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Incidence of neutropenia and use of granulocyte colony-stimulating factors in multiple myeloma: is current clinical practice adequate?

Although immunomodulatory drugs, alkylating agents, corticosteroids, protease inhibitors, and therapeutic monoclonal antibodies improve multiple myeloma outcomes, treatment burden is still an issue. Neutropenia is a known complication of cytotoxic cancer therapy and is often associated with infections; it is an important consideration in myeloma given the fact that patients often have a weakened immune system. The risk of febrile neutropenia increases with severe and persisting neutropenia. Recombinant granulocyte colony-stimulating factors (G-CSFs) are commonly used to reduce the incidence, d

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… Only two studies reported G-CSF use in patients receiving a VD-based triplet regimen. … Despite the high rates of neutropenia seen with these triplets, few patients experienced infections, and rates of febrile neutropenia were low (Table 2 ). …

Deep Learning-Based 30-Day Mortality Prediction in Critically Ill Bone and Bone Marrow Metastasis Patients: A Multicenter Retrospective Cohort Study.

Bone and bone marrow Metastasis (BBM) are life-threatening complications of advanced malignancies, frequently requiring intensive care and associated with high short-term mortality. However, prognostic tools specifically tailored to critically ill BBM patients are limited. This multicenter cohort study aimed to develop and validate deep learning models for predicting 30-day mortality using ICU data from MIMIC-IV, eICU-CRD, and the First Affiliated Hospital of Xinjiang Medical University. After univariate screening, XGBoost-Boruta and Lasso regression identified 11 key clinical features within

Monoclonal Antibodies to Treat Multiple Myeloma: A Dream Come True.

Immunotherapy is increasingly used in the treatment of multiple myeloma (MM). Monoclonal antibodies (mAbs) are safe and effective ways to elicit immunotherapeutic responses. In 2015, daratumumab has become the first mAb approved by the Food and Drug Administration for clinical use in MM and, in the last 5 years, a lot of clinical and preclinical research has been done to optimize the use of this drug class. Currently, mAbs have already become part of standard-of-care combinations for the treatment of relapsed/refractory MM and very soon they will also be used in the frontline setting. The succ

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… These two studies led to FDA approval in 2016 and EMA approval in 2017 of daratumumab triplets in RRMM patients. In the CASTOR study, Dara-Vd and Vd were compared. The primary endpoint was progression-free survival (PFS). … The ELOQUENT-1 trial evaluated the triplet elotuzumab-Rd in NTE NDMM patients, and it was recently announced that the primary endpoint (PFS) was not met [ 78 ]. …

Novel Non-Immunologic Agents for Relapsed and Refractory Multiple Myeloma: A Review Article.

Novel treatments are needed to address the lack of options for patients with relapsed or refractory multiple myeloma. Even though immunotherapy-based treatments have revolutionized the field in recent years, offering new opportunities for patients, there is still no curative therapy. Thus, non-immunologic agents, which have proven effective for decades, are still central to the treatment of multiple myeloma, especially for advanced disease. Building on their efficacy in myeloma, the development of proteasome inhibitors and immunomodulatory drugs has been pursued, and has led to the emergence o

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… Selinexor-based triplets are under evaluation for RRMM patients, and will potentially address the lack of treatments for IMiD-refractory patients. … One could argue that in a triplet combination a higher dosage of selinexor is not required, but there is currently no proof that selinexor can be as effective as a single agent at this weekly dosage. …

Optimizing oncology drug development: systematic review of 22 years of myeloma randomized controlled trials.

BACKGROUND: Although myeloma represents a key success story in oncology, some drugs have failed to meet primary endpoints in randomized controlled trials (RCTs), despite promising early phase activity. This analysis aimed to understand factors that increase the likelihood of meeting primary endpoints in myeloma RCTs. METHODS: Myeloma RCTs published through October 2023 were identified using MEDLINE, PubMed, Embase, and the Cochrane Registry. Studies were classified as head-to-head (substituting 1 regimen for another) or add-on (adding 1 drug to existing regimen). Trials were considered succes

An objective assessment in newly diagnosed multiple myeloma to avoid treatment complications and strengthen therapy adherence.

In heterogeneous multiple myeloma (MM) patients treatment decisions are challenging. The hypothesis was that adaptation of treatment intensity (dose reduction [DR] vs. none) according to an objective risk score (revised-myeloma comorbidity index [R-MCI]) rather than physician judgement alone may improve therapy efficacy and avoid toxicities. We performed this study in 250 consecutive MM patients who underwent a prospective fitness assessment at our center, after having received induction protocols based on physicians' judgement. DR, serious adverse events (SAE), response, progression-free surv

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… inclusion of proteasome inhibitors (PI), immunomodulatory drugs (IMiDs) and antibodies (Ab)/immunotherapies into induction and relapse protocols, response rates, progression-free survival (PFS) and overall survival (OS) have improved impressively. 2 Standard treatment in newly diagnosed MM (NDMM) includes triplets … Thus, any decrease in the lead agents’ standard dose intensity or change from triplets to doublets was defined as DR. …

Daratumumab as Single Agent in Relapsed/Refractory Myeloma Patients: A Retrospective Real-Life Survey.

