associations to Internet Gaming Disorder (IGD).

METHOD

Children and adolescents using free-to-play browser games were examined in a German school-based representative study (N=3967; age range 12 to 18). Based on a clinical self-report AICA-S (Wölfling et al., 2011), students were categorized into non-problematic, risky, and addicted users. Psycho-social problems (SDQ; Goodman, 1997), perceived stress (PSS; Cohen, Kamarck & Mermelstein, 1983), coping strategies (BriefCOPE; Carver, 1997), and Average Revenue per (Paying) User (ARPU) were investigated as dependent variables. Furthermore, an industry classification (Freeloaders, Minnows, Dolphins, and Whales) for free-to-play gamers was used for additional relations regarding IGD, SDQ, PSS, BriefCOPE, and ARPU.

RESULTS

Among free-to-play gamers the prevalence of IGD amounted to 5.2%. Subjects classified with IGD displayed higher psycho-social symptoms than non-problematic users, reported higher degrees of perceived stress, and applied dysfunctional coping strategies more frequently. Additionally, we found a higher ARPU among subjects with IGD.

CONCLUSION

ARPU is significantly associated with IGD. Whales share significant characteristics with addicted video gamers; Dolphins might be classified as risky consumers; Minnows and Freeloaders are rather non-pathological gamers. Vulnerability for stress, dysfunctional coping, and free-to-play gaming represent an unhealthy combination.

A scoping review of caregiver burden during allogeneic HSCT: lessons learned and future directions

The extant literature documents burden among caregivers of patients undergoing a hematopoietic stem cell transplantation (HSCT), but little is known about the burden of caregivers of patients receiving outpatient and homebound HSCTs. This scoping study sought to evaluate what is known about the burden of the increasing number of adult caregivers of patients receiving outpatient HSCTs and to create practice guidelines for how to best support this vulnerable group. Online databases were searched for studies that evaluated caregiver burden in adult caregivers of HSCT patients since 2010 (the publication date of the most recent systematic review on HSCT caregiver burden). Of the 1271 articles retrieved, 12 met the inclusion criteria, though none specifically examined outpatient or homebound caregivers. Overall, studies corroborated existing literature on the experience of significant burden among HSCT caregivers across the HSCT trajectory, and highlighted the emotional costs of outpatient transplants on caregivers and the need to identify caregivers at high risk for burden early in the transplant process. Future studies of outpatient caregivers should include a comprehensive assessment of burden and seek to identify points along the transplant trajectory at which caregivers are at particular risk for negative outcomes and when intervention is most appropriate.

Peer review in hematopoietic cell transplantation: are we doing our fair share?

Peer review is believed to be important in maintaining the quality and integrity of research in academic endeavors. Recently, the value of the current peer review process, which is more than 100 years old has come into question. In the field of hematopoietic cell transplantation (HCT), peer review was unable to prevent the publication of the largest and most notorious scientific fraud in our field. In order to assess how the HCT community views and how engaged it is with the peer review process, the American Society of Blood and Marrow Transplantation conducted a survey of all of its members in 2014. The survey was sent to all active members through multiple email communications in August and September 2014. Of a total of 1183 members, 149 responded. Almost all of the respondents had participated in the peer review process, with few respondents declining ever to review manuscripts. The most common cause for declining review requests was lack of time. Most respondents (68%) thought that the current peer review process was relatively fair and unbiased, whereas only 9% of the respondents stated that they did not believe in the peer review process. In conclusion, among the respondents of this survey most felt the peer review process to be valuable and fair, however, the lack of response suggests that further study into improving the peer review process in the field of HCT is warranted in the era of electronic publishing and communication.

