Improved survival of patients with multiple myeloma after the introduction of novel agents and the applicability of the International Staging System (ISS): an analysis of the Greek Myeloma Study Group (GMSG)

Kastritis, Efstathios; Zervas, Konstantinos; Symeonidis, Argiris; Terpos, Evangelos; Delimbassi, S; Anagnostopoulos, Nikolaos; Michali, Evridiki; Zomas, Athanasios; Katodritou, Eirini; Gika, Dimitra; Pouli, Anastasia; Christoulas, Dimitrios; Ρούσσου, Μαρία; Kartasis, Zafiris; Economopoulos, Theofanis

doi:10.1038/leu.2008.402

Cited by 176 publications

(107 citation statements)

References 20 publications

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“…The introduction of these novel agents has contributed to a significant improvement in recent years in outcomes for patients with MM, as seen in population-based analyses [11][12][13][14]. In addition, numerous large phase III randomized studies have demonstrated improved outcomes with novel-agentbased therapies versus other chemotherapies and previous standards-of-care, including in previously untreated patients with MM who were ineligible [15][16][17][18] or eligible [19 -22] for high-dose therapy with stem cell transplantation (SCT), and in patients with relapsed or refractory disease [23,24].…”

Section: Introductionmentioning

confidence: 99%

Health Care Costs and Resource Utilization, Including Patient Burden, Associated With Novel-Agent-Based Treatment Versus Other Therapies for Multiple Myeloma: Findings Using Real-World Claims Data

et al. 2013

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Background. Treatment of multiple myeloma has dramatically improved with the introduction of bortezomib (BOR), thalidomide (THAL), and lenalidomide (LEN). Studies assessing health care costs, particularly economic burden on patients, are limited. We conducted a claims-based, retrospective analysis of total health care costs as well as patient burden (patient out-of-pocket costs and number of ambulatory/hospital visits) associated with BOR/THAL/LEN treatment versus other therapies (OTHER). Conclusions. Adjusted analyses of real-world claims data show that total health care costs, as well as patient out-of-pocket costs, are higher with THAL/LEN treatment episodes than with BOR/OTHER therapies. Additionally, similar rates of ambulatory visits suggest that any perceived advantage in patient convenience of the orally administered drugs THAL/LEN is not supported by these data. The Oncologist 2013;18:37-45 Implications for Practice: In addition to efficacy and safety considerations, economic factors associated with novel treatments are important issues for payers and patients. Claims data provide real-world insight into health care costs associated with treatment for multiple myeloma. In this study, total health care costs and patient out-of-pocket costs were measured during one year post-initiation and analyzed per treatment episode. Adjusted for patient characteristics, comorbidities, and line of treatment, the costs of "other" therapies (i.e., other chemotherapy or radiotherapy) and bortezomib were similar, but the costs of thalidomide or lenalidomide treatment were significantly higher. Despite different routes of administration for bortezomib (intravenous), and thalidomide and lenalidomide (oral), the number of ambulatory visits (i.e., clinic/physician office and hospital outpatient visits) appeared similar across therapies with the only significant difference being between the rates for lenalidomide and "other" treatment. These data show differential real-world costs and patient burden associated with these treatments and may support decision-making with regard to multiple myeloma treatment.

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Section: Introductionmentioning

confidence: 99%

Health Care Costs and Resource Utilization, Including Patient Burden, Associated With Novel-Agent-Based Treatment Versus Other Therapies for Multiple Myeloma: Findings Using Real-World Claims Data

et al. 2013

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“…[1][2][3] Induction chemotherapy followed by autologous hematopoietic stem cell transplantation (HSCT) is currently the standard treatment for younger myeloma patients. However, relapse is the rule and median PFS after first line therapy is usually o 4 years.…”

Section: Introductionmentioning

confidence: 99%

Favorable long-term outcome of patients with multiple myeloma using a frontline tandem approach with autologous and non-myeloablative allogeneic transplantation

