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Cost savings of home bortezomib injection in patients with multiple myeloma treated by a combination care in Outpatient Hospital and Hospital care at Home.

At home injectable chemotherapy for patients receiving treatment for hematological diseases is still in debate. Given the expense of new innovative medicines, at home treatment has been proposed as a suitable option for improving patient quality of life and decreasing treatment costs. We decided to assess the cost of bortezomib administration in France among multiple myeloma patients from an economic standpoint. Patients in this study were treated within a regional hematological network combining outpatient hospital care and Hospital care at Home administration. To make the cost comparison, ou

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… It is also indicated in combination with melphalan and prednisone for the treatment of adult patients with previously untreated multiple myeloma who are not eligible for high-dose chemotherapy with bone marrow transplantation. Bortezomib has a 3-week treatment cycle. … San Miguel JF Schlag R Khuageva NK Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma N Engl J Med 2008 359 9 906 917 10.1056/NEJMoa0801479 18753647 10. …

Cardiovascular Disease After Hematopoietic Stem Cell Transplantation in Adults: JACC: CardioOncology State-of-the-Art Review.

The use of hematopoietic cell transplantation (HCT) has expanded in the last 4 decades to include an older and more comorbid population. These patients face an increased risk of cardiovascular disease after HCT. The risk varies depending on several factors, including the type of transplant (autologous or allogeneic). Many therapies used in HCT have the potential to be cardiotoxic. Cardiovascular complications after HCT include atrial arrhythmias, heart failure, myocardial infarction, and pericardial effusions. Before HCT, patients should undergo a comprehensive cardiovascular assessment, with

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… Role: conditioning before transplantation. | Common: heart failure with LVSD (14.3% when used in combination with melphalan). 75 , 76 | It is unclear if there is a synergistic risk of left ventricular failure when melphalan is administered with fludarabine. … A case report: high dose melphalan as a conditioning regimen for multiple myeloma induces sinus arrest. Cardiooncology. 2020;6:4. doi: 10.1186/s40959-020-0059-0. 83. Yanamandra U., Gupta S., Khadwal A., Malhotra P. Melphalan-induced cardiotoxicity: ventricular arrhythmias. …

Double Relapsed and/or Refractory Multiple Myeloma: Clinical Outcomes and Real World Healthcare Costs.

Double relapsed and/or refractory multiple myeloma (DRMM), MM that is relapsed and/or refractory to bortezomib and lenalidomide, carries a poor prognosis. The healthcare costs of DRMM have not previously been reported. We analyzed detailed medical resource utilization (MRU) costs, drug costs and outcomes for 39 UK patients receiving standard DRMM therapy. Median OS in this cohort was 5.6 months. The mean cost of DRMM treatment plus MRU until death was £23,472 [range: £1,411-£90,262], split between drug costs £11,191 and other resource use costs £12,281. The cost per assumed quality-adjusted li

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… with stem cell rescue | 17 (43.5%) Previous additional alternative treatment(s): | Vincristine-based regime | 7 (17.9%) Melphalan-based regime | 5 (12.8%) Allograft | 1 (2.6%) Median years from diagnosis to DRMM point (range)* | 4 years 9.5 months (6.5 mo– 10.5 y) Median number regimes prior to DRMM … , dexamethasone | 2 (28.6%) Thalidomide-based regime | 2 (28.6%) Pomalidomide, dexamethasone | 1 (14.3%) 3 rd DRMM therapy (n = 4): | Bortezomib, cyclophosphamide, dexamethasone | 2 (50.0%) Bortezomib, melphalan, prednisone | 1 (25.0%) Bendamustine, thalidomide, dexamethasone | 1 (25.0%) Response to …

Anti-Angiogenic Activity of Drugs in Multiple Myeloma.

Angiogenesis represents a pivotal hallmark of multiple myeloma (MM) that correlates to patients' prognosis, overall survival, and drug resistance. Hence, several anti-angiogenic drugs that directly target angiogenic cytokines (i.e., monoclonal antibodies, recombinant molecules) or their cognate receptors (i.e., tyrosine kinase inhibitors) have been developed. Additionally, many standard antimyeloma drugs currently used in clinical practice (i.e., immunomodulatory drugs, bisphosphonates, proteasome inhibitors, alkylating agents, glucocorticoids) show anti-angiogenic effects further supporting t

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… Melphalan is a widely used alkylating agent for the treatment of MM patients in combination with other drugs, such as bortezomib, prednisone, thalidomide, and daratumumab [ 104 ]. … Melphalan-flufenamide (mel-flufen) is a newly developed alkylating agent [ 111 ]. It is a pro-drug of melphalan activated by the aminopeptidases overexpressed by tumor cells, going on to a faster and greater intracellular drug accumulation [ 111 ]. …

Novel agents for the treatment of multiple myeloma: proteasome inhibitors and immunomodulatory agents.

