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SEARCH QUERY ('bortezomib'/exp OR bortezomib) AND ('cyclophosphamide'/exp OR cyclophosphamide) AND ('dexamethasone'/exp OR dexamethasone) AND ('multiple myeloma'/exp OR 'multiple myeloma') AND 'newly diagnosed' AND 'clinical trial' AND 'induction therapy'
RECORD 1 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten Efficacy and Safety of a Weekly Cyclophosphamide-Bortezomib-Dexamethasone Regimen as Induction Therapy Prior to Autologous Stem Cell Transplantation in Japanese Patients with Newly Diagnosed Multiple Myeloma: A Phase 2 Multicenter Trial Tanaka K., Toyota S., Akiyama M., Wakimoto N., Nakamura Y., Najima Y., Doki N., Kakihana K., Igarashi A., Kobayashi T., Ohashi K., Kudo D., Shinagawa A., Takano H., Fujio T., Okoshi Y., Hori M., Kumagai T., Saito T., Mukae J., Yamamoto K., Tsutsumi I., Komeno T., Yoshida C., Yamamoto M., Kojima H. Acta Haematologica (2019) 141:2 (111-118). Date of Publication: 1 Feb 2019
We assessed the efficacy and safety of weekly cyclophosphamide-bortezomib dexamethasone (CBD) induction prior to autologous stem cell transplantation (ASCT) in newly diagnosed Japanese patients with multiple myeloma (MM). This regimen consisted of four 28-day cycles of once-weekly oral cyclophosphamide (300 mg/m(2)), subcutaneous bortezomib (1.3 mg/m(2)), and oral dexamethasone (40 mg). Responding patients underwent stem cell collection followed by ASCT. The primary endpoint was the postinduction rate of achieving a near complete response (nCR) or better. Among the 38 enrolled patients, a complete response (CR), an nCR, a very good partial response (VGPR), and a partial response (PR) were achieved in 10.5, 2.6, 23.7, and 36.8% of cases, respectively. A grade 4 hematological adverse event (AE) was observed in 1 patient. Grade 3-4 infection, including febrile neutropenia, was observed in 4 patients (10.5%). Although 2 patients dropped out due to AE, 94.7% of the patients completed the induction phase. However, because of a poor response to induction chemotherapy ( 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 1 Dexamethasone+Regimen+as+Induction+Therapy+Prior+to+Autologous+Stem+Cell+Tr ansplantation+in+Japanese+Patients+with+Newly+Diagnosed+Multiple+Myeloma%3A+ A+Phase+2+Multicenter+Trial&stitle=Acta+Haematol.&title=Acta+Haematologica&volu me=141&issue=2&spage=111&epage=118&aulast=Tanaka&aufirst=Keisuke&auinit=K. &aufull=Tanaka+K.&coden=ACHAA&isbn=&pages=111 118&date=2019&auinit1=K&auinitm= RECORD 2 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten A phase II study of lenalidomide consolidation and maintenance therapy after autologous PBSCT in patients with multiple myeloma Fuchida S.-I., Sunami K., Matsumoto M., Okumura H., Murayama T., Miyamoto T., Otsuka E., Fujishima N., Izumi T., Tamaki S., Hiramatsu Y., Kuroda Y., Shimazaki C., Akashi K., Harada M. International Journal of Hematology (2019) 109:1 (107-114). Date of Publication: 22 Jan 2019 The efficacy and safety of lenalidomide (LEN) consolidation therapy and subsequent LEN maintenance therapy after high-dose therapy with autologous peripheral blood stem cell transplantation (auto-PBSCT) were evaluated in patients with newly diagnosed symptomatic multiple myeloma (MM). Forty-one patients were enrolled and received high-dose dexamethasone (DEX) therapy as an initial induction. The patients who did not respond to the DEX therapy were further treated with four cycles of bortezomib plus DEX (BD) induction therapy. For patients who responded to BD, PBSC harvesting was scheduled following high-dose cyclophosphamide and filgrastim administration. After PBSC harvesting, high-dose chemotherapy of melphalan with auto-PBSCT was performed. One hundred days after auto-PBSCT, patients received consolidation therapy consisting two cycles of LEN plus low-dose DEX (Ld) and LEN maintenance therapy. Only one death occurred during mobilization therapy, but the protocol developed in this study was considered generally safe to provide. Overall response rates after consolidation and maintenance therapies were 73.7% and 81.6%, respectively. Two-year progression-free survival and overall survival were 76.3% and 92.1%, respectively. These observations suggest that LEN consolidation and maintenance therapy are effective and safe, and provide favorable response rates in patients with MM. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=18653774 &id=doi:10.1007%2Fs12185-018-2543 y&atitle=A+phase+II+study+of+lenalidomide+consolidation+and+maintenance+therapy +after+autologous+PBSCT+in+patients+with+multiple+myeloma&stitle=Int.+J.+Hematol .&title=International+Journal+of+Hematology&volume=109&issue=1&spage=107&epag 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 2 Efficacy and safety of once-weekly cyclophosphamide-bortezomib dexamethasone (cbd) regimen as induction therapy prior to autologous stem cell transplantation in japanese patients with newly diagnosed multiple myeloma.-A phase 2 multicenter trial Kudo D., Komeno T., Yoshida C., Tsutsumi I.O., Ohashi K., Kakihana K., Kobayashi T., Doki N., Najima Y., Igarashi A., Hori M., Okoshi Y., Fujio T., Shinagawa A., Yamamoto M., Takano H., Kumagai T., Yamamoto K., Toyota S., Nakamura Y., Kojima H. Blood (2018) 132 Suppl. 1. Date of Publication: 1 Nov 2018 Introduction: Although a previous study with small numbers of patients (Pts) reported comparable efficacy and less toxicity of once-weekly CBD as an induction compared to twice-weekly CBD for newly diagnosed MM (NDMM) Pts (Blood 2010; 11 5:341 6-341 7), it has never been verified thereafter. Methods: This multicenter, single-arm, open label, phase 2 study was conducted at 1 3 institutions in Japan. Pts aged 1 5-65 years with NDMM were eligible. Additional inclusion criteria were ECOG PS 0-2 and adequate organ functions. Pts with ≥G2 peripheral neuropathy (PN) were excluded. Pts were enrolled between January 201 3 and November 201 5. Induction chemotherapy consisted of four 28-day cycles of cyclophosphamide (CPA: 300 mg/m(2), PO), bortezomib (1.3 mg/m(2), SC), and dexamethasone (40 mg/body, PO) each administered on day 1, 8, 15, and 22. Stem cells were mobilized by administering CPA plus G-CSF. High-dose therapy (HDT) prior to ASCt was performed using melphalan (200 mg/m(2)). The primary endpoint was the post-induction ≥nCR rate. Observation was stopped on August 31, 2016. Results: A total of 38 Pts with median age of 61 (47 65 years old) were enrolled. ISS stages were I, II, and III in 1 0, 18, and 1 0 patients, respectively. Among the 34 chromosomal data-available Pts, del 1 3 and hypoploidy were observed in 2 and 1, respectively. During the induction, only one patient developed G4 hematological AE. G3 infectious AE was observed in 4 Pts (10.5%). Three Pts (7.9%) developed G4 non-hematological AE. PN was observed in 2 Pts (all 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 4 feasibility of the present study were compared with those in our previous study with the VAD/BD induction regimen, which contained one cycle of VAD followed by 3 cycles of twice-weekly BD (Int J Myeloma 201 5; 5:1 5-22). Although the percentage of Pts discontinuing the induction chemotherapy due to AE was lower for the CBD regimen (5.3% vs 19.5%, p=0.0894), discontinuation due to poor response showed the tendency to be more frequent (1 5.8% vs 4.9%, p=0.145). There was no significant difference in PFS or OS between these 2 studies. Conclusion: Although once-weekly CBD is a well tolerated standard induction chemotherapy prior to ASCt for most Japanese patients, its therapeutic power may be too low to achieve a deep response. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=00064971 &id=doi:10.1182%2Fblood-2018-99-113788&atitle=Efficacy+and+safety+of+once weekly+cyclophosphamide-bortezomib dexamethasone+%28cbd%29+regimen+as+induction+therapy+prior+to+autologous+st em+cell+transplantation+in+japanese+patients+with+newly+diagnosed+multiple+myelo ma. A+phase+2+multicenter+trial&stitle=Blood&title=Blood&volume=132&issue=&spage=&e page=&aulast=Kudo&aufirst=Daisuke&auinit=D.&aufull=Kudo+D.&coden=&isbn=&page s= &date=2018&auinit1=D&auinitm= RECORD 5 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten A randomized placebo-controlled phase II study of clarithromycin or placebo combined with VCD induction therapy prior to high-dose melphalan with stem cell support in patients with newly diagnosed multiple myeloma Gregersen H., Do T., Kristensen I.B., Frølund U.C., Andersen N.F., Nielsen L.K., Andersen C.L., Klausen T.W., Vangsted A.J., Abildgaard N. Experimental Hematology and Oncology (2018) 7:1 Article Number: 18. Date of Publication: 13 Aug 2018 Background: The objective of this randomized placebo-controlled study was to investigate the efficacy and safety of clarithromycin in combination with bortezomib cyclophosphamide-dexamethasone (VCD) in patients with newly diagnosed multiple myeloma eligible for high-dose therapy. Methods: Patients were randomized to receive tablet clarithromycin 500mg or matching placebo tablet twice daily during the first 3 cycles of VCD induction therapy. Primary endpoint was to compare the rate of very good partial response (VGPR) or better response after three cycles of VCD combined with clarithromycin or placebo. Results: The study was prematurely stopped for safety reasons after the inclusion of 58 patients (36% of the planned study population). The patients were randomly assigned to clarithromycin (n=27) or placebo (n=31). VGPR or better response after the VCD induction therapy was obtained in 12 patients (44.4%, 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 5 95% CI 25.5-64.7) and in 16 patients (51.6%, 33.1-69.8) (p=0.59) in the clarithromycin group and the placebo group, respectively. Seven patients (25.9%) in the clarithromycin group developed severe gastrointestinal complications (≥grade 3) comprising pain, neutropenic enterocolitis, paralytic ileus or peptic ulcer. These complications occurred in only one patient in the placebo group. Septicemia with Gram negative bacteria was observed in 5 patients in the clarithromycin group in contrast to one case of pneumococcal septicemia in the placebo group. Patient-reported QoL were negatively affected in the clarithromycin group compared to the placebo group. Conclusion: The study was prematurely stopped due to serious adverse events, in particular serious gastrointestinal complications and septicemia. The response data do not suggest any effect of clarithromycin when added to the VCD regimen. The combination of clarithromycin and bortezomib containing regimens is toxic and do not seem to offer extra anti-myeloma efficacy. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=21623619 &id=doi:10.1186%2Fs40164-018-0110-0&atitle=A+randomized+placebo- controlled+phase+II+study+of+clarithromycin+or+placebo+combined+with+VCD+inducti on+therapy+prior+to+high dose+melphalan+with+stem+cell+support+in+patients+with+newly+diagnosed+multiple +myeloma&stitle=Exp.+Hematol.+Oncol.&title=Experimental+Hematology+and+Oncolo gy&volume=7&issue=1&spage=&epage=&aulast=Gregersen&aufirst=Henrik&auinit=H. &aufull=Gregersen+H.&coden=&isbn=&pages=-&date=2018&auinit1=H&auinitm= RECORD 6 Nicht eingeschlossen, da VCD-Fallzahl zu gering Bortezomib maintenance therapy in transplant-ineligible myeloma patients who plateaued after bortezomib-based induction therapy: a multicenter phase II clinical trial Isoda A., Murayama K., Ito S., Kohara Y., Iino M., Miyazawa Y., Matsumoto M., Handa H., Imai Y., Ishiguro T., Izumita W., Kitano K., Hirabayashi Y., Nakazawa H., Ishida F., Mitsumori T., Kirito K., Chou T., Murakami H. International Journal of Hematology (2018) 108:1 (39-46). Date of Publication: 1 Jul 2018 In the era of novel therapeutic agents for multiple myeloma (MM), both the significance of achieving the plateau phase and the efficacy of subsequent maintenance therapy remain unclear. In the present study, we evaluated the efficacy and safety of bortezomib maintenance therapy (biweekly for 1 year) in transplant-ineligible MM patients who plateaued after bortezomib-based induction therapy. Of 36 evaluable patients, the overall response rate during induction therapy was 61%, with a stringent complete response in 6%, a complete response in 6%, a very good partial response in 17%, and 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 6 a partial response in 33%. Twenty patients achieved the plateau phase and subsequently received bortezomib maintenance therapy. Median progression-free survival from the induction and maintenance therapies was 13.8 months (95% confidence interval, 11.4–23.7 months) and 10.7 months (95% confidence interval, 3.7– 10.7 months), respectively. During maintenance therapy, there were no cases with grade ≥ 2 peripheral neuropathy, nor was there any improvement in the quality of the response. In conclusion, although maintenance therapy with biweekly bortezomib for up to 1 year was feasible, plateau-oriented bortezomib induction therapy followed by bortezomib maintenance therapy was not adequate in newly diagnosed transplant ineligible MM patients. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=18653774 &id=doi:10.1007%2Fs12185-018-2448 9&atitle=Bortezomib+maintenance+therapy+in+transplant ineligible+myeloma+patients+who+plateaued+after+bortezomib based+induction+therapy%3A+a+multicenter+phase+II+clinical+trial&stitle=Int.+J.+Hem atol.&title=International+Journal+of+Hematology&volume=108&issue=1&spage=39&ep age=46&aulast=Isoda&aufirst=Atsushi&auinit=A.&aufull=Isoda+A.&coden=IJHEE&isbn =&pages=39-46&date=2018&auinit1=A&auinitm= RECORD 7 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Clarithromycin added to the VCD regimen causes reduced health-related quality of life in multiple myeloma patients Nielsen L.K., Klausen T.W., Do T., Kristensen I.B., Frølund U.C., Andersen N.F., Andersen C.L., Vangsted A.J., Abildgaard N., Gregersen H. HemaSphere (2018) 2 Supplement 2 (659-660). Date of Publication: 1 Jun 2018 Background: Newly diagnosed multiple myeloma (MM) patients report improved health related quality of life (HRQoL) during induction treatment and autologous stem cell transplantation (ASCT). The Danish Myeloma Study Group initiated the CLAIM study; a randomized, placebo-controlled, double-blinded phase II study with the aim of investigating the efficacy and safety of adding clarithromycin (CLA) or placebo (PLA) to cyclophosphamide- bortezomib-dexamethasone (VCD) induction therapy in transplant eligible, newly diagnosed MM patients. The study was prematurely stopped due to severe gastrointestinal complications in the CLA-group. The response data suggested no effect of the addition of CLA to the VCD regimen (Gregersen et al., ASH 2017, abstract 3129). Aims: The objective was to compare patient-reported HRQoL between the two treatment groups. Methods: The patients answered three validated HRQoL questionnaires at inclusion and after two and six months. The European Organisation For Research And Treatment Of Cancer Quality Of Life Questionnaire (QLQC30), the 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 7 Multiple Myeloma module (MY20) and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group Neurotoxicity (FACT/GOG-ntx) subscale were used. Mean score for each domain in each group were calculated by mixed model repeated measures. The mean score difference between the two groups were interpreted by clinically relevant difference between groups. For the QLQ-C30 and MY20 domains the threshold of ≥ 5 points was used (Cocks et al., J Clin Oncol. 2011;29:88- 96) and for the FACT/GOG-ntx subscale the threshold of ≥ 11.8 was used (Calhoun et al., Int J Gynecol Cancer 2003, 13,1-8). Sensitivity analyses were carried out to explore the impact of unanswered questionnaires by identifying auxiliary variables for missing response and adding this information to the analysis. Results: Of the 58 included patients, 55 patients participated in the HRQoL reporting; 25 in the CLA-group and 30 in the PLA-group with compliance of 84% and 89% in the CLA- and PLA- group, respectively. At two months follow-up the patients in the CLA-group reported clinically relevant reduced global quality of life (QoL), physical, role, emotional and social functioning, body image and more fatigue, insomnia, disease symptoms, side effect of treatment, and peripheral neuropathy compared to the patients in the PLAgroup. For physical, role and social functioning, and insomnia the reduced HRQoL were persistent at six months follow-up. In the investigation of the pattern of missing answers to questionnaires, grade 3 and 4 adverse events were identified as auxiliary variables. When these were incorporating into the analysis of the global QoL domain, the mean score difference became larger. Summary/Conclusion: The results are underpowered because of lower sample size than planned. Still, the results demonstrate that MM patients report a clinically relevant reduced HRQoL, when clarithromycin is added to the VCD regimen. A possible explanation to these findings could be an interaction between bortezomib and clarithromycin, and the reduced HRQoL could be a result of increased exposure to bortezomib in the CLA-group. The study emphasizes the importance of including HRQoL as an endpoint in clinical trials and has a potential role as part of real time safety monitoring of symptomatic toxicities in clinical trials. Even though the compliance rate was high, we found that unanswered questionnaires should be incorporated in the interpretation of HRQoL results. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=25729241 &id=doi:10.1097%2FHS9.0000000000000060&atitle=Clarithromycin+added+to+the+VC D+regimen+causes+reduced+health related+quality+of+life+in+multiple+myeloma+patients&stitle=HemaSphere&title=Hema Sphere&volume=2&issue=&spage=659&epage=660&aulast=Nielsen&aufirst=L.K.&auini t=L.K.&aufull=Nielsen+L.K.&coden=&isbn=&pages=659 660&date=2018&auinit1=L&auinitm=K RECORD 8 Nicht eingeschlossen, da Abstract (keine Vollpublikation) 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 8 Gene expression profiling of prospective series in primary plasma cell leukemia revealed gene signature associated with survival Naudot M., Diouf M., Minvielle S., Caulier A., Avet-Loiseau H., Marolleau J.-P., Royer B. HemaSphere (2018) 2 Supplement 2 (220). Date of Publication: 1 Jun 2018 Background: Primary plasma cell leukemia (pPCL) is a rare, yet aggressive form of De novo plasma cell tumor, distinct from secondary PCL which represents a leukemic transformation of pre-existing multiple myeloma (MM). The prognosis of pPCL is poor, with median survival less than 1 year. The recent therapeutic progress in MM treatment offers novel agents (lenalidomide and bortezomib) to treat pPCL. A prospective phase II clinical trial of forty patients newly diagnosed pPCL combined novel agents and transplantation procedures (Royer et al., 2016). Patients received induction therapy composed of bortezomib, doxorubicine, cyclophosphamide and dexamethasone, followed by either a double autograft and long consolidation or an auto-allo-graft tandem. Overall response rate was 69% and median overall survival of 36 months. Aims: pPCL shows complex and heterogeneous molecular patterns: the aim is to investigated the transcriptome of pPCLs and characterized gene signature correlated with PFS and/or OS. Methods: Samples were available for 29 patients from the prospective phase II clinical trial and were analized with nCounter PanCancer pathways panel (nanostring). 