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Cost of hematopoietic stem cell transplantation in India.

Hematopoietic stem cell transplantation (HSCT) is a definite cure for many hematological diseases. With the increasing indications for HSCT and its relatively low cost in Indian subcontinent, an increasing number of patients are opting for this procedure. We retrospectively analyzed the cost of one hundred sixty two HSCTs done at our center in the last three years. The median cost of autologous transplant was USD, $ 12,500 (range $ 10,331-39,367) and the median cost of allogeneic transplant was $ 17,914 (range $ 10,832-44,701). The cost of HSCT is cheaper here compared to that in developed cou

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… The commonly used regimens were busulfan/cyclophosphamide, fludarabine/cyclophosphamide/antithymocyte globulin, fludarabine/melphalan, thiotepa/triosulphan/fludarabine, melphalan and carmustine/etoposide/cytarabine/melphalan ( Table 1 ). … | 20 (12.3%) Treosulphan/Thiotepa/Fludarabine | 27 (16.6%) Melphalan | 22 (13.6%) Carmustine/Etoposide/Cytarabine/Melphalan | 15 (9.3%) Acute GVHD | Grade I | 11 Grade II–IV | 12 * Results A total of 162 consecutive patients were evaluated for the cost of the procedure, focusing on the inpatient …

Progress and challenges in the treatment of cardiac amyloidosis: a review of the literature.

Cardiac amyloidosis is a restrictive cardiomyopathy determined by the accumulation of amyloid, which is represented by misfolded protein fragments in the cardiac extracellular space. The main classification of systemic amyloidosis is determined by the amyloid precursor proteins causing a very heterogeneous disease spectrum, but the main types of amyloidosis involving the heart are light chain (AL) and transthyretin amyloidosis (ATTR). AL, in which the amyloid precursor is represented by misfolded immunoglobulin light chains, can involve almost any system carrying the worst prognosis among amyl

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… standard‐dose melphalan plus high‐dose dexamethasone in 50 patients with AL, the authors concluded that the outcome of treatment of AL with high‐dose melphalan followed by auto‐HSCT was not superior to the outcome with standard‐dose melphalan plus dexamethasone, with a high transplant‐related mortality … High‐dose melphalan versus melphalan plus dexamethasone for AL amyloidosis. N Engl J Med 2007; 357: 1083–1093. 90. Varga C, Comenzo RL. High‐dose melphalan and stem cell transplantation in systemic AL amyloidosis in the era of novel anti‐plasma cell therapy: a comprehensive review. …

Efficacy of a novel device for cryoprevention of oral mucositis: a randomized, blinded, multicenter, parallel group, phase 3 trial.

Cryoprevention (CP) using ice (IC) is an effective strategy to prevent chemotherapy-induced oral mucositis (OM). However, the use of IC may cause adverse reactions and requires water of safe quality to minimize risk of serious infections. This randomized, blinded, parallel group, phase 3 trial was conducted in five Scandinavian centers. Eligible patients were diagnosed with multiple myeloma or lymphoma, scheduled to receive conditioning with high-dose chemotherapy prior to autologous hematopoietic stem cell transplantation (ASCT). Patients were assigned to cooling with IC or a novel intraoral

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… Patients were eligible given that the investigator considered them as appropriate candidates for high-dose melphalan (multiple myeloma) or high-dose regimen with BEAC (carmustine, cytarabine, etoposide, cyclophosphamide) and BEAM (carmustine, cytarabine, etoposide, melphalan) (lymphoma). … High-dose chemotherapy regimens for lymphoma: BEAC (carmustine; cytarabine; etoposide; cyclophosphamide) and BEAM (carmustine; cytarabine; etoposide; melphalan). a B-cell lymphomas. …

Acute Lymphoblastic Leukaemia in the Youngest: Haematopoietic Stem Cell Transplantation and Beyond.

