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Firestone RS, Socci ND, Shekarkhand T, Zhu M, Ge Qin W, Hultcrantz ML, Mailankody S, Tan CR, Korde N, Lesokhin AM, Hassoun H, Shah UA, Maclachlan KH, Rajeeve S, Landau HJ, Scordo M, Shah GL, Lahoud OB, Giralt SA, Murata K, Usmani SZ, Chung DJ. Antigen escape as a shared mechanism of resistance to BCMA-directed therapies in multiple myeloma. Blood 2024:blood.2023023557. [PMID: 38728378 DOI: 10.1182/blood.2023023557] [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] [Received: 01/03/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
B-cell maturation antigen (BCMA)-targeting therapeutics have dramatically improved outcomes in relapsed/refractory multiple myeloma (RRMM). However, whether the mechanisms of resistance between these therapies are shared and how the identification of such mechanisms before therapy initiation could refine clinical decision-making remains undefined. We analyzed outcomes for 72 RRMM patients treated with teclistamab, a CD3 x BCMA bispecific antibody (BsAb), 42% (30/72) of whom had prior BCMA-directed therapy exposure. Malignant plasma cell BCMA expression was present in all BCMA therapy-naïve patients. Prior therapy-mediated loss of plasma cell BCMA expression before teclistamab treatment, measured by immunohistochemistry, was observed in 3 patients, none of whom responded to teclistamab, and one of whom also did not respond to ciltacabtagene autoleucel. Whole exome sequencing of tumor DNA from one patient revealed biallelic loss of TNFRSF17 following treatment with belantamab mafodotin. Low-to-undetectable peripheral blood soluble BCMA levels correlated with the absence of BCMA expression by bone marrow plasma cells. Thus, although rare, loss of BCMA expression following TNFRSF17 gene deletions can occur following any BCMA-directed therapy and prevents response to subsequent anti-BCMA-directed treatments, underscoring the importance of verifying the presence of a target antigen.
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Affiliation(s)
- Ross S Firestone
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Nicholas D Socci
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | - Menglei Zhu
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Wei Ge Qin
- Department of Pathology and Laboratory Medicine, New York, New York, United States
| | - Malin L Hultcrantz
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Sham Mailankody
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | - Neha Korde
- Memorial Sloan Kettering, New York, New York, United States
| | | | - Hani Hassoun
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Urvi A Shah
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Kylee H Maclachlan
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | | | | | | | | | | | - Kazunori Murata
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Saad Z Usmani
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
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2
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Howard AJ, Concepcion I, Wang AX, Hamadeh IS, Hultcrantz ML, Mailankody S, Tan CR, Korde N, Lesokhin AM, Hassoun H, Shah UA, Maclachlan KH, Rajeeve S, Landau HJ, Scordo M, Shah GL, Lahoud OB, Chung DJ, Giralt SA, Usmani SZ, Firestone RS. Unscheduled healthcare interactions in multiple myeloma patients receiving T cell redirection therapies. Blood Adv 2024:bloodadvances.2024012871. [PMID: 38621239 DOI: 10.1182/bloodadvances.2024012871] [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] [Received: 02/06/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
Outcomes for relapsed/refractory multiple myeloma (RRMM) patients have dramatically improved following the development and now growing utilization of B cell maturation antigen targeted chimeric antigen receptor (CAR) T cell therapy and bispecific antibody (BsAb) therapy. However, healthcare utilization as a quality-of-life metric in these growing populations has not been thoroughly evaluated. We performed a retrospective cohort study evaluating the frequency and cause of unscheduled healthcare interactions (UHIs) among RRMM patients responding to B-cell maturation antigen targeted BsAbs and CAR T cell therapies (N = 46). This included analysis of remote UHIs including calls to physicians' offices and messages sent through an online patient portal. Our results showed that nearly all (89%) RRMM patients receiving these therapies required a UHI during the first 125 days of treatment, with a mean of 3.7 UHIs per patient. RRMM patients responding to BsAbs were significantly more likely to remotely contact their physicians' offices (1.8-fold increase, p = 0.038) or visit an urgent care center (>3-fold increase, p = 0.012) than RRMM patients responding to CAR T cell therapies. This was largely due to increased reports of mild upper respiratory tract infections in BsAb patients. Our results underscore the need to develop preemptive management strategies for commonly reported symptoms that RRMM patients experience while receiving CAR T cell or BsAb therapies. This preemptive management may significantly reduce unnecessary healthcare utilization in this vulnerable patient population.
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Affiliation(s)
- Anna J Howard
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Isabel Concepcion
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Alice X Wang
- Memorial Sloan Kettering, New York, New York, United States
| | | | - Malin L Hultcrantz
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Sham Mailankody
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | - Neha Korde
- Memorial Sloan Kettering, New York, New York, United States
| | | | - Hani Hassoun
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Urvi A Shah
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Kylee H Maclachlan
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Sridevi Rajeeve
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Heather J Landau
- Memorial Sloan-Kettering Cancer Center, New York, New York, United States
| | - Michael Scordo
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Gunjan L Shah
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Oscar B Lahoud
- NYU Langone - Perlmutter Cancer Center, Brooklyn, New York, United States
| | - David J Chung
- Memorial Sloan-Kettering Cancer Center, New York, New York, United States
| | - Sergio A Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Saad Z Usmani
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Ross S Firestone
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
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Hamadeh IS, Shekarkhand T, Rueda CJ, Firestone RS, Wang AX, Korde N, Hultcrantz ML, Lesokhin AM, Mailankody S, Hassoun H, Shah UA, Maclachlan KH, Rajeeve S, Patel D, Shah GL, Scordo M, Lahoud OB, Chung DJ, Landau HJ, Giralt SA, Usmani SZ, Tan CR. Patterns of CRS with Teclistamab in Relapsed/Refractory Multiple Myeloma patients with Prior T-Cell Redirection Therapy. Blood Adv 2024:bloodadvances.2024012724. [PMID: 38598713 DOI: 10.1182/bloodadvances.2024012724] [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] [Received: 01/22/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Teclistamab (Tec) is a first-in-class BCMA X CD3 bispecific T-cell engager antibody approved for treating multiple myeloma progressing after at least 4 lines of therapy. The objective of this study was to evaluate the rate of cytokine release syndrome (CRS) in patients who were treated with commercial Tec and had prior exposure to other T-cell redirection therapies. A retrospective chart review was performed to identify patients who completed the Tec step-up dosing phase between November 2022 and November 2023. Patients were divided into 2 cohorts based on prior exposure to T-cell redirection therapy (cohort 1: T-cell redirection therapy experienced; cohort 2: T-cell redirection therapy naïve). The primary objective was to compare the differences in the rates of CRS between the two cohorts. Univariate and multivariate logistic regression analyses were performed to assess the association between CRS rates with Tec and prior treatment with T-cell redirection therapy. A total of 72 patients were included in the analysis (27 in cohort 1 and 45 in cohort 2). The CRS rates were significantly lower in cohort 1 (37%, n=10) compared to cohort 2 (80%, n=36; p=0.0004). Based on multivariate logistic regression analysis, patients without prior exposure to T-cell redirection therapy (cohort 2) had about a 4-fold increase in the incidence of CRS (95% CI: 1.40-14.90, p=0.0002) with Tec. In our study, prior exposure to T-cell redirection therapy reduced the risk of CRS with Tec during the step-up dosing phase. This observation will allow for the optimization of CRS prophylactic strategies for Tec.
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Affiliation(s)
- Issam S Hamadeh
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | - Colin Joseph Rueda
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Ross S Firestone
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Alice X Wang
- Memorial Sloan Kettering, New York, New York, United States
| | - Neha Korde
- Memorial Sloan Kettering, New York, New York, United States
| | - Malin L Hultcrantz
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | - Sham Mailankody
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Hani Hassoun
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Urvi A Shah
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Kylee H Maclachlan
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Sridevi Rajeeve
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Dhwani Patel
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Gunjan L Shah
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Michael Scordo
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Oscar B Lahoud
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - David J Chung
- Memorial Sloan-Kettering Cancer Center, New York, New York, United States
| | - Heather J Landau
- Memorial Sloan-Kettering Cancer Center, New York, New York, United States
| | - Sergio A Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Saad Z Usmani
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
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Firestone RS, McAvoy D, Shekarkhand T, Serrano E, Hamadeh I, Wang A, Zhu M, Qin WG, Patel D, Tan CR, Hultcrantz M, Mailankody S, Hassoun H, Shah US, Korde N, Maclachlan KH, Landau HJ, Scordo M, Shah GL, Lahoud OB, Giralt S, Murata K, Hosszu KK, Chung DJ, Lesokhin AM, Usmani SZ. CD8 effector T cells enhance teclistamab response in BCMA-exposed and -naïve multiple myeloma. Blood Adv 2024; 8:1600-1611. [PMID: 37878808 PMCID: PMC10987849 DOI: 10.1182/bloodadvances.2023011225] [Citation(s) in RCA: 1] [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] [Received: 07/17/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
ABSTRACT Teclistamab, a B-cell maturation antigen (BCMA)- and CD3-targeting bispecific antibody, is an effective novel treatment for relapsed/refractory multiple myeloma (R/RMM), but efficacy in patients exposed to BCMA-directed therapies and mechanisms of resistance have yet to be fully delineated. We conducted a real-world retrospective study of commercial teclistamab, capturing both clinical outcomes and immune correlates of treatment response in a cohort of patients (n = 52) with advanced R/RMM. Teclistamab was highly effective with an overall response rate (ORR) of 64%, including an ORR of 50% for patients with prior anti-BCMA therapy. Pretreatment plasma cell BCMA expression levels had no bearing on response. However, comprehensive pretreatment immune profiling identified that effector CD8+ T-cell populations were associated with response to therapy and a regulatory T-cell population associated with nonresponse, indicating a contribution of immune status in outcomes with potential utility as a biomarker signature to guide patient management.
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Affiliation(s)
- Ross S. Firestone
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Devin McAvoy
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tala Shekarkhand
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edith Serrano
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Issam Hamadeh
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alice Wang
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Menglei Zhu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wei Ge Qin
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dhwani Patel
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carlyn R. Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Urvi S. Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kylee H. Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heather J. Landau
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Scordo
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gunjan L. Shah
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oscar B. Lahoud
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kazunori Murata
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kinga K. Hosszu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J. Chung
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexander M. Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Saad Z. Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Lesokhin A, Nath K, Shekarkhand T, Nemirovsky D, Derkach A, Costa BA, Nishimura N, Farzana T, Rueda C, Chung D, Landau H, Lahoud O, Scordo M, Shah G, Hassoun H, Maclachlan K, Korde N, Shah U, Tan CR, Hultcrantz M, Giralt S, Usmani S, Shahid Z, Mailankody S. Comparison of Infectious Complications with BCMA-directed Therapies in Multiple Myeloma. Res Sq 2024:rs.3.rs-3911922. [PMID: 38405866 PMCID: PMC10889082 DOI: 10.21203/rs.3.rs-3911922/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
B-cell-maturation-antigen (BCMA)-directed therapies are highly active for multiple myeloma, but infections are emerging as a major challenge. In this retrospective, single-center analysis we evaluated infectious complications after BCMA-targeted chimeric-antigen-receptor T-cell therapy (CAR-T), bispecific-antibodies (BsAb) and antibody-drug-conjugates (ADC). The primary endpoint was severe (grade ≥ 3) infection incidence. Amongst 256 patients, 92 received CAR-T, 55 BsAb and 109 ADC. The incidence of severe infections was higher with BsAb (40%) than CAR-T (26%) or ADC (8%), including grade 5 infections (7% vs 0% vs 0%, respectively). Comparing T-cell redirecting therapies, the incidence rate of severe infections was significantly lower with CAR-T compared to BsAb at 1-year (incidence-rate-ratio [IRR] = 0.43, 95%CI 0.25-0.76, P = 0.004). During periods of treatment-emergent hypogammaglobulinemia, BsAb recipients had higher infection rates (IRR:2.27, 1.31-3.98, P = 0.004) and time to severe infection (HR 2.04, 1.05-3.96, P = 0.036) than their CAR-T counterparts. During periods of non-neutropenia, CAR-T recipients had a lower risk (HR 0.44, 95%CI 0.21-0.93, P = 0.032) and incidence rate (IRR:0.32, 95% 0.17-0.59, P < 0.001) of severe infections than BsAb. In conclusion, we observed an overall higher and more persistent risk of severe infections with BsAb. Our results also suggest a higher infection risk during periods of hypogammaglobulinemia with BsAb, and with neutropenia in CAR-T recipients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Urvi Shah
- Memorial Sloan Kettering Cancer Center
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Shah UA, Moshier E, Derkach A, Huang Y, Mailankody S, Tan CR, Maclachlan K, Hultcrantz M, Korde N, Hassoun H, Thibaud S, Sanchez L, Rodriguez C, Richard S, Richter J, Rossi A, Cho HJ, Lesokhin A, Chari A, Usmani SZ, Jagannath S, Parekh S, Gallagher EJ. Prevalence and impact of diabetes on survival of patients with multiple myeloma in different racial groups. Blood Adv 2024; 8:236-247. [PMID: 37772981 PMCID: PMC10918423 DOI: 10.1182/bloodadvances.2023010815] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 09/30/2023] Open
Abstract
ABSTRACT Multiple myeloma (MM) is twice as common in Black individuals compared with in White individuals, and diabetes mellitus (DM) disproportionately affects Black patients. Although numerous studies have shown a correlation between DM and MM, this has not been studied in the context of race and in vivo mechanisms. We conducted a retrospective clinical study of 5383 patients with MM of which 15% had DM (White, 12% and Black, 25%). Multivariable Cox models showed reduced overall survival (OS) for patients with DM (hazard ratio, 1.27; 95% confidence interval, 1.11-1.47; P < .001). This appeared to be driven by a marked difference in OS between White patients with and without DM but not in Black patients. In contrast, obesity was associated with better OS in Black patients but not in White patients. To complement this analysis, we assessed MM growth in a genetically engineered immunocompromised nonobese diabetic (Rag1-/-/muscle creatinine kinase promoter expression of a human IGF1R [M] with a lysine [K] to arginine [R] point mutation) mouse model to evaluate the mechanisms linking DM and MM. MM.1S xenografts grew in more Rag1-/-/MKR mice and grew more rapidly in the Rag1-/-/MKR mice compared with in controls. Western blot analysis found that MM1.S xenografts from Rag1-/-/MKR mice had higher phosphorylated S6 ribosomal protein (Ser235/236) levels, indicating greater activation of the mammalian target of rapamycin pathway. Our study is, to our knowledge, the first to evaluate racial differences in DM prevalence and survival in MM, as well as the effect of DM on tumor growth in mouse models. Our results suggest that DM may contribute to the higher incidence of MM in Black patients; and to improve survival in MM, DM management cannot be ignored.