770 genes from 13 cancer-associated canonical pathways were screened. Dataset was analyzed with nCounter advanced analysis software. To define statistically significant genes, p-value were adjusted with Benjamini-Yekutieli (BY) method. Results: We found some upregulated genes CCND1, WHSC1 and FGFR3 in patients corresponding to genomic alterations, respectively t(11-14) and t(4-14), already characterized by FISH. nCounter advanced analysis software allocated patients into 4 groups according to the similarity of gene expression. This distribution is proved to be independent of the major cytogenetic alterations. These groups have strong expression characteristics and are correlated with PFS and OS. Group 3 overexpresses a large number of genes compared to all patients and has the more favorable outcome (PFS and OS). We investigated the dataset for differentially expressed genes in patients who failed to respond to induction therapy. No significant genes signatures were identified. Next, we assessed the relationship between each of the 770 genes across the pPCL dataset and OS. 2 genes: WNT5B and CD40, reached a highly significant correlation (BY. P value <0,05) with OS (Figure 1). Summary and Conclusions: This analysis, performed in a homogeneously treated population for a pPCL, allowed us to find 2 genes predictive of survival, whereas not predictive of the response to induction therapy. However the low number of patients in the non-responder group makes identification of gene signature less powerfull. These first hopeful results need to be confirmed with more patients. (Figure Presented) . OPEN URL LINK 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 9 http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=25729241 &id=doi:10.1097%2FHS9.0000000000000060&atitle=Gene+expression+profiling+of+pr ospective+series+in+primary+plasma+cell+leukemia+revealed+gene+signature+associ ated+with+survival&stitle=HemaSphere&title=HemaSphere&volume=2&issue=&spage= 220&epage=&aulast=Naudot&aufirst=M.&auinit=M.&aufull=Naudot+M.&coden=&isbn=& pages=220-&date=2018&auinit1=M&auinitm= RECORD 9 Nicht eingeschlossen (nach Rücksprache mit dem BfArM), da Artikel nicht erhältlich Treatment of Transplant Eligible Patients with Multiple Myeloma Sonneveld P., Einsele H., Brioli A.M., Cavo M. Hematologic Malignancies (2018) :9783319255842 (29-60). Date of Publication: 2018 Since more than 35 years high-dose therapy with melphalan (HDM) followed by autologous stem cell transplantation (ASCT) has been the cornerstone of treatment in eligible patients with newly diagnosed multiple myeloma (MM). In general these patients are up to 70 years of age, have little co-morbidities, and are able to tolerate intensive treatment. The standard approach in these patients is to initiate treatment with 3–4 induction cycles consisting of at least three drugs followed by hematopoietic stem cell mobilization, followed by HDM and ASCT. In this chapter Dr Sonneveld will discuss the various choices and combinations of induction, as well as the results of HDM/ASCT including single versus double ASCT. In part 2 Dr. Cavo will discuss the possibility to give consolidation treatment after the autologous transplantation and what the effect of such treatment will be on response quality and (progression-free) survival. Recently maintenance treatment with lenalidomide after HDM/ASCT was approved based on recent trials. The consequences of maintenance treatment and the potential choices will be discussed. Finally, in part 3 Dr. Einsele will discuss the role of allogeneic (donor) stem cell transplantation in newly diagnosed and relapsed MM. Several transplantation strategies are possible including the possibility to infuse donor lymphocyte cells. Graft versus-host disease represents a significant clinical challenge in these patients. Choosing the right moment and an effective preparative regimen plus post transplantation treatment may offer a valuable treatment option for patients with high risk disease. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=21979774 &id=doi:10.1007%2F978-3-319-25586 6 3&atitle=Treatment+of+Transplant+Eligible+Patients+with+Multiple+Myeloma&stitle= Hematol.+Malig.&title=Hematologic+Malignancies&volume=&issue=9783319255842&s page=29&epage=60&aulast=Sonneveld&aufirst=P.&auinit=P.&aufull=Sonneveld+P.&co den=&isbn=&pages=29-60&date=2018&auinit1=P&auinitm= RECORD 10 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 10 RECORD 10 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Response and survival in newly diagnosed multiple myeloma patients treated with cybord regimen using generic bortezomib-data from two centres from India Sidharthan N., Sivadas A., Devasia A.J., Kulkarni U.P., Sudevan R., Pavithran K., Prabhu R., Ganapathy R., Philip A., Jose W., Unni M., Korula A., Nisham P.N., Abraham A., Srivastava A., Mathews V., George B. Blood (2017) 130 Supplement 1. Date of Publication: 1 Dec 2017 Background: The standard of care for patients with newly diagnosed multiple myeloma is induction chemotherapy using novel agents followed by autologous stem cell transplantation, if eligible. In resource limited countries, generic drugs have allowed wider access to novel agents. There is limited data on the outcome of patients treated with induction therapy with generic novel agents. Hence we evaluated the clinical outcomes of patients with newly diagnosed multiple myeloma initiated on a common induction therapy consisting of Cyclophosphamide-Bortezomib-Dexamethasone (CyBorD) using generic Bortezomib at two centres in India. Objectives: The objective of the study was to evaluate (i) response to treatment (ii) progression free survival and (iii) overall survival in patients with MM who were treated with CyBorD regimen using generic Bortezomib as the first line of treatment. Methods: We retrospectively analyzed data of all patients with newly diagnosed multiple myeloma treated with a uniform induction therapy of CyBorD during the study period from January 2012 to June 2016 at two tertiary care centres in India. A total of 195 patients were included. All received Bortezomib 2mgIV/SC on days 1,8 15 and 22; Cyclophosphamide 300mg/m IV/Oral on days 1, 8, 15 and 22; Dexamethasone 40 mg IV/Oral on days 1-4 and then weekly once. All drug dosages were prescribed as per the NCCN guideline. All drugs were given on a 28 day cycle and repeated for four cycles. The response to treatment and progression of disease were defined according to the IMWG criteria. Statistical analysis was done in SPSS version 20. Continuous variables were represented as mean (SD) and categorical variables as percentages. Survival analysis was computed by Kaplan- Meier method. Results: The median age of patients was 58 years (range-23 to 78 years). The proportion of females was 28.72%. The distribution of patients under International Staging System (ISS) I, II and III (n=157) were 24.84%, 28.66% & 46.5% respectively. The median number of CyBorD cycles were 4 (range 2 to 7). Five patients did not have assessment done at the end of induction chemotherapy. Of the remaining 190 patients, the proportion of patients with VGPR (very good partial response) or more, PR (partial response) and stable or progressive disease were 57.9%, 32.1% and 10% respectively. Following treatment with CyBorD, 123 (63.1%) received maintenance Bortezomib while 54 patients (27.69%) underwent an autologous stem cell transplant. On follow up, 59 patients (31.05%) had evidence of disease progression. The mean progression free survival (PFS) was 36.4 (95% CI 31.2-41.6) months and the mean 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 11 overall survival (OS) was 48.95 (95% CI 45.86-52.05) months (Fig 1). The proportion of Grade III or higher nonhematologic and hematologic toxicity was 32.9% and 8.8% respectively. Peripheral neuropathy (n=22; 11.28%) was the major toxicity seen in our study. Among the 195 patients, 31 (15.90%) died at a median follow up of 21.7 months. The average expenditure for 16 weeks of treatment with generic Bortezomib is US$ 1137.6 USD compared to US$ 9850 for the innovator. Conclusion: Treatment with CyBorD is an effective regimen in newly diagnosed MM patients. The regimen appears tolerable with manageable toxicities and at affordable costs in a resource limited setting. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 &id=doi:&atitle=Response+and+survival+in+newly+diagnosed+multiple+myeloma+patie nts+treated+with+cybord+regimen+using+generic+bortezomib data+from+two+centres+from+India&stitle=Blood&title=Blood&volume=130&issue=&sp age=&epage=&aulast=Sidharthan&aufirst=Neeraj&auinit=N.&aufull=Sidharthan+N.&cod en=&isbn=&pages=-&date=2017&auinit1=N&auinitm= RECORD 11 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten A randomized placebo-controlled phase II study of clarithromycin or placebo combined with VCD induction therapy prior to high-dose melphalan with stem cell support in patients with newly diagnosed multiple myeloma Gregersen H., Abildgaard N., Hieu Do T., Kristensen I.B., Frølund U.C., Andersen N.F., Nielsen L.K., Andersen C.L., Klausen T.W., Vangsted A.J. Blood (2017) 130 Supplement 1. Date of Publication: 1 Dec 2017 Background: Uncontrolled studies and a case-matched study indicate that clarithromycin might exert synergistic effects in combination with thalidomide or lenalidomide in the treatment of multiple myeloma. Recent cellular studies have shown that the combination of clarithromycin and bortezomib results in increased cytotoxicity compared to bortezomib alone in myeloma cell lines. A possible mechanism underlying this synergistic effect might be simultaneous inhibition of the ubiquitin-proteasome system by bortezomib and the autophagy-lysosome system by clarithromycin resulting in enhanced endoplasmic reticulum stress-mediated apoptosis in myeloma cells (Moriya et al. Int J Oncol 2013). The Danish Myeloma Study Group (DMSG) initiated the CLAIM trial (NCT02573935), a randomized placebo-controlled phase II study, to investigate the efficacy and safety of clarithromycin in combination with the bortezomib containing VCD regimen. Methods: Patients with newly diagnosed multiple myeloma were randomized (1:1) to receive p.o. clarithromycin 500 mg or a matching placebo tablet twice daily for 63 days in combination with VCD induction therapy. The randomization was stratified according to International Staging System stage. The VCD consisted of 21-day cycles of subcut bortezomib 1.3 mg/sqm days 1, 4, 8, 11, i.v. cyclophosphamide 500 mg/sqm on 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 12 days 1 and 8, and p.o. dexamethasone 40 mg days 1, 2, 4, 5, 8, 9, 11, 12. After induction treatment the patients proceeded to cyclophosphamide priming (2000 mg/sqm), leukapheresis and high-dose melphalan (200 mg/sqm) with hematopoietic stem cell support (HDT). Patients from six Danish hematology departments participated in the trial. Primary endpoint was to compare rate of very good partial response or better response after three cycles of VCD combined with clarithromycin or placebo. Important secondary end-points were to compare very good partial response or better response two months after HDT, number of stem cells harvested, frequency of infections and safety. The responses were assessed according to the IMWG criteria and analyses were by intention to treat. Results: The study was prematurely stopped for safety reasons after the inclusion of 58 patients (36% of the planned study population). The enrolled patients were randomly assigned to clarithromycin (27) or placebo (31), and the clinical characteristics at baseline were balanced (Table I). VGPR or better response after the VCD induction therapy was obtained in 12 patients (44.4%, (95% CI, [25.5 64.7]) and in 16 patients (51.6%, [33.1 - 69.8], P = 0.59) in the clarithromycin group and the control group, respectively. There was no difference in the secondary endpoints between the treatment groups (Table I). A total of 26 serious adverse events were reported in 16 (59.3%) patients in the clarithromycin group and 16 serious adverse events in 10 (32.3%) patients in the control group. Seven patients (25.9%) in the clarithromycin group developed severe gastrointestinal complications (SAE ≥ grade 3) comprising pain, neutropenic enterocolitis, paralytic ileus or peptic ulcer. These complications occurred in only one patient in the control group (Table I). Septicaemia with Gram negative bacteria was observed in 5 patients in the clarithromycin group. By contrast, the only case of septicaemia detected in the control group was pneumococcal sepsis associated with pneumonia. In consequence of this imbalance in occurrence of severe gastrointestinal symptoms and septicaemia the study safety board decided to stop inclusion of new patients and to stop administration of the study drug on 16 September 2016. Conclusion: The study was prematurely stopped due to a number of serious adverse events. Although we only could analyse response data in 58 included patients the data do not suggest any effect of clarithromycin when added to the VCD regimen and our trial does not encourage further clinical studies on the combination of clarithromycin and bortezomib. Surprisingly, our study found an increased frequency of serious adverse events, in particular serious gastrointestinal complications and septicaemia, in the clarithromycin group. It emphasizes the need for controlled studies on the effect of clarithromycin, both in assessment of potential anti-myeloma effects as well as assessment of safety measures. (Table Presented). OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 &id=doi:&atitle=A+randomized+placebo- controlled+phase+II+study+of+clarithromycin+or+placebo+combined+with+VCD+inducti 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 13 on+therapy+prior+to+high dose+melphalan+with+stem+cell+support+in+patients+with+newly+diagnosed+multiple +myeloma&stitle=Blood&title=Blood&volume=130&issue=&spage=&epage=&aulast=Gr egersen&aufirst=Henrik&auinit=H.&aufull=Gregersen+H.&coden=&isbn=&pages= &date=2017&auinit1=H&auinitm= RECORD 12 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Autologous stem cell transplantation in newly diagnosed elderly multiple myeloma patients: A single centre experience Berno T., Riva M., Ammirati L., Brugnaro L., Gurrieri C., Branca A., Mitja N., Visentin A., Imbergamo S., Piazza F., Trentin L., Zambello R., Semenzato G. Blood (2017) 130 Supplement 1. Date of Publication: 1 Dec 2017 Introduction: Multiple myeloma (MM) is a plasma cell malignancy that affects older adults with a median age at diagnosis of 70 years. Autologous stem cell transplantation (ASCT) in combination with novel agents is the standard of care for young patients with newly diagnosed MM. The safety and efficacy of High Dose Therapy (HDT) as upfront treatment in elderly patients remain still uncertain, because elderly patients age are frequently associated with increased comorbidities, compromised physical conditions and a suspected increased treatment-related toxicity. In our centre we analyzed the treatment-related toxicities and the outcome in a homogeneous cohort of newly diagnosed elderly MM patients treated with HDT approach. Methods: we retrospectively evaluated 16 newly diagnosed elderly MM patients, according to International Myeloma Working Group (IMWG). All of them were fit/low-risk according to revised Myeloma Comorbidity Index. Median age at diagnosis was 66 years (range 65-68 years), and at transplantation 67 years (range 65-69). The MM immunoglobulin subtypes were: 9 IgG k (56.25%); 1 IgG l (6.25%), 1 IgA k (6.25%), 1 IgA l (6.25%), 1 light chain l (6.25%) and 3 light chain k (18,75%). In 5 patients we detected extramedullary plasmocitoma. The revised International Staging System (R-ISS) stage was: I in 8 patients (50%), II in 5 cases (31.25%) and III in 3 patients (18.75%). FISH analysis was performed at diagnosis in all patients, we found standard-risk in 10 patients (62.5%), intermediate-risk in 3 cases (18.75%) and high-risk in 3 cases (18.75%). All patients had a normal renal function. Immunoparesis occurred in 13 patients (81.25%) at diagnosis. The induction therapy was bortezomib-based in association with dexamethasone (VD) with or without thalidomide (VTD). Radiotherapy was performed in extramedullary disease. The mobilization regimen included cyclophosphamide at different doses (2 to 4 gr/mq) followed by G-CSF. The conditioning regimen consisted of melphalan 140 mg/mq or 200 mg/mq given over two days. A short 2-month consolidation phase bortezomib based was given three months post ASCT. Results: As induction therapy 8 patients (50%) received VD, the other 50% VDT. Five patients (31.25%) underwent 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 14 radiotherapy. A median of 12.6x10 /kg CD34+cells were collected after cyclophosphamide treatment. Melphalan 140 mg/mq conditioning regimen was administered in 10 patients (62.5%) and 200 mg/mq in 6 patients (37.5%). Seven patients (43.75%) received consolidation treatment. The overall response rate (ORR) to induction therapy (≥ PR) was 93.75% including 2 CR (12.5%), 7 VGPR (43.75%) and 6 PR (37.5%). The ORR after ASCT increased to 100%: 3 CR (18.75%), 11 VGPR (68.75%) and 2 PR (12.5%). Immunoglobulin recovery 1 year after ASCT occurred in 9 patients (69.23%) out of 13 with immunoparesis. Median time to neutrophil and platelet engraftment was 10 days (range 6-18 days). No significant difference in toxicity was found among the two groups (MEL140 vs MEL200). The non-hematological toxicities after ASCT (G3-G4) included infections in 8 patients (50%), gastrointestinal disorders in 8 cases (50%), and nervous system disorders (G3) in 7 cases (43.75 %). In 1 patient we observed cardiac toxicity (G2). The day-100 post ASCT treatment-related mortality (TRM) was 0%. During follow up we reported secondary malignancies in 2 cases (12.5%) and one therapy-related myeloid neoplasm (t-MDS) (6.25%). After a median follow up of 59.5 months (range 21-73.3 months) the median PFS was 16.7 months in MEL140 group vs 28.3 months in MEL200. The difference among these two groups was statistically significant (p= 0.04). Conclusions:our results suggest that ASCT is a safe and well-tolerated procedure in our small cohort of elderly and fit patients. We detected among the two regimens (MEL140 and MEL200) a similar profile of toxicities. The dose of Melphalan (MEL200) impacted on the duration of response and the PFS resulted significantly higher. According to literature we confirm that an accurate assessment of elderly patients performance status, comorbidities and myeloma characteristics (by means of R-MCI) at diagnosis can help to develop individualized risk-adapted treatment strategies to improve the outcome, especially in elderly MM patients even in the era of new and highly effective drugs. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 &id=doi:&atitle=Autologous+stem+cell+transplantation+in+newly+diagnosed+elderly+m ultiple+myeloma+patients%3A+A+single+centre+experience&stitle=Blood&title=Blood& volume=130&issue=&spage=&epage=&aulast=Berno&aufirst=Tamara&auinit=T.&aufull =Berno+T.