The ALL SCTped 2012 FORUM (For Omitting Radiation Under Majority age) trial compared outcomes for children ≥4 years of age transplanted for acute lymphoblastic leukaemia (ALL) who were randomised to myeloablation with a total body irradiation (TBI)-based or chemotherapy-based conditioning regimen. The TBI-based preparation was associated with a lower rate of relapse compared with chemoconditioning. Nevertheless, the age considered suitable for TBI was progressively raised over time to spare the most fragile youngest patients from irradiation-related complications. The best approach to use for

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… The recommended conditioning regimen consisted of busulfan, cyclophosphamide and melphalan ( Figure 1B ). Between 2006 and 2011, 13 of 50 (26%) patients who underwent transplantation died of HSCT-related complications. … In the HLA compatible setting, TBI both in combination with cyclophosphamide (120 mg/kg) and etoposide (30–60 mg/kg) or with melphalan (180–200 mg/m 2 ) provided superior EFS rates compared with other regimens. …

Lenalidomide, bortezomib and dexamethasone induction therapy for the treatment of newly diagnosed multiple myeloma: a practical review.

For patients with newly diagnosed multiple myeloma, survival outcomes continue to improve significantly: however, nearly all patients will relapse following induction treatment. Optimisation of induction therapy is essential to provide longer term disease control and the current standard of care for most patients incorporates an immunomodulatory agent and proteasome inhibitor, most commonly lenalidomide and bortezomib in combination with dexamethasone (RVD), with maintenance until progression. Historically there has been limited access to RVD as an induction strategy outside of the United Stat

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… Bortezomib cumulative dose, efficacy, and tolerability with three different bortezomib‐melphalan‐prednisone regimens in previously untreated myeloma patients ineligible for high‐dose therapy . … High‐dose melphalan significantly increases mutational burden in multiple myeloma cells at relapse: results from a randomized study in multiple myeloma . …

Alkylating anticancer agents and their relations to microRNAs.

Alkylating agents represent an important class of anticancer drugs. The occurrence and emergence of tumor resistance to the treatment with alkylating agents denotes a severe problem in the clinics. A detailed understanding of the mechanisms of activity of alkylating drugs is essential in order to overcome drug resistance. In particular, the role of non-coding microRNAs concerning alkylating drug activity and resistance in various cancers is highlighted in this review. Both synthetic and natural alkylating agents, which are approved for cancer therapy, are discussed concerning their interplay w

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… From MM patients treated with melphalan circulating exosomal let-7b and miR-18a were identified as prognostic factors (i.e., improved survival) [ 26 ] . … In addition, it was suggested that suppression of miR-451 can enhance the activity of melphalan in multiple myeloma via downregulation of multidrug resistance gene 1 (MDR1) [ 30 ] . A list of miRNAs involved in melphalan activity in myeloma is given in Table 2 . …

A Review of The Synergistic Effects of Curcumin with Proteasome Inhibitors in Multiple Myeloma Preclinical Models.

Proteasome inhibitors are the cornerstone of multiple myeloma treatment, but challenges still remain despite the increased survival rates. We conducted a review on the role of curcumin, a natural product, as an adjunct to bortezomib and carfilzomib in preclinical multiple myeloma models. Four studies reviewed showed enhanced anticancer effects when curcumin was combined with bortezomib compared to either treatment alone. Two additional studies showed similar results with carfilzomib. Synergistic mechanisms include inhibition of NF-kB, IL-6-induced signaling pathways, JNK pathway modulation, an

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… More recently, a randomized controlled trial with 33 transplant ineligible MM patients receiving melphalan, prednisone and curcumin (8 g oral daily) showed significantly increased remission and decrease in cytokines compared to melphalan, prednisone and placebo. 28 Further randomized controlled trials … Though not formally studied as a part of this review, curcumin has known anti-inflammatory effects and may have additional benefit in reducing some of the adverse effects of MM therapies in clinical settings. 29 In a recent randomized controlled clinical trial, oral curcumin in addition to melphalan …

Воздействие вицеральной ожирения на клинический исход и качество жизни пациентов с множественной миеломой: вторичный анализ данных о СТАМИНЕ (BMT CTN) 0702) Судебное разбирательство