BackgroundThe anti-CD38 monoclonal antibody daratumumab is approved as a single agent for the treatment of patients with relapsed/refractory multiple myeloma (RRMM) who received at least three prior lines of therapy, including proteasome inhibitor and immunomodulatory agent. A retrospective multicentric study was designed to evaluate feasibility, tolerability, and efficacy of daratumumab in monotherapy in RRMM.MethodsThis study included 44 consecutive RRMM patients that underwent daratumumab monotherapy after a median number of four prior therapies (range 2-9). Patients were treated in seven S

Прогнозируемое значение изолированной Беты 2-Microglobulin Возвращение в тайскую Множественную миелому: влияние оценки реалов.

ИСТОРИЯ ВОПРОСА: 2024 Международная рабочая группа < < Миэлома > > (Миломское общество)2- микроглобулин (β2M) с нормальной сывороткой креатинин (SCr) в виде множественной миэломы высокого риска (MM). Однако определения почек на основе креатинина могут быть неточными для азиатских популяций с меньшей массой мышц. Мы стремились оценить прогнозируемое воздействие изолированного повышенного уровня β2M на общее выживание (ОС) с использованием определений, основанных на Креатинине Кр и Коккрофт-Го (CrCl). МЕТОДЫ: Это ретроспективное исследование охватывало новых пациентов с диагнозом MM

35 :: многолетние академические испытания с уделением особого внимания высокодозированной терапии и аутологической трансплантации стволовых клеток: опыт работы в рамках Межгрупповой франкоязычной программы < < Мьеломе > > .

Прифронтовая высокодозированная терапия (HDT) 2025, стандарт ухода за пациентами с множественной миеломой (ММ), имеющими право на автологическую трансплантацию стволовых клеток (ASCT). По возможности также предлагается систематически проводить индукционную терапию с комбинациями четырехкратной дозы. В соответствии с международными руководящими принципами рекомендуется также поддерживать леналидомид до тех пор, пока не будет достигнут прогресс. Эта стратегия разрабатывалась на протяжении последних десятилетий на основе результатов фазы 3 - судебные процессы, разработанные и проведенные различны

30 Years of Improved Survival in Non-Transplant-Eligible Newly Diagnosed Multiple Myeloma.

The treatment of multiple myeloma (MM) has greatly evolved these past few years. Recent advances in therapeutics have largely benefited elderly patients now renamed "non-transplant-eligible" (NTE) patients. Since the 1960s, and for several decades, chemotherapy was the only treatment for MM. Then, the field was marked by the emergence of targeted therapies in the 2000s, such as immunomodulating agents (thalidomide, lenalidomide, and pomalidomide) and proteasome inhibitors (bortezomib, carfilzomib, and ixazomib), which were the first steps towards an increase in survival. Thereafter, the appari

Safety and Efficacy of Combination Maintenance Therapy with Ixazomib and Lenalidomide in Patients with Posttransplant Myeloma.

PurposeIn this study, the addition of ixazomib to lenalidomide maintenance post-autologous stem cell transplant (ASCT) in 64 patients with newly diagnosed multiple myeloma was evaluated on the basis of the observed benefit of lenalidomide-only maintenance in prior studies.Patients and methodsPatients were started on maintenance therapy with lenalidomide and ixazomib within 60-180 days of stem cell infusion.ResultsResponse rates deepened over time from baseline post-ASCT for 39 patients. The complete response (CR)/stringent CR rate was 43% and median overall survival was not reached with a medi

The Role of Immunotherapy in Non-transplant Eligible Multiple Myeloma.

As the global population is aging and survival in multiple myeloma (MM) is increasing, treating older MM patients, redefined as non-transplant eligible (NTE), is becoming more frequent. Yet, treating these patients remains a real challenge especially because of a marked heterogeneity in the population and an increased susceptibility to treatment toxicity. Indeed, the balance between efficacy and safety must be considered at all time throughout the treatment history for these patients. Therefore, younger and older patients were historically treated in a very different way, even though the safet

Colesevelam for lenalidomide associated diarrhea in patients with multiple myeloma.

Аннотация не предоставлена источником. Откройте карточку для перехода к публикации.

VRD versus VCD as induction therapy before autologous stem cell transplantation in multiple myeloma: a nationwide population-based study.

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Case report: Relapsed/refractory extranodal natural killer/T-cell lymphoma nasal type with extensive central nervous system involvement.