&coden=&isbn=&pages=-&date=2017&auinit1=T&auinitm= RECORD 13 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Weekly cybord-DARA Is a safe and effective upfront treatment for newly diagnosed multiple myeloma. preliminary results of the early phase 16-BCNI 001/CTRIAL-IE (ICORG) 16-02 Study McEllistrim C., Cahill M.R., Murphy P., Mykytiv V., Quinn J., Bray A., Walsh J., Lenihan E., Kenny T., Hirakata G., Parker I., Hernando A., O'Dwyer M. Blood (2017) 130 Supplement 1. Date of Publication: 1 Dec 2017 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 15 Introduction: Daratumumab (DARA) is a human IgG1k monoclonal antibody licenced for second line use as monotherapy or in combination with either lenalidomide or bortezomib (Bor) plus dexamethasone (D) for patients (pts) who have received at least one prior therapy. There are no published data on front line use of DARA in combination regimens. CyBorD is considered a safe and effective induction regimen for patients with newly diagnosed MM eligible for transplantation. Up to 60% of patients achieve very good partial response (VGPR) or better following 4 cycles of induction (Reeder CB et al, Blood 2010). Since our pre-clinical data showed enhanced antibody dependent cellular phagocytosis (ADCP) following Cyclophosphamide (Cy) exposure (Rigalou et al, ASH 2016), we set out to explore the feasibility of combining DARA with weekly CyBorD in newly diagnosed transplant eligible MM patients. We aim to demonstrate safety, efficacy, convenience and cost-effectiveness in a Phase 1b clinical trial of newly diagnosed patients with MM. Methods: This ongoing phase Ib, open-label, single arm, dose escalation study has recruited 12 patients from November 2016 to June 2017 across 3 sites in Ireland (3 pts in DL 1, 3 pts in DL 2 and 6 pts in DL 3). Baseline demographic factors include: 75% males, 25% females; median age of 57.5 years (35 66 years); 83% ISS stage I, 17% ISS stage II/III. FISH analysis detected t(4;14) in 0% of pts (0/12), t(14;16) in 0% of pts (0/12) and del17p in 17% of pts (2/12). The study is designed to assess the safety and efficacy of 4 cycles of induction therapy with Cy and Bor on days 1, 8, 15 and 22, D 20/mg/day on days 1, 2, 8, 9, 15, 16, 22 and 23 and DARA 16mg/kg on days 1, 8, 15 and 22 for cycles 1 and 2 and on days 1 and 15 for cycles 3 and 4. Following the induction therapy, patients proceed with stem cell mobilization and high dose Melphalan 200mg/m(2) autologous stem cell transplant (ASCT). Following SCT 2 cycles of consolidation therapy with Cy and Bor on days 1, 8, 15 and 22, D 20/mg/day on days 1, 2, 8, 9, 15, 16, 22 and 23 and DARA 16mg/kg on days 1 and 15 were administered. After consolidation therapy, all patients are scheduled to receive DARA maintenance on day 1 every 4 weeks until progression, unacceptable toxicity or withdrawal of consent (limited to a maximum duration of 2 years). Patients with high-risk features receive subcutaneous (SQ) Bor on days 1 and 15 during maintenance phase. We used a standard 3+3 design in sequential cohorts (3 dose levels (DL) of Cy and Bor: DL 1: Cy 150mg/m(2) and Bor 1.3mg/m(2), DL 2: Cy 300mg/m(2)and Bor 1.3mg/m(2) and DL 3: Cy 300mg/m(2) and Bor 1.5mg/m(2) ; and a DL -1: Cy 100mg/m(2) and Bor 1.3mg/m(2) . Six additional patients will be enrolled in an expansion cohort as the maximum tolerated dose (MTD) has been determined as DL 3. The primary endpoints are the incidence of dose limiting toxicity (DLT) within the first cycle of combination at each dose level and complete response (CR) rate post ASCT. Secondary endpoints include: safety, CR rates at the end of induction, consolidation and maintenance, best overall response, minimal residual disease (MRD) negative rate, progression-free survival, clinical benefit rate and overall survival. Response will be 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 16 investigator-assessed as per IMWG criteria. This trial is registered at www.clinicaltrials.gov as NCT02955810. Results: We report the safety data from interim analysis following completion of the dose escalation phase of CyBorD-DARA trial. The most common adverse events (AE) of grade 3 severity or higher were thrombocytopenia, postoperative wound infection, urinary tract infection, hyponatraemia, back pain, bone pain. Five serious adverse events (SAE) were reported but none related to the study treatment. No DLT occurred in any group. To date all pts continue on treatment and enrolment is ongoing. Although follow up is still short, the combination shows a promising response rate. Following 4 cycles of induction therapy the first 6 patients enrolled (at DL1 and DL2) have achieved VGPR or better. Safety and efficacy data will be updated at ASH meeting. Conclusion: DARA can be safely combined with weekly CyBorD. MTD/RP2D is Cy 300mg/m(2) and Bor 1.5mg/m(2) in combination with D and DARA and early analysis demonstrates promising efficacy. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 &id=doi:&atitle=Weekly+cybord DARA+Is+a+safe+and+effective+upfront+treatment+for+newly+diagnosed+multiple+my eloma.+preliminary+results+of+the+early+phase+16-BCNI-001%2FCTRIAL IE+%28ICORG%29+16 02+Study&stitle=Blood&title=Blood&volume=130&issue=&spage=&epage=&aulast=Mc Ellistrim&aufirst=Cian&auinit=C.&aufull=McEllistrim+C.&coden=&isbn=&pages= &date=2017&auinit1=C&auinitm= RECORD 14 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Cyclophosphamide-bortezomib-dexamethasone (CYBORD) compared to bortezomib-dexamethasone (Vel-Dex) as induction therapy for transplant eligible patients with newly diagnosed multiple myeloma Lavoie-Gagnon C., St-Gelais J., Adam J.-P., Viens D., Gagné F., Décarie Y., Lemieux- Blanchard E. Blood (2017) 130 Supplement 1. Date of Publication: 1 Dec 2017 Introduction In Canada, Cyclophosphamide, bortezomib and dexamethasone (CyBorD) induction regimen has become the standard of care for transplant-eligible patients with newly diagnosed multiple myeloma (MM). In a phase II study, CyBorD produces a rapid and profound response without modifying the survival parameters (Leukemia . 2009 July; 23(7): 1337-1341). However, this protocol has never been compared to bortezomib and dexamethasone (Vel-Dex) regimen in a prospective trial. To compare the response at induction and at day-100 post autologous stem cell transplant (ASCT) and toxicity profiles of the Quebec population to these 2 regimens, we performed a retrospective trial in 2 tertiary centres in the Montreal area. Objectives The primary objective was to 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 17 compare overall response rates and very good partial responses or better (ORR and ≥ VGPR) between CyBorD and Vel- Dex after induction and at day 100 after ASCT. The secondary objectives were the evaluation of the toxicities and the overall survival at day 100 post-ASCT. Method We performed a retrospective observational multicenter study in a cohort of patients treated in Montreal area from January 1st 2010 to June 30th 2016. The inclusion criteria were patients ≥ 18 years-old with a new symptomatic MM diagnosis defined by the 2014 International Myeloma Working Group criteria, had received a first line induction treatment with Vel-Dex or CyBorD and were transplant eligible. Continuous variables were reported as a combination of means and medians and compared using Student's t-test and Mann-Whitney test respectively. Categorical variables were compared using Pearson's chi-square test. Results On a total of 99 patients, 84 were included and received CyBorD (n=40) or Vel-Dex (n=44) regimen. The median age was 56 and 59 years in CyBorD and Vel-Dex group respectively. Clinical characteristics were equivalent between the two groups, except for ISS stage III MM that were more numerous in Vel-Dex group (27.3% vs 17.5%; p=0.42) and MM with del17p ≥ 10% of alleles that were more frequent in CyBorD group (12.5% vs 3.4%; p=0.41). The mean cumulative bortezomib dose was 20.6 and 24.0 mg/m(2) in Vel-Dex and CyBorD group respectively (p=0.002). There were no significant differences in term of modification in the regimen schedule. ORR and ≥ VGPR rates after a median of 4 cycles of induction were 92.5% and 35% for patients treated with CyBorD, and 90.9% and 43.2% for Vel-Dex respectively (p>0.99 and p=0.59). At day -100 post-ASCT, an ORR and ≥ VGPR rates of 97.5% and 62.5% for the CyBorD group and 90.9% and 56.8% for the Vel-Dex group, respectively (p=0.42 and 0.76) (Fig 1). No patient died within 100 days after ASCT. Also, there was no significant difference for the number of CD34 cells mobilized (15 in Vel-Dex vs 14.7x10(9)/kg in CyBorD group; p=0.88). Treatment options after ASCT vary between the CyBorD and Vel-Dex groups for lenalidomide maintenance (10% vs 2%; p=0.3), second ASCT (2.5% vs 20.5%; p=0.02) and allogenic mini-transplant as part of a research protocol (10% vs 0%; p=0.05). Finally, there was not any evidence of a significant difference in terms of grade 3 and 4 toxicities, except for sensitive neuropathies that were more prevalent in the Vel-Dex group (15.9% vs 0%; p=0.01) even though the cumulative dose of bortezomib was significantly lower. However the very few toxicities noted prevent us from drawing any clear conclusion. Conclusion CyBorD and Vel-Dex appear to have similar overall efficacy for newly diagnosed transplant eligible patients with MM in our cohort.Surprisingly, the response at induction and at day-100 post-ASCT in the CyBorD group did not seem better nor deeper compared to the Vel-Dex group despite more stage III MM in the latter group. At day-100 post-ASCT, there may be a trend in favour of the CyBorD group, but the sample size is too small to detect a significant difference. Adding cyclophosphamide to the chemotherapy regimen did not seem to impair the stem cell collection and was not associated with more grade 3 or 4 toxicities. Longer 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 18 follow-up is required to detect if what seems to be a more favourable response post- ASCT with CyBorD leads to differences in progression free survival and overall survival. (Figure Presented). OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 &id=doi:&atitle=Cyclophosphamide-bortezomib dexamethasone+%28CYBORD%29+compared+to+bortezomib dexamethasone+%28Vel Dex%29+as+induction+therapy+for+transplant+eligible+patients+with+newly+diagnose d+multiple+myeloma&stitle=Blood&title=Blood&volume=130&issue=&spage=&epage=& aulast=Lavoie-Gagnon&aufirst=Claudie&auinit=C.&aufull=Lavoie Gagnon+C.&coden=&isbn=&pages=-&date=2017&auinit1=C&auinitm= RECORD 15 Nicht eingeschlossen, da Abstract (keine Vollpublikation) A predictive score for early mortality during induction therapy in newly diagnosed transplant-eligible multiple myeloma-an analysis from five GMMG and HOVON multicenter phase III trials Mai E.K., Hielscher T., Bertsch U., Schlenzka J., Salwender H.J., Lokhorst H.M., Munder M., Van Der Holt B., Gerecke C., Pfreundschuh M., Duhrsen U., Brossart P., Zweegman S., Neben K., Hillengass J., Raab M.-S.S., Hose D., Vellenga E., Merz M., Breitkreutz I., Jauch A., Kersten M.J., Martin H., Lindemann H.-W., Peter N., Croockewit S., Blau I.W., Scheid C., Weisel K.C., Sonneveld P., Goldschmidt H. Blood (2017) 130 Supplement 1. Date of Publication: 1 Dec 2017 Introduction: Early mortality is up to 10% in newly diagnosed multiple myeloma (MM) with no improvement in subsequent study generations until 2002 (Augustson et al., JCO, 2005). Recent data on the causes of early mortality in transplant-eligible (te) MM patients during induction therapy (IT) and associated risk factors are not available. Patients and Methods: This retrospective multi-cohort analysis included 1515 patients from three subsequently conducted phase III multicenter trials for teMM (HD3, HD4, MM5) from the German-speaking Myeloma Multicenter Group (GMMG). The analyzed IT period was defined from the first dose of IT until the last dose of IT plus 30 days or until start of stem cell mobilization. Patients were analyzed as treated if they received at least one dose of trial medication and no more than three IT cycles. Early deaths were defined as any deaths in the defined period. Severe infections (SI) were defined as any infection ≥ grade 3 according to the Common Terminology Criteria for Adverse Events (CTCAE). Three cycles of a three-drug IT were applied in each trial: vincristine, doxorubicin (DOX), dexamethasone (DEX; VAD) vs. thalidomide, DOX, DEX (TAD) in the HD3 trial (09/2001-09/2004, Breitkreutz et al., Leukemia, 2007; n=529); VAD vs. bortezomib (BTZ), DOX, DEX (PAD) in the HD4 trial (05/2005-05/2008, Sonneveld et 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 19 al., JCO, 2012; n=388); and PAd vs. BTZ, cyclophosphamide (CYC), DEX (VCD) in the MM5 trial (07/2010-11/2013, Mai et al., Leukemia, 2015; n=598). Major inclusion/exclusion criteria were similar between the trials, except for the maximum age for inclusion: 65 years (HD3, HD4) vs. 70 years (MM5). Uni-and multivariate logistic regression models were built to assess risk factors. Trial effect was accounted for. Based on the risk factors for SI during IT, a predictive score for SI-related/overall mortality during IT was developed. Data from the Dutch-Belgian Cooperative Trial Group for Hematology Oncology (HOVON)-50 (VAD and TAD IT, 11/2001-05/2005, Lokhorst et al., Blood, 2010, n=528) and HOVON-65 (VAD and PAD IT, 05/2005 05/2008, Sonneveld et al., JCO, 2012; n=430) multicenter phase III trials for teMM were used to validate the prognostic score for mortality during IT. Results: Severe infections occurred in 22.3% vs. 27.3% vs. 10.0% vs. 18.8% of patients in the HD3, HD4, MM5, and pooled population, respectively. In the HD3, HD4, MM5 and pooled cohort, 6.2% vs. 3.1% vs. 1.3% vs. 3.5% (n=33/12/8/53) of patients died during IT, respectively. Infections were the single largest cause of death during IT (n=26, 49.1%). Besides trial effects (HD4, odds ratio [OR]=1.42, p=0.03; MM5, OR=0.37, p>0.001, both vs. HD3), pooled multivariate analyses identified World Health Organization performance status >1 (WHO>1, OR=1.97, p<0.001), age >60 years (age>60, OR=1.42, p=0.01) and lactate dehydrogenase > upper level of normal (LDH>ULN, OR=1.45, p=0.04) as trial independent significant predictors for SI during IT. Combination of these factors allowed the stratification in three groups according to the risk of SI during IT: high risk (HiR, WHO>1 plus age>60 and/or LDH>ULN, n=95, SI incidence: 37.9%), low risk (LoR, no risk factors or age>60 only, n=1046, SI incidence: 15.8%) and intermediate risk (ImR, neither HiR nor LoR, n=310, SI incidence: 21.6%). In the HiR group, the incidence of death from any cause or SI was 14.7%/8.4% vs. 6.1%/2.6% vs. 1.4%/0.9% in the ImR and LoR groups, respectively. The increased risk of death from any cause or SI in the HiR and ImR group was independent of trial effects (HiR group: OR [any cause/SI]=11.46/10.19, both p<0.001 and ImR group: OR [any cause/SI]=4.83/3.23, p<0.001/0.02; vs. LoR group). To validate the constructed risk score, we analyzed the HOVON-50 and HOVON-65 trials (n=922): 5.8% (n=53) of patients died during IT. Similar to the GMMG cohort, the HiR group included 7.7% of patients with an overall mortality of 18.3% vs. 6.1% and 4.3% in the ImR (21.4% of patients) and LoR groups (70.9% of patients) during IT, respectively. Again, the increased risk for death from any cause during IT was independent of trial effects (HiR group: OR=4.90, p<0.001). Conclusions: Our validated risk score for early mortality in teMM identifies a subgroup of patients with an excessive mortality during IT. These patients are at risk to miss the benefits of modern anti-MM therapy, thus intensive clinical monitoring and the development of strategies to prevent early mortality are needed. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 20 &id=doi:&atitle=A+predictive+score+for+early+mortality+during+induction+therapy+in+n ewly+diagnosed+transplant-eligible+multiple+myeloma an+analysis+from+five+GMMG+and+HOVON+multicenter+phase+III+trials&stitle=Bloo d&title=Blood&volume=130&issue=&spage=&epage=&aulast=Mai&aufirst=Elias+K.&aui nit=E.K.&aufull=Mai+E.K.&coden=&isbn=&pages=-&date=2017&auinit1=E&auinitm=K RECORD 16 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten Response-adapted lenalidomide maintenance in newly diagnosed, transplant eligible multiple myeloma: Results from the multicenter phase III GMMG-MM5 Trial Goldschmidt H., Dürig J., Mai E.K., Scheid C., Weisel K.C., Kunz C., Hielscher T., Bertsch U., Munder M., Lindemann H.-W., Jauch A., Huhn S., Seckinger A., Hose D., Huegle-Doerr B., Rabold B., Elmaagacli A., Gerecke C., Brossart P., Goerner M., Bernhard H., Hoffmann M., Hillengass J., Blau I.W., S Raa M.-S., Hänel M., Salwender H.J. Blood (2017) 130 Supplement 1. Date of Publication: 1 Dec 2017 Background: The open-label, multicenter, randomized MM5 trial from the German- Speaking Myeloma Multicenter Group (GMMG) aimed at the investigation of the best treatment strategy with respect to progression-free survival (PFS) in newly diagnosed, transplant-eligible multiple myeloma (MM). Treatment strategies are defined by bortezomib (BTZ) and dexamethasone (DEX)-containing induction therapy (IT) with either doxorubicine (PAd) or cyclophosphamide (VCD), standard intensification with high-dose melphalan (HDM, 200mg/m(2) ) and autologous blood stem cell transplantation (ASCT), lenalidomide (LEN) consolidation and maintenance treatment (MT) with LEN for 2 years (LEN-2Y) vs. LEN MT until achievement of a complete response (CR; LEN-CR). Patients and Methods: Fivehundred and two patients were equally randomized between the four treatment arms: arm A1: PAd + LEN-2Y (n=125), arm A2: VCD + LEN-2Y (n=126), arm B1: PAd + LEN-CR (n=126) and arm B2: VCD + LEN-CR (n=125). HDM/ASCT was carried out according to standard procedures. Tandem HDM/ASCT was recommended if no near complete response or better (≥nCR) was achieved after first HDM/ASCT. Following HDM/ASCT, two cycles of LEN consolidation (25mg, d1-21, repeated d29) were applied. LEN MT was applied continuously as 10mg/d for the first 3 months. LEN dose was increased to 15mg/d thereafter if treatment was well tolerated. The primary endpoint reports on PFS. Secondary endpoints include overall survival (OS), response rates (Durie et al., Leukemia, 2006) and toxicity (Common Terminology Criteria for Adverse Events, version 4.0). Results: The median follow-up was 60.1 months, 321 PFS / 162 OS events occurred. The ≥VGPR rates after consolidation were similar between the study arms: A1+B1 [PAd IT]: 81.2% vs. A2+B2 [VCD IT]: 77.2%, (p=0.38). In the LEN-2Y arms 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 21 A1/A2, 74% and 75% vs. 39% and 50% of patients in the LEN-CR arms B1/B2 started LEN MT. In the LEN-CR arms B1/B2, 25%/23% of patients did not start LEN MT after consolidation due to CR, and another 12%/10% of patients stopped LEN during MT due to CR. Two years of LEN MT on study were applied in 35%, 35%, 14% and 18% patients in the arms A1, A2, B1 and B2, respectively. Toxicity was significantly increased in the LEN-2Y arms (A1+A2) compared to the LEN-CR arms (B1+B2; relevant adverse events [AE], defined as ≥ grade 3 and infections, cardiac disorders, neuropathy and thromboembolic events ≥ grade 2; A1: 87.3% vs. A2: 91.3% vs. B1: 79.5% vs. B2: 77.4%, p=0.01), mainly because of an increased number of AE during LEN MT in the LEN-2Y arms (A1+A2: 77.6% vs. B1+B2: 58.2%, p<0.001). Infections (≥ grade 2) were the major AE during LEN MT (A1+A2: 52.7% vs. B1+B2: 32.3%, p<0.001). The primary endpoint, PFS from randomization between the treatment arms was not significantly different (stratified log-rank test p=0.60) with a median PFS of 43.2 vs. 40.9 vs. 35.9 vs. 35.7 months in the arms A1, A2, B1 and B2, respectively. OS was significantly different (p=0.02) with a 36- months OS rate of 82.9 vs. 85.2 vs. 75.1 vs. 77.1% in the arms A1, A2, B1 and B2, respectively. To compare LEN-CR/LEN-2Y treatment strategies, arms A1+A2 and B1+B2 were pooled. Yet, PFS was not significantly different comparing the LENCR vs. LEN-2Y groups (hazard ratio [HR]=1.15, 95% confidence interval [95%CI]: 0.93-1.44, p=0.20), but the LEN-2Y showed significantly better OS (HR=1.42, 95%CI: 1.04-1.93 p=0.03). On landmark analyses from the start of LEN MT, comparison of LEN-CR/LEN-2Y groups according to response after consolidation (CR/non-CR) revealed significantly shortened PFS (HR=1.84, 95%CI: 1.08-3.13, p=0.02) but not OS (HR=1.80, 95%CI: 0.74-4.36, p=0.19) for patients with CR in the LEN-CR group. Among non-CR patients, PFS and OS were similar in the LEN-CR vs. LEN-2Y groups (PFS/OS: HR=1.01/1.50, 95%CI: 0.72-1.41/0.90-2.50, p=0.97/0.12). In multivariate analyses, International Staging System stages (ISS) II/III (II/III: HR=1.45/1.66, p=0.02/0.002; vs. ISS stage I) and adverse cytogenetics (CA, defined as either deletion17p13 and/or translocation t(4;14) and/or gain 1q21; HR=1.97, p<0.001; vs. no CA) were associated with an adverse PFS. Conclusions: This is the first randomized phase III trial providing data on the response-adapted administration of LEN MT in transplant-eligible MM. LEN MT beyond CR improved OS but not PFS and is associated with an increased toxicity. Our results suggest that LEN MT should be applied beyond the achievement of a CR. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 &id=doi:&atitle=Response adapted+lenalidomide+maintenance+in+newly+diagnosed%2C+transplant- eligible+multiple+myeloma%3A+Results+from+the+multicenter+phase+III+GMMG MM5+Trial&stitle=Blood&title=Blood&volume=130&issue=&spage=&epage=&aulast=Go ldschmidt&aufirst=Hartmut&auinit=H.&aufull=Goldschmidt+H.&coden=&isbn=&pages= 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 22 &date=2017&auinit1=H&auinitm= RECORD 17 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten Double autologous stem cell transplantation significantly prolongs progression free survival and overall survival in comparison with single autotransplantation in newly diagnosed multiple myeloma: An analysis of Phase 3 EMN02/HO95 Study Cavo M., Gay F.M., Patriarca F., Zamagni E., Montefusco V., Galli M., Dozza L., Bringhen S., Grasso M., Testoni N., Ballanti S., Tacchetti P., Semenzato G., Liberati A.M., Benevolo G., Spriano M., Di Bartolomeo P., Di Toritto T.C., Palmas A.D., Cafro A.M., Morabito F., Musto P., Rizzi R., Palumbo A., Sonneveld P. Blood (2017) 130 Supplement 1. Date of Publication: 1 Dec 2017 Background The role of single vs double autologous stem cell transplantation (ASCT) for newly diagnosed (ND) multiple myeloma (MM) continues to be debated in the novel agent era. Methods The phase III EMN02/HO95 study was designed to administer 3-4 cycles of bortezomib-cyclophosphamide-dexamethasone as induction therapy for NDMM and afterwards to randomize eligible patients to receive (randomization 1, R1) standard-dose intensification treatment with bortezomibmelphalan- prednisone (VMP) for four 42-day cycles or high-dose intensification treatment with melphalan at 200 mg/m(2) (HDM) plus ASCT. A second randomization to receive or not receive consolidation therapy was planned after the intensification phase, followed by lenalidomide maintenance in both arms. In centers committed to a double ASCT policy, patients were randomized (1:1:1) to receive VMP or single ASCT (ASCT-1) or two sequential courses of HDM (administered 2 to 3 months apart) plus double ASCT (ASCT-2) in order to prospectively compare ASCT-1 vs ASCT-2, which was an additional study objective. For this purpose, and for consistency with the primary study end point, progression-free survival (PFS) from R1 was evaluated. Results A total of 1503 patients aged ≤65 years were registered and 1192 were eligible for R1. By study design, 618 patients who received the diagnosis of MM in centers with a double ASCT policy were randomly assigned to VMP (n=203) or ASCT-1 (n=208) or ASCT-2 (n=207). 415 of these patients who were randomized to receive ASCT-1 or ASCT-2 were included in the current pre-specified analysis. Median age was 58 years for patients in the ASCT-1 group and 57 years for those in the ASCT-2 group. The frequency of ISS stage III was 19% in both groups. According to IMWG criteria, a high-risk (HiR) cytogenetic profile defined by t(4;14) ± t(14;16) ± del(17p) positivity (HiR-cyto-3) was detected in 26% and 21% of patients who were evaluable in ASCT-1 (80%) and ASCT-2 (86%) groups. The presence of amp(1q) ± del(1p) ± 1 or more of t(4;14), t(14;16) and del(17p) identified a HiR cytogenetic profile (HiR-cyto-5) which was detected in 55% of patients in ASCT-1 arm and 50% of those in ASCT-2 arm. Median follow-up from R1 was 38 (IQR: 29-47) months for the overall patient population (36 and 39 months for 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 23 patients randomized to ASCT-1 and ASCT-2, respectively). On an intention-to-treat basis, 3-year estimate of PFS was 73% (95% CI=66-79) for ASCT-2 group vs 64% (CI=57-71) for ASCT-1 group (HR=0.70; CI=0.50-0.98; P=0.040), which represented a 30% reduced risk of progression or death in the ASCT-2 group compared with the ASCT-1 group (Fig. 1a). PFS benefit associated with ASCT-2 was confirmed in subgroups of patients with HiR-cyto-3 (HR=0.42; CI=0.21-0.84; P=0.014), revised ISS (R- ISS) stage II+III (HR=0.64; CI=0.43-0.97; P=0.034), age >55 years (HR=0.64; CI=0.43-0.96; P=0.033); HiR-cyto-5 (HR=0.65; CI=0.42-1.01; P=0.059) and best ≥VGPR (HR=0.64; CI=0.44-0.94; P=0.023). Importantly, ASCT-2 overcame the adverse prognosis conferred by HiR-cyto-3 (3- year PFS: 76% vs 69% for patients with standard risk cytogenetic profile; P=0.482) (Fig. 1b). In particular, 3-year PFS estimate for patients randomized to ASCT-2 and carrying or lacking del(17p) was 72% vs 73%, respectively (P=0.534). The corresponding PFS values in the ASCT-1 group were 43% vs 67%, respectively (P=0.014). In a multivariate Cox regression analysis, randomization to ASCT-2 (HR=0.65; CI=0.44-0.95; P=0.029), RISS I (HR=0.60; CI=037 0.98; P=0.042), absence of HiR-cyto-5 (HR=0.35; CI=0.22-0.55; P<0.001) and best ≥VGPR (HR=0.27; CI=0.17-0.44; P<0.001) were the leading independent predictors of PFS. Overall survival (OS) from R1 was significantly prolonged with ASCT-2 as compared with ASCT-1 (3-year rate: 89% vs 82%; HR=0.52; CI=0.31-0.86; P=0.011) (Fig. 1c), a benefit also seen in subgroups of patients with adverse prognosis, including those with R-ISS stage II+III (HR=0.48; CI=0.27-0.86; P=0.013) and HiR-cyto-5 (HR=0.52; CI=0.28-0.98; P=0.042). Conclusions Randomization to ASCT-2 was superior over ASCT-1 in terms of prolonged PFS and OS for the overall patient population and for poor prognosis subgroups of patients with advanced R-ISS disease stage and HiR cytogenetic profile. Incorporation of bortezomib into ASCT-2 abrogated the increased risk of progression or death imparted by t(4;14) ± t(14;16) ± del(17p), and in particular by del(17p) positivity. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 &id=doi:&atitle=Double+autologous+stem+cell+transplantation+significantly+prolongs+p rogression free+survival+and+overall+survival+in+comparison+with+single+autotransplantation+in +newly+diagnosed+multiple+myeloma%3A+An+analysis+of+Phase+3+EMN02%2FHO 95+Study&stitle=Blood&title=Blood&volume=130&issue=&spage=&epage=&aulast=Cav o&aufirst=Michele&auinit=M.&aufull=Cavo+M.&coden=&isbn=&pages= &date=2017&auinit1=M&auinitm= RECORD 18 Nicht eingeschlossen, da Abstract (keine Vollpublikation) First line therapy for multiple myeloma Terpos E. 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 24 Leukemia Research (2017) 61 Supplement 1 (S2-S3). Date of Publication: 1 Oct 2017 Patients who are eligible for autologous transplantation: Therapy options for newly diagnosed multiple myeloma (NDMM) who are eligible for autologous stem cell transplantation (ASCT) focus on disrupting myeloma cell-bone marrow stroma interactions, enhancing the immune system response, and specific targeting of myeloma clonal cells attempting to deepen the response rates and increase the rates of minimal residual disease (MRD) negativity. Proteasome inhibitors (PI) have become an integral part of induction therapy regimens for MM. The recommendation to use a bortezomibbased regimen is based on the results randomized trials, which have been summarized in two meta-analyses and which confirmed the superiority of bortezomib based regimens over conventional regimens. VTD (bortezomib, thalidomide and dexamethasone) and VCD (bortezomib, cyclophosphamide and dexamethasone) are widely used in Europe, while VRd (bortezomib, lenalidomide and dexamethasone) is mainly used in the USA. VRd was also used as induction regimen in a recent study by the IFM (Attal et al. N Engl J Med 2017;376:1311-1320). Despite a lack of regulatory approval, the use of post-transplant therapy, in particular consolidation, defined as a short distinct course of treatment, is increasing across Europe in routine practice, with VTD or VRd being the predominant regimens used. Bortezomib has also been investigated in the maintenance setting, resulting in significant improvements in PFS; however, in these trials bortezomib was also used during induction therapy. Hence, it is as yet not clear which part of bortezomib exposure contributed to the results. However, to-date bortezomib maintenance is recommended at least for del17p patients. Subcutaneous dosing of bortezomib in MM has been demonstrated to be as active as intravenous dosing with a better toxicity profile in NDMM. The second generation PI, carfilzomib, has also been tested in NDMM but has not been approved yet for this indication. The combination of carfilzomib, lenalidomide and dexamethasone (KRD) followed by lenalidomide maintenance provides high rates of deep remission and minimal residual disease (MRD) negativity. The novel PI ixazomib, used in an oral regimen with lenalidomide, has been reported to provide response rates of 23- 33% in young patients with NDMM. Following induction with ixazomib/ lenalidomide/dexamethasone, maintenance of up to 1.5 years with ixazomib alone improved response rates with a median duration of response of 26.5 months in NDMM patients not undergoing ASCT. Clinical studies assessing single agent ixazomib maintenance after ASCT and in combination with lenalidomide after ASCT are ongoing. Maintenance therapy with immunomodulatory drugs (IMiDs) has been also investigated in a number of trials in the post-ASCT setting. A recent meta-analysis based on three studies were lenalidomide maintenance was compared to placebo confirmed the superiority of lenalidomide maintenance versus placebo with a 2.5 years of median overall survival advantage for patients who receive lenalidomide maintenance till 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 25 progression after a median follow-up of 7 years. However, patients with high-risk cytogenetics and ISS-3 seem no to have survival advantage by lenalidomide maintenance. Elderly patients not eligible for ASCT: The combinations of melphalan, prednisone and thalidomide (MPT) or bortezomib (MPV) and of cyclophosphamide, dexamethasone and thalidomide (CDT) are widely used for NDMM patients who are not eligible for ASCT. The results of the phase 3 FIRST study showed that continuous Rd is very effective for NDMM patients who are not eligible for ASCT. Compared to MPT, Rd prolonged both PFS (median: 25.5 vs. 21.2 months) and OS (median: 59 vs. 48.5 months). FDA approved Rd for NDMM on the 18th of February 2015. In a very recent study of the Southwest Oncology Group (SWOG) and the National Clinical Trial Network (NCTN), Durie et al (Lancet 2017;389:519-527) reported the results of a randomized study which compared the combination of bortezomib with lenalidomide and dexamethasone (VRd; n=264) versus Rd (n=261). Median PFS was significantly improved in the VRd group (43 months vs 30 months in the Rd group; stratified HR 0.712, 96% CI 0.56-0.906; one-sided p value 0.0018). The median overall survival was also significantly improved in the VRd group (75 months vs 64 months in the Rd group, HR 0.709, 95% CI 0.524-0.959; two-sided p value 0.025). The rates of overall response were 82% (176/216) in the VRd group and 72% (153/214) in the Rd group, and 16% (34/216) and 8% (18/214) of patients who were assessable for response in these respective groups had a CR or better. This study has established VRd as the standard of care induction regimen in the USA. In summary, induction regimen with a bortezomib based triplet (VTD or VRd) is the standard of care for newly diagnosed MM patients who are eligible for ASCT. Consolidation with 2 cycles of the same induction regimen seems to be beneficial, while maintenance with lenalidomide improves survival for all patients except of those with high-risk cytogenetic features and ISS. For this subgroup of patients, a tandem second ASCT followed by bortezomib maintenance is possibly the best approach to-date. For the fit elderly, VRd I the treatment of choice, while VD or Rd can be used in more frail patients. Finally, novel PIs in combination with IMiDs and monoclonal antibodies, such as daratumumab may be the future in the management of newly-diagnosed myeloma patients. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=18735835 &id=doi:&atitle=First+line+therapy+for+multiple+myeloma&stitle=Leuk.+Res.&title=Leuk emia+Research&volume=61&issue=&spage=S2&epage=S3&aulast=Terpos&aufirst=Ev angelos&auinit=E.&aufull=Terpos+E.&coden=&isbn=&pages=S2 S3&date=2017&auinit1=E&auinitm= RECORD 19 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Treatment of transplant-eligible patients with newly diagnosed multiple myeloma Nakaseko C. 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 26 Annals of Oncology (2017) 28 Supplement 9 (ix15). Date of Publication: 1 Oct 2017 For the past 20 years, high-dose chemotherapy plus autologous stem cell transplantation (ASCT) has been the standard treatment for newly diagnosed multiple myeloma in adults up to 65 years of age. After the introduction of new agents of proteasome inhibitors and immunomodulatory drugs such as bortezomib, thalidomide and lenalidomide, effective induction therapy for transplant-eligible patients has been developed and now two or three drug combinations with a backbone of bortezomib has been widely used. After 3 or 4 courses of induction therapy, peripheral blood stem cells are collected with high-dose cyclophosphamide plus G-CSF or G-CSF alone and ASCT is performed after high-dose melphalan conditioning. In addition, post-transplant consolidation and maintenance could lead increased rates of minimal residual disease (MRD) negativity. However, this treatment requires hospitalization and can be associated with substantial toxic effects. The improved efficacy of novel agents has raised questions about the role and timing of transplantation in the era of novel agents. To address these issues, Intergroupe Francophone du Myelome conducted a phase 3 trial to compare the efficacy and safety of combination therapy with lenalidomide, bortezomib, and dexamethasone (RVD) alone with the efficacy and safety of RVD plus ASCT for the treatment of newly diagnosed multiple myeloma in adults up to 65 years of age. RVD therapy plus ASCT was associated with significantly longer progression-free survival than RVD therapy alone. Although overall survival did not differ significantly between the two approaches, ASCT remains as a standard of care even VRD induction regimen is used. The use of a combination therapy that incorporates newer proteasome inhibitors, next-generation immunomodulatory drugs, and potent monoclonal antibodies along with transplantation tailored according to MRD detection could further improve outcomes among adults up to 65 years of age with multiple myeloma. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15698041 &id=doi:10.1093%2Fannonc%2Fmdx596&atitle=Treatment+of+transplant eligible+patients+with+newly+diagnosed+multiple+myeloma&stitle=Ann.+Oncol.&title=A nnals+of+Oncology&volume=28&issue=&spage=ix15&epage=&aulast=Nakaseko&aufir st=Chiaki&auinit=C.&aufull=Nakaseko+C.&coden=&isbn=&pages=ix15 &date=2017&auinit1=C&auinitm= RECORD 20 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten Treatment of light chain amyloidosis Palladini G., Milani P. Haematologica (2017) 102 Supplement 3 (201-203). Date of Publication: 1 Oct 2017 With an estimated incidence of 1 case per million person year, immunoglobulin light 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 27 chain (AL) amyloidosis is the most common form of systemic amyloidosis, accounting for 10-12% of patients who progress from monoclonal gammopathy of undetermined significance (MGUS). This disease is caused by misfolding, aggregation and deposition in tissues of light chains produced from usually small plasma cell clones that infiltrate the bone marrow by <10% in 50% of cases. The process leading to the formation of amyloid deposits in target organs causes progressive organ damage eventually leading to organ failure and death if it is not recognized at an early stage and effectively treated (1). Despite recent advances in the management of this disease, still approximately 30% of patients die within the first year from diagnosis, because they are diagnosed only after irreversible cardiac damage has ensued (1). Symptoms of organ involvement are late and mimic more common diseases, and 40% of subjects are diagnosed more than one year after the disease has become symptomatic. However, organ involvement by AL amyloidosis can be detected at a pre-symptomatic stage with biomarkers, N- terminal pro-natriuretic peptide type-B (NT-proBNP) for the heart, albuminuria for the kidney, and alkaline phosphatase for the liver. Moreover, increased circulating free light chains (FLC) consistently precede the presentation of AL amyloidosis by 4 years or more. Thus, we advocated screening with biomarkers of amyloid organ involvement of all patients with MGUS and abnormal FLC ratio. Although some clinical features, such as the association of a monoclonal component, heart or soft tissue involvement, and albuminuria, can in some instances strongly suggest AL amyloidosis, there is often substantial overlap in the clinical presentation of different types of systemic amyloidosis. Thus, unequivocal typing of the amyloid deposits is mandatory before starting specific treatment. Immune fluorescence and standard light-microscopy immunohistochemistry have poor specificity, and reliable techniques, such as immunohistochemistry with custom-made antibodies, immuno-electron microscopy, or mass spectrometry, should be employed referring patients to specialized centers (1). DNA analysis is required to confirm hereditary forms. The therapeutic approaches targeting the amyloidogenic plasma cell are usually borrowed from multiple myeloma. However, patients with AL amyloidosis not only have a hematologic malignancy, but their multi-organ involvement makes them particularly fragile and susceptible to treatment toxicity. Thus, the treatment of patients with AL amyloidosis needs a critical level of expertise, and should be risk adapted, carefully balancing treatment efficacy and toxicity, with close, specialized monitoring of fluid retention, hypotension, and cardiac and renal function. A close monitoring of hematologic and organ response to treatment with validated biomarker based response criteria is also mandatory (2). The treatment plan should be reconsidered every two or three cycles or three months after autologous stem cell transplantation (ASCT), being ready to shift patients to rescue therapy based on the quality of response (1). To date, no randomized clinical trials of modern treatment approaches have been published. Thus, whenever possible, patients should be referred to specialized centers for treatment and inclusion in clinical trials. Low-risk patients 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 28 represent approximately 15% of all subjects with AL amyloidosis and are candidates for ASCT (1). This procedure is associated with a substantially higher risk of early mortality in AL amyloidosis compared to multiple myeloma. The great majority of transplant related deaths occur in patients with elevated cardiac biomarkers, and subjects whose NT-proBNP is >5000 ng/L and/or cardiac troponin T is >0.06 ng/mL should not be offeres ASCT. Other eligibility criteria for ASCT are age <65 years, performance status (Eastern Cooperative Oncology Group) 0-2, eGFR >50 mL/min per 1.73 m(2) unless on dialysis, New York Heart Association (NYHA) class 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 29 bortezomib/dexamethasone alone is preferred in patients with potentially reversible contraindications to ASCT, being stem cell sparing (1). The remaining 20% of patients with renal AL amyloidosis are high-risk, most frequently because of advanced cardiac stage (stage IIIb, NT-proBNP >8500 ng/L and troponin I >0.1 ng/mL) (1). High-risk patients are treated with low-dose combinations, with weekly dose escalation based on tolerability, under intensive monitoring (1). So far, no treatment approach, was able to overcome the poor prognosis of these patients, whose median survival ranges from 3 to 7 months. Nevertheless, the few stage IIIb patients who survive long enough (at least 3 months) to take advantage of response to chemotherapy have a significantly better outcome (4). Upfront therapy can be repeated at relapse, if possible, although this is associated with shorter time to retreatment without reduction in overall survival. Lenalidomide and pomalidomide can be used in refractory patients, being able to overcome resistance to alkylating agents, proteasome inhibitors, and thalidomide. However, the use of lenalidomide is associated with worsening renal failure in patients with nephrotic syndrome. Hematologic response to pomalidomide is rapid (median 1 months) and is observed in up to two thirds of patients in the refractory setting (6). Newer agents have proven effective in relapsed/refractory patients, and are being considered for novel upfront combinations. The oral proteasome inhibitor ixazomib was particularly active in bortezomib-naïve patients, and is currently being tested in a randomized phase III trial (NCT01659658) (7). Two trials of this agent in combination with cyclophosphamide and dexamethasone (NCT03236792, NCT01864018) are ongoing in the upfront setting. Daratumumab is a very promising drug in AL amyloidosis. A recently published series showed a 76% hematologic response rate with 36% CRs in a median time of 1 month (8). Two phase II trials of daratumumab in relapsed/refractory patients are underway (NCT02841033, NCT02816476) and a phase III randomized trial of daratumumab in combination with CyBorD vs. CyBorD alone in newly-diagnosed patients is about to begin (NCT03201965). New therapeutic approaches specifically targeting the amyloid deposits or interfering with amyloid formation and organ targeting are emerging as a possible complement of chemotherapy. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15928721 &id=doi:&atitle=Treatment+of+light+chain+amyloidosis&stitle=Haematologica&title=Hae matologica&volume=102&issue=&spage=201&epage=203&aulast=Palladini&aufirst=G. &auinit=G.&aufull=Palladini+G.&coden=&isbn=&pages=201 203&date=2017&auinit1=G&auinitm= RECORD 21 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten Treatment of newly diagnosed multiple myeloma: Goals and options Tacchetti P., Zamagni E., Pantani L., Cavo M. Haematologica (2017) 102 Supplement 3 (212-215). Date of Publication: 1 Oct 2017 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 30 Introduction: The treatment landscape of multiple myeloma (MM) has dramatically evolved over the last decades, with an increasing availability of highly active new therapies which have considerably improved patient outcomes. The first major change was the introduction of autologous stem cell transplantation (ASCT) in the 90'. Moreover, the understanding of the complex system of interactions between myeloma cells and the bone marrow microenvironment has further expanded the treatment options, through the introduction of new drugs targeting the MM clone in the bone marrow milieu. These remarkable therapeutic advances have led to a radical switch of treatments paradigms, providing the opportunity to enhance the rate of complete response (CR) and prolonging median overall survival (OS) by 3- to 4-fold. Availability of new classes of novel agents, including proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs), and use of these agents in combinations have ultimately led to higher response rates and deeper responses in the vast majority of patients with newly diagnosed and relapsed/refractory MM. Ongoing clinical trials incorporating second generation PIs and IMiDs, as well as monoclonal antibodies (mAb), are actually being explored as possible treatment options for MM in the near future. Optimal upfront therapies continue to evolve and their choice is dictated by the intent to transplant, age and comorbidities. Goals of treatment: Unprecedented levels of genetic heterogeneity and genomic instability characterizing MM have been defined, as well as clonal evolution underlying the progression of the disease. According to this model based on the random acquisition of genetic hits and darwinian selection, clonal tides may evolve during the course of MM, and shift in dominant and sub-dominant clones with variable response to therapy and possible selection of minor drug-resistant clone(s) that may ultimately become lethal [1]. The coexistence of multiple clones with variable drug sensitivity raises the rationale for the use of combination therapy and provides the basis of continuous exposure to suppressive therapy. Moreover, the concepts of minor drug-resistant clones that may become lethal emphasize the importance of achieving and maintaining the best possible response early in the course of the disease. Indeed, extensive data indicate a clear association between the depth of response and long-term survival outcomes. Based on these data, primary goals of treatment are to maximize the depth of response, to minimize the burden of residual tumor cells and to prevent or delay relapse as a way to prolong progression free survival (PFS) and untimely OS. The integration of combination therapies and the use of sequential treatment blocks - including induction, intensification, consolidation, and maintenance - is aimed at targeting multiple clones and keeping them under control as long as possible. Current therapies leading to unprecedented rates and depth of response, have requested the development of new tools for the detection of minimal residual disease (MRD). Next generation flow and sequencing methods to quantify MRD in the bone marrow with sensitivities in the range of 10-5 10-6 cells are currently in use. 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 31 These technologies may be combined with functional imaging techniques to detect MRD outside of bone marrow [2]. Longer PFS and OS have been consistently reported for patients who have achieved MRD negativity, regardless of the risk of patients and the type of treatment. Therefore, eradicating the different tumor clones and potentially curing the disease should be considered the actual treatment end points for the management of transplant-eligible and elderly fit patients, though additional trials are needed to determine if changes in treatment are need based on MRD status. On the other hand, a disease control approach should be applied for elderly frail patients, for whom settling for a lower degree of response may be reasonable as treatmentrelated toxicities could outshine any benefit derived from the achievement of high quality responses. Recent developments have focused on identifying these vulnerable patients through geriatric assessment and novel MM scoring system, including the notions of frailty, disability and comorbidities [3]. This frailty score could predict survival and toxicity, as the frail patient population usually displays an increased risk of death, progression, non-hematologic adverse events and treatment discontinuation, regardless of ISS stage, chromosome abnormalities and type of treatment. Thus, maintaining a good quality of life along with avoiding treatment-related complications have become important aims in elderly patients, even if possible prolongation of OS remains the ultimate goal. Proper identification of fit and frail patients allows avoiding their possible undertreatment or overtreatment. Transplant eligible patients: Patients aged ≤65-70 years and without significant comorbidities are candidates for ASCT. The current treatment paradigm for ASCT-eligible MM patients includes sequential blocks of therapy delivered as an induction phase, followed by intensification (ASCT), consolidation, and a maintenance phase. As previously emphasized, the objectives are to maximize the rate and duration of MRD negativity [4]. Patients typically receive a limited number of cycles of induction therapy to reduce tumor cell mass before collection of autologous hematopoietic stem cells. Novel agents, including IMiDs and PIs, combine well with traditional therapies and with one another to form various doublet and triplet regimens which have yielded unprecedented rates of high-quality responses, an early predictor of favourable outcomes following ASCT. An integrated analysis of three different randomized phase III trials has shown the superiority of bortezomib-based versus non bortezomib-based induction regimens, in terms of high-quality response rates and extended PFS. Moreover, the addition of a third agent to the bortezomib dexamethasone (VD) backbone, such as thalidomide (VTD), doxorubicin (PAD), or cyclophosphamide (VCD), resulted in improved outcomes over doublet regimens. Based on these results, VTD has been approved by the European Medicines Agency (EMA) and is listed as one of the preferred upfront option in preparation for ASCT in several guidelines [5]. (Figure presented) One randomized trial showed that VCD and PAD were equally effective in terms of response, with more favorable toxicity profile for VCD. Moreover, based on both a retrospective case-matches analysis and a 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 32 prospective trial, VTD resulted a more effective regimen compared with VCD in terms of high-quality response rates, despite a higher rate of peripheral neuropathy. VD plus the second generation IMiD lenalidomide (VRD) is likely to become a new standard induction therapy in the next few years, based on efficacy data and a lower neurotoxicity profile compared with VTD. Furthermore, preliminary data of phase II trials indicate high rates of deep responses with triplet regimens including the second generation PI carfilzomib plus ASCT, with MRD negativity rates averaging 70-80% at the end of the whole treatment program. Response rates after novel agent-based induction regimens are shown in Figure 1. The observed benefits of newer therapies incorporating the novel agents have raised questions about the role and timing of ASCT in the initial treatment of young and fit patients. Two recent phase III trials (EMN02/HO95 MM, and IFM 2009) comparing ASCT versus a “standard dose” intensification phase, in the context of a triplet bortezomib-based induction therapy, have shown that highdose therapy translates into prolonged PFS, proving that ASCT should remain a standard of care even in the current era [6-7]. Another important question to be addressed in the era of novel agents includes the role of single versus double ASCT. In a retrospective analysis of three phase III European studies, double ASCT resulted in longer PFS and OS than a single ASCT in patients failing to achieve CR after a bortezomibbased induction therapy and carrying del(17p) and/or t(4;14). Preliminary results of the EMN02/HO95 MM trial designed to randomly assign patients to single or double ASCT in centers with a double ASCT policy confirmed the superior outcomes afforded by double ASCT in the high-risk cytogenetic subgroup. Despite these important results, a fraction of patients fails to achieve CR after ASCT. Consolidation therapy is typically short-term and is aimed at further increasing the rate and depth of response after high-dose therapy as a way to improve clinical outcomes. Similarly to the induction phase, the novel agents have been successfully incorporated into newer consolidation regimens. Preliminary results of the EMN02/HO95 MM trial showed extended PFS for patients randomized to receive a consolidation therapy with VRD versus no consolidation. Conversely, no benefit with consolidation treatment has been reported in the STAMINA trial designed to randomize patients to receive either a single ASCT followed or not by consolidation therapy or double ASCT, with lenalidomide maintenance in all treatment arms. Major unconsistencies between these two studies hamper any possible comparison and efforts to reconcile conflicting results. Finally, the goal of maximizing and sustaining responses has provided the rationale of “maintenance treatment”, whereby continuous therapy is given to keep under control residual clonal subpopulations and to kill myeloma stem cells coming into cell cycle. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15928721 &id=doi:&atitle=Treatment+of+newly+diagnosed+multiple+myeloma%3A+Goals+and+o ptions&stitle=Haematologica&title=Haematologica&volume=102&issue=&spage=212&e 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 33 page=215&aulast=Tacchetti&aufirst=P.&auinit=P.&aufull=Tacchetti+P.&coden=&isbn=& pages=212-215&date=2017&auinit1=P&auinitm= RECORD 22 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten Intensification therapy with autologous stem cell transplantation versus bortezomib-melphalan-prednisone for newly diagnosed multiple myeloma patients: A multicenter, phase III study of the european myeloma network (EMN02/HO95 MM trial) Tacchetti P., Tacchetti P., Beksac M., Dimopoulos M., Zamagni E., Di Raimondo F., Gay F., Hájek R., Marzocchi G., Cellini C., Mellqvist U.H., Johnsen H.E., Ludwig H., Zweegman S., Wester R., Wu K.L., Driessen C., Troia R., Cornelisse P., Van Der Holt B., Palumbo A., Sonneveld P., Cavo M. Haematologica (2017) 102 Supplement 3 (26). Date of Publication: 1 Oct 2017 The prospective, multicenter, phase III EMN02/HO95 MM trial was designed to randomly compare (R1) (1:1 ratio; stratification by ISS) four 42-day cycles of standard dose bortezomib-melphalan-prednisone (VMP) vs either a single or two sequential courses of melphalan 200 mg/m(2) followed by autologous stem cell transplantation (ASCT), as intensification therapy for newly diagnosed multiple myeloma (MM) patients. A second randomization (R2) to consolidation therapy with bortezomib-lenalidomide dexamethasone vs no consolidation was performed after intensification, to be followed by lenalidomide maintenance until progression or toxicity in both arms. A primary study end point was progression-free survival (PFS) from R1. From February 2011 to April 2014, 1510 patients aged ≤65 years were registered. Of these, 1192 patients randomized to VMP (n=497) or ASCT (n=695) could be evaluated after having received 3 to 4 cycles of bortezomib-cyclophosphamide-dexamethasone induction therapy. Median age was 58 years in both groups, ISS stage III was 21% in VMP and 20% in ASCT arms, while revised ISS stage III was 9% in both groups. The frequency of conventionally defined high-risk cytogenetic changes, including t(4;14) and/or del(17p) and/or t(14;16) as detected by FISH analysis, was 25% in both groups. Median follow up from R1 was 32 (IQR 25-40) months. On an intention-to-treat basis, median PFS was 42.5 months in the VMP arm and was not yet reached in the ASCT arm; 3-year estimates of PFS were 57% and 65%, respectively (HR=0.73; 95% CI=0.61-0.88; P=.001). PFS benefit with ASCT was retained across predefined subgroups, including patients with a high-risk cytogenetic profile (HR=0.53; CI=0.37-0.76; P=0.001). The probability of achieving a very good partial response or higher quality response was 85.5% in the ASCT group vs 74% in the VMP group (odds ratio=1.90; CI=1.42-2.54; P<0.001). In a multivariate Cox regression analysis, randomization to ASCT (HR=0.69; CI=0.55-0.86; P<0.001) and absence of high-risk cytogenetic abnormalities (0.69; CI=0.52-0.91; P=0.008) were the leading independent predictors of prolonged PFS. 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 34 Overall survival was not yet mature and no difference between the two treatment groups was evident. It is concluded that upfront ASCT still continues to be the reference treatment choice for fit patients with newly diagnosed MM, even in the era of bortezomib-based therapies. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15928721 &id=doi:&atitle=Intensification+therapy+with+autologous+stem+cell+transplantation+ver sus+bortezomib-melphalan prednisone+for+newly+diagnosed+multiple+myeloma+patients%3A+A+multicenter%2C +phase+III+study+of+the+european+myeloma+network+%28EMN02%2FHO95+MM+tri al%29&stitle=Haematologica&title=Haematologica&volume=102&issue=&spage=26&ep age=&aulast=Tacchetti&aufirst=P.&auinit=P.&aufull=Tacchetti+P.&coden=&isbn=&page s=26-&date=2017&auinit1=P&auinitm= RECORD 23 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Prediction of early overall and infection-related mortality during induction therapy in transplant-eligible multiple myeloma-a pooled analysis from three GMMG phase III trials Mai E.K., Hielscher T., Bertsch U., Schlenzka J., Salwender H.J., Munder M., Gerecke C., Pfreundschuh M., Dührsen U., Brossart P., Neben K., Hillengass J., Raab M.S., Hose D., Merz M., Breitkreutz I., Jauch A., Martin H., Lindemann H.-W., Scheid C., Weisel K.C., Blau I.W., Goldschmidt H. Oncology Research and Treatment (2017) 40 Supplement 3 (36-37). Date of Publication: 1 Sep 2017 Introduction: Early mortality is up to 10% in newly-diagnosed multiple myeloma (MM). The present analysis aimed at the identification of patients with a high risk for severe infections (SI), which is the major cause of early death during induction therapy (IT) in transplant-eligible MM (teMM). Methods: Between 09/2001 and 11/2013, 1515 patients from three phase III multicenter trials from the German-speaking Myeloma Multicenter Group (GMMG) were included in this pooled multi-cohort analysis. Patients were analysed as treated if they received at least one dose of trial medication and no more than three IT cycles. SI were defined as any infection ≥ grade 3 according to the Common Terminology Criteria for Adverse Events (CTCAE). In each trial, three cycles of a 3-drug IT were applied: HD3: vincristine, doxorubicin (DOX), dexamethasone (DEX; VAD) vs. thalidomide, DOX, DEX (TAD) [n = 529]; HD4: VAD vs. bortezomib (BTZ), DOX, DEX (PAD) [n = 388] and MM5: PAD vs. BTZ, cyclophosphamide (CYC), DEX (VCD) [n = 598]. Uni- and multivariate logistic regression models were used to assess risk factors. Trial effect was accounted for. Results: SI and death occurred in 22.3/27.3/10.0/18.8% and 6.2/3.1/1.3/3.5% of patients in the HD3/HD4/MM5/pooled 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 35 cohort, respectively. Pooled multivariate analyses identified World Health Organization performance status >1 (WHO>1, odds ratio [OR]=1.97, p < 0.001), age >60 years (age > 60, OR = 1.42, p = 0.01) and lactate dehydrogenase > upper level of normal (LDH>ULN, OR = 1.45, p = 0.04) as trial-independent significant predictors for SI during IT. Combination of these factors allowed the stratification in three groups according to the risk of SI during IT: high risk (HiR, WHO>1 plus age>60 and/or LDH>ULN, n = 95, SI incidence: 37.9%), low risk (LoR, no risk factors or age>60 only, n = 1046, SI incidence: 15.8%) and intermediate risk (ImR, neither HiR nor LoR, n = 310, SI incidence: 21.6%). In the HiR group, the incidence of death from any cause or SI was 14.7%/8.4% vs. 6.1%/2.6% vs. 1.4%/0.9% in the ImR and LoR groups, respectively. The increased risk of death from any cause or SI in the HiR and InR group was independent of trial effects (HiR group: OR[any cause/SI] = 11.46/10.19, both p < 0.001 and ImR group: OR[any cause/SI] = 4.83/3.23, p < 0.001/0.02; vs. LoR group). Conclusions: Our simple risk score identifies a subgroup of teMM with an excessive risk of death during IT despite improvements in subsequent trial generations. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=22965262 &id=doi:10.1159%2F000479566&atitle=Prediction+of+early+overall+and+infection related+mortality+during+induction+therapy+in+transplant-eligible+multiple+myeloma a+pooled+analysis+from+three+GMMG+phase+III+trials&stitle=Oncol.+Res.+Treat.&titl e=Oncology+Research+and+Treatment&volume=40&issue=&spage=36&epage=37&au last=Mai&aufirst=E.K.&auinit=E.K.&aufull=Mai+E.K.&coden=&isbn=&pages=36 37&date=2017&auinit1=E&auinitm=K RECORD 24 Nicht eingeschlossen, da nur Abstracts diskutiert werden Highlights of Multiple Myeloma at the Annual Meeting of American Society of Hematology, 2016 Tandon N., Kumar S.K. Indian Journal of Hematology and Blood Transfusion (2017) 33:2 (153-158). Date of Publication: 1 Jun 2017 This review discusses the landmark studies in the field of multiple myeloma (MM) which were presented at American society of hematology annual meeting, 2016. There were contrary results from two large phase III trials (one from US and one from Europe) that evaluated the role of additional interventions like tandem autologous transplant (ASCT) and consolidation after induction therapy followed by ASCT in newly diagnosed MM (NDMM) patients, but there were critical differences between the two studies. Novel agents like carfilzomib and ixazomib proved to be of benefit when used as induction and post ASCT consolidation and maintenance in NDMM. The early data on subcutaneous administration of daratumumab (DARA) looked promising. The high rate of minimal 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 36 residual disease negativity after using DARA even in relapsed/refractory MM (RRMM) setting reinforces the benefit of targeting CD38. The responses seen with venetoclax in RRMM with t(11;14)(high BCL-2, low BCL-XL and MCL-1) and selinexor in penta refractory myeloma which fulfills the FDA category of unmet need, opens up newer options for these patients. BCMA CAR-T infusion shows encouraging results in advanced refractory myeloma patients. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=09740449 &id=doi:10.1007%2Fs12288-017-0796 x&atitle=Highlights+of+Multiple+Myeloma+at+the+Annual+Meeting+of+American+Socie ty+of+Hematology%2C+2016&stitle=Indian+J.+Hematol.+Blood+Transfus.&title=Indian +Journal+of+Hematology+and+Blood+Transfusion&volume=33&issue=2&spage=153&e page=158&aulast=Tandon&aufirst=Nidhi&auinit=N.&aufull=Tandon+N.&coden=IJHTF&i sbn=&pages=153-158&date=2017&auinit1=N&auinitm= RECORD 25 Nicht eingeschlossen, da Abstract (keine Vollpublikation) High efficacy and safety of vtd as an induction protocol in newly diagnosed MM patients eligible for HDT/AUTOSCT - A report of Polish multiple myeloma study group Hus I., Manko J., Jawniak D., Jurczyszyn A., Usnarska-Zubkiewicz L., Sawicki M., Charlinski G., Razny M., Rodzaj M., Waszczuk-Gajda A., Drozd-Sokolowska J., Galazka A., Swiderska A., Poglodek B., Pluta A., Druzd-Sitek A., Grzasko N., Kopinska A., Pasternak A., Blonska D., Hus M., Dmoszynska A. Haematologica (2017) 102 Supplement 2 (515). Date of Publication: 1 Jun 2017 Background: Three drug bortezomib-based regimens are nowadays generally recommended standard induction therapy for transplant-eligible patients with newly diagnosed multiple myeloma (MM). The choice between different regimens depends on drug availability in particular countries, their toxicity profile and local preferences. Observations from routine practice might have though significant clinical importance. Aims: The aim of this retrospective analysis was to evaluate the efficacy and safety of VTD regimen in newly diagnosed MM patients eligible for HDT/autoSCT in routine clinical practice. Methods: We collected the clinical data of 169 patients qualified to HDT/autoSCT treated with VTD as an induction regimen in 14 Polish hematology/ oncology centers. VTD protocol recommended by Polish Multiple Myeloma Study Group was as follows: bortezomib: 1.3mg/m2 (days 1,4,8,11), thalidomide: 100 - 200mg a day (days 1-21), dexamethasone 20mg a day (days: 1,2, 4,5, 8,9, 11,12) or 40mg a day (days 1- 4), every 21 days. Patients were included into analysis if ≥1 cycle of VTD was administered. Adverse events (AEs) were graded according to CTCAE v4.0. The analysis involved also the impact of VTD regimen on efficiency of stem cells 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 37 mobilization as well as high dose therapy/ autologous stem cell transplantation (HDT/autoSCT) procedure. Results: In the cohort of 169 patients, median age was 59 years (range 36-70). ISS stage 1 was found in 30.8% of patients, ISS 2 and 3 in 20.7% and 45.5%, respectively. Median number of VTD cycles was 5. In 81.6% of patients bortezomib was administered subcutaneously. Thalidomide dose was 100mg a day in 85.1% of patients. Bortezomib dose was reduced in 43 patients (25.4%) with peripheral polyneuropathy as the most common reason (75%). Polyneuropathy was also the most common grade 3/4 adverse event, observed in 20 patients (11.8%) and neutropenia was the most common hematologic toxicity, though it was noted only in 5 patients (3%). Response rate ≥ PR was achieved in 95% of patients, including 5.6% of sCR, 27.1% of CR and 35.1% of VGPR. So far, stem cell mobilization was performed in 110 patients, most commonly used protocols were cyclophosphamide (42.9%) and cytosine arabinoside (36.2%). In 69.3% of patients one apheresis allowed to obtain the number of stem cells sufficient for transplantation. Median yield of CD34+ cells was 11 x 106/kg (max 55.7×106/kg) that was sufficient for two transplantations in the majority of patients. HDT/autoSCT was performed so far in 89 patients with MEL 200 protocol as conditioning regimen in 77.6% of patients. Median number of transplanted CD34+ cells was 4.4 x 106/kg. Median time to reach ANC count <0.5 G/L and PLT count <20 G/L was 11 days and 12 days, respectively. In the evaluation of response 100 days after HDT/autoSCT performed in 81 patients, sCR rate increased from 5.6% to 12.7% and CR from 27.1% to 36.7%. Summary/Conclusions: VTD regimen allowed allowed to achieve ≥ PR in 95% of patients including ≥ VGPR u 64.8% of patients as compared to 73.5% ≥ PR including 36% of ≥ nCR achieved in patients treated with CTD in our previous study (Dmoszynska et al. Leuk Res 2010). In 96% of patients subsequently undergoing stem cell mobilization sufficient numer of CD34+ cells was obtain during first procedure. HDT/autoSCT further increased response rate after VTD induction (≥ CR up to 43.5%, ≥ VGPR up to 83.5%). OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15928721 &id=doi:&atitle=High+efficacy+and+safety+of+vtd+as+an+induction+protocol+in+newly+ diagnosed+MM+patients+eligible+for+HDT%2FAUTOSCT+ +A+report+of+Polish+multiple+myeloma+study+group&stitle=Haematologica&title=Hae matologica&volume=102&issue=&spage=515&epage=&aulast=Hus&aufirst=I.&auinit=I. &aufull=Hus+I.&coden=&isbn=&pages=515-&date=2017&auinit1=I&auinitm= RECORD 26 Nicht eingeschlossen, da Abstract (keine Vollpublikation) High efficacy and safety of VTD as an induction protocol in newly diagnosed MM patients eligible for HDT/autoSCT - A report of Polish multiple myeloma study group Hus I., Manko J., Jawniak D., Jurczyszyn A., Usnarska-Zubkiewicz L., Sawicki M., 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 38 Charlinski G., Razny M., Rodzaj M., Waszczuk-Gajda A., Drozd-Sokolowska J., Galazka A., Swiderska A., Poglodek B., Pluta A., Druzd-Sitek A., Grzasko N., Kopinska A., Pasternak A., Blonska D., Hus M., Dmoszynska A. Hematological Oncology (2017) 35 Supplement 2 (387-388). Date of Publication: 1 Jun 2017 Introduction: Three drug bortezomib-based regimens are nowadays generally recommended standard induction therapy for transplant-eligible patients with newly diagnosed multiple myeloma (MM). The choice between different regimens depends on drug availability in particular countries, their toxicity profile and local preferences. Aims: The aim of this retrospective analysis was to evaluate the efficacy and safety of VTD regimen in newly diagnosed MM patients eligible for HDT/autoSCT in routine clinical practice. Methods: We collected the clinical data of 169 patients qualified to HDT/autoSCT treated with VTD as an induction regimen in 14 Polish hematology centers. VTD protocol recommended by Polish Multiple Myeloma Study Group was as follows: bortezomib: 1.3 mg/m2 (days 1, 4, 8, 11), thalidomide: 100-200 mg a day (days 1-21), dexamethasone 20 mg a day (days: 1, 2, 4, 5, 8, 9, 11, 12) or 40 mg a day (days 1-4), every 21 days. Adverse events (AEs) were graded according to CTCAE v4.0. The analysis involved also the impact of VTD regimen on efficiency of stem cells mobilization as well as high-dose therapy/ autologous stem cell transplantation (HDT/autoSCT) procedure. Results: In the cohort of 169 patients, median age was 59 years (range 36-70). ISS stage 1 was found in 30.8% of patients, ISS 2 and 3 in 20.7% and 45.5%, respectively. Median number of VTD cycles was 5. In 81.6% of patients, bortezomib was administered subcutaneously. Thalidomide dose was 100 mg a day in 85.1% of patients. Bortezomib dose was reduced in 43 patients (25.4%) with peripheral polyneuropathy as the most common reason (75%). The most common grade 3/4 adverse event was polyneuropathy, observed in 20 patients (11.8%) and neutropenia, noted only in 5 patients (3%). Response rate-PR was achieved in 95% of patients, including 5.6% of sCR, 27.1% of CR and 35.1% of VGPR. So far, stem cell mobilization was performed in 110 patients, most commonly used protocols were cyclophosphamide (42.9%) and cytosine arabinoside (36.2%). In 69.3% of patients, one apheresis allowed to obtain the number of stem cells sufficient for transplantation. Median yield of CD34+ cells was 11 × 106 /kg (max 55.7 × 106 /kg). HDT/autoSCT was performed so far in 89 patients with MEL 200 protocol as conditioning regimen in 77.6% of patients. Median number of transplanted CD34+ cells was 4.4 × 106 /kg. Median time to reach ANC count >0.5 G/L and PLT count >20 G/L was 11 days and 12 days, respectively. In the evaluation of response 100 days after HDT/autoSCT performed in 81 patients, sCR rate increased from 5.6% to 12.7% and CR from 27.1% to 36.7%. Conclusions: VTD regimen allowed allowed to achieve ≥PR in 95% of patients including ≥VGPR u 64.8% of patients as compared to 73.5% ≥ PR including 36% of ≥nCR achieved in patients 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 39 treated with CTD in our previous study (Dmoszynska et al. Leuk Res 2010). In 96% of patients subsequently undergoing stem cell mobilization, sufficient numer of CD34+ cells was obtain during first procedure. HDT/autoSCT further increased response rate after VTD induction (≥CR up to 43.5%, ≥VGPR up to 83.5%). OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=02780232 &id=doi:10.1002%2Fhon.2439&atitle=High+efficacy+and+safety+of+VTD+as+an+induct ion+protocol+in+newly+diagnosed+MM+patients+eligible+for+HDT%2FautoSCT+ +A+report+of+Polish+multiple+myeloma+study+group&stitle=Hematol.+Oncol.&title=He matological+Oncology&volume=35&issue=&spage=387&epage=388&aulast=Hus&aufir st=I.&auinit=I.&aufull=Hus+I.&coden=&isbn=&pages=387 388&date=2017&auinit1=I&auinitm= RECORD 27 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten Evaluation of stem cell mobilization in patients with multiple myeloma after lenalidomide-based induction chemotherapy within the GMMG-HD6 trial Wuchter P., Bertsch U., Salwender H.-J., Munder M., Haenel M., Benner A., Becker N., Fenk R., Duerig J., Blau I.W., Lisenko K., Hillengass J., Raab M.S., Baertsch M.A., Seidel-Glaetzer A., Ho A.D., Graeven U., Scheid C., Weisel K., Goldschmidt H. Blood (2016) 128:22. Date of Publication: 2 Dec 2016 Introduction: The German-Speaking Myeloma Multicenter Group (GMMG) has initiated a randomized multicenter phase III trial on the effect of elotuzumab in VRD (bortezomib, lenalidomide, dexamethasone) induction/consolidation and lenalidomide maintenance in patients with newly diagnosed multiple myeloma (GMMG-HD6 trial, NCT02495922). The study compares four cycles induction therapy with VRD vs. VRD + elotuzumab, followed by standard intensification (i.e. mobilization and stem cell transplantation), two cycles consolidation with VRD/VRD + elotuzumab and lenalidomide maintenance +/ elotuzumab. The primary endpoint is determination of the best of four treatment strategies regarding progression-free survival. Here we present a first analysis of stem cell mobilization within this study. Patients and Methods: We performed a retrospective analysis of collection data on all patients who underwent peripheral blood stem cell (PBSC) collection between trial initiation in June 2015 and June 2016. Only patients with completely available datasets in respect of mobilization were considered (n=1 11). The vast majority of 99 patients (89%) received chemomobilization with CAD (cyclophosphamide, adriamycin, dexamethasone) followed by 5-10 μ g G-CSF/kg body weight (bw)/d (starting day +9 until completion of PBSC collection), while in one case (1%) dexamethasone was omitted and in 10 cases (9%) cyclophosphamide mono was administered. One patient underwent steady-state mobilization with G-CSF only (10μ g/kg bw/d). 55/111 patients received VRD (50%), whereas the remaining patients 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 40 received VRD + elotuzumab. According to the recommendations of the study group, PBSCs for three stem cell transplants were to be collected. One transplant ideally consisted of ≥2.5 x10(-6) CD34+ cells/kg bw, but in the event of poor mobilization as low as ≥2.0 x10(-6) CD34+ cells/kg bw would be considered acceptable. Results: The median number of collected CD34+ cells was 10.4 x10(-6)/kg bw (range 2.88 to 23.01 x10(-6)/kg bw). Overall, 92 patients (83%) collected ≥7.5 x10(-6) CD34+ cells/kg bw and another 12 patients (11%) collected between 6.0 and 7.5 x10(-6) CD34+ cells/kg bw, resulting in three transplants, respectively. Only 7 patients (6%) collected below 6.0 x10(-6) CD34+ cells/kg bw; 5 of them had been treated in the VRD-arm without elotuzumab. Due to insufficient PBSC mobilization after conventional treatment, 14 patients (13%) received a rescue mobilization with plerixafor, from which 12 patients collected ≥6.0 x10(-6) CD34+ cells/kg bw. Overall, 7 serious adverse events (SAEs) occurred during mobilization phase, 4 of them in the study arm with elotuzumab. Conclusions: Cyclophosphamide-based chemomobilization after induction therapy with VRD is feasible. Efficient PBSC collection of ≥6.0 x10(-6) CD34+ cells/kg bw could be performed in 104 of 111 patients (94%), with a low incidence of SAEs. The need for rescue mobilization was not higher than that of comparable previous GMMG treatment protocols. The addition of elotuzumab during induction phase did not impede PBSC collection. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 &id=doi:&atitle=Evaluation+of+stem+cell+mobilization+in+patients+with+multiple+myelo ma+after+lenalidomide-based+induction+chemotherapy+within+the+GMMG HD6+trial&stitle=Blood&title=Blood&volume=128&issue=22&spage=&epage=&aulast= Wuchter&aufirst=Patrick&auinit=P.&aufull=Wuchter+P.&coden=&isbn=&pages= &date=2016&auinit1=P&auinitm= RECORD 28 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Results of salvage autologous stem cell transplantation (ASCT) for relapsed multiple myeloma (MM) in the era of novel agents: Outcome of patients (Pts) receiving prior bortezomib (BTZ)-based therapy Zarabi S.F., Masih-Khan E., Chen C., Kukreti V., Prica A., Tiedemann R., Trudel S., Reece D. Blood (2016) 128:22. Date of Publication: 2 Dec 2016 Background: A second (salvage) ASCT has frequently been offered to MM patients with relapsed disease who experience benefit from the first procedure. We have previously reported that pts undergoing a salvage ASCT in the era of VAD or thalidomide (thal) have a median progression-free survival (PFS) of 19 months (mos). The best results were observed in pts who experienced ≥ 2 year benefit after their first ASCT (Jimenez 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 41 Zepeda VH et al. Biol Blood Marrow Transplant 2012; 18: 773-9). However, the utility of this approach after the introduction of novel chemotherapeutic agents-such as bortezomib (BTZ)-remains unclear. Initially, provincial funding for BTZ in Ontario was provided only for relapsed disease. However, in 2007, the combination of either BTZ + dexamethasone (BTZ-dex) or cyclophosphamide, BTZ + dex (CyBorD) was adopted as the standard induction regimen for newly diagnosed pts before ASCT performed as part of first-line therapy. We now examine the results of salvage ASCT in our centre after the availability of BTZ. Methods: We used the Princess Margaret Myeloma Database to identify and characterize patients with relapsed MM who had received a bortezomib (BTZ)-based regimen for remission induction prior to their first ASCT or for re-induction before salvage ASCT. A retrospective chart review was performed to investigate the PFS and overall survival (OS) outcomes of these pts. Results: Between 01/2005 and 07/2015, 64 pts with MM who had previously received BTZbased therapies underwent salvage ASCT for relapsed disease at our centre (Table 1). Median age was 56.9 yrs (range 37-67.3); 37 (58%) were male. ISS stage was 1 in 32 (50%), 2 in 16 (25%), 3 in 14 (22%) and NA in 2 (3%). The median interval between first and salvage ASCT for all pts was 48.6 mos (range 26.9-130.3), reflecting our policy of preferentially offering salvage ASCT to pts with at least a 2-yr benefit from the first transplant; the median time between re- induction therapy and salvage ASCT was 6.3 mos (range 0.3-95.9). Group A pts (n=27) had received BTZbased therapy before their first ASCT; 48% of these also received BTZ-based regimens again prior to salvage ASCT. Pts in Group B (n=37) received BTZ-based regimens before the salvage transplant only, while induction therapy before the first ASCT consisted of VAD (21), dex alone (8), thal + dex or other regimens (5). Twenty-two (34%) of the pts received maintenance therapy between the first and salvage ASCT (most often thal-based), while 35 (55%) of the pts received maintenance therapy following salvage ASCT (most frequently lenalidomide [len] based). The survival outcomes are summarized in Table 2. Median duration of follow-up (F/U) following salvage ASCT was 19.1 mos (range 0.8-96.4). One patient (1.6%) died several days following salvage ASCT. No other transplant-related mortality occurred. The median PFS following salvage ASCT was 19.1 mos (range 0.8- 87.5) with a median OS of 26.5 mos (range 0.8-101.9) in all pts. The median PFS after salvage ASCT was 15.8 mos for Group A and 25.2 mos for Group B pts. Conclusions: Even in the era of novel agents, salvage ASCT may provide PFS benefit to pts with relapsed MM who were previously treated with a BTZ-based regimen. However, the details of the optimal approach in this setting are not certain, including the impact of maintenance therapy given after the first and/or salvage ASCT. We are performing additional analyses of this population to try to identify factors associated with the best outcomes. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 42 %29+for+relapsed+multiple+myeloma+%28MM%29+in+the+era+of+novel+agents%3A +Outcome+of+patients+%28Pts%29+receiving+prior+bortezomib+%28BTZ%29 based+therapy&stitle=Blood&title=Blood&volume=128&issue=22&spage=&epage=&aul ast=Zarabi&aufirst=Sara+Farshchi&auinit=S.F.&aufull=Zarabi+S.F.