Ahmad

LeBlanc

Cohen

et al. 2015

Bone Marrow Transplant

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Despite survival improvement with novel agents and use of autologous hematopoietic stem cell transplantation (HSCT), cure of patients with multiple myeloma (MM) remains anecdotal. Initial observations suggested that chronic GvHD was accompanied by an anti-myeloma effect after myeloablative HSCT, but unfortunately this procedure was hampered by high non-relapse mortality (NRM). To maximize the anti-myeloma effect and minimize NRM, we developed a non-myeloablative (NMA) regimen associated with a high incidence of chronic GvHD and tested its efficacy on patient survival and disease eradication. From 2001 to 2010, 92 patients aged ⩽ 65 years with a compatible sibling donor received autologous HSCT followed by an outpatient NMA allogeneic HSCT using a conditioning of fludarabine and cyclophosphamide. Patient median age was 52 years and 97% presented DurieSalmon stages II-III disease. After a median follow-up of 8.8 years, probability of 10-year progression free and overall survival were 41% and 62%, respectively. Although the cumulative incidence of extensive chronic GvHD was high (at 79%), the majority of longterm survivors were off immunosuppressive drugs by year 5 and NRM was low (at 10%). Together, our results suggest that potential MM cure can be achieved with NMA transplantation regimens that maximize graft-versus-myeloma effect and minimize NRM.

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“…The introduction of newer therapies, immunomodulatory drugs (thalidomide and lenalidomide), and the first-in-class proteasome inhibitor bortezomib ushered in a period of remarkable progress as the profound impact of such novel agents became evident early in the disease course. 1,13 Therefore, the Mayo prognostic model For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings a .…”

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confidence: 99%

Evidence for Cytogenetic and Fluorescence In Situ Hybridization Risk Stratification of Newly Diagnosed Multiple Myeloma in the Era of Novel Therapies

Kapoor

Fonseca

Rajkumar

et al. 2010

Mayo Clinic Proceedings

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Overall survival (OS) has improved with increasing use of novel agents in multiple myeloma (MM). However, the disease course remains highly variable, and the heterogeneity largely reflects different genetic abnormalities. We studied the impact of the Mayo risk-stratification model of MM on patient outcome in the era of novel therapies, evaluating each individual component of the model-fluorescence in situ hybridization (FISH), conventional cytogenetics (CG), and the plasma cell labeling index-that segregates patients into high-and standard-risk categories. This report consists of 290 patients with newly diagnosed MM, predominantly treated with novel agents, who were risk-stratified at diagnosis and were followed up for OS. Of these patients, 81% had received primarily thalidomide (n=50), lenalidomide (n=199), or bortezomib (n=79) as frontline or salvage therapies. Our retrospective analysis validates the currently proposed Mayo risk-stratification model (median OS, 37 months vs not reached for high-and standard-risk patients, respectively; P=.003). Although the FISH or CG test identifies a high-risk cohort with hazard ratios of 2.1 (P=.006) and 2.5 (P=.006), respectively, the plasma cell labeling index cutoff of 3% fails to independently prognosticate patient risk (hazard ratio, 1.4; P=.41). In those stratified as standard-risk by one of the 2 tests (FISH or CG), the other test appears to be of additional prognostic significance. This study validates the high-risk features defined by FISH and CG in the Mayo risk-stratification model for patients with MM predominantly treated with novel therapies based on immunomodulatory agents. Proc. 2010;85(6):532-537 CG = cytogenetics; CI = confidence interval; FISH = fluorescence in situ hybridization; HR = hazard ratio; IgH = immunoglobulin heavy chain; MM = multiple myeloma; mSMART = Mayo Stratification of Myeloma and RiskAdapted Therapy; NR = not reached; PCLI = plasma cell labeling index; SCT = stem cell transplantation Mayo Clin

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Improved survival of patients with multiple myeloma after the introduction of novel agents and the applicability of the International Staging System (ISS): an analysis of the Greek Myeloma Study Group (GMSG)

Cited by 176 publications

References 20 publications

Health Care Costs and Resource Utilization, Including Patient Burden, Associated With Novel-Agent-Based Treatment Versus Other Therapies for Multiple Myeloma: Findings Using Real-World Claims Data

Health Care Costs and Resource Utilization, Including Patient Burden, Associated With Novel-Agent-Based Treatment Versus Other Therapies for Multiple Myeloma: Findings Using Real-World Claims Data

Favorable long-term outcome of patients with multiple myeloma using a frontline tandem approach with autologous and non-myeloablative allogeneic transplantation

Evidence for Cytogenetic and Fluorescence In Situ Hybridization Risk Stratification of Newly Diagnosed Multiple Myeloma in the Era of Novel Therapies

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