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Affiliation(s)
- Urvi A. Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Erin Moshier
- Department of Population Health Science and Policy, Mount Sinai Health System, New York, NY
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yuanhui Huang
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Carlyn R. Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Kylee Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Santiago Thibaud
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Larysa Sanchez
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cesar Rodriguez
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shambavi Richard
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Richter
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adriana Rossi
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hearn Jay Cho
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ajai Chari
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Saad Z. Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sundar Jagannath
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samir Parekh
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emily J. Gallagher
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY
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Firestone RS, Mailankody S. Current use of CAR T cells to treat multiple myeloma. Hematology Am Soc Hematol Educ Program 2023; 2023:340-347. [PMID: 38066841 PMCID: PMC10727084 DOI: 10.1182/hematology.2023000434] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Anti-B-cell maturation antigen (BCMA) chimeric antigen receptor (CAR) T-cell therapies currently approved by the US Food and Drug Administration (FDA) have dramatically improved clinical outcomes for patients with heavily pretreated multiple myeloma who have disease refractory to conventional proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies. However, despite this progress, multiple myeloma remains an incurable hematologic malignancy. In this review, we discuss practical considerations for currently FDA approved CAR T-cell therapies, including newer data evaluating those agents in earlier lines of therapy. We also discuss considerations for patients following relapse from anti-BCMA CAR T-cell therapy, which currently represents an unmet clinical need.
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Affiliation(s)
- Ross S Firestone
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sham Mailankody
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Myeloma Service, Memorial Sloan Kettering Cancer Center New York, NY
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Sadek NL, Costa BA, Nath K, Mailankody S. CAR T-Cell Therapy for Multiple Myeloma: A Clinical Practice-Oriented Review. Clin Pharmacol Ther 2023; 114:1184-1195. [PMID: 37750399 DOI: 10.1002/cpt.3057] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/02/2023] [Indexed: 09/27/2023]
Abstract
The emergence of chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment of hematologic malignancies, including multiple myeloma (MM). Two BCMA-directed CAR T-cell products - idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel) - have received US Food and Drug Administration (FDA) approval for patients with relapsed/refractory MM who underwent four or more prior lines of therapy (including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody). Despite producing unprecedented response rates in an otherwise difficult to treat patient population, CAR T-cell therapies are commonly associated with immune-related adverse events (e.g., cytokine release syndrome and neurotoxicity), cytopenias, and infections. Moreover, many patients continue to exhibit relapse post-treatment, with resistance mechanisms yet to be fully understood. Ongoing basic, translational, and clinical research efforts are poised to generate deeper insights into the optimal utilization of these therapies, improve their efficacy, minimize associated toxicity, and identify new target antigens in patients with MM.
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Affiliation(s)
- Norah Layla Sadek
- Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bruno Almeida Costa
- Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karthik Nath
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sham Mailankody
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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Nath K, Mailankody S, Usmani SZ. The Role of Chimeric Antigen Receptor T-Cell Therapy in the Era of Bispecific Antibodies. Hematol Oncol Clin North Am 2023; 37:1201-1214. [PMID: 37330347 DOI: 10.1016/j.hoc.2023.05.011] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies are a class of T-cell engaging immunotherapies that have demonstrated considerable promise for patients with blood cancers. In comparison with traditional cancer therapeutics, T-cell engaging therapies harness the power of the host immune system to attack malignant cells expressing a target antigen of interest. Although these therapies are altering the natural history of blood cancers, the availability of several products has created uncertainty regarding treatment selection. In this review, we discuss the role of CAR T-cell therapy in the emerging era of bispecific antibodies with a particular focus on multiple myeloma.
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Affiliation(s)
- Karthik Nath
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sham Mailankody
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Saad Z Usmani
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA; Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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10
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Maura F, Boyle EM, Coffey D, Maclachlan K, Gagler D, Diamond B, Ghamlouch H, Blaney P, Ziccheddu B, Cirrincione A, Chojnacka M, Wang Y, Siegel A, Hoffman JE, Kazandjian D, Hassoun H, Guzman E, Mailankody S, Shah UA, Tan C, Hultcrantz M, Scordo M, Shah GL, Landau H, Chung DJ, Giralt S, Zhang Y, Arbini A, Gao Q, Roshal M, Dogan A, Lesokhin AM, Davies FE, Usmani SZ, Korde N, Morgan GJ, Landgren O. Genomic and immune signatures predict clinical outcome in newly diagnosed multiple myeloma treated with immunotherapy regimens. Nat Cancer 2023; 4:1660-1674. [PMID: 37945755 DOI: 10.1038/s43018-023-00657-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 09/20/2023] [Indexed: 11/12/2023]
Abstract
Despite improving outcomes, 40% of patients with newly diagnosed multiple myeloma treated with regimens containing daratumumab, a CD38-targeted monoclonal antibody, progress prematurely. By integrating tumor whole-genome and microenvironment single-cell RNA sequencing from upfront phase 2 trials using carfilzomib, lenalidomide and dexamethasone with daratumumab ( NCT03290950 ), we show how distinct genomic drivers including high APOBEC mutational activity, IKZF3 and RPL5 deletions and 8q gain affect clinical outcomes. Furthermore, evaluation of paired bone marrow profiles, taken before and after eight cycles of carfilzomib, lenalidomide and dexamethasone with daratumumab, shows that numbers of natural killer cells before treatment, high T cell receptor diversity before treatment, the disappearance of sustained immune activation (that is, B cells and T cells) and monocyte expansion over time are all predictive of sustained minimal residual disease negativity. Overall, this study provides strong evidence of a complex interplay between tumor cells and the immune microenvironment that is predictive of clinical outcome and depth of treatment response in patients with newly diagnosed multiple myeloma treated with highly effective combinations containing anti-CD38 antibodies.
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Affiliation(s)
- Francesco Maura
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
| | - Eileen M Boyle
- Myeloma Research Program, NYU Langone, Perlmutter Cancer Center, New York, NY, USA
| | - David Coffey
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Kylee Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Dylan Gagler
- Myeloma Research Program, NYU Langone, Perlmutter Cancer Center, New York, NY, USA
| | - Benjamin Diamond
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Hussein Ghamlouch
- Myeloma Research Program, NYU Langone, Perlmutter Cancer Center, New York, NY, USA
| | - Patrick Blaney
- Myeloma Research Program, NYU Langone, Perlmutter Cancer Center, New York, NY, USA
| | - Bachisio Ziccheddu
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Anthony Cirrincione
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Monika Chojnacka
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Yubao Wang
- Myeloma Research Program, NYU Langone, Perlmutter Cancer Center, New York, NY, USA
| | - Ariel Siegel
- Myeloma Research Program, NYU Langone, Perlmutter Cancer Center, New York, NY, USA
| | - James E Hoffman
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Dickran Kazandjian
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily Guzman
- Genome Technology Center, NYU Langone, Perlmutter Cancer Center, New York, NY, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Carlyn Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Michael Scordo
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gunjan L Shah
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather Landau
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J Chung
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio Giralt
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yanming Zhang
- Cytogenetics Laboratory, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arnaldo Arbini
- Myeloma Research Program, NYU Langone, Perlmutter Cancer Center, New York, NY, USA
| | - Qi Gao
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mikhail Roshal
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Dogan
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander M Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Faith E Davies
- Myeloma Research Program, NYU Langone, Perlmutter Cancer Center, New York, NY, USA
| | - Saad Z Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Gareth J Morgan
- Myeloma Research Program, NYU Langone, Perlmutter Cancer Center, New York, NY, USA.
| | - Ola Landgren
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
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11
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Mi X, Penson A, Abdel-Wahab O, Mailankody S. Genetic Basis of Relapse after GPRC5D-Targeted CAR T Cells. N Engl J Med 2023; 389:1435-1437. [PMID: 37819961 DOI: 10.1056/nejmc2308544] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Xiaoli Mi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alex Penson
- Memorial Sloan Kettering Cancer Center, New York, NY
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12
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Tan CR, Derkach A, Nemirovsky D, Ciardiello A, Diamond B, Hultcrantz M, Hassoun H, Mailankody S, Shah U, Maclachlan K, Patel D, Lahoud OB, Landau HJ, Chung DJ, Shah GL, Scordo M, Giralt SA, Lesokhin A, Usmani SZ, Landgren O, Korde N. Bortezomib, lenalidomide and dexamethasone (VRd) vs carfilzomib, lenalidomide and dexamethasone (KRd) as induction therapy in newly diagnosed multiple myeloma. Blood Cancer J 2023; 13:112. [PMID: 37491332 PMCID: PMC10368661 DOI: 10.1038/s41408-023-00882-y] [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] [Received: 02/21/2023] [Revised: 06/17/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
Lenalidomide and dexamethasone with bortezomib (VRd) or carfilzomib (KRd) are commonly used induction regimens in the U.S. This single-center, retrospective study evaluated outcomes and safety of VRd and KRd. Primary endpoint was progression-free survival (PFS). Of 389 patients with newly diagnosed multiple myeloma, 198 received VRd and 191 received KRd. Median PFS was not reached (NR) in both groups; 5-year PFS was 56% (95%CI, 48-64%) for VRd and 67% (60-75%) for KRd (P = 0.027). Estimated 5-year EFS was 34% (95%CI, 27-42%) for VRd and 52% (45-60%) for KRd (P < 0.001) with corresponding 5-year OS of 80% (95%CI, 75-87%) and 90% (85-95%), respectively (P = 0.053). For standard-risk patients, 5-year PFS was 68% (95%CI, 60-78%) for VRd and 75% (65-85%) for KRd (P = 0.20) with 5-year OS of 87% (95%CI, 81-94%) and 93% (87-99%), respectively (P = 0.13). For high-risk patients, median PFS was 41 months (95%CI, 32.8-61.1) for VRd and 70.9 months (58.2-NR) for KRd (P = 0.016). Respective 5-year PFS and OS were 35% (95%CI, 24-51%) and 69% (58-82%) for VRd and 58% (47-71%) and 88% (80-97%, P = 0.044) for KRd. Overall, KRd resulted in improved PFS and EFS with a trend toward improved OS compared to VRd with associations primarily driven by improvements in outcome for high-risk patients.
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Affiliation(s)
- Carlyn Rose Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Nemirovsky
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amanda Ciardiello
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Benjamin Diamond
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Urvi Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kylee Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dhwani Patel
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oscar B Lahoud
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather J Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saad Z Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Kourelis T, Bansal R, Berdeja J, Siegel D, Patel K, Mailankody S, Htut M, Shah N, Wong SW, Sidana S, Cowan AJ, Alsina M, Cohen A, Holstein SA, Bergsagel L, Ailawadhi S, Raje N, Dhakal B, Rossi A, Lin Y. Ethical Challenges with Multiple Myeloma BCMA Chimeric Antigen Receptor T Cell Slot Allocation: A Multi-Institution Experience. Transplant Cell Ther 2023; 29:255-258. [PMID: 36681151 PMCID: PMC10040426 DOI: 10.1016/j.jtct.2023.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Abstract
Chimeric antigen receptor T cell (CAR-T) therapies are Food and Drug Administration (FDA)-approved for patients with triple refractory multiple myeloma (MM). Real-world access to CAR-T therapy remains challenging owing to supply chain limitations impacting manufacturing. The goal of this study was to evaluate the extent of this issue and how major centers are handling the challenges of CAR-T manufacturing slot allocation. MM CAR-T physician leaders at each CAR-T treatment center across the United States were surveyed. We received responses from 17 of 20 centers. A median of 1 slot is allocated per month per center, and the median number of patients per center on the waitlist since the FDA's approval of idecabtagene vicleucel is 20 (range, 5 to 100). As a result, patients remain on the waitlist for a median of 6 months (range, 2 to 8 months) prior to leukapheresis. For patient selection, all centers reported using a committee of experienced CAR-T physicians to ensure consistency. To ensure transparency, 15 centers make selection criteria, selection timelines, and priority scores readily available for CAR-T providers. Centers also reported using ethical values for selection: (1) equal treatment: time spent on waiting list (n = 12); (2) priority to the worst-off: limited therapeutic options (n = 14), MM burden (n = 11), high Hematopoietic Cell Transplantation Comorbidity Index (n = 5); (3) maximize benefit: most likely to complete apheresis (n = 13) or infusion (n = 13) or to achieve response (n = 8); and (4) social value: younger patients (n = 3). Maximizing benefit was considered the most important criterion by 10 centers. This study is the first attempt to evaluate existing issues with CAR-T access for patients with MM and the variability and challenges in patient selection. Integrating ethical resource allocation strategies, similar to those described here, into formal institutional policies would help streamline access to CAR-T therapy and protect the needs of both current and future patients and physicians.