The integration of novel agents into the treatment of multiple myeloma (MM) has shifted the focus from an incurable disease to one that is chronic, with a realistic hope of someday achieving a cure. Proteasome inhibitors and immunomodulatory agents are the backbone of novel therapies for MM. These agents are particularly important for patients with relapsed or refractory disease, a fate faced by the majority of myeloma patients over the course of their disease. Review of recent clinical trial data for the proteasome inhibitors and immunomodulatory agents, including clinical efficacy and safety

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… San Miguel and colleagues reported data from the randomized phase III VISTA trial evaluating bortezomib in combination with oral melphalan and prednisone (VMP) vs. oral melphalan and prednisone (MP) in non–transplant-eligible newly diagnosed MM patients (San Miguel et al., 2012). … Persistent overall survival benefit and no increased risk of second malignancies with bortezomib-melphalan-prednisone versus melphalan-prednisone in patients with previously untreated multiple myeloma. …

In search of the optimal proteosome inhibitor. How, when and for whom?

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… Due to the higher toxicity of KMP versus VMP, melphalan was possibly also a less ideal drug to combine with carfilzomib, a notion similarly discussed by supporters of cyclophosphamide instead of melphalan. 3 Table 1. … Carfilzomib or bortezomib with melphalan-prednisone for transplant-ineligible patients with newly diagnosed multiple myeloma . Blood . 2019 ; 133 ( 18 ): 1953 - 1963 . 30819926 10.1182/blood-2018-09-874396 4. Kumar SK Jacobus SJ Cohen AD . …

Small Centers with Big Ventures: Autologous Stem Cell Transplantation Survival Data

We present the first-ever autologous stem cell transplantation (ASCT) outcome data from a secondary-care healthcare facility. Albeit exact details of patient and disease characteristics and co-morbidity scores for all patients are not available, the engraftment and survival data is very similar to those published from large tertiary-care cancer centres, both regionally and internationally. Transplant Related Mortality (TRM) of 3.1% is within the expected range and includes a patient who died of acute drug reaction (ADR) during conditioning chemotherapy, prior to the ASCT. Furthermore, cyclopho

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… Patients who proceeded to HDT after successful PBSC collection received conditioning with BEAM (BCNU/Carmustine, Etoposide, Cytarabine, Melphalan) or melphalan, either full dose of 200mg/m 2 or intermediate dose of < 200mg/m 2 . … All patients but 2 did not achieve neutrophil engraftment and both had received BEAM conditioning. 5 patients did not accomplish platelet engraftment, 4 from the BEAM arm and 1 from the intermediate-dose melphalan cohort. The engraftment data is shown in Table 2 . …

Chemistry and Pharmacology of Fluorinated Drugs Approved by the FDA (2016-2022).

Fluorine is characterized by high electronegativity and small atomic size, which provide this molecule with the unique property of augmenting the potency, selectivity, metabolic stability, and pharmacokinetics of drugs. Fluorine (F) substitution has been extensively explored in drug research as a means of improving biological activity and enhancing chemical or metabolic stability. Selective F substitution onto a therapeutic or diagnostic drug candidate can enhance several pharmacokinetic and physicochemical properties such as metabolic stability and membrane permeation. The increased binding a

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… Melphalan flufenamide Melphalan flufenamide is a prodrug of melphalan used to treat relapsed or refractory multiple myeloma ( Table 8 ). Melphalan flufenamide is more readily uptaken by cells than melphalan and it is cleaved to the active metabolite by aminopeptidases. … Desethyl-melphalan and melphalan are produced through the metabolism of melphalan flufenamide. Monohydroxy and dihydroxy-melphalan are produced spontaneously during the hydrolysis of melphalan. There is little reliable information about how melphalan flufenamide is removed from the body. …

A case of paraprotein-negative POEMS syndrome: Case report and literature review.