Detection of Tephra Layers in Antarctic Sediment Cores with Hyperspectral Imaging

Tephrochronology uses recognizable volcanic ash layers (from airborne pyroclastic deposits, or tephras) in geological strata to set unique time references for paleoenvironmental events across wide geographic areas. This involves the detection of tephra layers which sometimes are not evident to the naked eye, including the so-called cryptotephras. Tests that are expensive, time-consuming, and/or destructive are often required. Destructive testing for tephra layers of cores from difficult regions, such as Antarctica, which are useful sources of other kinds of information beyond tephras, is always undesirable. Here we propose hyperspectral imaging of cores, Self-Organizing Map (SOM) clustering of the preprocessed spectral signatures, and spatial analysis of the classified images as a convenient, fast, non-destructive method for tephra detection. We test the method in five sediment cores from three Antarctic lakes, and show its potential for detection of tephras and cryptotephras.

Upfront plerixafor plus G-CSF versus cyclophosphamide plus G-CSF for stem cell mobilization in multiple myeloma: efficacy and cost analysis study

Cyclophosphamide plus G-CSF (C+G-CSF) is one of the most widely used stem cell (SC) mobilization regimens for patients with multiple myeloma (MM). Plerixafor plus G-CSF (P+G-CSF) has demonstrated superior SC mobilization efficacy when compared with G-CSF alone and has been shown to rescue patients who fail mobilization with G-CSF or C+G-CSF. Despite the proven efficacy of P+G-CSF in upfront SC mobilization, its use has been limited, mostly due to concerns of high price of the drug. However, a comprehensive comparison of the efficacy and cost effectiveness of SC mobilization using C+G-CSF versus P+G-CSF is not available. In this study, we compared 111 patients receiving C+G-CSF to 112 patients receiving P+G-CSF. The use of P+G-CSF was associated with a higher success rate of SC collection defined as ⩾5 × 10(6) CD34+ cells/kg (94 versus 83%, P=0.013) and less toxicities. Thirteen patients in the C+G-CSF arm were hospitalized owing to complications while none in the P+G-CSF group. C+G-CSF was associated with higher financial burden as assessed using institutional-specific costs and charges (P<0.001) as well as using Medicare reimbursement rates (P=0.27). Higher rate of hospitalization, increased need for salvage mobilization, and increased G-CSF use account for these differences.

Sediment delivery and lake dynamics in a Mediterranean mountain watershed: Human-climate interactions during the last millennium (El Tobar Lake record, Iberian Range, Spain)

Land degradation and soil erosion are key environmental problems in Mediterranean mountains characterized by a long history of human occupation and a strong variability of hydrological regimes. To assess recent trends and evaluate climatic and anthropogenic impacts in these highly human modified watersheds we apply an historical approach combining lake sediment core multi-proxy analyses and reconstructions of past land uses to El Tobar Lake watershed, located in the Iberian Range (Central Spain). Four main periods of increased sediment delivery have been identified in the 8m long sediment sequence by their depositional and geochemical signatures. They took place around 16th, late 18th, mid 19th and early 20th centuries as a result of large land uses changes such as forest clearing, farming and grazing during periods of increasing population. In this highly human-modified watershed, positive synergies between human impact and humid periods led to increased sediment delivery periods. During the last millennium, the lake depositional and geochemical cycles recovered quickly after each sediment delivery event, showing strong resilience of the lacustrine system to watershed disturbance. Recent changes are characterized by large hydrological affections since 1967 with the construction of a canal from a nearby reservoir and a decreased in anthropic pressure in the watershed as rural areas were abandoned. The increased fresh water influx to the lake has caused large biological changes, leading to stronger meromictic conditions and higher organic matter accumulation while terrigenous inputs have decreased. Degradation processes in Iberian Range watersheds are strongly controlled by anthropic activities (land use changes, soil erosion) but modulated by climate-related hydrological changes (water availability, flood and runoff frequency).