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Affiliation(s)
| | - Radhika Bansal
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - David Siegel
- Department of Hematology/Oncology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Krina Patel
- Department of Lymphoma - Myeloma, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sham Mailankody
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer, New York, NY
| | - Myo Htut
- Division of Myeloma, Department of Hematology and Hematopietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Nina Shah
- Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
| | - Sandy W Wong
- Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
| | - Surbhi Sidana
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, California
| | - Andrew J Cowan
- Division of Medical Oncology, University of Washington Fred Hutchinson Cancer Center, Seattle, Washington
| | - Melissa Alsina
- Department of Malignant Hematology, H. L. Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Adam Cohen
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah A Holstein
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Leif Bergsagel
- Department of Hematology/Oncology,Mayo Clinic, Phoenix, Arizona
| | | | - Noopur Raje
- Center for Multiple Myeloma, Massachusetts General Hospital, Boston, MA
| | - Binod Dhakal
- BMT and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Adriana Rossi
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
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14
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Korde N, Tavitian E, Mastey D, Lengfellner J, Hevroni G, Zarski A, Salcedo M, Mailankody S, Hassoun H, Smith EL, Hultcrantz M, Shah U, Tan C, Diamond B, Shah G, Scordo M, Lahoud O, Chung DJ, Landau H, Giralt S, Derkach A, Atkinson TM, Sabbatini P, König F, Usmani SZ, Landgren O, Lesokhin AM. Association of patient activity bio-profiles with health-related quality of life in patients with newly diagnosed multiple myeloma: a prospective observational cohort study. EClinicalMedicine 2023; 57:101854. [PMID: 36895800 PMCID: PMC9989635 DOI: 10.1016/j.eclinm.2023.101854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Due to the nature of their disease, patients with multiple myeloma (MM) often have bone disease-related pain that limits physical activity and diminishes health-related quality of life (HRQOL). Digital health technology with wearables and electronic patient reported outcome (ePRO) tools can provide insights into MM HRQoL. METHODS In this prospective observational cohort study conducted at Memorial Sloan Kettering Cancer in NY, NY, USA, patients with newly diagnosed MM (n = 40) in two cohorts (Cohort A - patients <65 years; Cohort B - patients ≥65 years) were passively remote-monitored for physical activity at baseline and continuously for up to 6 cycles of induction therapy from Feb 20, 2017 to Sep 10, 2019. The primary endpoint of the study was to determine feasibility of continuous data capture, defined as 13 or more patients of each 20-patient cohort compliant with capturing data for ≥16 h of a 24-hr period in ≥60% of days of ≥4 induction cycles. Secondary aims explored activity trends with treatment and association to ePRO outcomes. Patients completed ePRO surveys (EORTC - QLQC30 and MY20) at baseline and after each cycle. Associations between physical activity measurements, QLQC30 and MY20 scores, and time from the start of treatment were estimated using a linear mixed model with a random intercept. FINDINGS Forty patients were enrolled onto study, and activity bioprofiles were compiled among 24/40 (60%) wearable user participants (wearing the device for at least one cycle). In an intention to treat feasibility analysis, 21/40 (53%) patients [12/20 (60%) Cohort A; 9/20 (45%) Cohort B] had continuous data capture. Among data captured, overall activity trended upward cycle over cycle for the entire study cohort (+179 steps/24 h per cycle; p = 0.0014, 95% CI: 68-289). Older patients (age ≥65 years) had higher increases in activity (+260 steps/24 h per cycle; p < 0.0001, 95% CI: -154 to 366) compared to younger patients (+116 steps/24 h per cycle; p = 0.21, 95% CI: -60 to 293). Activity trends associated with improvement of ePRO domains, including physical functioning scores (p < 0.0001), global health scores (p = 0.02), and declining disease burden symptom scores (p = 0.042). INTERPRETATION Our study demonstrates that feasibility of passive wearable monitoring is challenging in a newly diagnosed MM patient population due to patient use. However, overall continuous data capture monitoring remains high among willing user participants. As therapy is initiated, we show improving activity trends, mainly in older patients, and that activity bioprofiles correlate with traditional HRQOL measurements. FUNDING Grants -National Institutes of HealthP30 CA 008748, Awards - Kroll Award 2019.
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Affiliation(s)
- Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Corresponding author. Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 E.74th St., NY, 10021, USA
| | - Elizabet Tavitian
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Donna Mastey
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph Lengfellner
- Research and Technology Management, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gil Hevroni
- Department of Medicine, SUNY Downstate, New York, NY, USA
| | - Andrew Zarski
- Research and Technology Management, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghan Salcedo
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Urvi Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carlyn Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Gunjan Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oscar Lahoud
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J. Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andriy Derkach
- Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas M. Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Sabbatini
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francesca König
- Department of Physical Medicine & Rehabilitation, University of Colorado Medicine, Aurora, CO, USA
| | - Saad Z. Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Alexander M. Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Pianko MJ, Tiutan T, Derkach A, Flynn J, Salvatore SP, Jaffer-Sathick I, Rossi AC, Lahoud O, Hultcrantz M, Shah UA, Maclachlan K, Chung DJ, Shah GL, Landau HJ, Korde N, Mailankody S, Lesokhin A, Tan C, Scordo M, Jaimes EA, Giralt SA, Usmani S, Hassoun H. Assessment of renal outcome following therapy in monoclonal immunoglobulin deposition disease: Emphasizing the need for a consensus approach. Am J Hematol 2023; 98:421-431. [PMID: 36588413 PMCID: PMC10329474 DOI: 10.1002/ajh.26801] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 01/03/2023]
Abstract
Monoclonal immunoglobulin deposition disease (MIDD), often associated with plasma cell dyscrasias, predominantly affects the kidneys. In this disease, hematologic response (HR) to treatment can be reliably assessed by International Myeloma Working Group (IMWG) consensus criteria, while uniform criteria for assessing renal response are lacking. We report a retrospective analysis of renal outcomes among 34 patients with MIDD. With most patients treated with bortezomib and autologous stem cell transplantation, 26 of 28 (94%) achieved very good partial HR or better. We demonstrate that both IMWG (based on estimated glomerular filtration rate, eGFR) and amyloid (based on proteinuria) criteria are needed to capture renal response: among 28 evaluable patients, 6 (21%) had isolated proteinuria, while 13 (46%) had isolated decreased eGFR. Using both criteria, which were concordant in patients with both decreased eGFR and proteinuria, 22 of 28 patients (79%) achieved a renal response, including 2 of 7 discontinuing dialyses. All 6 patients (100%) with isolated proteinuria and 7 of 13 (54%) with isolated decreased eGFR achieved renal response, suggesting that isolated proteinuria is an early manifestation of MIDD associated with reversible renal damage. Baseline eGFR predicted renal response (p = .02 by quartile) and survival (p = .02), while HR (CR vs. non-CR) did not, probably because of high HR rate. With a median follow-up of 110 months, the median overall survival was 136 months (95% CI: 79-NR) and median renal survival had not been reached. Prospective studies using uniform renal response criteria are needed to optimize the management of MIDD.
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Affiliation(s)
- Matthew J. Pianko
- Michigan Medicine, University of Michigan Health, Ann Arbor, MI, United States
| | - Timothy Tiutan
- New York-Presbyterian – Weill Cornell Medical Center, New York, NY, United States
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Andriy Derkach
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Jessica Flynn
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Steven P. Salvatore
- New York-Presbyterian – Weill Cornell Medical Center, New York, NY, United States
| | - Insara Jaffer-Sathick
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Adriana C. Rossi
- New York-Presbyterian – Weill Cornell Medical Center, New York, NY, United States
| | - Oscar Lahoud
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Malin Hultcrantz
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Urvi A. Shah
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Kylee Maclachlan
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - David J. Chung
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Gunjan L. Shah
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Heather J. Landau
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Neha Korde
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Sham Mailankody
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Alexander Lesokhin
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Carlyn Tan
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Michael Scordo
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Edgar A. Jaimes
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Sergio A. Giralt
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Saad Usmani
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
| | - Hani Hassoun
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical School, New York, NY, United States
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16
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Cornetta K, Yao J, House K, Duffy L, Adusumilli PS, Beyer R, Booth C, Brenner M, Curran K, Grilley B, Heslop H, Hinrichs CS, Kaplan RN, Kiem HP, Kochenderfer J, Kohn DB, Mailankody S, Norberg SM, O'Cearbhaill RE, Pappas J, Park J, Ramos C, Ribas A, Rivière I, Rosenberg SA, Sauter C, Shah NN, Slovin SF, Thrasher A, Williams DA, Lin TY. Replication competent retrovirus testing (RCR) in the National Gene Vector Biorepository: No evidence of RCR in 1,595 post-treatment peripheral blood samples obtained from 60 clinical trials. Mol Ther 2023; 31:801-809. [PMID: 36518078 PMCID: PMC10014217 DOI: 10.1016/j.ymthe.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/24/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
The clinical impact of any therapy requires the product be safe and effective. Gammaretroviral vectors pose several unique risks, including inadvertent exposure to replication competent retrovirus (RCR) that can arise during vector manufacture. The US FDA has required patient monitoring for RCR, and the National Gene Vector Biorepository is an NIH resource that has assisted eligible investigators in meeting this requirement. To date, we have found no evidence of RCR in 338 pre-treatment and 1,595 post-treatment blood samples from 737 patients associated with 60 clinical trials. Most samples (75%) were obtained within 1 year of treatment, and samples as far out as 9 years after treatment were analyzed. The majority of trials (93%) were cancer immunotherapy, and 90% of the trials used vector products produced with the PG13 packaging cell line. The data presented here provide further evidence that current manufacturing methods generate RCR-free products and support the overall safety profile of retroviral gene therapy.
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Affiliation(s)
- Kenneth Cornetta
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA; Brown Center for Immunotherapy, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Jing Yao
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kimberley House
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lisa Duffy
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Claire Booth
- Molecular and Cellular Immunology, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Malcolm Brenner
- Center for Cell and Gene Therapy Baylor College of Medicine, Houston TX, USA
| | - Kevin Curran
- Memorial Sloan Kettering Cancer Center, Department of Pediatrics, New York, NY, USA; Weill Cornell Medical College, Department of Pediatrics, New York, NY, USA
| | - Bambi Grilley
- Center for Cell and Gene Therapy Baylor College of Medicine, Houston TX, USA
| | - Helen Heslop
- Center for Cell and Gene Therapy Baylor College of Medicine, Houston TX, USA
| | - Christian S Hinrichs
- Duncan and Nancy MacMillan Cancer Immunology and Metabolism Center of Excellence, New Brunswick, NJ 08901, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Rosandra N Kaplan
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD 20892, USA
| | - Hans-Peter Kiem
- Fred Hutchison Cancer Center and University of Washington, Seattle, WA, USA
| | | | - Donald B Kohn
- Departments of Microbiology, Immunology and Molecular Genetics, Pediatrics (Hematology/Oncology) and Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sham Mailankody
- Myeloma and Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Jae Park
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carlos Ramos
- Center for Cell and Gene Therapy Baylor College of Medicine, Houston TX, USA
| | - Antonio Ribas
- Jonsson Comprehensive Cancer Center at the University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | | | | | - Craig Sauter
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, MD 20892, USA
| | - Susan F Slovin
- Genitourinary Oncology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Adrian Thrasher
- Molecular and Cellular Immunology, UCL Great Ormond Street Institute of Child Health, London, UK
| | - David A Williams
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tsai-Yu Lin
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA; Brown Center for Immunotherapy, Indiana University School of Medicine, Indianapolis, IN, USA
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17
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Tan CR, Derkach A, Nemirovsky D, Ciardiello A, Diamond B, Hultcrantz M, Hassoun H, Mailankody S, Shah U, Maclachlan K, Patel D, Lahoud O, Landau H, Chung D, Shah G, Scordo M, Giralt S, Lesokhin A, Usmani S, Landgren O, Korde N. Bortezomib, Lenalidomide and Dexamethasone (VRd) vs Carfilzomib, Lenalidomide and Dexamethasone (KRd) as Induction Therapy in Newly Diagnosed Multiple Myeloma. Res Sq 2023:rs.3.rs-2583053. [PMID: 36865246 PMCID: PMC9980212 DOI: 10.21203/rs.3.rs-2583053/v1] [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] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Lenalidomide and dexamethasone with bortezomib (VRd) or carfilzomib (KRd) are commonly used induction regimens in the U.S. This single-center, retrospective study evaluated outcomes and safety of VRd and KRd. Primary endpoint was progression-free survival (PFS). Of 389 patients with newly diagnosed multiple myeloma, 198 received VRd and 191 received KRd. Median PFS was not reached (NR) in both groups; 5-year PFS was 56% (95%CI, 48%-64%) for VRd and 67% (60%-75%) for KRd (P = 0.027). Estimated 5-year EFS was 34% (95%CI, 27%-42%) for VRd and 52% (45%-60%) for KRd (P < 0.001) with corresponding 5-year OS of 80% (95%CI, 75%-87%) and 90% (85%-95%), respectively (P = 0.053). For standard-risk patients, 5-year PFS was 68% (95%CI, 60%-78%) for VRd and 75% (65%-85%) for KRd (P = 0.20) with 5-year OS of 87% (95%CI, 81%-94%) and 93% (87%-99%), respectively (P = 0.13). For high-risk patients, median PFS was 41 months (95%CI, 32.8-61.1) for VRd and 70.9 months (58.2-NR) for KRd (P = 0.016). Respective 5-year PFS and OS were 35% (95%CI, 24%-51%) and 69% (58%-82%) for VRd and 58% (47%-71%) and 88% (80%-97%, P = 0.044) for KRd. Overall, KRd resulted in improved PFS and EFS with a trend toward improved OS compared to VRd with associations primarily driven by improvements in outcome for high-risk patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Urvi Shah
- Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | | | | | | | | | - Ola Landgren
- Sylvester Comprehensive Cancer Center, University of Miami
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18
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Van Oekelen O, Nath K, Mouhieddine TH, Farzana T, Aleman A, Melnekoff DT, Ghodke-Puranik Y, Shah GL, Lesokhin A, Giralt S, Thibaud S, Rossi A, Rodriguez C, Sanchez L, Richter J, Richard S, Cho HJ, Chari A, Usmani SZ, Jagannath S, Shah UA, Mailankody S, Parekh S. Interventions and outcomes of patients with multiple myeloma receiving salvage therapy after BCMA-directed CAR T therapy. Blood 2023; 141:756-765. [PMID: 36327160 PMCID: PMC10082354 DOI: 10.1182/blood.2022017848] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
B-cell maturation antigen (BCMA)-directed chimeric antigen receptor T-cell (CAR T) therapy has demonstrated remarkable efficacy in patients with relapsed/refractory multiple myeloma, and now there are two US Food and Drug Administration-approved BCMA-directed CAR T products. However, despite high initial response rates, most patients eventually relapse. The outcomes of patients with disease recurrence after BCMA-directed CAR T have not been comprehensively studied, and such an analysis would help define optimal treatment strategies. We analyzed the salvage treatments and outcomes of 79 patients with multiple myeloma from two academic institutions, who had progression of disease after treatment with BCMA-directed CAR T. A total of 237 post-CAR T salvage treatment lines were used, and patients received a median of 2 (range, 1-10) treatment lines. The median overall survival from the date of relapse post-CAR T therapy was 17.9 months (95% confidence interval [CI], 14.0 non-estimable). The overall response rate to the first salvage regimen was 43.4%, with a median progression-free survival of 3.5 months (CI, 2.5-4.6). Thirty-five patients (44.3%) received a T-cell-engaging therapy (bispecific antibody or subsequent CAR T) as salvage treatment. The overall survival in patients who received subsequent T-cell-engaging therapy was not reached after a median follow up of 21.3 months. Patients with multiple myeloma who relapse after BCMA-directed CAR T have a limited prognosis but can be potentially treated with multiple lines of salvage therapy. T-cell-engaging therapies appear to maintain pronounced clinical activity in this setting.