RATIONALE: POEMS syndrome is a rare monoclonal plasma cell disease. The diagnosis of POEMS requires polyradiculoneuropathy and monoclonal plasma proliferating as 2 mandatory criteria, at least 1 of the major criteria (Castleman disease, elevated vascular endothelial growth factor level, and sclerotic bone lesion), and at least 1 of the minor criteria (organomegaly, extravascular volume overload, endocrinopathy, skin changes, papilledema, and thrombocytosis/polycythemia). This multisystem disorder is of high heterogeneity, and few variants of POEMS with no evidence of monoclonal gammopathy have

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… Indeed, the ASCT group experienced the highest response rate, followed by the RD regimen and, finally, the melphalan plus dexamethasone regimen. … Combination of melphalan and dexamethasone for patients with newly diagnosed POEMS syndrome. Blood. 2011;117:6445–9. [23] Li J, Huang XF, Cai QQ, et al. …

Open-label pilot study of romiplostim for thrombocytopenia after autologous hematopoietic cell transplantation.

There are no standard treatments to prevent or hasten the recovery from severe conditioning-regimen-induced thrombocytopenia occurring after autologous hematopoietic cell transplantation (auto-HCT). We conducted an open-label, single-arm pilot study of romiplostim, a thrombopoietin receptor agonist, to enhance platelet recovery in patients with multiple myeloma or lymphoma undergoing auto-HCT. All patients were treated weekly with romiplostim starting day +1 after auto-HCT until the platelet count was >50 × 109/L without transfusion. Compared with contemporary retrospective data from romiplost

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… Eligible conditioning regimens included high-dose melphalan for patients with MM, and carmustine, etoposide, cytarabine, melphalan (BEAM); cyclophosphamide, carmustine, etoposide (CBV); or thiotepa, busulfan, cyclophosphamide (TBC) for patients with lymphoma. … All 40 study patients with MM received high-dose melphalan, and the 19 patients with lymphoma received either BEAM (84%) or TBC (16%). …

Treatment pattern and clinical outcomes in multiple myeloma patients in Japan using the Medical Data Vision claims database.

Multiple myeloma therapy has made remarkable progress with the advent of new drugs. We explored the treatment pattern and outcomes in Japanese patients with multiple myeloma using the Medical Data Vision database. Patients were categorized as per the initial diagnosis period (2003-2015 and 2016-2020), considering the adoption of these new agents and then based on stem cell transplantation. Overall, 6438 patient data were extracted as eligible for data analysis, and the median age at the index diagnosis date was 72.0 years. Bortezomib/dexamethasone was the most common regimen for induction ther

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… For transplant-ineligible patients, bortezomib/melphalan/prednisolone (VMP), melphalan/prednisolone (MP), and Vd were recommended in 2013 [ 13 ], which was updated to only recommend VMP and lenalidomide/dexamethasone (Rd; 18 cycles) in the 2018 version [ 7 ]. … Cy+Dex, cyclophosphamide/dexamethasone; MP, melphalan/prednisolone; Rd, lenalidomide/dexamethasone; VCd, bortezomib/cyclophosphamide/dexamethasone; Vd, bortezomib/dexamethasone; VMP, bortezomib/melphalan/predonisolone; VRd, bortezomib/lenalidomide/dexamethasone. …

Последние тенденции в области заболеваемости, выживания и лечения множественной миеломы в Финляндии - общенациональное когортное исследование.

Цель этого исследования состояла в том, чтобы определить распространенность и распространенность множественной миеломы (ММ) в Финляндии. 2015-2019, для характеристики взрослых пациентов, недавно диагностированных MM, и для контроля за их общим выживанием (OS) и схемами лечения до конца 2020. Мы почерпнули данные о стационарном и амбулаторном диагнозе, амбулаторном лечении и дате смерти из всеобъемлющих общенациональных регистров. Мы опознали 2037 пациенты с MM 2015-2019. В среднем годовой показатель общего числа случаев 8.8 и возрастная стандартная распространенность (мировой стандарт населени

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… (melphalan-prednisone or cyclophosphamide-prednisone). … Conversely, the proportion of patients purchasing lenalidomide already during the first year after the index date increased from 26.5% to 47.6%, and that of melphalan declined from 17.4% to less than 6–7%. …

Utilization of novel systemic therapies for multiple myeloma: A retrospective study of front-line regimens using the SEER-Medicare data.

