[Show abstract][Hide abstract] ABSTRACT: We report the characteristics of relapse, treatment response, and outcomes of 145 elderly patients with multiple myeloma in first relapse after front-line treatment with VMP or VTP. Reappearance of CRAB symptoms (113 patients) and more aggressive forms of disease (32 patients) were the most common patterns of relapse. After second-line therapy, 75 (51.7%) patients achieved at partial response and 16 (11%) complete response (CR). Overall survival was longer among patients receiving VMP as front-line induction (21.4 vs. 14.4 months, P=0.037), in patients achieving CR (28.3 vs. 14.8 months; P=0.04), and in patients without aggressive relapse (28.6 vs. 7.6 months; P=0.0007).
Leukemia Research Reports 10/2015; 4(2):64-69. DOI:10.1016/j.lrr.2015.09.002
[Show abstract][Hide abstract] ABSTRACT: In contrast to the upfront setting in which the role of high dose therapy with autologous hematopoietic cell transplantation (HCT) as consolidation of a 1(st) remission in patients with multiple myeloma (MM) is well established, the role of high dose therapy with autologous or allogeneic HCT has not been extensively studied in MM patients relapsing after primary therapy. The International Myeloma Working Group together with the Blood and Marrow Transplant Clinical Trials Network (BMT-CTN), the American Society of Blood and Marrow Transplantation (ASBMT), and the European Society of Blood and Marrow Transplantation (EBMT) convened a meeting of MM experts to: 1. Summarize current knowledge regarding the role of autologous or allogeneic HCT in MM patients progressing after primary therapy; 2. Propose guidelines for the use of salvage HCT in MM; 3. Identify knowledge gaps; 4 Propose a research agenda and 5. Develop a collaborative initiative to move the research agenda forward. After reviewing the available data, the expert committee came to the following consensus statement for salvage autologous HCT: 1. In transplant eligible patients relapsing after primary therapy that did NOT include an autologous HCT, high dose therapy with HCT as part of salvage therapy should be considered standard; 2. High dose therapy and autologous HCT should be considered appropriate therapy for any patients relapsing after primary therapy that includes an autologous HCT with initial remission duration of more than 18 months; 3. High dose therapy and autologous HCT can be used as a bridging strategy to allogeneic HCT; 4. The role of post salvage HCT maintenance needs to be explored in the context of well designed prospective trials that should include new agents such as monoclonal antibodies, immune-modulating agents and oral proteasome inhibitors; 5. Autologous HCT consolidation should be explored as a strategy to develop novel conditioning regimens or post HCT strategies in patients with short (less than 18 months remissions) after primary therapy; 6. Prospective randomized trials need to be performed to define the role of salvage autologous HCT in patients with MM relapsing after primary therapy comparing to "best non HCT" therapy. The expert committee also underscored the importance of collecting enough hematopoietic stem cells to perform two transplants early in the course of the disease. In regards to allogeneic HCT the expert committee agreed on the following consensus statements: 1. Allogeneic HCT should be considered appropriate therapy for any eligible patient with early relapse (less than 24 months) after primary therapy that included an autologous HCT and/or high risk features (i.e cytogenetics, extramedullary disease, plasma cell leukemia or high LDH); 2. Allogeneic HCT should be performed in the context of a clinical trial if possible; 3. The role of post allogeneic HCT maintenance therapy needs to be explored in the context of well designed prospective trials; 4. Prospective randomized trials need to be performed to define the role salvage allogeneic HCT in patients with MM relapsing after primary therapy.
Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 10/2015; 21(12). DOI:10.1016/j.bbmt.2015.09.016 · 3.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Infectious complications are an important risk factor for early mortality in patients with multiple myeloma. However, data about the impact and severity of infections in these patients in the era of new therapies have not been properly analyzed. We have reviewed the incidence and severity of infections complications and infection-related mortality during induction treatment in patients with newly diagnosed myeloma receiving regimens with new drugs within randomized trials. The results show that infections are still a major cause of morbidity especially among elderly patients receiving immunomodulatory drugs seeing in up to 28% of patients in some trials versus less than 10% among transplant-eligible patients. Overall infection-related mortality ranged from 0% to 7% in transplant-ineligible patients with no infection-related deaths in the majority of the trials including younger patients. Strategies directed to further reduce these complications and a better knowledge of their impact in patients treated outside clinical trials are needed.
Leukemia and Lymphoma 10/2015; DOI:10.3109/10428194.2015.1088647 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The introduction of the novel agents, thalidomide, bortezomib and lenalidomide as part of the frontline induction both in transplant and non-transplant candidates have markedly improved the anti-myeloma efficacy of the different therapeutic regimens and improved patients' prognosis. Current treatment goals are aimed to further improve the rate of complete remission, time to progression, progression-free survival and overall survival without increasing toxicity. Besides, different strategies are being developed in the elderly population as this group of patients requires a closer monitoring with individualized, dose-modified regimens to improve tolerability while maintaining their quality of life. This article reviews the current landscape of frontline treatment both in transplant-eligible and transplant-ineligible patients with newly diagnosed multiple myeloma.
[Show abstract][Hide abstract] ABSTRACT: Bendamustine is an increasingly used hybrid alkylating agent that is active in lymphoid neoplasias via a novel mechanism of action. There are some pending questions about its use in clinical practice because of its developmental features. A consensus panel of several leading Spanish hematologists with broad experience in the clinical use of bendamustine has established recommendations for the management and treatment of hematological patients with bendamustine based on available clinical data and the experience of the participants. These recommendations address the dose and treatment regimen for different clinical indications, the management of toxicity and support therapy. This article contains the conclusions of this consensus panel, which are intended to serve as guidelines for the use of bendamustine. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
European Journal Of Haematology 07/2015; DOI:10.1111/ejh.12633 · 2.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We study a diluted Blume-Capel model of 3-state sites as an attempt to
understand how some social processes as cooperation or organization happen. For
this aim we study the effect of the complex network topology on the equilibrium
properties of the model, by focusing on three different substrates: random
graph, Watts-Strogatz and Newman substrates.
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT The availability of novel drugs with different and innovative mechanisms of action such as proteasome inhibitors such as bortezomib and immunomdulatory agents as thalidomide and lenalidomide have changed the landscape of the treatment of patients with newly diagnosed multiple myeloma, allowing the development of several new therapeutic regimens both for transplant-eligible and -ineligible patients. Among these new agents, lenalidomide has become one of the most commonly used in these patients. In this article, we review the current state-of-the-art of different induction and maintenance lenalidomide-containing regimens administered in transplant-eligible and -ineligible patients with newly diagnosed multiple myeloma. We also discuss the safety profile and potential long-term side effects of this drug and analyze its utility in certain subgroups of patients like those with high-risk disease or different degrees of renal impairment.
[Show abstract][Hide abstract] ABSTRACT: [e-Letter], Blood (http://www.bloodjournal.org/content/125/9/1470.e-letters). March 13, 2015. Accessed Marchy 25, 2015.
Other Contributors: Arturo Pereira , Javier de la Rubia , José Antonio García-Erce , Cristina Arbona , Enric Contreras , Miguel Lozano.