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Affiliation(s)
- Oliver Van Oekelen
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Karthik Nath
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tarek H. Mouhieddine
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tasmin Farzana
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Adolfo Aleman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David T. Melnekoff
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Gunjan L. Shah
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexander Lesokhin
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Santiago Thibaud
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adriana Rossi
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cesar Rodriguez
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Larysa Sanchez
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Richter
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shambavi Richard
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hearn J. Cho
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
- Multiple Myeloma Research Foundation, Norwalk, CT
| | - Ajai Chari
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Saad Z. Usmani
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sundar Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Urvi A. Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sham Mailankody
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samir Parekh
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
- Marc and Jennifer Lipschultz Precision Immunology Institute at the Icahn School of Medicine at Mount Sinai, New York, NY
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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19
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Lipitz-Snyderman A, Chimonas S, Mailankody S, Kim M, Silva N, Kriplani A, Saltz LB, Sihag S, Tan CR, Widmar M, Zauderer M, Weingart S, Perchick W, Roman BR. Clinical value of second opinions in oncology: A retrospective review of changes in diagnosis and treatment recommendations. Cancer Med 2023; 12:8063-8072. [PMID: 36737878 PMCID: PMC10134380 DOI: 10.1002/cam4.5598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/08/2022] [Accepted: 12/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Data on the clinical value of second opinions in oncology are limited. We examined diagnostic and treatment changes resulting from second opinions and the expected impact on morbidity and prognosis. METHODS This retrospective cohort study included patients presenting in 2018 to a high-volume cancer center for second opinions about newly diagnosed colorectal, head and neck, lung, and myeloma cancers or abnormal results. Two sub-specialty physicians from each cancer type reviewed 30 medical records (120 total) using a process and detailed data collection guide meant to mitigate institutional bias. The primary outcome measure was the rate of treatment changes that were "clinically meaningful", i.e., expected to impact morbidity and/or prognosis. Among those with treatment changes, another outcome measure was the rate of clinically meaningful diagnostic changes that led to treatment change. RESULTS Of 120 cases, forty-two had clinically meaningful changes in treatment with positive expected outcomes (7 colorectal, 17 head and neck, 11 lung, 7 myeloma; 23-57%). Two patients had negative expected outcomes from having sought a second opinion, with worse short-term morbidity and unchanged long-term morbidity and prognosis. All those with positive expected outcomes had improved expected morbidity (short- and/or long-term); 11 (0-23%) also had improved expected prognosis. Nine involved a shift from treatment to observation; 21 involved eliminating or reducing the extent of surgery, compared to 6 adding surgery or increasing its extent. Of the 42 with treatment changes, 13 were due to clinically meaningful diagnostic changes (1 colorectal, 5 head and neck, 3 lung, 4 myeloma; 3%-17%) . CONCLUSIONS Second-opinion consultations sometimes add clinical value by improving expected prognoses; more often, they offer treatment de-escalations, with corresponding reductions in expected short- and/or long-term morbidity. Future research could identify subgroups of patients most likely to benefit from second opinions.
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Affiliation(s)
- Allison Lipitz-Snyderman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Susan Chimonas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sham Mailankody
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michelle Kim
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nicholas Silva
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anuja Kriplani
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Leonard B Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Smita Sihag
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carlyn Rose Tan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria Widmar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marjorie Zauderer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Saul Weingart
- Rhode Island Hospital and Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Wendy Perchick
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Benjamin R Roman
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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20
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Affiliation(s)
- Karthik Nath
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bruno A Costa
- Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sham Mailankody
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer, New York, NY, USA. .,Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
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21
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Shah UA, Whiting K, Devlin S, Ershler R, Kanapuru B, Lee DJ, Tahri S, Gwise T, Rustad EH, Mailankody S, Lesokhin AM, Kazandjian D, Maura F, Auclair D, Birmann BM, Usmani SZ, Gormley N, Marinac CR, Landgren O. Extreme body mass index and survival in newly diagnosed multiple myeloma patients. Blood Cancer J 2023; 13:13. [PMID: 36631444 PMCID: PMC9834289 DOI: 10.1038/s41408-022-00782-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Affiliation(s)
- Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Department of Medicine, Weill Cornell Medical College, 400 East 67th Street, New York, NY, 10065, USA.
| | - Karissa Whiting
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, 1275 York Avenue, New York, NY, 10065, USA
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, 1275 York Avenue, New York, NY, 10065, USA
| | - Rachel Ershler
- Division of Hematologic Malignancies II, Center for Drug Evaluation and Research, U.S. Food, and Drug Administration, 5901-B Ammendale Road, Beltsville, MD, 20705-1266, USA
| | - Bindu Kanapuru
- Division of Hematologic Malignancies II, Center for Drug Evaluation and Research, U.S. Food, and Drug Administration, 5901-B Ammendale Road, Beltsville, MD, 20705-1266, USA
| | - David J Lee
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
| | - Sabrin Tahri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Hematology, Erasmus University Medical Center, 3000CA, Rotterdam, The Netherlands
| | - Thomas Gwise
- Division of Biometrics IX, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 5901-B Ammendale Road, Beltsville, MD, 20705-1266, USA
| | - Even H Rustad
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital Radiumhospitalet, 0379, Oslo, Norway
- Department of Medicine, Lovisenberg Diaconal Hospital, 0456, Oslo, Norway
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, 400 East 67th Street, New York, NY, 10065, USA
| | - Alexander M Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, 400 East 67th Street, New York, NY, 10065, USA
| | - Dickran Kazandjian
- Department of Medicine, Sylvester Comprehensive Cancer Center at the University of Miami, 1475 NW 12th Avenue, Miami, FL, 33136, USA
| | - Francesco Maura
- Department of Medicine, Sylvester Comprehensive Cancer Center at the University of Miami, 1475 NW 12th Avenue, Miami, FL, 33136, USA
| | - Daniel Auclair
- Multiple Myeloma Research Foundation, 383 Main Avenue #5, Norwalk, CT, 06851, USA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA
| | - Saad Z Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Medicine, Weill Cornell Medical College, 400 East 67th Street, New York, NY, 10065, USA
| | - Nicole Gormley
- Division of Hematologic Malignancies II, Center for Drug Evaluation and Research, U.S. Food, and Drug Administration, 5901-B Ammendale Road, Beltsville, MD, 20705-1266, USA
| | - Catherine R Marinac
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Ola Landgren
- Department of Medicine, Sylvester Comprehensive Cancer Center at the University of Miami, 1475 NW 12th Avenue, Miami, FL, 33136, USA
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22
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Nath K, Shekarkhand T, Salcedo M, Derkach A, Rueda S, Chansakul A, Hulcrantz M, Korde N, Shah UA, Tan C, Chung DJ, Lahoud OB, Hassoun H, Lesokhin AM, Landau HJ, Shah G, Scordo M, Giralt SA, Usmani SZ, Roshal M, Landgren O, Mailankody S. A short course of daratumumab in patients with multiple myeloma and minimal residual disease after induction therapy. Leuk Lymphoma 2022; 63:3488-3492. [PMID: 36282633 DOI: 10.1080/10428194.2022.2131417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/15/2022] [Accepted: 09/20/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Karthik Nath
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tala Shekarkhand
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghan Salcedo
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andriy Derkach
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Siobhan Rueda
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Aisara Chansakul
- Emergency Department, Division of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Malin Hulcrantz
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neha Korde
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Urvi A Shah
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carlyn Tan
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J Chung
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oscar B Lahoud
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hani Hassoun
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander M Lesokhin
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather J Landau
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gunjan Shah
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Scordo
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio A Giralt
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saad Z Usmani
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mikhail Roshal
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sham Mailankody
- Department of Medicine, Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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23
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Green AK, Tabatabai SM, Aghajanian C, Landgren O, Riely GJ, Sabbatini P, Bach PB, Begg CB, Lipitz-Snyderman A, Mailankody S. Clinical Trial Participation Among Older Adult Medicare Fee-for-Service Beneficiaries With Cancer. JAMA Oncol 2022; 8:1786-1792. [PMID: 36301585 PMCID: PMC9614676 DOI: 10.1001/jamaoncol.2022.5020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/11/2022] [Indexed: 11/14/2022]
Abstract
Importance Clinical trials play a critical role in the development of novel cancer therapies, and precise estimates of the frequency with which older adult patients with cancer participate in clinical trials are lacking. Objective To estimate the proportion of older adult Medicare Fee-for-Service (FFS) beneficiaries with cancer who participate in interventional cancer clinical trials, using a novel population-based methodology. Design, Setting, and Participants In this retrospective cohort study evaluating clinical trial participation among older adult patients with cancer from January 1, 2014, through June 30, 2020, claims data from Medicare FFS were linked with the ClinicalTrials.gov to determine trial participation through the unique National Clinical Trial (NCT) identifier. The proportion of patients with newly diagnosed or newly recurrent cancer in 2015 participating in an interventional clinical trial and receiving active cancer treatment from January 2014 to June 2020 was estimated. Data analysis was performed from November 18, 2020, to November 1, 2021. Exposures Patients with cancer aged 65 years or older with Medicare FFS insurance, with and without active cancer treatment. Main Outcomes and Measures Enrollment in clinical trials among all patients with cancer 65 years and older and among patients receiving active cancer treatments as defined by the presence of at least 1 NCT identifier corresponding to an interventional cancer clinical trial in Medicare claims. Results Among 1 150 978 patients (mean [SD] age, 75.7 [8.4] years; 49.9% men and 50.1% women) with newly diagnosed or newly recurrent cancer in 2015, 12 028 (1.0%) patients had a billing claim with an NCT identifier indicating enrollment in an interventional cancer clinical trial between January 2014 and June 2020. In a subset of 429 343 patients with active cancer treatment, 8360 (1.9%) were enrolled in 1 or more interventional trials. Patients enrolled in a trial tended to be younger, male, a race other than Black, and residing in zip codes with high median incomes. Conclusions and Relevance Findings of this cohort study show that clinical trial enrollment among older adult patients with cancer remains low, with only 1.0% to 1.9% of patients with newly diagnosed or recurrent cancer in 2015 participating in an interventional cancer clinical trial as measured by the presence of NCT identifiers in Medicare claims. These data provide a contemporary estimate of trial enrollment, persistent disparities in trial participation, and only limited progress in trial access over the past 2 decades.
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Affiliation(s)
- Angela K. Green
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sara M. Tabatabai
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carol Aghajanian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Gregory J. Riely
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul Sabbatini
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Colin B. Begg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allison Lipitz-Snyderman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sham Mailankody
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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24
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Shah UA, Maclachlan KH, Derkach A, Salcedo M, Barnett K, Caple J, Blaslov J, Tran L, Ciardiello A, Burge M, Shekarkhand T, Adintori P, Cross J, Pianko MJ, Hosszu K, McAvoy D, Mailankody S, Korde N, Hultcrantz M, Hassoun H, Tan CR, Lu SX, Patel D, Diamond B, Shah G, Scordo M, Lahoud O, Chung DJ, Landau H, Usmani SZ, Giralt S, Taur Y, Landgren CO, Block G, Block T, Peled JU, van den Brink MRM, Lesokhin AM. Sustained Minimal Residual Disease Negativity in Multiple Myeloma is Associated with Stool Butyrate and Healthier Plant-Based Diets. Clin Cancer Res 2022; 28:5149-5155. [PMID: 36170461 PMCID: PMC9722533 DOI: 10.1158/1078-0432.ccr-22-0723] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/23/2022] [Accepted: 09/26/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE Sustained minimal residual disease (MRD) negativity is associated with long-term survival in multiple myeloma. The gut microbiome is affected by diet, and in turn can modulate host immunity, for example through production of short-chain fatty acids including butyrate. We hypothesized that dietary factors affect the microbiome (abundance of butyrate-producing bacteria or stool butyrate concentration) and may be associated with multiple myeloma outcomes. EXPERIMENTAL DESIGN We examined the relationship of dietary factors (via a food frequency questionnaire), stool metabolites (via gas chromatography-mass spectrometry), and the stool microbiome (via 16S sequencing - α-diversity and relative abundance of butyrate-producing bacteria) with sustained MRD negativity (via flow cytometry at two timepoints 1 year apart) in myeloma patients on lenalidomide maintenance. The Healthy Eating Index 2015 score and flavonoid nutrient values were calculated from the food frequency questionnaire. The Wilcoxon rank sum test was used to evaluate associations with two-sided P < 0.05 considered significant. RESULTS At 3 months, higher stool butyrate concentration (P = 0.037), butyrate producers (P = 0.025), and α-diversity (P = 0.0035) were associated with sustained MRD negativity. Healthier dietary proteins, (from seafood and plants), correlated with butyrate at 3 months (P = 0.009) and sustained MRD negativity (P = 0.05). Consumption of dietary flavonoids, plant nutrients with antioxidant effects, correlated with stool butyrate concentration (anthocyanidins P = 0.01, flavones P = 0.01, and flavanols P = 0.02). CONCLUSIONS This is the first study to demonstrate an association between a plant-based dietary pattern, stool butyrate production, and sustained MRD negativity in multiple myeloma, providing rationale to evaluate a prospective dietary intervention.
