A117 A Phase III Study of VMPT Versus VMP in Newly Diagnosed Elderly Myeloma Patients

Palumbo, A; Cangialosi, Clotilde; Gottardi, Daniela; Elice, Francesca; Bringhen, Sara; Rossi, D; Magarotto, Valeria; Baldini, Luca; Morabito, F; Musolino, Caterina; Falcone, Alfredo; Rosa, L De; Ceccolini, Michela; Ciambelli, Fabrizio; Zambello, Renato; Ferrara, F.; Musto, P.; Omedè, Paola; Raimondo, F. Di; Boccadoro, Mario

doi:10.1016/s1557-9190(11)70467-x

Cited by 5 publications

(5 citation statements)

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“…In this bortezomib-dense treatment, HR vs SR patients had similar PFS. 74 The IFM group observed that across bortezomib regimens, no benefit was achieved in HR-CA NTE patients. 75 Consensus statement.…”

Section: Treatment Options For High-risk Diseasementioning

confidence: 99%

Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group

Sonneveld

Avet-Loiseau

Lonial

et al. 2016

Blood

740

601

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The International Myeloma Working Group consensus updates the definition for high-risk (HR) multiple myeloma based on cytogenetics Several cytogenetic abnormalities such as t(4;14), del(17/17p), t(14;16), t(14;20), nonhyperdiploidy, and gain(1q) were identified that confer poor prognosis. The prognosis of patients showing these abnormalities may vary with the choice of therapy. Treatment strategies have shown promise for HR cytogenetic diseases, such as proteasome inhibition in combination with lenalidomide/pomalidomide, double autologous stem cell transplant plus bortezomib, or combination of immunotherapy with lenalidomide or pomalidomide. Careful analysis of cytogenetic subgroups in trials comparing different treatments remains an important goal. Cross-trial comparisons may provide insight into the effect of new drugs in patients with cytogenetic abnormalities. However, to achieve this, consensus on definitions of analytical techniques, proportion of abnormal cells, and treatment regimens is needed. Based on data available today, bortezomib and carfilzomib treatment appear to improve complete response, progression-free survival, and overall survival in t(4;14) and del(17/17p), whereas lenalidomide may be associated with improved progression-free survival in t(4;14) and del(17/17p). Patients with multiple adverse cytogenetic abnormalities do not benefit from these agents. FISH data are implemented in the revised International Staging System for risk stratification.

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Section: Treatment Options For High-risk Diseasementioning

confidence: 99%

Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group

Sonneveld

Avet-Loiseau

Lonial

et al. 2016

Blood

740

601

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“…68 Recent evidence suggests that once weekly dosing may be helpful in this regard, although efficacy may be compromised. 69 Neuropathy and constipation with thalidomide or low blood counts with lenalidomide are well recognized and can again be managed by dose adjustment, symptom management and growth factor support. 70 Thrombosis is relatively common when thalidomide or lenalidomide is used with steroids, and is particularly frequent when treating newly diagnosed patients and when using these drugs in concert with an anthracycline or alkylator.…”

Section: Supportive Carementioning

confidence: 99%

How I treat multiple myeloma in younger patients

Stewart

Richardson

Miguel

2009

Blood

121

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Therapeutic options for multiple myeloma (MM) patients have changed quickly in recent years and uncertainty has arisen about optimal approaches to therapy. A reasonable goal of MM treatment in younger "transplant eligible" patients is to initiate therapy with a target goal of durable complete remission, and the anticipated consequence of long-term disease control. To achieve this goal we recommend induction therapy with multiagent combination chemotherapies (usually selected from bortezomib, lenalidomide, thalidomide, cyclophosphamide, and corticosteriods) which when employed together elicit frequent, rapid, and deep responses. We recommend consolidation with high-dose melphalan and autologous stem cell transplantation in the majority of patients willing and able to undergo this procedure and subsequent maintenance therapy, especially in those failing to achieve a complete response or at high risk for early relapse based on prognostic, genetically defined risk factors. Defining genetic risk for early relapse is therefore an important aspect of early diagnostic testing and attention to minimizing expected toxicities once therapy begins is critical in ensuring the efficacy of modern combination therapy approaches. When access to newer drugs is restricted participation in clinical trials should be pursued. (Blood. 2009;114: 5436-5443)

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“…37,39 More recently, multi-agent studies have shown that, in addition to dose reduction, weekly dosing may prevent the progression of PN and reduce severe PN (Ն grade 3). 54 Weekly bortezomib dosing is therefore considered to be an effective strategy to prevent further worsening of PN once patients have developed PN grade 1. Based on expert advice, this approach is currently recommended, and will be implemented in the International Myeloma Working Group (IMWG) consensus guidelines.…”

Section: Dose and Schedulementioning

confidence: 99%

Dealing with Neuropathy in Plasma-Cell Dyscrasias

Sonneveld¹,

Jongen

2010

Hematology

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Peripheral neuropathy (PN) is a frequent complication of plasma-cell dyscrasias such as monoclonal gammopathy of undetermined significance, multiple myeloma, Waldenströ m's disease, POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome, Castleman's disease, and light-chain amyloidosis. PN can be associated with the underlying disease or it can related to the treatment. The novel immunomodulatory drugs thalidomide and lenalidomide and the proteasome inhibitor bortezomib have changed the standard treatment of multiple myeloma. Treatment-related PN induced by thalidomide (TiPN) or bortezomib (BiPN) has become the most frequent cause of symptomatic polyneuropathy in multiple myeloma and related diseases. Dealing with PN has become a major challenge in current clinical practice for multiple myeloma patients. This review deals with practical issues such as etiology, incidence, symptoms, and clinical management of treatment-emergent PN. The major focus of the hematologist should be on the prevention of PN, primarily by frequent monitoring of the patient and by timely and adequate dose reduction of thalidomide and bortezomib. Thalidomide should not be given for periods longer than 18 months, and if it is, then patients should be carefully monitored with a low threshold for discontinuation in the face of any emergent neuropathy. In the case of BiPN, the dose of bortezomib should be reduced and/or the administration interval should be prolonged from biweekly to weekly. Adequate pain management and supportive care require a multidisciplinary approach involving the treating physician, expert nursing staff, and a neurologist as clinically indicated.

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A117 A Phase III Study of VMPT Versus VMP in Newly Diagnosed Elderly Myeloma Patients

Cited by 5 publications

References 0 publications

Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group

Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group

How I treat multiple myeloma in younger patients

Dealing with Neuropathy in Plasma-Cell Dyscrasias

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