Краткое изложение проблемы ожирения является общей проблемой для здоровья многих пациентов, страдающих миеломой (ММ), и она связана с плохими клиническими результатами и качеством жизни (КОЛ). Мы провели вторичный анализ БМТ CTN 0702, выборочное, контролируемое испытание с сопоставлением результатов three :: лечение после одной пересадки гематополиетических клеток (ГХТ) для изучения воздействия висцерального ожирения, измеряемого соотношением талии и голени (ВПЧ), на клинические результаты и QOL у пациентов с MM. 549 Пациенты ММ, средний возраст 55.5 Годы, были зачислены в исследование. Больши

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… Patients receiving high-dose melphalan alone had similar treatment outcomes across different BMI groups. … High-dose melphalan dosing Melphalan dosing was standardized based on patient weight, with ideal body weight (IBW) used for patients weighing between 100–120% of their IBW. …

Efficacy and safety of biosimilar Peg-filgrastim after autologous stem cell transplant in myeloma and lymphoma patients: a comparative study with biosimilar Filgrastim, Lenograstim, and originator Peg-filgrastim.

Data about biosimilar Peg-filgrastim (bioPEG) in autologous stem cell transplant (ASCT) are still scarce. The aim of this study has been to assess efficacy and safety of bioPEG among lymphoma and myeloma patients undergoing ASCT, comparing these data with historical controls receiving other G-CSFs. Furthermore, an economic evaluation has been included to estimate the savings by using bioPEG. This is a prospective cohort study comparing lymphoma and myeloma patients undergoing ASCT and receiving bioPEG (n = 73) with three historical consecutive cohorts collected retrospectively who received oth

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… The most widely used conditioning regimes around the globe are MEL200 (melphalan 200 mg/sqm) for multiple myeloma patients, BEAM (carmustine, etoposide, cytarabine, and melphalan) or BEAC (carmustine, etoposide, cytarabine, and cyclophosphamide) for lymphoma patients and BU-CY2 (busulfan and cyclophosphamide … 200 mg/sq m; MEL 140 melphalan 140 mg/sq m; BEAM carmustine, etoposide, cytarabine, melphalan; FEAM fotemustine, etoposide, cytarabine, melphalan * Pearson’s chi-square test ** Kruskall-Wallis test Parameter | Biosimilar Peg-filgrastim, N = 73 | Biosimilar Filgrastim N = 392 | Lenograstim, N = 101 | …

Fanconi syndrome developing and worsening during anti-myeloma therapy in multiple myeloma: a case report and literature review.

BACKGROUND: Fanconi syndrome (FS) is a rare renal complication of monoclonal gammopathies including multiple myeloma (MM), typically diagnosed before or at the time of MM presentation. Onset and progression of FS during anti-myeloma treatment are extremely rare and easily misdiagnosed, resulting in delayed electrolyte correction and clinical deterioration. CASE PRESENTATION: We report a 55-year-old woman with κ light chain MM who developed FS during induction therapy and experienced recurrence after autologous stem cell transplantation (ASCT). Initial workup showed subclinical tubular dysfunc

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… , cyclophosphamide, prednisolone; MP, melphalan plus prednisone; VD, bortezomib, dexamethasone; MT, melphalan, thalidomide; NA, not available. … Melphalan is an alkylating agent secreted and reabsorbed via renal tubules and is generally considered to have low nephrotoxicity. Nevertheless, case reports of melphalan−induced acute kidney injury exist, especially in patients with pre−existing tubular dysfunction ( 29 ). …

Eficacy of Cryotherapy in the Prevention of Oral Mucosistis in Adult Patients with Chemotherapy.

Oral mucositis (OM) is a common side effect of cancer therapies. It causes ulcerative, painful lesions in the oral cavity that can provoke malnutrition, increased risk of infection, longer hospital stays, and seriously affect the quality of life. Cooling the mucosa with oral cryotherapy (OC) during and/or after chemotherapy is the most accessible and tolerable intervention available. The aim of this study is to define the efficacy of OC for preventing OM induced by chemotherapy/radiotherapy in adult patients with cancer. Secondary endpoints include associated problems as pain. A systematic sea

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… Patients were instructed to hold ice chips in their mouth for 5 min prior to high-dose melphalan infusion, during the 30-min infusion, and 30 min after completion of the infusion. The conditioning regimen of chemotherapy (high-dose melphalan) was administered 2 days before the transplant date. … Chemotherapy regimens were mainly based on melphalan in cases of HSCT [ 20 , 23 , 25 , 27 ] and fluoronacil in cases of digestive cancer [ 21 , 24 , 26 ]. …

Cardiac toxicities in multiple myeloma: an updated and a deeper look into the effect of different medications and novel therapies.