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Affiliation(s)
- Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Kylee H Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meghan Salcedo
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kelly Barnett
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julia Caple
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jenna Blaslov
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Linh Tran
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amanda Ciardiello
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miranda Burge
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tala Shekarkhand
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter Adintori
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Justin Cross
- Donald B. and Catherine C. Marron Cancer Metabolism Center, Sloan Kettering Institute, New York, New York
| | - Matthew J Pianko
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kinga Hosszu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Devin McAvoy
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Carlyn R Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sydney X Lu
- Department of Medicine, Division of Hematology, Stanford University School of Medicine, Palo Alto, California
| | - Dhwani Patel
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin Diamond
- Myeloma Program, Department of Medicine, University of Miami, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Gunjan Shah
- Department of Medicine, Weill Cornell Medical College, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Scordo
- Department of Medicine, Weill Cornell Medical College, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oscar Lahoud
- Department of Medicine, Weill Cornell Medical College, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David J Chung
- Department of Medicine, Weill Cornell Medical College, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heather Landau
- Department of Medicine, Weill Cornell Medical College, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Saad Z Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio Giralt
- Department of Medicine, Weill Cornell Medical College, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ying Taur
- Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - C Ola Landgren
- Myeloma Program, Department of Medicine, University of Miami, Sylvester Comprehensive Cancer Center, Miami, Florida
| | | | | | - Jonathan U Peled
- Department of Medicine, Weill Cornell Medical College, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marcel R M van den Brink
- Department of Medicine, Weill Cornell Medical College, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexander M Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
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25
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Hubbeling H, Silverman E, Tomas AA, Tringale K, Wijetunga N, Hajj C, Mailankody S, Batlevi C, Dahi P, Giralt S, Lin R, Park J, Scordo M, Sauter C, Shah G, Perales M, Palomba M, Shouval R, Yahalom J, Imber B. Radiotherapy for Relapse after Chimeric Antigen Receptor T Cell Therapy in Hematologic Malignancies. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.437] [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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26
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Godkhindi V, Mailankody S, Udupa K, Pai A, Kudva R, V G, Pai K, Mathew M, PS S, Sharma S, Singh B, Nayak D, Babu K Udupa C, HC D. 404P Adolescent & young adult cancers (AYA): Experience from a large rural teaching hospital in South India. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.435] [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: 12/05/2022] Open
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27
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Mailankody S, Salcedo M, Tavitian E, Burge M, Korde N, Hassoun H, Lesokhin A, Lahoud O, Smith E, Hultcrantz M, Tan C, Shah U, Devlin S, Landgren O. Ixazomib and dexamethasone in high risk smoldering multiple myeloma: a clinical and correlative pilot study. Leuk Lymphoma 2022; 63:2760-2761. [PMID: 35838493 DOI: 10.1080/10428194.2022.2095626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Meghan Salcedo
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Miranda Burge
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Alexander Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Oscar Lahoud
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- BMT service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Smith
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Carlyn Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Urvi Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Myeloma Program and Experimental Therapeutics Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
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28
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Mailankody S, Devlin SM, Landa J, Nath K, Diamonte C, Carstens EJ, Russo D, Auclair R, Fitzgerald L, Cadzin B, Wang X, Sikder D, Senechal B, Bermudez VP, Purdon TJ, Hosszu K, McAvoy DP, Farzana T, Mead E, Wilcox JA, Santomasso BD, Shah GL, Shah UA, Korde N, Lesokhin A, Tan CR, Hultcrantz M, Hassoun H, Roshal M, Sen F, Dogan A, Landgren O, Giralt SA, Park JH, Usmani SZ, Rivière I, Brentjens RJ, Smith EL. GPRC5D-Targeted CAR T Cells for Myeloma. N Engl J Med 2022; 387:1196-1206. [PMID: 36170501 DOI: 10.1056/nejmoa2209900] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T-cell therapies have generated responses in patients with advanced myeloma, but relapses are common. G protein-coupled receptor, class C, group 5, member D (GPRC5D) has been identified as an immunotherapeutic target in multiple myeloma. Preclinical studies have shown the efficacy of GPRC5D-targeted CAR T cells, including activity in a BCMA antigen escape model. METHODS In this phase 1 dose-escalation study, we administered a GPRC5D-targeted CAR T-cell therapy (MCARH109) at four dose levels to patients with heavily pretreated multiple myeloma, including patients with relapse after BCMA CAR T-cell therapy. RESULTS A total of 17 patients were enrolled and received MCARH109 therapy. The maximum tolerated dose was identified at 150×106 CAR T cells. At the 450×106 CAR T-cell dose, 1 patient had grade 4 cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS), and 2 patients had a grade 3 cerebellar disorder of unclear cause. No cerebellar disorder, ICANS of any grade, or cytokine release syndrome of grade 3 or higher occurred in the 12 patients who received doses of 25×106 to 150×106 cells. A response was reported in 71% of the patients in the entire cohort and in 58% of those who received doses of 25×106 to 150×106 cells. The patients who had a response included those who had received previous BCMA therapies; responses were observed in 7 of 10 such patients in the entire cohort and in 3 of 6 such patients who received 25×106 to 150×106 cells. CONCLUSIONS The results of this study of a GPRC5D-targeted CAR T-cell therapy (MCARH109) confirm that GPRC5D is an active immunotherapeutic target in multiple myeloma. (Funded by Juno Therapeutics/Bristol Myers Squibb; ClinicalTrials.gov number, NCT04555551.).
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Affiliation(s)
- Sham Mailankody
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Sean M Devlin
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Jonathan Landa
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Karthik Nath
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Claudia Diamonte
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Elizabeth J Carstens
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Douglas Russo
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Romany Auclair
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Lisa Fitzgerald
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Briana Cadzin
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Xiuyan Wang
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Devanjan Sikder
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Brigitte Senechal
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Vladimir P Bermudez
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Terence J Purdon
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Kinga Hosszu
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Devin P McAvoy
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Tasmin Farzana
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Elena Mead
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Jessica A Wilcox
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Bianca D Santomasso
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Gunjan L Shah
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Urvi A Shah
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Neha Korde
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Alexander Lesokhin
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Carlyn R Tan
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Malin Hultcrantz
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Hani Hassoun
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Mikhail Roshal
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Filiz Sen
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Ahmet Dogan
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Ola Landgren
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Sergio A Giralt
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Jae H Park
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Saad Z Usmani
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Isabelle Rivière
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Renier J Brentjens
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Eric L Smith
- From the Myeloma Service (S.M., U.A.S., N.K., A.L., C.R.T., M.H., H.H., O.L., S.Z.U.), the Cellular Therapy Service (S.M., K.N., L.F., B.C., T.F., G.L.S., A.L., S.A.G., J.H.P., S.Z.U.), the Adult Bone Marrow Transplantation Service (G.L.S., S.A.G.), and the Leukemia Service (J.H.P.), Department of Medicine, the Departments of Epidemiology and Biostatistics (S.M.D.), Radiology (J.L.), and Pathology and Laboratory Medicine (R.A., M.R., F.S., A.D.), the Cell Therapy and Cell Engineering Facility (X.W., D.S., B.S., V.P.B., I.R.), the Center for Cell Engineering and the Molecular Pharmacology Program (X.W., I.R.), and the Departments of Pediatrics (K.H., D.P.M.), Anesthesiology and Critical Care Medicine (E.M., S.Z.U.), and Neurology (J.A.W., B.D.S.), Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College (S.M., G.L.S., U.A.S., N.K., A.L., C.R.T., M.H., H.H., S.A.G., J.H.P., S.Z.U.), New York, and the Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo (C.D., T.J.P., R.J.B.) - all in New York; the Department of Medical Oncology, Dana-Farber Cancer Center, Boston (E.J.C., D.R., E.L.S.); and the Myeloma Division, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
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Kuo AM, Hassoun H, Shah U, Gordon A, Hollmann TJ, Landau HJ, Lezcano C, Mailankody S, Tan CC, Lesokhin AM, Markova A. Dupilumab for the treatment of refractory lenalidomide rash in patients with multiple myeloma. Leuk Lymphoma 2022; 63:2233-2237. [PMID: 35532206 PMCID: PMC9680041 DOI: 10.1080/10428194.2022.2068002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/23/2022] [Accepted: 04/09/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Alyce M. Kuo
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Urvi Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Allison Gordon
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Travis J. Hollmann
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Heather J. Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cecilia Lezcano
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carlyn C. Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander M. Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Lahoud OB, Landau H, Nguyen J, Devlin S, Lendvai N, Weltz J, Ayorinde T, Chung DJ, Lesokhin AM, Kewalramani T, Korde N, Mailankody S, Landgren CO, Giralt S, Comenzo RL, Hassoun H. Continuous induction with lenalidomide/dexamethasone versus autologous stem cell transplantation in newly diagnosed multiple myeloma: a case for response-adapted approach. Leuk Lymphoma 2022; 63:2126-2135. [PMID: 35648041 PMCID: PMC9703606 DOI: 10.1080/10428194.2022.2062347] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
Although upfront autologous stem cell transplantation (ASCT) generally improves progression-free survival (PFS) in newly diagnosed multiple myeloma (NDMM), the overall survival (OS) benefit and optimal timing of ASCT are not well established. Patients with early response may be able to safely continue induction and avoid ASCT without compromised outcomes. We report an extended follow-up analysis of a phase 2 trial that randomized transplant-eligible patients with NDMM who responded to induction (50/65 patients) to continued induction or ASCT; median follow-up was 8.0 years. Patients had similar 8-year PFS (55% vs. 43%), 8-year OS (83% vs. 72%), and rates of at least very good partial response (72% vs. 84%) whether continuing induction of lenalidomide and dexamethasone (Ld arm) or receiving ASCT (Ld + ASCT arm) (p = 0.5). Notably, over 50% of patients receiving continuous Ld had PFS of 5-10 years. These results suggest the need for prospective trials incorporating response-adapted therapeutic approaches to NDMM.STATEMENT OF PRIOR PRESENTATIONPresented in abstract form (interim analysis) at the 56th annual meeting of the American Society of Hematology (San Francisco, CA, 6 December 2014) and at the 57th annual meeting of the American Society of Hematology (Orlando, FL, 3 December 2015).
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Affiliation(s)
- Oscar B. Lahoud
- Adult Bone Marrow Transplant Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather Landau
- Adult Bone Marrow Transplant Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Nguyen
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean Devlin
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nikoletta Lendvai
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan Weltz
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timininu Ayorinde
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J. Chung
- Adult Bone Marrow Transplant Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander M. Lesokhin
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tarun Kewalramani
- Department of Hematology/Oncology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Neha Korde
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sham Mailankody
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C. Ola Landgren
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymond L. Comenzo
- Hematology/Oncology Service, Department of Medicine, Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
| | - Hani Hassoun
- Myeloma Service, Division of Hematologic Malignancies, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bajpai J, Mailankody S, Budukh A, Swaminathan R, Dikshit R, Perera S, Dhimal M, Tshomo U, Bagal S, Bhise M, Banavali S, Gupta S, Chaturvedi P, Badwe R, Trama A. 1336P Epidemiology of rare cancers in South Asian Association for Regional Cooperation (SAARC) countries: Remembering the forgotten. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1468] [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: 11/26/2022] Open
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Mailankody S, Lewis Salins S, Pai A, Udupa K, Shenoy R, Sherigar P, Rao S. 1608P Feasibility of the PENS approach for breaking bad news (BBN) in the Indian oncology outpatient setting. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1701] [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: 11/01/2022] Open
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Affiliation(s)
- Sham Mailankody
- From the Myeloma and Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (S.M.); and the Division of Myeloma, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
| | - Ola Landgren
- From the Myeloma and Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (S.M.); and the Division of Myeloma, Sylvester Comprehensive Cancer Center, University of Miami, Miami (O.L.)