The landscape of treatment for multiple myeloma (MM) has significantly changed over the last decade due to novel agents that have shown superiority in efficacy such as proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs) over traditional therapies. However, the real-world utilization of these new agents has not been studied well. This study evaluated year-to-year changes in treatment choices in a cohort of patients aged 66 or older in the Surveillance, Epidemiology, and End Results (SEER) registry linked with Medicare claims (SEER-Medicare) data who were diagnosed with MM between 200

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… Bortezomib‐melphalan‐prednisone‐thalidomide followed by maintenance with bortezomib‐thalidomide compared with bortezomib‐melphalan‐prednisone for initial treatment of multiple myeloma: a randomized controlled trial . … 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 . …

The Effects of Oral Cryotherapy on Chemotherapy-Induced Oral Mucositis in Patients Undergoing Autologous Transplantation of Blood Stem Cells: A Clinical Trial.

BackgroundOral mucositis is one of the irritating side effects of chemotherapy in patients undergoing bone marrow transplantation. However, up until now, the common methods of oral mucositis therapy have failed to show significant effects.ObjectivesThe aim of this study was to investigate the effects of local cryotherapy on the intensity of chemotherapy-induced oral mucositis in autologous bone marrow transplantation patients.Patients and methodsIn this single, blinded, randomized clinical trial, 29 patients undergoing stem cell transplantation in Iran were selected by convenience sampling, an

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… Melphalan was used in those patients with Hodgkin’s and non-Hodgkin’s transplantations, and in multiple myeloma transplantations, drugs such as melphalan, cytarabine, etoposide, and lomustine were used. … Lilleby et al. ( 21 ) published a paper in 2006 reporting their study on 40 patients with melphalan medicine regimens via case and control groups evaluating the effects of cryotherapy and washing with normal saline. …

Bortezomib in the management of multiple myeloma.

Multiple myeloma (MM) is a B-cell malignancy characterized by clonal expansion of plasma cells within the bone marrow, the presence of a serum and/or urine monoclonal protein, lytic bone lesions, and anemia. On a cellular level, the disease is characterized by complex interactions between tumor cells and the surrounding bone marrow microenvironment. Understanding of the relationship between malignant plasma cells and the microenvironment has sparked ongoing efforts to develop targeted therapeutic agents for treatment of this disease. The successful development of the first-in-class small-molec

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… In a large, multicenter phase III trial involving 682 ASCT-ineligible patients with newly diagnosed MM, bortezomib plus melphalan and prednisone (VMP) was compared to MP alone. 42 All patients received melphalan 9 mg/m 2 and prednisone 60 mg/m 2 days 1–4 of each 6-week cycle, while bortezomib was administered … Comparison of melphalan and prednisone with vincristine, carmustine, melphalan, cyclophosphamide, and prednisone in the treatment of multiple myeloma – Results of Eastern Cooperative Oncology Group Study E2479. Cancer. 1997;79(8):1561–1567. 7. Barlogie B, Smith L, Alexanian R. …

INSIGHT MM: a large, global, prospective, non-interventional, real-world study of patients with multiple myeloma.

With the introduction of new drugs with different mechanisms of action, multiple myeloma (MM) patients' outcomes have improved. However, the efficacy seen in clinical trials is often not seen in real-world settings and data on the effectiveness of MM therapies are needed. INSIGHT MM is a prospective, global, non-interventional, observational study that is enrolling approximately 4200 patients with newly diagnosed or relapsed/refractory MM, making it the largest study of its kind to date. The study aims to describe contemporary, real-world patterns of patient characteristics, clinical disease p

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… , prednisone, lenalidomide, plus lenalidomide maintenance; MPT: Melphalan, prednisone, thalidomide; NDMM: Newly diagnosed multiple myeloma; PAD: Bortezomib, doxorubicin, dexamethasone; Pano-K: Panobinostat, carfilzomib; Pano-Rd: Panobinostat, lenalidomide, dexamethasone; Pano-Vd: Panobinostat, bortezomib … melphalan, prednisone, thalidomide; VRd: Bortezomib, lenalidomide, dexamethasone; VT: Bortezomib, thalidomide; VTD: Bortezomib, thalidomide, dexamethasone. …

Influence of anticancer agents on sexual function: An in vivo study based on the US FDA Adverse Event Reporting System.

