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Front-line treatment approaches in multiple myeloma: real-world data from a community-based oncology network.

BACKGROUND: The front-line (1L) treatment landscape for newly diagnosed multiple myeloma (NDMM) is rapidly evolving with guidelines endorsing triplet and quadruplet regimens as new standard-of-care. Despite this, real-world evidence on current treatment patterns for NDMM remain limited, especially in community settings, where most care is delivered. This study describes 1L treatment patterns for NDMM using recent data from a large US community oncology network. METHODS: This retrospective, observational study analyzed structured and unstructured medical records of patients treated at Texas On

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… While the adoption of quadruplet regimens started to increase from 2020 in this study, the overall use of quadruplets in this community practice network was still low (9.4%) in 2022, highlighting an opportunity for improvement in quadruplet treatment uptake in the real-world. … Such studies will measure changes in 1L quadruplet regimen use and gather changes in physician opinion on quadruplet regimens. …

Perinatal outcome after multifetal reduction to twins compared with nonreduced multiple gestations.

The outcomes of twins resulting from multifetal reduction were analyzed to examine whether the outcome was improved over that of triplet and quadruplet pregnancies and similar to that of twin pregnancies not involving multifetal reduction. Maternal and perinatal outcomes were examined retrospectively in 62 infertile women who conceived multiple gestations with ovulation induction. The mean gestational age at birth of quadruplets was significantly less than that of twins reduced from quadruplets (24.8 versus 31.0 weeks; P less than .001), and there was appreciable neonatal mortality in the nonr…

Treatment Intensity in the Frontline Setting for Transplant-Ineligible Patients With Multiple Myeloma.

The management of newly diagnosed transplant-ineligible multiple myeloma remains challenging, largely because frailty complicates treatment decisions and frequently leads to the exclusion of frail patients from pivotal clinical trials. Recent subgroup analyses provide useful insight into whether quadruplet therapy may offer advantages over triplet therapy in this population. Data from the IMROZ and CEPHEUS trials were reviewed to compare outcomes between quadruplet and triplet regimens in both the overall intent-to-treat cohorts and the frailty-defined subgroups. Frailty was assessed using the

The causes of high-order multiple gestation.

Most recent reviews of multiple gestations have reported that the major cause of triplet and quadruplet pregnancy is therapy with human menopausal gonadotropin (hMG). In an attempt to decrease the number of high-order multiple gestations due to hMG, serial ovarian ultrasound evaluation was introduced in the mid-1970s. To assess the impact of changing technology on the causes of high-order multiple gestation, we reviewed the experience at our institution from 1983 to 1987. During this time period, 35,119 deliveries were performed, including 13 triplet and 2 quadruplet deliveries. Of the triplet

Efficacy and safety of daratumumab-based quadruplet therapy vs non-daratumumab-based triplet therapy in newly diagnosed multiple myeloma patients: A GRADE assessed systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Multiple myeloma (MM) is the second most common hematologic malignancy worldwide. Recent therapeutic innovations, including the addition of daratumumab to standard regimens, have shown promising improvements in patient outcomes. OBJECTIVES: This study aims to compare the efficacy and safety of daratumumab-based quadruplet therapy regimens with standard triplet therapy regimens in newly diagnosed multiple myeloma (NDMM) patients. DESIGN: Systematic review and meta-analysis of randomized controlled trials. DATA SOURCES AND METHODS: A comprehensive literature search was conducted on P

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… Recently The NCCN Guidelines Version 5.2026 recommended four-drug regimens, including anti-CD38 monoclonal antibody–based quadruplets, as preferred primary therapy options for eligible patients with newly diagnosed multiple myeloma. 6 Currently, quadruplet therapy regimens comprising an anti-CD 38 monoclonal … in overall survival (HR 0.71) further supports the clinical benefit of daratumumab-based quadruplet therapy. …

Serum magnesium levels during magnesium sulfate tocolysis in high-order multiple gestations.

The objective of this study was to determine the serum levels of magnesium associated with various intravenous infusion rates of magnesium sulfate (MgSO4) in high-order multiple gestations. A retrospective review of 12 triplet and 4 quadruplet pregnancies cared for in Phoenix from August 1988 to January 1992 was performed. The mothers received MgSO4 for tocolysis of preterm labor. Serum magnesium levels were drawn to help manage patients with symptoms of an excessive magnesium level or an inadequate tocolytic effect. The results are presented for triplets and quadruplets with and without pregn…

Reconstruction of a large pelvic defect by transfer of a quadruplet combination of pedicled flaps from the medial thigh using bilateral muscular gracilis flaps and bilateral vertical posteromedial thigh (vPMT) propeller flaps-A case report.