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Mohan M, Becnel MR, Shah UA, Dong H, Gundarlapalli S, Peterson T, Orozco JS, Horowitz S, Chhabra S, Dhakal B, Thanendrarajan S, Radhakrishnan SV, Hadidi SA, Tan C, Mailankody S, Hultcrantz M, Korde N, Hassoun H, Lesokhin AM, Thomas SK, Patel KK, Manasanch EE, Weber DM, Szabo A, Kaufman GP, Lee HC, Zangari M, van Rhee F, Usmani SZ, D’Souza A, Orlowski RZ, Schinke C. Clinical efficacy of sequencing CD38 targeting monoclonal antibodies in relapsed refractory multiple myeloma: A multi-institutional experience. Am J Hematol 2022; 97:E276-E280. [PMID: 35472167 PMCID: PMC10476149 DOI: 10.1002/ajh.26580] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/26/2022] [Accepted: 04/18/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Meera Mohan
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Melody Renee Becnel
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Urvi A. Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Huaying Dong
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Sravani Gundarlapalli
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | | | - Sandra Horowitz
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Saurabh Chhabra
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Binod Dhakal
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Sharmilan Thanendrarajan
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Samer Al Hadidi
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Carlyn Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander M. Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sheeba K. Thomas
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Krina K. Patel
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Elisabet E. Manasanch
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Donna M. Weber
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Aniko Szabo
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Gregory P. Kaufman
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Hans C. Lee
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Maurizio Zangari
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Frits van Rhee
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Saad Z. Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anita D’Souza
- Medical College of Wisconsin, Froedtert Clinical Cancer Center, Division of Hematology/Oncology, Milwaukee, Wisconsin, USA
| | - Robert Z. Orlowski
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, Texas, USA
| | - Carolina Schinke
- Myeloma Center, Division of Hematology/Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Stuver R, Shah GL, Korde NS, Roeker LE, Mato AR, Batlevi CL, Chung DJ, Doddi S, Falchi L, Gyurkocza B, Hamilton A, Lin YH, Jakubowski AA, Joffe E, Landau HL, Lin RJ, Mailankody S, Palomba ML, Park JH, Perales MA, Ponce DM, Ramanathan LV, Salles GA, Scordo M, Seo SK, Shah UA, Stein EM, Straus D, Usmani SZ, Young JW, Zelenetz AD, Noy A, Vardhana SA. Activity of AZD7442 (tixagevimab-cilgavimab) against Omicron SARS-CoV-2 in patients with hematologic malignancies. Cancer Cell 2022; 40:590-591. [PMID: 35598602 PMCID: PMC9108069 DOI: 10.1016/j.ccell.2022.05.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Robert Stuver
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neha S Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lindsey E Roeker
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthony R Mato
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Connie L Batlevi
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sital Doddi
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lorenzo Falchi
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Boglarka Gyurkocza
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Audrey Hamilton
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ya-Hui Lin
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ann A Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erel Joffe
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather L Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard J Lin
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Lia Palomba
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jae H Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Doris M Ponce
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lakshmi V Ramanathan
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gilles A Salles
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan K Seo
- Infectious Disease Service, Division of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eytan M Stein
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saad Z Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James W Young
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew D Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ariela Noy
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Santosha A Vardhana
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Akhlaghi T, Maclachlan K, Korde N, Mailankody S, Lesokhin AM, Hassoun H, Lu SX, Patel D, Shah UA, Tan C, Derkach A, Lahoud OB, Landau HJ, Shah GL, Scordo M, Chung DJ, Giralt S, Usmani SZ, Landgren CO, Hultcrantz M. Evaluating serum-free light chain ratio as a biomarker for multiple myeloma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8047] [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
8047 Background: In 2014, the definition of multiple myeloma was updated to include serum free light chain (FLC) ratio ≥100 as a myeloma defining biomarker, based on retrospective data indicating a 2-year progression rate of 80% and a median time to progression (TTP) of 12 months associated with this marker. However, two recent studies have reported lower 2-year progression rates, 30-44%, and longer median TTP of 40 months in patients with FLC ratio ≥100. Because of the disparity in risk prediction by FLC ratio across studies, we were motivated to assess the risk of progression in patients with SMM and a FLC ratio ≥100. Methods: We performed a retrospective analysis of patients diagnosed with SMM at Memorial Sloan Kettering Cancer Center between January 2000 and December 2017. Diagnosis of SMM and progression to MM was defined according to the International Myeloma Working Group (IMWG) criteria at the time of diagnosis. Kaplan-Meier method was used to assess TTP and generate survival curves, with log-rank test for comparison between groups. Results: A total of 438 patients were included in the study, with a median follow-up time of 52 months. While all patients with a FLC ratio ≥100 (n = 66) had elevated involved FLC levels, 35 (53%) had an involved FLC concentration > 100 mg/L. Per current diagnostic criteria, we only included patients with an involved FLC concentration > 100 mg/L in the FLC ratio ≥100 group, and found a median TTP of 31 months (95% confidence interval [CI] 16-59 months) and a 2-year progression rate of 49% (CI 28-63%). In a sensitivity analysis including all 66 cases with FLC ratio ≥100 (independent of involved FLC concentration), we found the median TTP to be 41 months (CI 30-72 months), compared to 101 months for those with a FLC ratio < 100 (CI 78-127 months; p < 0.0001). The risk of progression within 2 years was 35% (CI 22-46%) compared to 18% (CI 14-23%; p < 0.0001). Of note, 22 patients with a FLC ratio ≥100 were monitored expectantly for > 4 years, among whom 12 patients had an involved FLC level > 100 mg/L. Ten patients (7 with involved FLC level > 100 mg/L) were followed over a period ranging from 4 to 8.5 years before eventually progressing, and 12 patients (5 with involved FLC level > 100 mg/L) were followed between 4 and 8 years and did not progress during the study period. Conclusions: While FLC ratio ≥100 is associated with a high risk of progression in patients with SMM, it does not infer an imminent risk of progression, defined by the IMWG as median TTP of 12 months and 2-year progression rate of at least 80%. On the contrary, select patients with FLC ratio ≥100 can be followed for many years without progressing and some may never progress despite long-term follow-up. These findings suggest that in patients where FLC ratio ≥100 is the only myeloma-defining event, other high-risk features as well as the evolution of FLCs over time should be considered in the decision to start a patient on treatment.
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Affiliation(s)
- Theresia Akhlaghi
- Department of Internal Medicine, Icahn School of Medicine, Mount Sinai Morningside and West, New York, NY
| | - Kylee Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexander M. Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sydney X. Lu
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dhwani Patel
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carlyn Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oscar Boutros Lahoud
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heather Jolie Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gunjan L. Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J. Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Saad Zafar Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carl Ola Landgren
- Myeloma Service, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Ciardiello A, Korde N, Hultcrantz M, Hassoun H, Mailankody S, Shah UA, Lu SX, Patel D, Maclachlan K, Lahoud OB, Shah GL, Scordo M, Chung DJ, Landau HJ, Giralt S, Derkach A, Usmani SZ, Lesokhin AM, Tan CRC. Clinical efficacy of daratumumab (DARA)-based second line therapy after DARA-containing and DARA-free induction therapies in multiple myeloma: A single center experience. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e20005] [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
e20005 Background: DARA has been FDA approved for newly diagnosed multiple myeloma (NDMM) in combination with lenalidomide/dexamethasone (Rd), bortezomib/melphalan/dex, and bortezomib/thalidomide/dex since 2018. With the increase use of DARA combinations in NDMM, understanding the role of DARA retreatment at relapse needs to be examined in clinical practice. Herein, we describe a single institution experience of the efficacy of DARA-based retreatment as second line of therapy (LOT2) for patients (pts) who received DARA-based induction compared to DARA-free induction regimens. Methods: Thirty-three pts treated with DARA-based LOT2 at MSK from 1/2015 to 9/2021 were included in this retrospective analysis. Primary endpoint was overall response rate (ORR; ≥PR by IMWG criteria). Discrete patient characteristics were summarized by frequency (percentage) and continuous characteristics were summarized by median (IQR). Progression free survival (PFS) was evaluated by Kaplan-Meier method. Results: Two cohorts were identified based on prior DARA exposure: cohort 1 (N=6) received DARA-based induction without meeting DARA-refractory criteria and cohort 2 (N=27) had carfilzomib and Rd (KRd) induction (Table). Median follow-up was 13.8 and 14.5 months for cohorts 1 and 2, respectively. In cohort 1, 5 pts received DARA-KRd and 1 had DRd as first line therapy (LOT1). Median time between last dose of DARA in LOT1 and first dose of DARA in LOT2 was 17.5 months (IQR 12.1-19.8). ORR were 83% and 79% for cohorts 1 and 2, respectively. In cohort 1, ORR comprised of 1 sCR, 1 VGPR, and 3 PR. For cohort 2, there were 5 sCR/CR, 7 VGPR, and 9 PR. Median PFS was not reached in cohort 1 and 16.2 months in cohort 2. Conclusions: In a cohort of pts retreated with DARA after DARA-based induction, our findings suggest that DARA-exposed MM pts may derive benefit from DARA retreatment in subsequent lines of therapy similarly to pts who were DARA-naïve prior to DARA-based LOT2. Longer follow-up is needed to assess survival outcomes. In addition, larger confirmatory studies are warranted to further characterize response characteristics of DARA combinations in LOT2, especially as DARA-based therapy is increasingly used in treating NDMM. [Table: see text]
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Affiliation(s)
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sydney X. Lu
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dhwani Patel
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kylee Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oscar Boutros Lahoud
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gunjan L. Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J. Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heather Jolie Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Saad Zafar Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexander M. Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Kourelis T, Bansal R, Patel KK, Berdeja JG, Raje NS, Alsina M, Cohen AD, Siegel DSD, Mailankody S, Htut M, Sidana S, Holstein SA, Cowan A, Shah N, Bergsagel PL, Ailawadhi S, Lin Y. Ethical challenges with CAR T slot allocation with idecabtagene vicleucel manufacturing access. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e20021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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
e20021 Background: CAR T cell therapies are FDA approved for patients with triple refractory multiple myeloma (MM) and >4 lines of therapy. The median survival of this is group is less than 12 months so salvage therapies need to be implemented quickly. Real-world access to CAR T remains challenging due to supply chain limitations impacting manufacturing. The goal of this study was to evaluate how centers are handling the challenges of CAR T slot allocation. Methods: MM CAR T physician leaders at each CAR T treatment center certified for idecabtagene vicleucel across the US were surveyed. Results: We received responses from 15/20 centers. Summary of CAR T volumes and outcomes of patient on waitlists are shown in the table. The median time on the waiting list was 6 months with only 25% of patients receiving CAR T eventually. For patient selection, all centers reported using a committee of experienced CART physicians to ensure consistency. Selection committee included: primary MD (n=9), CAR T MD (n=12), social workers (n=3), CAR T RN (n=10), APP (n=2), pharmacists (n=2) and ethicists (n=1). To ensure transparency, centers have clear selection criteria (n=10), priority score (n=8) and selection timeline (n=11) . To ensure accountability, centers document priority scores (n=5) and have pre-specified criteria (n=9) for selection. Centers also reported using ethical principles for selection: a) equal treatment: time spent on waiting list (n=8); b) priority to the worst-off: limited therapeutic options (n=10), MM burden (n=7), ineligible for trials (n=2); c) maximize benefit: most likely to complete apheresis (n=8) or infusion (n=8) or achieve response (n=6) and d) social value: younger pts (n=2). Maximizing benefit was considered the most important criterion by 7 centers. Conclusions: More stringent GMP manufacturing requirements with FDA approved CAR T and real-world practice with broader patient demographics can present challenges to implementation of CAR T in standard of practice. Our study is the first attempt to evaluate and highlight existing issues with MM CAR T access and the variability and challenges in patient selection. Learning from other models of resource allocation (ex: UNOS) and sharing experience across centers can help providers optimize slot allocation to improve accrual. Increasing supplies of key reagents and novel manufacturing methods(eg: non-viral vectors and allogeneic CAR) could help overcome these limitations. [Table: see text]
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Affiliation(s)
| | | | - Krina K. Patel
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Noopur S. Raje
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | | | - Adam D. Cohen
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | | | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Myo Htut
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Surbhi Sidana
- Stanford University School of Medicine, Stanford, CA
| | - Sarah A. Holstein
- Division of Oncology & Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Andrew Cowan
- University of Washington School of Medicine, Seattle, WA
| | - Nina Shah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Yi Lin
- Mayo Clinic, Rochester, MN
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Dhakal B, Shah N, Kansagra A, Kumar A, Lonial S, Garfall A, Cowan A, Poudyal BS, Costello C, Gay F, Cook G, Quach H, Einsele H, Schriber J, Hou J, Costa L, Aljurf M, Chaudhry M, Beksac M, Prince M, Mohty M, Janakiram M, Callander N, Biran N, Malhotra P, Otero PR, Moreau P, Abonour R, Iftikhar R, Silberman R, Mailankody S, Gregory T, Lin Y, Carpenter P, Hamadani M, Usmani S, Kumar S. ASTCT Clinical Practice Recommendations for Transplantation and Cellular Therapies in Multiple Myeloma. Transplant Cell Ther 2022; 28:284-293. [PMID: 35306217 DOI: 10.1016/j.jtct.2022.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Over the past decade, therapeutic options in multiple myeloma (MM) have changed dramatically. Given the unprecedented efficacy of novel agents, the role of hematopoietic cell transplantation (HCT) in MM remains under scrutiny. Rapid advances in myeloma immunotherapy including the recent approval of chimeric antigen receptor (CAR) T-cell therapy will impact the MM therapeutic landscape. The American Society for Transplantation and Cellular Therapy convened an expert panel to formulate clinical practice recommendations for role, timing, and sequencing of autologous (auto-HCT), allogeneic (allo-HCT) and CAR T-cell therapy for patients with newly diagnosed (NDMM) and relapsed/refractory MM (RRMM). The RAND-modified Delphi method was used to generate consensus statements. Twenty consensus statements were generated. The panel endorsed continued use of auto-HCT consolidation for patients with NDMM as a standard-of-care option, whereas in the front line allo-HCT and CAR-T were not recommended outside the setting of clinical trial. For patients not undergoing auto-HCT upfront, the panel recommended its use in first relapse. Lenalidomide as a single agent was recommended for maintenance especially for standard risk patients. In the RRMM setting, the panel recommended the use of CAR-T in patients with 4 or more prior lines of therapy. The panel encouraged allo-HCT in RRMM setting only in the context of clinical trial. The panel found RAND-modified Delphi methodology effective in providing a formal framework for developing consensus recommendations for the timing and sequence of cellular therapies for MM.