With the continuous improvement in survival of cancer patients, including those with multiple myeloma, related to the novel treatment agents and therapeutic approaches, the probability for patients to develop cardiovascular disease has significantly increased, especially in elderly patients and those with additional risk factors. Multiple myeloma is indeed a disease of the elderly population and so these patients are, solely by age, at an increased risk of cardiovascular disease. Risk factors for these events can be patient-, disease- and/or therapy-related, and they have been shown to adverse

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… Anti-myeloma drugs can also be associated with an array of cardiac toxicities including HF, arrhythmias such as bradycardia or atrioventricular block (bortezomib, cyclophosphamide, thalidomide), atrial fibrillation (cyclophosphamide, melphalan), supraventricular tachycardias (cyclophosphamide, melphalan … Autologous stem cell transplant using high dose melphalan still plays an important role in the management of newly diagnosed and relapsed disease. …

Post-marketing safety of immunomodulatory drugs in multiple myeloma: A pharmacovigilance investigation based on the FDA adverse event reporting system.

Objective: In recent years, the emergence of immunomodulatory drugs (IMiDs) has significantly improved clinical outcomes in patients with multiple myeloma (MM); however, serious adverse events (AEs) have hindered their safe clinical application. This study aimed to characterize the safety profiles and differences in IMiDs through a disproportionality analysis using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS), a post-marketing surveillance database. Methods: This study filtered reports of thalidomide, lenalidomide, and pomalidomide as primary suspect drugs in FA

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… The ECOG E1A06 study found ten and four hematologic SPMs in MPT (melphalan, prednisone, thalidomide) and MPR (melphalan, prednisone, lenalidomide) groups, respectively ( Stewart et al., 2015 ). … Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): A randomised trial . …

Clinical Management of Triple-Class Refractory Multiple Myeloma: A Review of Current Strategies and Emerging Therapies.

Major progress has been made in the upfront treatment of multiple myeloma, but the disease ultimately relapses and leads to death in the vast majority of those afflicted. New treatment strategies and modalities are necessary to treat myeloma in relapse, particularly in cases of triple-refractory status defined by disease progression during or shortly after treatment with immunomodulatory agents, proteasome inhibitors, and anti-CD38 monoclonal antibody therapy. In this manuscript, we review recent promising developments in the treatment of triple-class refractory myeloma including bispecific an

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… Another novel therapy evaluated for triple-refractory MM is melphalan flufenamide (Melflufen). … Based on these data, melphalan flufenamide received accelerated approval for triple-class refractory MM on 26 February 2021. …

Characteristics and treatment patterns in patients with multiple myeloma in Japan: A retrospective cohort analysis.

BackgroundApproval of proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies (mAbs), such as daratumumab, has reshaped treatment patterns in patients with multiple myeloma (MM) in Japan. This retrospective study evaluated patient characteristics, treatment patterns, and trends in MM patients using Medical Data Vision, the largest electronic health records database in Japan with anonymous inpatient and outpatient health information.MethodsPatients aged ≥18 years, with ≥2 records of an MM diagnostic and disease code and ≥1 record of MM treatment between 01 April 2008

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… D-VMpd: daratumumab, bortezomib, melphalan, prednisolone, dexamethasone; DRd: daratumumab, lenalidomide, dexamethasone; DRpd: daratumumab, lenalidomide, prednisolone, dexamethasone; DVd: daratumumab, bortezomib, dexamethasone; VMpd: bortezomib, melphalan, prednisolone, dexamethasone; LOT: line of therapy … In the 1+L SCT cohort, VRd + high-dose (HD)-melphalan (30.7%) and DVRd + HD-melphalan (4.8%) were the most common induction/consolidation regimens; ixazomib (26.8%), Rd (19.9%), and lenalidomide (11.3%) were the most common maintenance regimens ( S1 Table ). …

Melflufen and Dexamethasone in Heavily Pretreated Relapsed and Refractory Multiple Myeloma.