Background: Extranodal natural killer/T-cell lymphoma (ENKL) is a rare subtype of mature T and natural killer cell lymphomas associated with Epstein-Barr virus. Case: A 20-year-old presented with severe neurological symptoms and was diagnosed with stage IV ENKL, nasal type, with CNS involvement. Overall, the patient received nine treatment lines, including chemotherapy, craniospinal irradiation, allogeneic stem cell transplant (alloSCT), donor lymphocyte infusions, and novel agents (Nivolumab, Daratumumab, Thalidomide, Lenalidomide, virus-specific T cells) combined with intrathecal chemotherap

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… After the first line of SMILE chemotherapy with concomitant intrathecal triplets, the patient’s neurological condition improved significantly, ophthalmoplegia disappeared (which resulted in regained vision), hearing improved, pelvic organ function normalized, she regained full control of both arms and … The combination of the backbone DHAP with intrathecal triplets and Daratumumab resulted in the total elimination of ENKL cells in the CSF (flow cytometry), blood EBV clearance, and one of the lowest EBV counts in the CSF throughout the whole course of the disease. …

Multiple Myeloma in 2023 Ways: From Trials to Real Life.

Multiple myeloma is a chronic hematologic malignancy that obstinately tends to relapse. Basic research has made giant strides in better characterizing the molecular mechanisms of the disease. The results have led to the manufacturing of new, revolutionary drugs which have been widely tested in clinical trials. These drugs have been approved and are now part of the therapeutic armamentarium. As a consequence, it is essential to combine what we know from clinical trials with real-world data in order to improve therapeutic strategies. Starting with this premise, our review aims to describe the cu

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… All these triplets have demonstrated a benefit over Rd doublet. By comparing these trials in a hazard ratio-based-meta-analysis, we can realize that the triplet D-Rd shows the lowest PFS and OS hazard ratio. … After a median FU of 18 months, both triplets obtained comparable results in terms of PFS and OS. In univariate analysis, ISS 3, previous LENA exposure, age >65 y and number of prior lines were predictors of worse prognosis [ 70 ]. …

Breaking through Multiple Myeloma: A Paradigm for a Comprehensive Tumor Ecosystem Targeting.

Multiple myeloma (MM) is a cancerous condition characterized by the proliferation of plasma cells within the hematopoietic marrow, resulting in multiple osteolytic lesions. MM patients typically experience bone pain, kidney damage, fatigue due to anemia, and infections. Historically, MM was an incurable disease with a life expectancy of around three years after diagnosis. However, over the past two decades, the development of novel therapeutics has significantly improved patient outcomes, including response to treatment, remission duration, quality of life, and overall survival. These advancem

Plasma Cells Out for a Swim! A Study on Myelomatous Involvement of Effusion Fluid and Cerebrospinal Fluid: A 10-Year Experience from a Tertiary Cancer Center.

BackgroundMultiple myeloma (MM), a hematological malignancy marked by clonal plasma cells in the bone marrow, occasionally presents with myelomatous effusion-a rare condition with a median survival of AimsTo analyze the plasma cell involvement in body fluids and CSF in plasma cell neoplasms, correlating these findings with treatment strategies and patient outcomes.Materials and methodsThis retrospective study was conducted in the Oncopathology Department of a tertiary state cancer institute over 10 years (2013-July 2024). It included cases of plasma cell neoplasms with confirmed involvement of

Clinical evidence for immune-based strategies in early-line multiple myeloma: current challenges in decision-making for subsequent therapy.

Almost all patients with multiple myeloma (MM) will eventually develop disease that has relapsed with or become refractory to available treatments and will require additional therapy. However, data are still lacking on how best to sequence regimens in the relapsed/refractory (RR) setting after the failure of early-line lenalidomide, bortezomib, and/or daratumumab, the most commonly used agents in clinical practice today. With the treatment landscape rapidly changing in response to emerging clinical trial data and approvals of several new drugs and additional combinations, it is critically impo

Воздействие телереабилитационного вмешательства пилатеса через Интернет на людей с множественным склерозом: протокол для случайного контролируемого испытания.

Физическая активность (ПА) была рекомендована при множественном склерозе (MS) для поддержания хорошей физической пригодности и психического здоровья, снижения степени серьезности симптомов и риска рецидива, а также улучшения качества жизни. Пилатесы были предложены в качестве идеального ПА для регулирования физических, когнитивных и психологических симптомов MS и в качестве полезного метода поддержания и улучшения баланса и походки. ЦЕЛЬ: В настоящем документе представлен протокол исследования, целью которого является оценка эффективности в физической области (особенно сбалансированности и пох

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… from genomic DNA; sequencing products will be purified using a rapid, high-performance dye-terminator removal kit and will be subjected to electrophoresis; AAT repetitions will be counted on the resulting electropherograms (short AAT: homozygous or heterozygous for an allele with ≤11 repeats of AAT triplets … ; long AAT: homozygous for an allele with ≥12 repeats of AAT triplets). …