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Affiliation(s)
- Binod Dhakal
- Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nina Shah
- Division of Hematology-Oncology, University of California, San Francisco, California
| | - Ankit Kansagra
- Department of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ambuj Kumar
- Program for Comparative Effectiveness Research, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Alfred Garfall
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew Cowan
- University of Washington, Seattle WA, and Fred Hutch, Seattle, Washington
| | - Bishesh Sharma Poudyal
- Department of Clinical Hematology and Bone Marrow Transplant, Civil Service Hospital, Kathmandu, Nepal
| | - Caitlin Costello
- UCSD/Sharp Healthcare Transplant Program, Blood & Marrow Transplant Services, Moore's Cancer Center, San-Diego, California
| | - Francesca Gay
- Division of Hematology 1 Clinical Trial Unit, AOU CIttà della salute e della Scienza, University of Torino, Turin, Italy
| | - Gordon Cook
- Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trial Research, University of Leeds, Leeds, United Kingdom
| | - Hang Quach
- University of Melbourne, St. Vincent's Hospital, Melbourne, Australia
| | - Herman Einsele
- Universitätsklinikum Würzburg, Department of Internal Medicine II, Würzburg, Germany
| | - Jeff Schriber
- Cancer Treatment Centers of America, Phoenix, Arizona
| | - Jian Hou
- Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Luciano Costa
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Maria Chaudhry
- Department of hematology/Oncology, George Washington University and Cancer Center, Washington, District of Columbia
| | - Meral Beksac
- Department of Hematology, Ankara University, Ankara, Turkey
| | - Miles Prince
- Epworth Healthcare and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France
| | - Murali Janakiram
- Division of Myeloma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, California
| | | | - Noa Biran
- Hackensack Meridian Health, John Theurer Cancer Center, Multiple Myeloma Division, Hackensack, New Jersey
| | - Pankaj Malhotra
- Department of Clinical Hematology & Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| | - Rafat Abonour
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | - Rebecca Silberman
- Department of Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New, York, New York
| | - Tara Gregory
- Colorado Blood Cancer Institute, Sarah Cannon Cancer Network, Denver, Colorado
| | - Yi Lin
- Mayo Clinic, Rochester, Minnesota
| | - Paul Carpenter
- Division of Clinical Research, Fred Hutchinson Cancer Research Center and Department of Pediatrics, University of Washington, Seattle, Washington
| | - Mehdi Hamadani
- Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Saad Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New, York, New York
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Akhlaghi T, Maclachlan K, Korde N, Mailankody S, Lesokhin AM, Hassoun H, Lu SX, Patel D, Shah UA, Tan C, Derkach A, Lahoud OB, Landau HJ, Shah GL, Scordo M, Chung DJ, Giralt S, Usmani SZ, Landgren CO, Hultcrantz M. African American patients with smoldering multiple myeloma may have a lower risk of progression compared to White patients. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8045] [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
8045 Background: The incidence of multiple myeloma (MM) is two to threefold higher in African Americans (AAs) compared to whites when adjusted for socioeconomics, age, and sex. However, there is limited information on whether racial background affects the risk of progression from smoldering MM (SMM) to MM. Methods: Patients with SMM presenting to Memorial Sloan Kettering Cancer Center between the years 2000 and 2019 and who identified as either AA or white were included in the study. Baseline characteristics were collected at the time of diagnosis including laboratory, imaging, and pathology reports. Differences in distributions of continuous and discrete characteristics were assessed by Kruskal-Wallis and chi-square tests. Time to progression (TTP) was assessed using the Kaplan-Meier method with log-rank test for comparisons. Univariate and multivariate Cox proportional hazard models were used to estimate effects of risk factors on TTP with hazard ratios (HR) and 95% confidence intervals (CI). Results: A total of 576 patients were included (70 were AA, 12%). Median follow-up time was 3 years in AAs and 4 years in whites. Differences in baseline characteristics between AAs and whites included median age (60 years in AAs vs 64 years in whites, p = 0.01), median hemoglobin level (12.3g/dL in AA vs 12.8g/dL in whites, p = 0.02), and immunoparesis including 1 or 2 uninvolved immunoglobulins (31% and 10% in AAs vs 56% and 27% in whites, p = 0.002). There was no difference in bone marrow plasma cells, M-spike, free light chain ratio, or Mayo-2018 SMM risk score. AA race was associated with a significantly decreased risk of progression in the univariate model (HR 0.57, CI 0.34-0.94). In the multivariate model adjusting for age, sex, and variables associated with an increased risk of progression in the univariate model (bone marrow plasma cells, M-spike, free light chain ratio, immunoparesis and low albumin), AA race remained associated with a decreased risk of progression (HR 0.39, CI 0.16-0.95). Overall, AA patients with SMM had a significantly (p = 0.027) longer median TTP (9.7 vs 6.2 years), and a lower 2-year (12.6% vs 20.1%) and 5-year (34% vs 44.6%) progression rate than whites. Because AA patients were younger at diagnosis, we stratified patients by age group, < 65 vs ≥65 years. In patients < 65 years, there was no difference in progression rate. In patients aged ≥65 years, AA patients continued to have a longer TTP than whites (9.8 vs 5.2 years, p = 0.02). Conclusions: In our retrospective single institution experience, AA patients with SMM had a lower risk of progression to MM compared to whites. Both groups had similar Mayo-2018 risk scores, however, AA patients had a lower degree of immunoparesis at baseline. Future studies are needed to better understand if these differences are explained by differences in disease biology including genomic mechanisms, immune microenvironment, and systemic immune response.
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Affiliation(s)
- Theresia Akhlaghi
- Department of Internal Medicine, Icahn School of Medicine, Mount Sinai Morningside and West, New York, NY
| | - Kylee Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexander M. Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sydney X. Lu
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dhwani Patel
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Urvi A Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carlyn Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oscar Boutros Lahoud
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heather Jolie Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gunjan L. Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J. Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Saad Zafar Usmani
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carl Ola Landgren
- Myeloma Service, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Hultcrantz M, Rustad EH, Yellapantula V, Jacob A, Akhlaghi T, Korde N, Mailankody S, Lesokhin AM, Hassoun H, Smith EL, Lahoud OB, Landau HJ, Shah GL, Scordo M, Chung DJ, Giralt S, Papaemmanuil E, Landgren O. Capture Rate of V(D)J Sequencing for Minimal Residual Disease Detection in Multiple Myeloma. Clin Cancer Res 2022; 28:2160-2166. [PMID: 35553646 DOI: 10.1158/1078-0432.ccr-20-2995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/28/2020] [Accepted: 02/18/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Minimal residual disease (MRD) negativity is a strong predictor for outcome in multiple myeloma. To assess V(D)J clonotype capture using the updated Adaptive next-generation sequencing (NGS) MRD assay in a clinical setting, we analyzed baseline and follow-up samples from patients with multiple myeloma who achieved deep clinical responses. EXPERIMENTAL DESIGN A total of 159 baseline and 31 follow-up samples from patients with multiple myeloma were sequenced using the NGS MRD assay. Baseline samples were also sequenced using a targeted multiple myeloma panel (myTYPE). We estimated ORs with 95% confidence intervals (CI) for clonotypes detection using logistic regression. RESULTS The V(D)J clonotype capture rate was 93% in baseline samples with detectable genomic aberrations, indicating presence of tumor DNA, assessed through myTYPE. myTYPE-positive samples had significantly higher V(D)J clonotype detection rates in univariate (OR, 7.3; 95% CI, 2.8-22.6) and multivariate analysis (OR, 4.4; 95% CI, 1.4-16.9; P = 0.016). Higher disease burden was associated with higher probability of V(D)J clonotype capture, meanwhile no such association was found for age, gender, or type of heavy or light immunoglobulin chain. All V(D)J clonotypes detected at baseline were detected in MRD-positive samples indicating that the V(D)J clonotypes remained stable and did not undergo further rearrangements during follow-up. Of the 31 posttreatment samples, 12 were MRD-negative using the NGS MRD assay. CONCLUSIONS NGS for V(D)J rearrangements in multiple myeloma offers a reliable and sensitive method for MRD tracking with high detection rates in the clinical setting.
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Affiliation(s)
- Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York.,Karolinska Institute, Department of Medicine, Solna, Stockholm, Sweden
| | - Even H Rustad
- Department of Cancer Immunology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - Venkata Yellapantula
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | | | - Theresia Akhlaghi
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Alexander M Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Eric L Smith
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Oscar B Lahoud
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Heather J Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Sergio Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Manhattan, New York
| | - Elli Papaemmanuil
- Department of Cancer Immunology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
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Shah GL, Bal S, Rodriguez C, Chhabra S, Bayer RL, Costa LJ, Lambird J, Ferrer C, Parascondola A, Marcello L, Shulman L, Obadi O, Acosta J, Hassoun H, Hultcrantz M, Korde NS, Mailankody S, Tan CR, Shah UA, Lesokhin AM, Lahoud OB, Scordo M, Chung DJ, Landau HJ, Giralt SA. Interim Analysis of the 2nd Chance Protocol: A Multicenter Trial of Daratumumab, Carfilzomib, Lenalidomide, & Dexamethasone for Relapsed/Refractory Myeloma with Salvage Autologous Hematopoietic Cell Transplantation. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00693-5] [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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Green AK, Tabatabai SM, Bai X, Mishra Meza A, Lesny AM, Aghajanian C, Landgren O, Riely GJ, Sabbatini P, Salner A, Lipkin S, Ip A, Bach PB, Begg CB, Mailankody S, Lipitz-Snyderman A. Validation of a Population-Based Data Source to Examine National Cancer Clinical Trial Participation. JAMA Netw Open 2022; 5:e223687. [PMID: 35315914 PMCID: PMC8941352 DOI: 10.1001/jamanetworkopen.2022.3687] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE The Centers for Medicare & Medicaid Services requires health care organizations to report the National Clinical Trial (NCT) identifier on claims for items and services related to clinical trials that qualify for coverage. This same NCT identifier is used to identify clinical trials in the ClinicalTrials.gov registry. If linked, this information could facilitate population-based analyses of clinical trial participation and outcomes. OBJECTIVE To evaluate the validity of a linkage between fee-for-service (FFS) Medicare claims and ClinicalTrials.gov through the NCT identifier for patients with cancer enrolled in clinical trials. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 2 complementary retrospective analyses for a validation assessment. First, billing data from 3 health care institutions were used to estimate the missingness of the NCT identifier in claims by calculating the proportion of known participants in cancer clinical trials with no NCT identifier on any submitted Medicare claims. Second, the Surveillance Epidemiology and End Results-Medicare data set, which includes a subset of all FFS Medicare beneficiaries for whom health insurance claims are linked with cancer registry data, was used to identify adult patients diagnosed with cancer between 2006 and 2015 with an NCT identifier in claims corresponding to an interventional cancer clinical trial. To estimate the accuracy of the NCT identifier when present, the proportion of NCT identifiers that corresponded to trials that were aligned with the patients' known primary or secondary diagnoses was calculated. Data were analyzed from March 2020 to March 2021. EXPOSURES An NCT identifier present in Medicare claims. MAIN OUTCOMES AND MEASURES The main outcome was participating in a clinical trial relevant to patient's cancer diagnosis. RESULTS A total of 1 171 816 patients were included in analyses. Across the 3 participating institutions, there were 5061 Medicare patients enrolled in a clinical trial, including 3797 patients (75.0%) with an NCT identifier on at least 1 billing claim that matched the clinical trial on which the patient was participating. Among 1 171 816 SEER-Medicare patients, 29 138 patients (2.5%) had at least 1 claim with a value entered in the NCT identifier field corresponding to 32 950 unique patient-NCT identifier pairs. There were 26 694 pairs (81.0%) with an NCT identifier corresponding to a clinical trial registered in ClinicalTrials.gov, of which 10 170 pairs (38.1%) were interventional cancer clinical trials. Among these, 9805 pairs (96.4%) were considered appropriate. CONCLUSIONS AND RELEVANCE In this cohort study, this data linkage provided a novel data source to study clinical trial enrollment patterns among Medicare patients with cancer on a population level. The presence of the NCT identifiers in claims for Medicare patients participating in clinical trials is likely to improve over time with increasing adherence with the Centers for Medicare & Medicaid Services mandate.
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Affiliation(s)
- Angela K. Green
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sara M. Tabatabai
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Xing Bai
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Akriti Mishra Meza
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne-Marie Lesny
- Patient Revenue Support, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carol Aghajanian
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Gregory J. Riely
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul Sabbatini
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew Salner
- Hartford Healthcare Cancer Institute, Hartford Hospital, Hartford, Connecticut
| | - Scott Lipkin
- Miami Cancer Institute, Baptist Health South Florida, Miami
| | - Andrew Ip
- Division of Outcomes and Value Research, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Peter B. Bach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Colin B. Begg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sham Mailankody
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allison Lipitz-Snyderman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
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Piedra K, Peterson T, Tan C, Orozco J, Hultcrantz M, Hassoun H, Mailankody S, Lesokhin A, Shah U, Lu S, Patel D, Derkach A, Wilkins C, Korde N. Comparison of venous thromboembolism incidence in newly diagnosed multiple myeloma patients receiving bortezomib, lenalidomide, dexamethasone (RVD) or carfilzomib, lenalidomide, dexamethasone (KRD) with aspirin or rivaroxaban thromboprophylaxis. Br J Haematol 2022; 196:105-109. [PMID: 34396516 PMCID: PMC9527668 DOI: 10.1111/bjh.17772] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 06/03/2021] [Revised: 07/22/2021] [Accepted: 07/30/2021] [Indexed: 01/03/2023]
Abstract
Incidence of venous thromboembolism (VTE) varies across different regimens in newly diagnosed multiple myeloma (NDMM) patients. Limited data exist on the use of direct oral anticoagulants as thromboprophylaxis in the setting of haematologic malignancies, specifically multiple myeloma. In this retrospective study of 305 NDMM patients, VTE rates in those treated with carfilzomib, lenalidomide, dexamethasone (KRD) + aspirin (ASA), bortezomib, lenalidomide, dexamethasone (RVD) + ASA, and KRD + rivaroxaban were statistically significant, 16·1%, 4·8%, and 4·8%, respectively. The findings confirm a higher incidence of VTE when using KRD induction compared to RVD induction and reveal that the use of low-dose rivaroxaban thromboprophylaxis can mitigate this risk without an observable increase in bleeding rates.
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Affiliation(s)
- Katrina Piedra
- Department of Pharmacy, Sylvester Comprehensive Cancer Center, University of Miami Hospitals and Clinics, 1475 NW 12th Ave, Miami, FL 33136
| | - Tim Peterson
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1250 1st Avenue New York, NY 10065
| | - Carlyn Tan
- Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, NY, NY 10021,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065
| | - Jennifer Orozco
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1250 1st Avenue New York, NY 10065
| | - Malin Hultcrantz
- Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, NY, NY 10021,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065
| | - Hani Hassoun
- Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, NY, NY 10021,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065
| | - Sham Mailankody
- Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, NY, NY 10021,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065
| | - Alexander Lesokhin
- Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, NY, NY 10021,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065
| | - Urvi Shah
- Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, NY, NY 10021,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065
| | - Sydney Lu
- Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, NY, NY 10021,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065
| | - Dhwani Patel
- Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, NY, NY 10021,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue New York NY 10065
| | - Cy Wilkins
- Hematology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue New York NY 10065
| | - Neha Korde
- Multiple Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, NY, NY 10021,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065
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Chung DJ, Shah GL, Devlin SM, Ramanathan LV, Doddi S, Pessin MS, Hoover E, Marcello LT, Young JC, Boutemine SR, Serrano E, Sharan S, Momotaj S, Margetich L, Bravo CD, Papanicolaou GA, Kamboj M, Mato AR, Roeker LE, Hultcrantz M, Mailankody S, Lesokhin AM, Vardhana SA, Knorr DA. Disease- and Therapy-Specific Impact on Humoral Immune Responses to COVID-19 Vaccination in Hematologic Malignancies. Blood Cancer Discov 2021; 2:568-576. [PMID: 34778797 PMCID: PMC8580617 DOI: 10.1158/2643-3230.bcd-21-0139] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/31/2021] [Accepted: 09/09/2021] [Indexed: 12/30/2022] Open
Abstract
Coronavirus disease-19 (COVID-19) vaccine response data for patients with hematologic malignancy, who carry high risk for severe COVID-19 illness, are incomplete. In a study of 551 hematologic malignancy patients with leukemia, lymphoma, and multiple myeloma, anti-SARS-CoV-2 spike IgG titers and neutralizing activity were measured at 1 and 3 months from initial vaccination. Compared with healthy controls, patients with hematologic malignancy had attenuated antibody titers at 1 and 3 months. Furthermore, patients with hematologic malignancy had markedly diminished neutralizing capacity of 26.3% at 1 month and 43.6% at 3 months, despite positive seroconversion rates of 51.5% and 68.9% at the respective time points. Healthy controls had 93.2% and 100% neutralizing capacity at 1 and 3 months, respectively. Patients with leukemia, lymphoma, and multiple myeloma on observation had uniformly blunted responses. Treatment with Bruton tyrosine kinase inhibitors, venetoclax, phosphoinositide 3-kinase inhibitors, anti-CD19/CD20-directed therapies, and anti-CD38/B-cell maturation antigen-directed therapies substantially hindered responses, but single-agent immunomodulatory agents did not. Significance Patients with hematologic malignancy have compromised COVID-19 vaccine responses at baseline that are further suppressed by active therapy, with many patients having insufficient neutralizing capacity despite positive antibody titers. Refining vaccine response parameters is critical to guiding clinical care, including the indication for booster vaccines, for this vulnerable population.See related article by Tamari et al., p. 577. This article is highlighted in the In This Issue feature, p. 549.