The reconstruction of defects of the perianal area and vagina places a high demand on a reconstructive surgeon. Different reconstructive methods include a skin graft, a local skin flap, a musculocutaneous flap, and a pedicled perforator flap. Here, we report the case of a 59-year-old female patient with a pelvic defect, who underwent reconstruction with a quadruplet combination of pedicled flaps from the medial thigh, due to an extensive resection of a recurrence of a squamous cell carcinoma of the anus, vulva, and partially the colon. The surgical oncologist performed a rectum amputation, a p

Nuanced treatment decision in newly diagnosed multiple myeloma patients aged 65-75 years: a real-world study.

PURPOSE: The optimal treatment strategy for patients aged 65-75 years with multiple myeloma (MM) remains undefined, as most clinical trials involving transplant-eligible patients have excluded this subgroup. We investigated the real-world treatment patterns, outcomes, and clinical impact of autologous stem cell transplantation (ASCT) and quadruplet therapy in this population. METHODS: We retrospectively analyzed 561 patients aged 65-75 years with newly diagnosed MM treated between 2015 and 2023 at two tertiary centers. Patients were stratified by age (< 70 vs. ≥ 70 years) and ASCT status. RE

The relative contribution of assisted reproductive technologies and ovulation induction to multiple births in the United States 5 years after the Society for Assisted Reproductive Technology/American Society for Reproductive Medicine recommendation to limit the number of embryos transferred.

OBJECTIVE: To examine the effect of the 1998 Society for Assisted Reproductive Technology/American Society for Reproductive Medicine (SART/A … percentages of multiple births due to ART and OI were twins 16% and 21%, triplets 45% and 37%, and quadruplets/+ 30% and 62%, respectively. CONCLUSION(S): Following publication of the SART/ASRM recommended limits on number of embryos transferred, the ratio of HOMB births to total ART births decreased substantially; however, U.S. HOMB did not decrease due to …

[Neonatal outcome multiple pregnancies at the Neonatal Department of Research Institute of Polish Mother's Memorial Hospital].

OBJECTIVES: The purpose of this study was to analyze the course of neonatal period among babies born from truly higher-order multiple pregna … quences of prematurity. RESULTS: Among the multiples (> or = 3) the mean birth weight of triplets, quadruplets and quintuplets was respectively: 1656 g vs 1166 g vs 725 g, the diminished gestational age was also noticed: 32.4 vs 30 vs 26.5 GA. The cesarean section ratio in triplet deliveries was 95%, while quadruplets and quintuplets pregnancies were always …

Twins With Feingold Syndrome: Overview and Interview/Twin Research Summaries: Pseudoamonoamniotic Twins; Selective Fetal Growth Restriction in Monoamniotic Twins; Twin Authorship Attribution; Twins Discordant for Clubfoot/Human Interest: Twins with Different Fathers; Biological Relatedness in a Married Couple; Birth of Identical Quadruplets; Twins Switching Places.

A pair of young monozygotic male twins affected with Feingold syndrome were briefly described in previous issues of Twin Research and Human … ng twins with different fathers, biological relatedness in a married couple, the birth of identical quadruplets, and twins switching places.

Biophysical profile testing as an indicator of fetal well-being in high-order multiple gestations.

OBJECTIVE: The purpose of this investigation was to determine the value of biophysical profile testing in preventing intrapartum death in patients with high-order multiple gestations (triplets or quadruplets). STUDY DESIGN: A retrospective review was performed of patients with triplets and quadruplets cared for by Phoenix Perinatal Associates from October 1988 to December 1991. Biophysical profile testing was used as the primary method of fetal surveillance in these pregnancies. Fetal heart rate monitoring on an external monitor was used as back-up and in cases sent to labor and delivery for …

The quadruple immunotherapy for colorectal cancer (QuICC) trial for mismatch repair-proficient metastatic colorectal cancer.

