Treatment Options for Triple-Class Refractory Multiple Myeloma
Publication date: Available online 9 October 2019Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): Joseph MikhaelAbstractThe advent of new, more effective, and less toxic therapies has revolutionized the management of multiple myeloma in the past decade. Despite the availability of new treatments, the majority of patients with multiple myeloma will become refractory to the therapies that currently comprise the hematologic standard of care for the malignancy: proteasome inhibitors, immunomodulatory agents, and monoclonal antibodies. Moreover, in recent years, a new subset of patients refractory to all 3 of these agents has emerged. This population, in which a clear treatment paradigm remains undefined, is characterized by poor survival outcomes. Current approaches to the treatment of triple-class refractory disease are limited, and include conventional chemotherapy, salvage autologous stem cell transplantation, and recycling prior regimens, each of which have generally short-lived efficacy. It is anticipated that additional agents will be available for triple refractory disease in the near future, namely selinexor, chimeric antigen receptor T cell therapy, and next-generation monoclonal antibodies. The development and further refinement of novel treatments for this subset of patients in the coming years should be considered a key clinical and research priority.
ConclusionPlerixafor proved effective to mobilize adequate numbers of PBSCs in individual patients with relapsed malignancies after prior single or tandem HDC+PBSCT. These PBSCs could establish sustained multi-lineage hematopoietic engraftment without any sequelae.
ConclusionChemotherapy followed by ASCT using a conditioning regimen of reduced melphalan and pharmacokinetically targeted busulfan is a promising strategy for treating patients with relapsed or refractory DLBCL who also have end-stage renal disease and are receiving hemodialysis.
Publication date: Available online 7 November 2019Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): Kaoru Morita, Masahiro Ashizawa, Yumiko Toda, Takashi Ikeda, Shin-ichiro Kawaguchi, Shoko Ito, Shin-ichi Ochi, Takashi Nagayama, Kiyomi Mashima, Kento Umino, Daisuke Minakata, Hirofumi Nakano, Ryoko Yamasaki, Chihiro Yamamoto, Kaoru Hatano, Shin-ichiro Fujiwara, Kazuya Sato, Iekuni Oh, Ken Ohmine, Kazuo MuroiAbstractAbout 40% of patients with diffuse large B cell lymphoma (DLBCL) relapse after or are refractory to standard chemotherapy with rituximab plus cyclophosphamide, hydroxydaunorubicin, vincristine, and prednis...
A treatment strategy of salvage chemotherapy and autologous stem-cell transplantation (ASCT) in relapsed or refractory diffuse large B-cell lymphoma (DLBCL) patients receiving hemodialysis has not yet been established. We conducted a pharmacokinetic analysis in a patient with refractory DLBCL with end-stage renal disease and successfully administered adjusted dosing of salvage chemotherapies and a conditioning regimen in ASCT without any adverse events.
A treatment strategy of salvage chemotherapy and autologous stem cell transplantation in relapsed or refractory DLBCL patients on hemodialysis has not yet been established. We conducted a pharmacokinetic analysis in a refractory DLBCL patient with end-stage renal disease, and successfully administered adjusted dosing of salvage chemotherapies and conditioning regimen in autologous stem cell transplantation without any adverse events.
CONCLUSION: All tested biosimilars demonstrated similar effectiveness and safety profiles in patients with hematological tumors undergoing PBSC mobilization; therefore, they can be used interchangeably. PMID: 31663634 [PubMed - as supplied by publisher]
This study emphasizes the feasibility of autologous stem cell transplant in an outpatient model of care and outlines the resources necessary to run such a unit.
This study emphasizes the feasibility of ASCT in an outpatient model of care and outlines the resources necessary to run such a unit.
Publication date: Available online 2 October 2019Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): Avyakta Kallam, Julie M. VoseAbstractNon-Hodgkin lymphomas that are refractory to or relapse after frontline chemoimmunotherapy have a poor prognosis. Although high dose chemotherapy, followed by autologous stem cell transplantation remains the standard of care at relapse, this treatment modality leads to a cure in less than 50% of the patients. Adoptive cellular immunotherapy with anti CD 19 chimeric antigen receptor (CAR) T cell has changed the treatment landscape in B cell lymphomas. They have emerged as effective t...
A phase I/II trial was conducted to explore the safety and activity of addition of bortezomib on days -6, -3, and +1 relative to the day of autologous stem cell transplantation to a conditioning regimen with busulfan and melphalan (BuMel; 3.2 mg/kg/day busulfan on days -5 to -3 and 140 mg/m2/day melphalan on day -2) in patients with multiple myeloma (MM) following bortezomib-based induction chemotherapy. In phase I, doses of bortezomib (0.7, 1.0, and 1.3 mg/m2) with BuMel were administered to groups of three patients each.