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Affiliation(s)
- David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York.
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, MSKCC, New York, New York
| | | | - Sital Doddi
- Department of Laboratory Medicine, MSKCC, New York, New York
| | | | - Elizabeth Hoover
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York
| | - LeeAnn T Marcello
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York
| | - Jennifer C Young
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York
| | | | - Edith Serrano
- Myeloma Service, Department of Medicine, MSKCC, New York, New York
| | - Saumya Sharan
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | - Saddia Momotaj
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | - Lauren Margetich
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | | | | | - Mini Kamboj
- Infectious Disease Service, Department of Medicine, MSKCC, New York, New York
| | - Anthony R Mato
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | - Lindsey E Roeker
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
| | - Malin Hultcrantz
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Myeloma Service, Department of Medicine, MSKCC, New York, New York
| | - Sham Mailankody
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Myeloma Service, Department of Medicine, MSKCC, New York, New York
| | - Alexander M Lesokhin
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Myeloma Service, Department of Medicine, MSKCC, New York, New York
| | - Santosha A Vardhana
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Lymphoma Service, Department of Medicine, MSKCC, New York, New York
- Human Oncology and Pathogenesis Program, MSKCC, New York, New York
| | - David A Knorr
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Leukemia Service, Department of Medicine, MSKCC, New York, New York
- The Rockefeller University, New York, New York
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Shah U, Derkach A, Adintori P, Cross J, Maclachlan K, Mailankody S, Korde N, Hultcrantz M, Hassoun H, Tan C, Lu S, Patel D, Shah G, Scordo M, Lahoud O, Chung D, Landau H, Giralt S, Taur Y, Landgren O, Block T, Peled J, van den Brink M, Lesokhin A. P-042: Sustained minimal residual disease negativity in Multiple Myeloma is impacted positively by stool butyrate and healthier plant forward diets. Clinical Lymphoma Myeloma and Leukemia 2021. [DOI: 10.1016/s2152-2650(21)02176-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kazandjian D, Hill E, Dew A, Morrison C, Roswarski J, Korde N, Emanuel M, Petrosyan A, Bhutani M, Calvo KR, Dulau-Florea A, Kwok M, Lee MJ, Lee S, Lindenberg L, Mailankody S, Manasanch E, Maric I, Mena E, Patel N, Tageja N, Trepel JB, Turkbey B, Wang HW, Wang W, Yuan C, Zhang Y, Braylan R, Choyke P, Stetler-Stevenson M, Steinberg SM, Figg WD, Roschewski M, Landgren O. Carfilzomib, Lenalidomide, and Dexamethasone Followed by Lenalidomide Maintenance for Prevention of Symptomatic Multiple Myeloma in Patients With High-risk Smoldering Myeloma: A Phase 2 Nonrandomized Controlled Trial. JAMA Oncol 2021; 7:1678-1685. [PMID: 34529025 DOI: 10.1001/jamaoncol.2021.3971] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance High-risk smoldering myeloma has a 5-year risk of progression to symptomatic multiple myeloma of approximately 75%. Treatment with lenalidomide decreases the risk of progression; however, novel triplet regimens are superior, and earlier disease may be more treatment sensitive. Objective To evaluate the use of carfilzomib, lenalidomide, and dexamethasone (KRd) with lenalidomide maintenance therapy as early intervention in high-risk smoldering myeloma and to determine the rates of minimal residual disease (MRD)-negative complete response (CR). Design, Setting, and Participants In this single-arm, single-center, phase 2 nonrandomized controlled trial, responses were evaluated at every cycle during KRd treatment and every 3 cycles subsequently. Bone marrow biopsies and imaging were performed by cycle 8 and then annually. The study enrolled patients from May 29, 2012, to July 23, 2020, at the National Institutes of Health Clinical Center, a highly specialized tertiary cancer center. Patient key eligibility criteria included a diagnosis of high-risk smoldering myeloma based on the Mayo Clinic, Spanish, and/or Rajkumar, Mateos, and Landgren criteria. Interventions Patients received eight 4-week cycles of intravenous carfilzomib 36 mg/m2 (first 2 doses, 20 mg/m2), dexamethasone (20 mg, cycles 1-4; 10 mg, cycles 5-8 twice weekly), and lenalidomide 25 mg (days 1-21) followed by twenty-four 28-day cycles of maintenance lenalidomide 10 mg (days 1-21). Stem cell harvest and storage were optional. Main Outcomes and Measures The primary outcome was the MRD-negative CR rate. Key secondary outcomes included duration of MRD-negative CR and progression to multiple myeloma. Results A total of 54 patients (median age, 59 years [range, 40-79 years]; 30 men [55.6%]; and 2 Asian [3.7%], 15 Black [27.8%], 1 Hispanic [1.9%], and 36 White [66.7%] patients) were enrolled, with a median potential follow-up time of 31.9 months (range, 6.7-102.9 months). The MRD-negative CR rate was 70.4% (95% CI, 56.4%-82.0%), with a median sustained duration of 5.5 years (95% CI, 3.7 years to not estimable). The 8-year probability of being free from progression to multiple myeloma was 91.2% (95% CI, 67.4%-97.9%), and no deaths occurred. Nonhematologic grade 3 adverse events occurred in 21 patients (38.9%) and included thromboembolism, rash, and lung infection, with no grade 4 events. Conclusions and Relevance Results of this phase 2 nonrandomized controlled trial suggest that treatment of high-risk smoldering myeloma with novel triplet regimens, such as KRd and lenalidomide maintenance therapy, may alter the natural history of smoldering myeloma by significantly delaying development of end-organ disease. Randomized clinical trials are needed to confirm this favorable benefit-to-risk profile. Trial Registration ClinicalTrials.gov Identifier: NCT01572480.
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Affiliation(s)
- Dickran Kazandjian
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Multiple Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Elizabeth Hill
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Alexander Dew
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Hematology-Oncology Department, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Candis Morrison
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Joseph Roswarski
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Hematology-Oncology Department, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Neha Korde
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Emanuel
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ani Petrosyan
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Manisha Bhutani
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Levine Cancer Institute, Charlotte, North Carolina
| | - Katherine R Calvo
- Hematology Service, Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland
| | - Alina Dulau-Florea
- Hematology Service, Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland
| | - Mary Kwok
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Division of Hematology, University of Washington, Seattle
| | - Min-Jung Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sunmin Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Liza Lindenberg
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sham Mailankody
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elisabet Manasanch
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, Texas
| | - Irina Maric
- Hematology Service, Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland
| | - Esther Mena
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Nisha Patel
- Hematology Service, Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland
| | - Nishant Tageja
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jane B Trepel
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Baris Turkbey
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hao-Wei Wang
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Weixin Wang
- Hematology Service, Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland
| | - Constance Yuan
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Yong Zhang
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Raul Braylan
- Hematology Service, Department of Laboratory Medicine, National Institutes of Health, Bethesda, Maryland
| | - Peter Choyke
- Molecular Imaging Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maryalice Stetler-Stevenson
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Seth M Steinberg
- Biostatistics & Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William D Figg
- Molecular Pharmacology Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark Roschewski
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ola Landgren
- Multiple Myeloma Program, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Multiple Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
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Shah UA, Rögnvaldsson S, Derkach A, Björkholm M, Turesson I, David Y, Hultcrantz M, Tan C, Hassoun H, Korde N, Lesokhin A, Mailankody S, Kristinsson SY, Landgren CO. Diabetes mellitus and risk of plasma cell and lymphoproliferative disorders in 94,579 cases and 368,348 matched controls. Haematologica 2021; 107:284-286. [PMID: 34474548 PMCID: PMC8719074 DOI: 10.3324/haematol.2021.278772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Urvi A Shah
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York.
| | | | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Magnus Björkholm
- Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm
| | | | - Yael David
- Department of Chemical Biology, Sloan Kettering Institute, New York
| | - Malin Hultcrantz
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York
| | - Carlyn Tan
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York
| | - Hani Hassoun
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York
| | - Neha Korde
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York
| | - Alexander Lesokhin
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York
| | - Sham Mailankody
- Department of Medicine, Myeloma Service, Memorial Sloan Kettering Cancer Center, New York
| | - Sigurður Yngvi Kristinsson
- Department of Medicine, University of Iceland, Iceland; Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm
| | - C Ola Landgren
- Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami
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Diamond B, Korde N, Lesokhin AM, Smith EL, Shah U, Mailankody S, Hultcrantz M, Hassoun H, Lu SX, Tan C, Rustad EH, Maura F, Maclachlan K, Peterson T, Derkach A, Devlin S, Landau HJ, Scordo M, Chung DJ, Shah GL, Lahoud O, Thoren K, Murata K, Ramanathan L, Arcila ME, Ho C, Roshal M, Dogan A, Giralt SA, Landgren O. Dynamics of minimal residual disease in patients with multiple myeloma on continuous lenalidomide maintenance: a single-arm, single-centre, phase 2 trial. Lancet Haematol 2021; 8:e422-e432. [PMID: 34048681 DOI: 10.1016/s2352-3026(21)00130-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/22/2022]
Abstract
Background Lenalidomide maintenance improves progression-free survival for patients with multiple myeloma, although its optimal duration is unknown. Clearance of minimal residual disease (MRD) in the bone marrow results in superior outcomes, although its attainment or sustainment does not alter clinical decision-making. Studies that have evaluated MRD serially are limited in length. We therefore aimed to evaluate longitudinal changes in MRD-status (dynamics) and their association with progression-free survival in patients with multiple myeloma. METHODS In this single-centre, single-arm, phase 2 study, we enrolled patients aged 18 years and older from the Memorial Sloan Kettering Cancer Center (New York, NY, USA) who had newly diagnosed multiple myeloma following unrestricted frontline therapy and an Eastern Cooperative Oncology Group Performance Status of 2 or lower, including patients who started maintenance before study enrolment. All participants received lenalidomide maintenance at 10 mg for 21 days of 28-day cycles until progression or unacceptable toxic effects for up to 5 years on protocol. The primary endpoint was progression-free survival at 60 months per protocol and key secondary endpoints were MRD rates after completion of the 12th, 24th, and 36th cycle of maintenance and the association between progression-free survival and annual measurement of MRD status. MRD was assessed from first-pull bone marrow aspirates at baseline and annually by flow cytometry per International Myeloma Working Group criteria, (limit of detection of at least 1 × 10-5) up to a maximum of 5 years. Patients who completed at least four cycles of treatment were included in the analysis of the primary endpoint, and patients who had completed at least one dose of treatment on protocol were assessable for secondary endpoints. The study was registered at ClinicalTrials.gov, NCT02538198, and is now closed to accrual. FINDINGS Between Sept 8, 2015, and Jan 25, 2019, 108 patients (100 evaluable for the primary endpoint) were enrolled. Median follow-up was 40·7 months (95% CI 38·7-45·0). At 60 months, progression-free survival was 64% (95% CI 52-79). Median progression-free survival was unreached (95% CI unreached-unreached). MRD dynamics were assessed using 340 MRD assessments done over 5 years for 103 evaluable patients. Patients who sustained MRD negativity for 2 years (n=34) had no recorded disease progression at median 19·8 months (95% CI 15·8-22·3) past the 2-year maintenance landmark. By contrast, patients who lost their MRD-negative responses (n=10) were more likely to progress than those with sustained MRD negativity (HR infinite; p<0·0001) and those with persistent MRD positivity (HR 5·88, 95% CI 1·18-33·33; p=0·015) at the 2-year landmark. Haematological and non-haematological serious adverse events occurred in 19 patients (18%). The most common adverse events of grade 3 or worse were decreased lymphocyte count in 48 (44%) patients and decreased neutrophil count in 47 (44%) patients. One death occurred on study due to sepsis and heart failure and was considered unrelated to the study drug. INTERPRETATION Serial measurements of MRD allow for dynamic assessment of risk for disease progression. Early intervention should be investigated for patients with loss of MRD negativity. Sustained MRD positivity is not categorically an unfavourable outcome and might portend prolonged stability of low-level disease. FUNDING Memorial Sloan Kettering and Celgene.
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Affiliation(s)
- Benjamin Diamond
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Neha Korde
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander M Lesokhin
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric L Smith
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Urvi Shah
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sham Mailankody
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Malin Hultcrantz
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hani Hassoun
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sydney X Lu
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carlyn Tan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Even H Rustad
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francesco Maura
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Kylee Maclachlan
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tim Peterson
- Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andriy Derkach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heather J Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oscar Lahoud
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katie Thoren
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kazunori Murata
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lakshmi Ramanathan
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria E Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Caleb Ho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mikhail Roshal
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
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