PurposeMelphalan flufenamide (melflufen) is a first-in-class peptide-drug conjugate that targets aminopeptidases and rapidly and selectively releases alkylating agents into tumor cells. The phase II HORIZON trial evaluated the efficacy of melflufen plus dexamethasone in relapsed and refractory multiple myeloma (RRMM), a population with an important unmet medical need.Patients and methodsPatients with RRMM refractory to pomalidomide and/or an anti-CD38 monoclonal antibody received melflufen 40 mg intravenously on day 1 of each 28-day cycle plus once weekly oral dexamethasone at a dose of 40 mg …

Two Secondary Primary Malignancies after Bortezomib Therapy for Multiple Myeloma: A Single-center Experience.

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… The data from our center are much lower than those of Western data, which might be due to: (1) differences in therapeutic regimen (especially melphalan and lenalidomide); (2) missed diagnosis of MDS after MM; (3) racial differences; and (4) shorter OS. … as melphalan, thalidomide, and/or lenalidomide. …

Pulsed-dose-rate peri-operative brachytherapy as an interstitial boost in organ-sparing treatment of breast cancer.

PURPOSE: To evaluate peri-operative multicatheter interstitial pulsed-dose-rate brachytherapy (PDR-BT) with an intra-operative catheter placement to boost the tumor excision site in breast cancer patients treated conservatively. MATERIAL AND METHODS: Between May 2002 and October 2008, 96 consecutive T1-3N0-2M0 breast cancer patients underwent breast-conserving therapy (BCT) including peri-operative PDR-BT boost, followed by whole breast external beam radiotherapy (WBRT). The BT dose of 15 Gy (1 Gy/pulse/h) was given on the following day after surgery. RESULTS: No increased bleeding or delaye

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… A pivotal shift in MM management occurred in the 1990s with the introduction of high-dose melphalan (HDM) followed by autologous stem cell transplantation (ASCT). … In the VISTA trial, bortezomib combined with melphalan and prednisone yielded a median duration of response of 19.9 months compared to 13.1 months in the control group. …

Effect of general symptom level, specific adverse events, treatment patterns, and patient characteristics on health-related quality of life in patients with multiple myeloma: results of a European, multicenter cohort study.

PURPOSE: Novel multiple myeloma (MM) therapies have increased patient longevity but are often associated with notable symptom burden. This study quantified the effect of general symptom level, specific symptoms, and treatment-related adverse events (AEs) on MM patients' health-related quality of life (HRQoL). METHODS: The European Organization for Research and Treatment of Cancer (EORTC) generic cancer questionnaire (Quality of Life Questionnaire Core 30) and MM-specific questionnaire (QLQ-MY20) were used in this study to assess patients' HRQoL. Data were collected on sociodemographics, disea

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… and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial. … Bortezomib plus melphalan and prednisone compared with melphalan and prednisone in previously untreated multiple myeloma: updated follow-up and impact of subsequent therapy in the phase III VISTA trial. J Clin Oncol. 2010;28:2259–2266. doi: 10.1200/JCO.2009.26.0638. 15. …

Establishing measurable residual disease trajectories for patients on treatment for newly diagnosed multiple myeloma as benchmark for deployment of T-cell redirection therapy.

Autologous stem cell transplantation (ASCT) has been the prime consolidative strategy to increase the depth and duration of response in newly diagnosed multiple myeloma (NDMM), albeit with short- and long-term toxicities. Minimal residual disease (MRD) is an important early response endpoint correlating with clinically meaningful outcomes and may be used to isolate the effect of ASCT. We report the impact of ASCT on MRD burden and generate a benchmark for evaluation of novel treatments as consolidation. We collected MRD by next generation sequencing (NGS; clonoSEQ®) post induction and post-ASC

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… Patients received high dose melphalan (140–200 mg/m 2 at investigator discretion) followed by ASCT. … Overall, 69 (21%) patients received reduced dose melphalan (140 mg/m 2 ) as ASCT conditioning regimen per investigator discretion. Melphalan dose intensity did not influence the incremental reduction in disease burden with ASCT (Supplemental figure 1 ). …