Bortezomib in combination with thalidomide-dexamethasone for previously untreated multiple myeloma

In a previous trial among 137 previously untreated patients with multiple myeloma, the combination of thalidomide-dexamethasone induced remission in 66% of patients, including complete remission in 13%. In an attempt to induce more frequent remissions, we added bortezomib to this program. Between 7/03 and 3/06, 38 newly diagnosed patients with multiple myeloma received at least one, but no more than 3, courses of bortezomib in a dose of 1.3 mg/m(2) IV x 4; dexamethasone 20 mg/m(2) PO for 4 days beginning on days 1, 9, 17; thalidomide 100 mg PO daily increasing to a maximum of 200 mg. There was rapid onset of remission in 33 patients (87%) including 6 patients with complete remission (16%). Most side effects were preventable, but otherwise were usually mild and reversible. After a median of 4 months, 25 eligible patients received intensive therapy with high-dose melphalan supported by autologous blood stem cells, so that the myeloma was in complete remission in 14 patients (37% of all patients). The combination of bortezomib-thalidomide-dexamethasone was a highly effective primary treatment for newly diagnosed patients with multiple myeloma.

Graft-versus-host disease after double-unit cord blood transplantation has unique features and an association with engrafting unit-to-recipient HLA match

Manifestations of and risk factors for graft-versus-host disease (GVHD) after double-unit cord blood transplantation (DCBT) are not firmly established. We evaluated 115 DCBT recipients (median age, 37 years) who underwent transplantation for hematologic malignancies with myeloablative or nonmyeloablative conditioning and calcineurin inhibitor/mycophenolate mofetil immunosuppression. Incidence of day 180 grades II to IV and III to IV acute GVHD (aGVHD) were 53% (95% confidence interval, 44 to 62) and 23% (95% confidence interval, 15 to 31), respectively, with a median onset of 40 days (range, 14 to 169). Eighty percent of patients with grades II to IV aGVHD had gut involvement, and 79% and 85% had day 28 treatment responses to systemic corticosteroids or budesonide, respectively. Of 89 engrafted patients cancer-free at day 100, 54% subsequently had active GVHD, with 79% of those affected having persistent or recurrent aGVHD or overlap syndrome. Late GVHD in the form of classic chronic GVHD was uncommon. Notably, grades III to IV aGVHD incidence was lower if the engrafting unit human leukocyte antigen (HLA)-A, -B, -DRB1 allele match was >4/6 to the recipient (hazard ratio, 0.385; P = .031), whereas engrafting unit infused nucleated cell dose and unit-to-unit HLA match were not significant. GVHD after DCBT was common in our study, predominantly affected the gut, and had a high therapy response, and late GVHD frequently had acute features. Our findings support the consideration of HLA- A,-B,-DRB1 allele donor-recipient (but not unit-unit) HLA match in unit selection, a practice change in the field. Moreover, new prophylaxis strategies that target the gastrointestinal tract are needed.

Factors impacting stem cell mobilization failure rate and efficiency in multiple myeloma in the era of novel therapies: experience at Memorial Sloan Kettering Cancer Center

Thalidomide, lenalidomide and bortezomib have increasingly been incorporated in first-line induction therapies for multiple myeloma. Concerns regarding the impact of these agents, especially lenalidomide, on stem cell mobilization prompted us to re-evaluate the risk factors that impact mobilization, including exposure to novel induction regimens. Among 317 patients who proceeded to stem cell collection after induction therapy between 2000 and 2009, the rate of mobilization failure, defined as the inability to collect 5 × 10(6) CD34+ cells/kg following the first collection attempt, was 13%. By multivariate analysis, independent risk factors associated with mobilization failure included older age (P=0.04), lower platelet count (P=0.002) and use of single-agent G-CSF for mobilization (P<0.0001). When considering for outcome measurement stem cell collection efficiency measured by the number of CD34+ cells yielded per pheresis performed during first collection attempt, lower platelet count, use of single-agent G-CSF and older age were also associated with lower efficiency. In this population mobilized mostly with cyclophosphamide and G-CSF, the use of lenalidomide during induction was not associated with a lower stem cell collection efficiency by multivariate analysis. The data support the current International Multiple Myeloma Working Group guidelines recommending the use of cyclophosphamide and G-CSF based mobilization for patients previously exposed to lenalidomide.