BackgroundPatients with cancer are treated with chemotherapeutics that cause adverse effects, including erectile dysfunction (ED).Objectives … vernous nerve. Statistical significance was determined using Welch's t-test or two-way ANOVA.ResultsMelphalan (L-PAM; ROR = 4.72, 95% CI = 2.78-8.00), vincristine (VCR; ROR = 2.47, 95% CI = 1.54-3.97), docetaxel (DTX; ROR = 2.25, 95% CI = 1.28-3.95), methotrexate (MTX; ROR = 1.96, 95% CI = 1.39-2.75), and doxorubicin (DOX; ROR = 1.82, 95% CI = 1.07-3.19) en …

Response and progression-free survival according to planned treatment duration in patients with relapsed multiple myeloma treated with carfilzomib, lenalidomide, and dexamethasone (KRd) versus lenalidomide and dexamethasone (Rd) in the phase III ASPIRE study.

BACKGROUND: In ASPIRE, carfilzomib, lenalidomide, and dexamethasone (KRd) significantly improved progression-free survival (PFS) and response rates versus lenalidomide and dexamethasone (Rd) in patients with relapsed multiple myeloma. Per protocol, patients received KRd for a maximum of 18 cycles followed by Rd to progression, so the benefit/risk profile of KRd to progression was not established. METHODS: This post hoc analysis evaluated the efficacy and safety of KRd versus Rd at 18 months from randomization. Cumulative rates of complete response (CR) or better over time and PFS hazard ratio

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… Garrison LP Jr Wang ST Huang H Ba-Mancini A Shi H Chen K The cost-effectiveness of initial treatment of multiple myeloma in the U.S. with bortezomib plus melphalan and prednisone versus thalidomide plus melphalan and prednisone or lenalidomide plus melphalan and prednisone with continuous lenalidomide … Palumbo A Bringhen S Larocca A Rossi D Di Raimondo F Magarotto V Bortezomib-melphalan-prednisone-thalidomide followed by maintenance with bortezomib-thalidomide compared with bortezomib-melphalan-prednisone for initial treatment of multiple myeloma: updated follow-up and improved survival J Clin Oncol …

A predictive model for risk of early grade ≥ 3 infection in patients with multiple myeloma not eligible for transplant: analysis of the FIRST trial.

Infections are a major cause of death in patients with multiple myeloma. A post hoc analysis of the phase 3 FIRST trial was conducted to characterize treatment-emergent (TE) infections and study risk factors for TE grade ≥ 3 infection. The number of TE infections/month was highest during the first 4 months of treatment (defined as early infection). Of 1613 treated patients, 340 (21.1%) experienced TE grade ≥ 3 infections in the first 18 months and 56.2% of these patients experienced their first grade ≥ 3 infection in the first 4 months. Risk of early infection was similar regardless of treatme

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… Rd for 18 cycles (Rd18) or melphalan, prednisone, and thalidomide (MPT) in transplant-ineligible patients with newly diagnosed MM (NDMM) [ 7 , 8 ]. … , prednisone, and thalidomide, Rd cont lenalidomide plus low-dose dexamethasone until disease progression, Rd18 lenalidomide plus low-dose dexamethasone for 18 cycles, TE treatment emergent Table 2 Rate of TE grade ≥ 3 infections by treatment arm in the FIRST trial (safety population) MPT melphalan, …

Proteasome Inhibitors for the Treatment of Multiple Myeloma.

Use of proteasome inhibitors (PIs) has been the therapeutic backbone of myeloma treatment over the past decade. Many PIs are being developed and evaluated in the preclinical and clinical setting. The first-in-class PI, bortezomib, was approved by the US food and drug administration in 2003. Carfilzomib is a next-generation PI, which selectively and irreversibly inhibits proteasome enzymatic activities in a dose-dependent manner. Ixazomib was the first oral PI to be developed and has a robust efficacy and favorable safety profile in patients with multiple myeloma. These PIs, together with other

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… Recently, the phase III PETHEMA/GEM2012 study evaluated VRD for six cycles followed by ASCT conditioned with intravenous busulfan plus melphalan versus melphalan and post-transplant consolidation with two cycles of VRD [ 43 ]. … 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 VISTA trial J. Clin. Oncol. 2010 28 2259 2266 10.1200/JCO.2009.26.0638 20368561 52. De Weers M. …