BACKGROUND: Despite successes in other malignancies, immune checkpoint blockade (ICB) has not demonstrated reproducible efficacy in mismatch repair-proficient (pMMR) colorectal cancer (CRC). Preclinical studies indicate that multitargeted combination immunotherapy may sensitize resistant tumors to immune-mediated killing. This trial was designed to test this hypothesis by combining agents to induce and augment an immune response in pMMR CRC. METHODS: In this single-center, phase 1/2 trial, eligible patients had pMMR, RECIST v1.1-measurable metastatic CRC, ≥2 prior lines of therapy, and no pri

The addition of CD38 monoclonal antibody to triplet regimens improves survival in newly diagnosed multiple myeloma with high-risk cytogenetics: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The efficacy of CD38 monoclonal antibody (mAb)-based quadruplet regimens versus triplet regimens in newly diagnosed multiple myeloma (NDMM) patients with high-risk cytogenetics remains controversial. This meta-analysis aims to consolidate evidence from randomized controlled trials (RCTs) to resolve this clinical uncertainty. METHODS: We systematically searched PubMed, EMBASE, and the Cochrane Library for RCTs comparing CD38 mAb-based quadruplet regimens with triplet regimens in NDMM patients with high-risk cytogenetics. The primary outcomes were the rate of minimal residual diseas

Sleep in multiple pregnancy: breathing patterns, oxygenation, and periodic leg movements.

OBJECTIVES: Our goal was to study whether multiple pregnancy at the third trimester predisposes to breathing disturbances and arterial oxyhemoglobin desaturation during sleep. STUDY DESIGN: Nocturnal breathing, oxygenation, and movement activity were studied in 10 mothers: 8 with twins, 1 with triplets, and 1 with quadruplets. RESULTS: No obstructive and few central sleep apnea episodes were observed. Four subjects had episodes of increased respiratory resistance, but only one, the mother with quadruplets, was significantly affected. Arterial oxyhemoglobin saturation was always maintained ab…

Pregnancy outcome after early amniotic fluid leakage after transabdominal multifetal reduction.

OBJECTIVE: To assess the importance of amniotic fluid leakage in the early period ( < 14 days) after the fetal reduction procedure. DESIGN: … s of the procedure. INTERVENTIONS: Transabdominal multifetal pregnancy reduction from triplets and quadruplets to twins. MAIN OUTCOME MEASURE: Amniotic fluid leakage in the early period after fetal reduction. RESULTS: Early PROM occurred in eight (13.3%) patients from the triplets group and in six (19.3%) patients in the quadruplet group. Three of 60 (5.0% …

Quadruplets: Risks, Outcomes and a Set of Four/Twin Research Reviews and a Lawsuit: Antenatal Corticosteroids and Twins' Neonatal Outcomes; Fathers of Twins; Doppelgängers and Similarity; Monozygotic Co-Twin Difference in Asymmetric Pigmented Paravenous Chorioretinal Atrophy/In the News: Opposite-Sex Twin Holocaust Survivors; Twin Models at Gucci; Twins With Different Fathers; Reunited Twins Enter Same Convent; Death of a Twin Soldier During Training; Surgical Separation of Conjoined Twins.

Quadruplets are at elevated physical risks at prenatal, perinatal, and postnatal levels, relative to twins. A brief review of this area is followed by discussion of a female quadruplet with three co-quadruplet brothers. Next, several timely twin research reports are examined. The topics include antenatal corticosteroids and twins' neonatal outcomes, the meaning of fatherhood in families with twins, what doppelgängers (look-alikes) reveal about physical and behavioral similarity, and monozygotic (MZ) co-twin discordance for asymmetric pigmented paravenous chorioretinal atrophy. A lawsuit involv…

Retinopathy of Prematurity: Single versus Multiple-Birth Pregnancies.

PURPOSE: To compare the frequency and severity of retinopathy of prematurity (ROP) among singleton and multiple-birth neonates referred to Farabi Eye Hospital, Tehran- Iran. METHODS: In this retrospective study, records of 99 consecutive neonates from multiplegestation pregnancies including 68 twins, 26 triplets and 5 quadruplets who were screened for ROP from 2002 to 2004 were reviewed. The frequency, severity and risk factors for ROP were determined and compared to a group of singletons who were matched in terms of gender, birth weight (BW), gestational age (GA), oxygen therapy, respiratory…

Sex ratio and mortality in a laboratory colony of the common marmoset (Callithrix jacchus).

In a retrospective study sex ratio and mortality were analysed in a captive colony of common marmosets (Callithrix jacchus). Seven hundred and thirty-five infants in 294 litters (20 singletons, 119 twins, 140 triplets, 14 quadruplets) out of 57 breeding females were evaluated. The sex ratio at birth was 0.95 males:1.0 females. The frequency of males and females, as well as the sex composition of twins and triplets confirm the assumption of dizygotic twinning in the common marmoset. According to age at death, 9 categories were differentiated, with perinatal mortality being the highest. Once ear…