Cancer-testis antigen expression and immunogenicity in AL amyloidosis

Light-chain amyloidosis (AL) is a plasma cell dyscrasia closely related to multiple myeloma. In multiple myeloma, the cancer-testis antigens (CTAs) CT7 (MAGE-C1), CT10 (MAGE-C2) and MAGE-A CTAs are expressed in up to 80% of cases. In this study, we investigated the expression and immunogenicity of several CTAs in patients with AL amyloidosis in a total of 38 bone marrow specimens by employing standard immunohistochemistry techniques on paraffin-embedded archival tissues. Plasma samples from 35 patients (27 with matched bone marrow samples) were also analyzed by ELISA for sero reactivity to a group of full-length CTA proteins. CT7 was present in 25/38 (66%) while CT10 was demonstrated in 3/38 and GAGE in 1/38 AL amyloid cases. The expression pattern was mostly focal. There were no significant differences with regard to organ involvement, response to treatment, or prognosis in CTA positive compared to negative cases. None of the specimens showed spontaneous humoral immunity to CT7, but sero reactivity was observed in individual patients to other CTAs. This study identifies CT7 as the prevalent CTA in plasma cells of patients with AL amyloidosis. Further analyses determining the biology of CTAs in AL amyloidosis and their value as potential targets for immunotherapy are warranted.

Patterns of relapse and progression in multiple myeloma patients after auto-SCT: implications for patients' monitoring after transplantation

Auto-SCT (ASCT) is widely used in first-line treatment of multiple myeloma (MM). However, most patients eventually relapse or have progression of disease (R/POD). Although precise knowledge of R/POD patterns would be important to generate evidence-based surveillance recommendations after ASCT, such data is limited in the literature, especially after introduction of the free light chain assay (FLCA). This retrospective study examined the patterns of R/POD after first-line ASCT in 273 patients, using established criteria. At the time of R/POD, only 2% of patients had no associated serological evidence of R/POD. A total of 85% had asymptomatic R/POD, first detected by serological testing, whereas 15% had symptomatic R/POD with aggressive disease, early R/POD and short survival, with poor cytogenetics and younger age identified as risk factors. Although occult skeletal lesions were found in 40% of asymptomatic patients tested following serological R/POD, yearly skeletal surveys and urine testing were poor at heralding R/POD. We found a consistent association between paraprotein types at diagnosis and R/POD, allowing informed recommendations for appropriate serological monitoring and propose a new needed criterion using FLCA for patients relapsing by FLC only. Our findings provide important evidence-based recommendations that strengthen current monitoring guidelines after first-line ASCT in MM.

Connection between El Niño-Southern Oscillation events and river nitrate concentrations in a Mediterranean river

The causes of interannual nitrate variability in rivers remain uncertain, but extreme climatic events have been suggested as drivers of large nitrate inputs to rivers. Based on a 24-year data set (1983-2006), we suggest that El Niño-Southern Oscillation (ENSO) can affect nitrate behavior in a seasonal extra-tropical stream, the Llobregat (NE Iberian Peninsula), located thousands of kilometers away from the ENSO oscillating system via atmospheric teleconnections. Two commonly used indices, the Southern Oscillation Index (SOI) and the self-calibrating-Palmer Drought Severity Index (scPDSI) showed highly significant correlations with nitrate concentrations, which recurrently increased during La Niña phases, coinciding with severe droughts.

Rapid control of previously untreated multiple myeloma with bortezomib-lenalidomide-dexamethasone (BLD)

Between April 2006 and June 2009, 34 newly diagnosed patients with multiple myeloma received one to three courses of bortezomib 1.3 mg/m(2) i.v. four times, lenalidomide 25 mg p.o. daily for 21 days and dexamethasone 20 mg/m(2) p.o. for 4 days beginning on days 1, 9 and 17 (BLD). There was rapid onset of remission in 30 patients (88%) similar to the frequency of 87% induced by a previous combination of bortezomib-thalidomide-dexamethasone (BTD). After a median of 3.6 months, 28 patients received intensive therapy with high-dose melphalan supported by autologous blood stem cells, so that the overall frequency of complete remission (CR) was 44%, similar to the frequency of 37% observed previously. Side effects due to thalidomide with previous BTD were less frequent and severe with BLD. The combination of BLD given for one or two courses was an effective primary treatment for newly diagnosed patients with multiple myeloma.