&coden=&isbn=&pag es=-&date=2016&auinit1=S&auinitm=F RECORD 29 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten Upfront single versus double autologous stem cell transplantation for newly diagnosed multiple myeloma: An intergroup, multicenter, phase III study of the European Myeloma network (EMN02/HO95 MM trial) Cavo M., Petrucci M.T., Di Raimondo F., Zamagni E., Gamberi B., Crippa C., Marzocchi G., Grasso M., Ballanti S., Vincelli D.I., Tacchetti P., Offidani M., Semenzato G., Liberati A.M., Pascarella A., Benevolo G., Troia R., Palmas A.D., Cantore N., Rizzi R., Morabito F., Boccadoro M., Sonneveld P. Blood (2016) 128:22. Date of Publication: 2 Dec 2016 Background The role of single vs double autologous stem cell transplantation (ASCT) in patients with newly diagnosed (ND) multiple myeloma (MM) needs to be prospectively investigated in the novel agent era. Methods The phase III EMN02/HO95 study was designed to compare (first randomization, R1) (stratification according to ISS stage) standard-dose intensification therapy with bortezomibmelphalan- prednisone (VMP) vs high-dose intensification therapy with melphalan at 200 mg/m (HDM) followed by ASCT after 3-4 cycles of bortezomib-cyclophosphamide-dexamethasone as induction therapy. A second randomization to consolidation therapy vs no consolidation was performed after intensification therapy, to be followed by lenalidomide maintenance until progression or toxicity in both arms. A primary study endpoint was progression-free survival (PFS) from R1. In centers with a policy of double ASCT, patients were randomized in a 1:1:1 ratio to either VMP or single ASCT (ASCT-1) or two sequential courses (administered 2 to 3 months apart) of HDM and double ASCT (ASCT-2) in order to prospectively compare ASCT-1 with ASCT-2, which was an additional study objective. Results From February 2011 to April 2014, 1510 pts aged ≤65 years with symptomatic NDMM were registered and 1192 of these were eligible for R1. According to the design of the study, 614 eligible patients who received the diagnosis of MM in centers with a double intensification policy were randomly assigned to either VMP (n=199) or ASCT-1 (n=208) or ASCT-2 (n=207). Patients randomized to ASCT-1 or ASCT-2 were included in the current pre-specified analysis. Median age was 59 years for patients in the ASCT-1 group and 57 years for those in the ASCT-2 group. The frequency of ISS stage III was 18% and 19%, while revised ISS stage III was 9% and 11%, respectively. Cytogenetic abnormalities were detected by FISH analysis of CD138+ plasma cells. A high-risk (HR) cytogenetic profile, defined by t(4;14) and/or 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 43 del(17p) and/or t(14;16) (HR cyto-3), was observed in 26% of evaluable patients who were randomized to ASCT-1 and in 21% of those randomly assigned to ASCT-2. If amp(1q) and/or del(1p) were added for the definition of high-risk disease, a HR cytogenetic profile that included at least 1 of the 5 above mentioned chromosomal abnormalities (HR cyto-5) was reported in 55% of evaluable patients in the ASCT-1 group and in 54% of those in the ASCT-2 group. Median follow-up from R1 was 27 (IQR: 20-35) months. On an intention-to-treat basis, the median PFS was 45 months in the ASCT-1 arm and was not yet reached for patients in the ASCT-2 arm; 3-year estimates of PFS were 60% and 73%, respectively (HR=0.66; 95% CI=0.45-0.96; P=0.030). PFS benefit with ASCT-2 was retained across predefined subgroups, including patients with β2-microglobulin >3.5 mg/L (HR=0.59; CI=0.34-0.99; P=0.005), bone marrow plasma cells >60% (HR=0.41; CI=0.22-0.77; P=0.006), LDH values above the upper limits (HR=0.52; CI=0.28-095; P=0.034), revised ISS stage II (HR=0.50; CI=0.31-0.80; p=0.004), HR cyto-3 (HR=0.49; CI=0.24-1.02; P=0.057) and HR cyto-5 (HR=0.57; CI=0.35-0.93; P=0.024). In a multivariate Cox regression analysis stratified by ISS stage, randomization to ASCT-2 (HR=0.62; CI=0.40-0.95; P=0.027) and HR cyto-5 (HR=2.63; CI=1.63-4.16; P<0.001) were the leading independent predictors of PFS. Overall survival was not yet mature and no difference between the two treatment groups was evident. Conclusions Upfront double ASCT after bortezomib-based induction therapy for newly diagnosed MM was superior over a single ASCT in terms of prolonged PFS. Clinical benefits of double ASCT were mostly seen in patients with disease-related factors predicting for poor prognosis. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 &id=doi:&atitle=Upfront+single+versus+double+autologous+stem+cell+transplantation+f or+newly+diagnosed+multiple+myeloma%3A+An+intergroup%2C+multicenter%2C+pha se+III+study+of+the+European+Myeloma+network+%28EMN02%2FHO95+MM+trial%2 9&stitle=Blood&title=Blood&volume=128&issue=22&spage=&epage=&aulast=Cavo&auf irst=Michele&auinit=M.&aufull=Cavo+M.&coden=&isbn=&pages= &date=2016&auinit1=M&auinitm= RECORD 30 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten Intensification therapy with bortezomib-melphalan-prednisone versus autologous stem cell transplantation for newly diagnosed multiple myeloma: An intergroup, multicenter, phase III study of the European myeloma network (EMN02/HO95 MM trial) Cavo M., Beksac M., Dimopoulos M.A., Pantani L., Gay F., Hájek R., Testoni N., Mellqvist U.-H., Patriarca F., Montefusco V., Galli M., Johnsen H.E., Ludwig H., Zweegman S., Wester R., Wu K.L., Driessen C., Troia R., Cornelisse P., Van Der Holt B., Palumbo A., Sonneveld P. 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 44 Blood (2016) 128:22. Date of Publication: 2 Dec 2016 Background The role of upfront autologous stem cell transplantation (ASCT) for younger patients with newly diagnosed (ND) multiple myeloma (MM) has been questioned in the novel agent era. Methods A prospective, multicenter, phase III study was designed to compare (first randomization, R1) (1:1 ratio; stratification according to ISS stage) four 42-day cycles of bortezomib-melphalan-prednisone (VMP) given at the same dosing schedule reported in the VISTA study (NEJM 2008; 359:906-17) vs either a single course or two sequential courses of melphalan at 200 mg/m(2) (HDM) followed 2 by single or double ASCT, respectively, as intensification therapy after three to four 21-day cycles of induction therapy with bortezomib-cyclophosphamide-dexamethasone and subsequent collection of peripheral blood stem cells. A second randomization (R2) to consolidation therapy with bortezomiblenalidomide- dexamethasone vs no consolidation was performed after intensification, to be followed by lenalidomide maintenance until progression or toxicity in both arms. A primary study end point was progression-free survival (PFS) from R1. Results From February 2011 to April 2014, 1510 patients aged ≤65 years with symptomatic NDMM were registered. Of these, 1192 were eligible for R1 and were randomly assigned to receive either VMP (n=497 patients) or HDM (1±2 courses) (n=695 patients). Median age was 58 years in both groups, ISS stage III was 21% in VMP and 20% in HDM, while revised ISS stage III was 9% in both groups. Data on cytogenetic abnormalities, as detected by FISH analysis of CD138+ plasma cells, were available in 71% of patients (n=354) randomized to VMP and in 76% of those (n=529) assigned to HDM. The frequency of conventionally defined high-risk cytogenetic changes, including t(4;14) and/or del(17p) and/or t(14;16), was 25% in both arms. Median follow-up from R1 was 26 (IQR: 19-37) months. On an intention-to-treat basis, median PFS was 44 months in the VMP arm and was not yet reached in the HDM arm; 3-year estimates of PFS were 57.5% and 66%, respectively (HR=0.73; 95% CI=0.59-0.90; P=0.003). PFS benefit with HDM was retained across predefined subgroups, including patients with ISS stage I (HR=0.69; CI=0.48-0.98; P=0.037), revised ISS stage II (HR=0.70; CI=0.54-0.91; P=0.008), revised ISS stage III (HR=0.54; CI=0.30-0.97; P=0.040), standard-risk cytogenetics (HR=0.75, CI=0.56- 1.01; P=0.055) and a high-risk cytogenetic profile (HR=0.54; CI=0.37-0.80; P=0.002). The probability of achieving a very good partial response or higher quality response was 85.5% in the HDM group vs 74% in the VMP group (odds ratio=1.90; CI=1.42-2.54; P<0.001). In a multivariate Cox regression analysis stratified by ISS, randomization to HDM (HR=0.67; CI=0.53-0.85; P=0.001) and absence of high-risk cytogenetic abnormalities (0.71; CI=0.53-0.95; P=0.021) were the leading independent predictors of prolonged PFS. Overall survival was not yet mature and no difference between the two treatment groups was evident. Detection of minimal residual disease (MRD) after intensification therapy was performed by multiparameter flow cytometry and PET/CT in a subgroup of patients, 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 45 and details are provided in a separate abstract (E. Zamagni et al). Overall, MRD negativity favorably affected PFS and OS. Conclusions In comparison with VMP as standard-dose intensification therapy, upfront HDM and ASCT significantly improved PFS and increased the rate of high quality responses. An updated analysis with a longer follow-up will be reported at the meeting. Results of this phase III study, the largest so far reported, support the conclusion that upfront ASCT still continues to be the reference treatment for fit patients with NDMM, even in the novel agent era. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 &id=doi:&atitle=Intensification+therapy+with+bortezomib-melphalan prednisone+versus+autologous+stem+cell+transplantation+for+newly+diagnosed+multi ple+myeloma%3A+An+intergroup%2C+multicenter%2C+phase+III+study+of+the+Euro pean+myeloma+network+%28EMN02%2FHO95+MM+trial%29&stitle=Blood&title=Bloo d&volume=128&issue=22&spage=&epage=&aulast=Cavo&aufirst=Michele&auinit=M.& aufull=Cavo+M.&coden=&isbn=&pages=-&date=2016&auinit1=M&auinitm= RECORD 31 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten Prospective evaluation of 18F-FDG PET/CT as predictor of prognosis in newly diagnosed transplant eligible multiple myeloma (MM) patients: Results from the imaging sus-study of the EMN02/HO95 MM randomized phase III trial Zamagni E., Nanni C., Tacchetti P., Versari A., Chauvie S., Pantani L., Bianchi A., Rensi M., Bellò M., Rambaldi I., Gallamini A., Patriarca F., Terragna C., Bertone E., Gay F., Gamberi B., Larocca A., Zannetti B.A., Boccadoro M., Mancuso K., Fanti S., Sonneveld P., Cavo M. Blood (2016) 128:22. Date of Publication: 2 Dec 2016 F-18-fluorodeoxyglucose positron emission tomography integrated with computed tomography (FDG-PET/CT) enables to detect with relatively high sensitivity and specificity myeloma bone disease and extramedullary sites of metabolically active clonal plasma cells. FDGPET/ CT has also been used to assess and monitor the metabolic response to therapy and to predict the prognosis. One of the major limitation of PET/CT is the lack of standardized image criteria and of inter-observer reproducibility in interpreting the results. Aim of the present sub-study was to prospectively evaluate FDG-PET/CT at diagnosis, after 4 cycles of induction therapy and prior to maintenance therapy in a sub-group of patients enrolled into EMN02/HO95 MM international phase III trial. In particular, the two primary end points were firstly to assess the prognostic significance of PET/CT at diagnosis and after therapy and secondly to standardize PET/CT evaluation by centralized imaging and revision and definition of criteria for interpretation. Seven hundred and 18 patients with newly diagnosed transplant-eligible symptomatic MM have been prospectively randomized in Italy from February 2011 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 46 through April 2014 to receive 4 cycles of bortezomib-melphalan-prednisone (VMP) vs high-dose melphalan and single or double autologous stem cell transplantation (ASCT) as intensification following induction with bortezomib-cyclophosphamide dexamethasone (VCD). Consolidation therapy with bortezomib-lenalidomide dexamethasone vs no consolidation was planned after VMP or ASCT(s), followed by lenalidomide maintenance until progression or toxicity. One hundred and three patients were included in the PET/CT imaging sub-study, and followed for a median of 24 months. By study design, PET/CT was performed and analysed in each of the 8 participating centres at baseline, after induction therapy and prior to the start of maintenance (EOT). Each PET scan was a posteriori re-interpreted in a blinded independent central review process, managed by WIDEN®, by a panel of 5 expert nuclear medicine physicians. They described the following characteristics: bone marrow metabolic state (BM), number (Fx) and score (Fs) of focal PET positive lesions, osteolysis (Lx), presence and site of extramedullary disease (EM), and fractures(Fr), according to the IMPeTUs criteria (Nanni et al, EJNM 2015). Moreover, a global score (GS), from 1 to 5, was given to each patient, considering the highest score among BM, Fx, Fs and EM. Concordance among reviewers on different metrics was calculated using Krippendorf's alpha (AK) coefficient Baseline characteristics of the patients were the following: median age 58 years, ISS and R-ISS stage III 15% and 10%, high-risk cytogenetics (t(4;14) ± del(17p) ±del (1p)±1q gain detected by FISH) 42%. At baseline, 78% of the patients had FLs, with a median SUVmax of 6.0. The percentages of PET positive patients for the different characteristics are summarized in table 1. The agreement among reviewer was good for BM (AK=0.49), Fx (AK=0.65), Fs (AK=0.62), Lx (AK=0.62) and EM (AK=0.40). Of all parameters, only Fx ≥ 4 was associated with worse PFS and OS (P = 0.06) Following 4 cycles of VCD, PET/CT remained positive in 59% of the patients, with a median SUVmax of 3.7. Of all parameters, only Fs ≥ 4 was predictive of worse OS (P= 0.05). Prior to maintenance therapy, PET/CT remained positive in 34% of the patients, with a median SUVmax of 3.4. Normal PET/CT findings before maintenance (66%) were associated with a significant improvement in PFS, in particular the following: presence of FLs (P=0.03), Fx ≥ 4 (P=0.001), Fs ≥2 (P=0.03), 3 (P=0.03) and 4 (P=0.006) and SUVmax ≥ 3.4 (p=0.002). GS was also predictive for PFS if ≥ 3 (P=0.033), 4 (P=0.0001) and 5 (P=0.004). The same parameters were also predictive for OS. The prognostic relevance of pre-maintenance PET/CT was retained across the randomization arm (VMP or ASCT), in terms of PFS and OS. In conclusion, PET/CT was confirmed to be a reliable predictor of outcome in newly diagnosed transplant eligible MM patients, whatever the treatment. Normalization of PET/CT before maintenance was associated with a significant improvement for PFS and OS. FDG PET/CT is by now the preferred imaging technique for evaluating and monitoring response to therapy. (Table presented). OPEN URL LINK 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 47 http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 &id=doi:&atitle=Prospective+evaluation+of+18F FDG+PET%2FCT+as+predictor+of+prognosis+in+newly+diagnosed+transplant+eligible +multiple+myeloma+%28MM%29+patients%3A+Results+from+the+imaging+sus study+of+the+EMN02%2FHO95+MM+randomized+phase+III+trial&stitle=Blood&title=Bl ood&volume=128&issue=22&spage=&epage=&aulast=Zamagni&aufirst=Elena&auinit= E.&aufull=Zamagni+E.&coden=&isbn=&pages=-&date=2016&auinit1=E&auinitm= RECORD 32 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten Prognostic impact of minimal residual disease by ASO-RQ-PCR in multiple myeloma: A pooled analysis of 2 phase III studies in patients treated with lenalidomide after front-line therapy Oliva S., Gambella M., Larocca A., Spada S., Marzanati E., Mantoan B., Grammatico S., Conticello C., Gamberi B., Offidani M., Liberati A.M., Pautasso C., Omedé P., Palumbo A., Boccadoro M. Blood (2016) 128:22. Date of Publication: 2 Dec 2016 Background: The prognostic utility of minimal residual disease (MRD) analysis in multiple myeloma (MM) patients has been well described in the last few years. The role of prolonged maintenance therapy even in persistent MRD negative patients is still unclear. The aim of this study is to evaluate the role of MRD by allelic-specific oligonucleotide real-time quantitative polymerase chain reaction (ASO-RQ-PCR) as predictor of progression-free survival (PFS) in newly diagnosed MM (NDMM) patients receiving Lenalidomide maintenance after frontline treatment. Patients and Methods: NDMM patients enrolled in the RV-MM-EMN-441 (NCT01091 831) and the RV-MM COOP-0556 (EMN02/HO95 MM) phase III trials achieving ≥ very good partial response (VGPR) after consolidation/intensification were included in the pooled MRD molecular analysis. After induction therapy, patients in the RV-MM-EMN-441 study were randomized to Cyclophosphamide-Lenalidomide-Dexamethasone (CRD) or Autologous Stem Cell Transplantation (ASCT); patients in the RV-MM-COOP-0556 were randomized to Bortezomib-Melphalan-Prednisone (VMP) vs ASCT (Gay F et al Lancet Oncol 2016, Cavo M et al J Clin Oncol 34, 2016 abstr 8000). All patients received Lenalidomide maintenance until progression or intolerance. MRD analysis was performed on bone marrow (BM) aspirates after intensification/consolidation, after 6 courses of maintenance and then every 6 months until clinical relapse. Patient-specific IgH rearrangements were amplified and directly sequenced from genomic DNA at diagnosis. IgH-based MRD detection by ASO-RQ-PCR was performed using an AbiPrism7900HT.MRD analysis was interpreted following the Euro-MRD guidelines(van der Velden VH et al. Leukemia 2007). Molecular-CR (m-CR) was defined as two consecutive negative MRD results by ASO-RQ-PCR with minimal sensitivity of 10(-5). 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 48 PFS was analyzed using the Kaplan-Meier method, curves were compared with the log- rank test. Multivariate Cox model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: a total of 105 patients entered the molecular MRD pooled study: a specific IgH molecular marker was identified in 73 patients (70%), 32 (30%) did not obtain a successful sequencing. Median age was 57 years (37-65); 30 (41%) patients had International Staging System (ISS) stage I, 33 (45%) stage II and 10 (14%) stage III. FISH risk profile was standard in 43 (59%) patients, high in 24 (33%) and not available in 6 (8%). Thirty-eight (52%) patients did not receive ASCT consolidation and 35 (48%) underwent ASCT. After consolidation/intensification 33/73 (45%) patients achieved m-CR: 19/35 (54%) ASCT patients and 14/38 (37%) no ASCT patients. The impact of m-CR on outcome after consolidation was explored: after a median follow-up of 44 months, median PFS was 48.8 months versus not reached in no m-CR vs m-CR patients, respectively (p=0.01). Lenalidomide maintenance further improved depth of MRD response: 11/40 (27%) MRD positive patients after consolidation obtained a m-CR during maintenance and a median of 2 natural logarithms of tumor burden reduction was recorded. In multivariable Cox analysis the risk of progression/death was higher for ISS stage II/III versus I (HR, 2.91, CI: 1.01-8.41, p=0.048), high-risk FISH versus standard-risk (HR, 2.23 CI: 0.81-6.10, p=0.12), age > 60 years versus ≤60 years (HR: 3.55, CI: 1.26-10.04, p=0.017) and patients who did not achieve m-CR during treatment versus patients who did (HR, 7.65 CI: 2.77-21.11, p<0.001). We identified a very high risk group defined by high risk FISH at diagnosis and persistent MRD positivity, with a median PFS of 29.4 months (figure1). Conclusions: MRD status by ASO-RQ-PCR is a predictor of outcome significantly superior to standard risk factors in NDMM patients and the achievement of m-CR seems to overcome the high risk FISH status in PFS analysis. Molecular CR rate and reduction of tumor burden obtained after consolidation can be enhanced with Lenalidomide maintenance. Based on these preliminary results, the assessment and monitoring of MRD should be suggested as a better prognostic indicator than CR, and the potential role of a MRD-guided therapy should be investigated in future prospective trials. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15280020 &id=doi:&atitle=Prognostic+impact+of+minimal+residual+disease+by+ASO-RQ PCR+in+multiple+myeloma%3A+A+pooled+analysis+of+2+phase+III+studies+in+patien ts+treated+with+lenalidomide+after+front line+therapy&stitle=Blood&title=Blood&volume=128&issue=22&spage=&epage=&aulast =Oliva&aufirst=Stefania&auinit=S.&aufull=Oliva+S.&coden=&isbn=&pages= &date=2016&auinit1=S&auinitm= Nicht eingeschlossen, da PatientInnen mit VCD-Therapie nicht separat RECORD 33 analysiert werden A phase II trial of small-dose bortezomib, lenalidomide and dexamethasone 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 49 (sVRD) as consolidation/maintenance therapy in patients with multiple myeloma Ibata S., Sato T., Kuroda H., Nagamachi Y., Iyama S., Fujimi A., Kamihara Y., Konuma Y., Yoshida M., Tatekoshi A., Hashimoto A., Horiguchi H., Ono K., Murase K., Takada K., Miyanishi K., Kobune M., Hirayama Y., Kato J. Cancer Chemotherapy and Pharmacology (2016) 78:5 (1041-1049). Date of Publication: 1 Nov 2016 Purpose: Consolidation/maintenance therapy induces deep remission in patients with multiple myeloma (MM); however, the most suitable regimen has been under investigation. The combination therapy with bortezomib, lenalidomide and dexamethasone (VRD) is a powerful regimen for relapsed/refractory as well as newly diagnosed MM as an induction therapy. However, severe adverse events (AEs) may become a problem when VRD is introduced without dose reduction as a consolidation/maintenance therapy. Methods: In this single-arm phase II study, we evaluated the efficacy of small-dose VRD regimen (sVRD) in the consolidation/maintenance setting. Sixteen patients who had partial response (PR) or better after any induction therapy were enrolled. Patients received at least six 28-day cycles of subcutaneous bortezomib (1.3 mg/m(2) on days 1 and 15), lenalidomide (10 mg on days 1–21) and dexamethasone (40 mg on days 1, 8, 15 and 22). Results: The overall response rate and the complete response (CR) rate were 100 and 43.8 %, respectively. In particular, one patient with CR and two patients with very good PR at enrollment achieved stringent CR during 6 courses of sVRD. With a median follow-up time of 29.4 months, the median progression-free survival (PFS) and overall survival (OS) were not reached, while the PFS and OS rates at 2.5 years were 66.6 and 77.3 %, respectively. Univariate analysis demonstrated that disease progression as a reason for discontinuation of sVRD had a negative impact on OS. There were no grade 3 or 4 hematologic or nonhematologic AEs. Conclusion: Our sVRD regimen as a consolidation/maintenance therapy was highly effective and well tolerable. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=14320843 &id=doi:10.1007%2Fs00280-016-3163-y&atitle=A+phase+II+trial+of+small dose+bortezomib%2C+lenalidomide+and+dexamethasone+%28sVRD%29+as+consoli dation%2Fmaintenance+therapy+in+patients+with+multiple+myeloma&stitle=Cancer+C hemother.+Pharmacol.&title=Cancer+Chemotherapy+and+Pharmacology&volume=78& issue=5&spage=1041&epage=1049&aulast=Ibata&aufirst=Soushi&auinit=S.&aufull=Ibat a+S.&coden=CCPHD&isbn=&pages=1041-1049&date=2016&auinit1=S&auinitm= RECORD 34 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten Upfront autologous stem cell transplantation for newly diagnosed elder ly multiple myeloma patients: A prospective multicenter study 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 50 Garderet L., Beohou E., Caillot D., Stoppa A.M., Touzeau C., Chretien M.L., Karlin L., Moreau P., Fontan J., Blaise D., Polge E., Gueye M.S., Ikhlef S., Marjanovic Z., Labopin M., Mohty M. Haematologica (2016) 101:11 (1390-1397). Date of Publication: 31 Oct 2016 The feasibility and efficacy of high-dose melphalan followed by autologous hematopoietic stem cell transplantation in newly diagnosed elderly patients with multiple myeloma was analyzed prospectively. Fifty-six multiple myeloma patients, aged 65 years or over, from 6 French centers were studied. The induction therapy was bortezomib-based in combination with dexamethasone and either thalidomide, cyclophosphamide or lenalidomide, for 4-6 cycles. Peripheral blood stem cells were collected after high-dose cyclophosphamide plus G-CSF or G-CSF alone, with plerixafor if needed. The conditioning regimen consisted of melphalan at 140 mg/m2 in 18 patients (36%) and 200 mg/m2 in 32 (64%). Three months post autologous hematopoietic stem cell transplantation, a 2-month consolidation phase with either lenalidomide plus dexamethasone or bortezomibbased combination therapy was allowed, but maintenance treatment was not given. All but 6 patients underwent autologous hematopoietic stem cell transplantation and 3 had tandem transplantations. The treatment-related mortality was 0% at 100 days post transplantation. Sixtyeight percent received consolidation therapy following transplantation. The best response achieved was 40% complete response, 36% very good partial response, and 18% partial response. After a median follow up of 21 months (range 6-31), the estimated progression-free and overall survival rates at two years were 76% [95%CI: (61.6-94.1)] and 88% [95%CI: (76.7-100)], respectively. The higher dose of melphalan (200 mg/m2) afforded superior progression-free and overall survival rates. This prospective study provides evidence for the safety and efficacy of autologous hematopoietic stem cell transplantation as a first-line treatment approach in elderly multiple myeloma patients. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15928721 &id=doi:10.3324%2Fhaematol.2016.150334&atitle=Upfront+autologous+stem+cell+tran splantation+for+newly+diagnosed+elder+ly+multiple+myeloma+patients%3A+A+prospe ctive+multicenter+study&stitle=Haematologica&title=Haematologica&volume=101&issu e=11&spage=1390&epage=1397&aulast=Garderet&aufirst=Laurent&auinit=L.&aufull=G arderet+L.&coden=HAEMA&isbn=&pages=1390-1397&date=2016&auinit1=L&auinitm= RECORD 35 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Better outcome in al amyloidosis (ALA) treated with multiple myeloma-oriented regimens compared with cyclophosphamide/ bortezomib/dexamethasone (CYBORD) in a single center experience Belotti A., Ribolla R., Crippa C., Orlando V., D'Adda M., Re A., Morello E., Cattaneo C., 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 51 Rossi G. Haematologica (2016) 101 Supplement 1 (545). Date of Publication: 1 Jun 2016 Background: Treatment of AL amyloidosis (ALA) is based on anti-myeloma therapy but there is no standard. Treatment-related toxicity is deemed to be higher in pts with ALA compared with patients with multiple myeloma (MM). Recently, the combination of cyclophosphamide-bortezomib-dexamethasone (CyBorD) showed high rates of haematologic response, although the outcome of high risk patients remained poor. Aims: We compared the outcome of patients treated at our center with CyBorD with patients receiving more intensive therapy, including MM-type chemotherapy regimens followed or not by high doses of melphalan (HD-Mel) and autologous stem cell transplantation (ASCT) or upfront HD-Mel with ASCT. Methods: Of 50 ALA patients (median age 62 years) referred to our center, 48 of whom newly diagnosed between 2007 and 2015, 25 patients received CyBorD, and 5 of them (20%) subsequently underwent ASCT. By intention to treat, 18 patients (control group) received more intensive treatment (upfront ASCT: 6 (33%); conventional myeloma induction therapy (VAD, VTD, VMP): 12 (67%), followed by ASCT in 5 of them, 42%). Seven patients receiving less intensive therapy were excluded from analysis. Risk groups were identified as follows: cTnI >0.1ng/ml and/or ECOG PS ≥3: high risk; age ≤65 years with normal cTnI levels, ECOG PS<3 and eGFR >50ml/min: low risk. Intermediate risk patients were defined if not meeting criteria for high or low risk. MM diagnosis was made according to IMWG criteria. Haematological and organ response, overall survival (OS) and event free survival (EFS: time to 2nd line therapy or death) were analyzed. Results: The proportion of high risk patients was 32% in the CyBorD and 28% in the control group. Median age was 62 and 61 years in the CyBorD group and in the control group, respectively. Concomitant MM was present in 52% CyBorD and in 94% control patients. Treatment results of CyBorD patients were in line with those recently reported (Palladini et al, Blood 2015). Compared to the control group, no difference was observed in terms of haematologic response. Overall response rate (ORR) and complete remission (CR) were 72% and 20% in the CyBorD group and 89% and 39% in the control group, respectively. However, organ response rate was significantly lower in the CyBorD group (32% vs 75%, p 0.01). Toxicity was manageable in both groups. After a median follow up of 33 months no significant difference was seen between CyBorD and control group in terms of EFS (48% vs 61% at 2 years, respectively; HR 1.5, 95% CI 0.66-3.41), whereas OS was significantly inferior in the CyBorD group (47.6% vs 80% at 4 years, p 0.027, HR 3.45, 95% CI 1.15-10.36, see Figure 1). Excluding high risk patients in both groups, OS resulted similar, although a trend toward better long term survival was seen in the control group. Summary/Conclusions: despite the high haematologic response rates, CyBorD regimen seems not to overcome the long term poor prognosis associated with organ damage in ALA. of high risk patients. Selected patients, even in the high-risk 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 52 group may have a survival advantage with MM conventional treatment, including ASCT whenever possible. (Figuer Presented). OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15928721 &id=doi:&atitle=Better+outcome+in+al+amyloidosis+%28ALA%29+treated+with+multipl e+myeloma oriented+regimens+compared+with+cyclophosphamide%2F+bortezomib%2Fdexameth asone+%28CYBORD%29+in+a+single+center+experience&stitle=Haematologica&title= Haematologica&volume=101&issue=&spage=545&epage=&aulast=Belotti&aufirst=A.&a uinit=A.&aufull=Belotti+A.&coden=&isbn=&pages=545 &date=2016&auinit1=A&auinitm= RECORD 36 Nicht eingeschlossen, da Abstract (keine Vollpublikation) The impact of novel induction regimens on transplant outcome in newly diagnosed multiple myeloma after controlling for high-risk FISH cytogenetics Chakraborty R., Muchtar E., Kumar S., Buadi F., Dingli D., Dispenzieri A., Hayman S.R., Hogan W.J., Kapoor P., Lacy M., Leung N., Gertz M.A. Journal of Clinical Oncology (2016) 34 Supplement 15. Date of Publication: 1 May 2016 Background: Induction therapy with novel agents followed by autologous stem cell transplant (ASCT) is standard of care for eligible patients with newly diagnosed multiple myeloma (MM). The primary objective of our retrospective study was to compare overall survival (OS) in 1086 patients receiving frequently used novel agent-based induction regimens followed by early ASCT, after controlling for presence of high-risk cytogenetics by fluorescence in situ hybridization (FISH) at diagnosis. Methods: Study patients included those who had first transplant within 12 months of diagnosis, did not receive > 1 induction regimen, did not relapse prior to transplant and did not receive treatment for smoldering MM. Factors included in multivariate analysis were presence of high-risk FISH cytogenetics, induction-regimen group and use of maintenance or consolidation therapy post-transplant. Results: Major subgroups by induction therapy included cyclophosphamide-bortezomib-dexamethasone (CyBorD; n = 193), bortezomib lenalidomide-dexamethasone (VRd; n = 126), lenalidomide-dexamethasone (Rd; n = 251), thalidomide-dexamethasone (Td; n = 155), and bortezomib-dexamethasone (Vd; n = 64); vincristine-doxorubicin-dexamethasone or dexamethasone alone (VAD/Dex; n = 228) was used as the reference group. Median age at diagnosis was 60.3 (interquartile range 53.9- 65.9) years and median follow-up was 66.7 (95% CI 60.4-74.7) months. FISH cytogenetics at diagnosis was available for 466 patients. Using Kaplan-Meier analysis, 5-year OS rates (with 95% CI) for CyBorD, VRd, Vd, Rd, Td and VAD/Dex were 79.2 (65.3-88.5), 79.0 (65.7-88.1), 72.3 (58.5-82.9), 79.2 (72.9-84.4), 57.4 (49.5 65.0) and 63.2 (57.0-69.4) % respectively. Multivariate analysis showed VRd to have 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 53 superior OS compared to CyBorD (HR 0.35; 95% CI, 0.11-0.93; P = .0353) and Vd (HR, 0.20; 95% CI, 0.06-0.66; P = .0077) irrespective of high-risk FISH cytogenetics at diagnosis. Conclusions: In conclusion, our study showed that among patients completing induction therapy and having an early ASCT, use of VRd induction led to superior OS compared to CyBorD and Vd in those with or without high-risk FISH cytogenetics. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15277755 &id=doi:&atitle=The+impact+of+novel+induction+regimens+on+transplant+outcome+in+ newly+diagnosed+multiple+myeloma+after+controlling+for+high risk+FISH+cytogenetics&stitle=J.+Clin.+Oncol.&title=Journal+of+Clinical+Oncology&vol ume=34&issue=&spage=&epage=&aulast=Chakraborty&aufirst=Rajshekhar&auinit=R.& aufull=Chakraborty+R.&coden=&isbn=&pages=-&date=2016&auinit1=R&auinitm= Nicht eingeschlossen, da VCD-Therapie nur am Rande betrachtet wird und RECORD 37 auf Artikel verwiesen wird, die an anderer Stelle separat begutachtet werden Better therapy requires better response evaluation: Paving the way for minimal residual disease testing for every myeloma patient Landgren O., Owen R.G. Cytometry Part B - Clinical Cytometry (2016) 90:1 (14-20). Date of Publication: 2016 In 2015, there is a large body of evidence demonstrating that minimal residual disease (MRD) negativity after therapy is a powerful predictor of progression-free survival and overall survival in multiple myeloma. On the basis of available data, we believe MRD provides a meaningful endpoint for regulatory purposes, academic studies, and a valuable prognostic evaluation of individual patients in the clinical setting. Similar to what has been shown in acute and chronic lymphocytic leukemia, based on emerging data, the prognostic impact of MRD in multiple myeloma appears to be independent of induction therapy received. This fact raises fundamental questions regarding best possible treatment strategies (e.g., fixed number of cycles versus response adapted number of cycles) as well as optimal treatment modalities (e.g., newer effective but less intense combination therapies versus high dose melphalan followed by autologous stem cell transplantation), in particular for patients newly diagnosed with multiple myeloma. © 2015 International Clinical Cytometry Society. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15524957 &id=doi:10.1002%2Fcyto.b.21273&atitle=Better+therapy+requires+better+response+ev aluation%3A+Paving+the+way+for+minimal+residual+disease+testing+for+every+myel oma+patient&stitle=Cytometry+Part+B+Clin.+Cytometry&title=Cytometry+Part+B+ +Clinical+Cytometry&volume=90&issue=1&spage=14&epage=20&aulast=Landgren&au 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 54 20&date=2016&auinit1=O&auinitm= RECORD 38 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten Clinical risk factors for peripheral neuropathy in patients treated with subcutaneous or intravenous bortezomib for newly diagnosed multiple myeloma Merz M., Salwender H.-J., Haenel M., Bertsch U., Kunz C., Hielscher T., Blau I.W., Scheid C., Mai E.K., Hose D., Schurich B., Munder M., Brossart P., Gerecke C., Lindemann H.W., Zeis M., Weisel K.C., Duerig J., Goldschmidt H. Blood (2015) 126:23 (4233). Date of Publication: 3 Dec 2015 Background: Peripheral neuropathy (PN) is an important, dose-limiting toxicity of bortezomib (BTZ). Subanalysis of the phase 3 VISTA trial of intravenous (IV) BTZ in newly diagnosed MM patients identified baseline neuropathy as only clinical risk factor for Bortezomib-induced peripheral neuropathy (BiPN). Since subcutaneous (SC) application reduces rates of BiPN, BTZ is mainly applied subcutaneously in current clinical trials and general practice. Data on clinical risk factors for BiPN in the era of SC BTZ are limited. We analyzed risk factors for PN in patients treated with SC or IV BTZ in the prospective randomized MM5 phase III trial of the German Myeloma Multicenter Group (GMMG). Methods: Primary end-points of the MM5 trial were response to VCD (BTZ 1.3 mg/m(2), days 1, 4, 8, 11; Cyclophosphamide 900 mg/m(2) IV; day 1, Dexamethasone 40 mg/d, orally, days 1-2, 4-5, 8-9, 11-12) compared to PAd (BTZ 1.3 mg/m(2), days 1, 4, 8, 11; Doxorubicin 9 mg/m(2) IV, days 1-4; Dexamethasone 20 mg/d, orally, days 1-4, 9-12, 17-20) induction therapy with respect to remission and progression-free survival (PFS). Induction therapy was followed by stem cell mobilization and harvest, high-dose therapy and Lenalidomide-based consolidation/maintenance therapy. From 07/2010 until 11/2013, 604 patients were randomly assigned to receive 3 cycles of PAd or VCD. Based on the results by Moreau et al, administration of BTZ was changed from IV to SC in 02/2012 after 314 patients were enrolled. We performed univariate and multivariate testing to analyze the association of different factors with the occurrence of PN ≥ grade 2 according to NCI CTCAE version 4.0 after completion of induction therapy. Factors included: Treatment arm (PAd vs. VCD), route of administration (IV vs. SC), existing baseline PN as well as baseline ISS, creatinine ≥2.0 mg/dl , body mass index (BMI), hemoglobin and calcium levels. Fisher's exact test was used for univariate analyses. A multivariate logistic regression model was adapted to analyze the influence of all factors on the occurrence of PN. In this model the impact of a single factor on PN is measured by an odds ratio (OR) based on a characteristic effect (change of one unit for categorical factors and change of interquartile range for continuous factors). Results: Of the analyzed patients, who received at least one dose of trial medication (PAd: n=150 IV/140 SC; VCD: n=154 IV/140 SC), 61 patients (10.2%) developed PN ≥ grade 2. Rates of PN were higher in 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 55 patients treated with PAd (n=40; 13.5%) compared to VCD (n=21; 7.0%). Neither the presence of higher ISS stage at baseline, nor the route of administration had an impact on development of PN after 3 cycles of induction therapy in univariate analyses. However, PN was more frequent in IV-treated patients during the third cycle of induction therapy (IV: 7.6%; SC: 1.8%, p = 0.001). Median baseline BMI was significantly higher in patients who developed PN (26.9 kg/m(2); 19.5-43.7 kg/m(2)) compared to patients without PN (25.7 kg/m(2); 16.7-44-6 kg/m(2), p=0.04). Also baseline hemoglobin levels were higher in patients with PN (12.0 g/dl; 6.8-15.9 g/dl) compared to patients without PN (10.8 g/dl; 5.8-16.3 g/dl, p=0.004). While baseline calcium levels were significantly lower in patients with PN (2.3 mmol/l; 1.6-3.5 mmol/l) compared to patients without PN (2.4 mmol/l; 1.6-5.4 mmol/l, p=0.04), baseline creatinine were not different in both groups. Multivariate logistic regression adjusting for the above mentioned factors confirmed the effect of VCD treatment compared to PAd on the development of PN (OR 0.49, 95% confidence interval (CI) [0.28, 0.89], p=0.02) and the importance of pre existing PN (OR 3.12, 95% CI [1.26, 7.76], p=0.01). Also baseline calcium (OR 0.71, 95% CI [0.51, 0.99], p=0.04) and hemoglobin levels (OR 1.53, 95% CI [1.01, 2.33], p=0.05) proved to have an impact on the development of PN in the multivariate model. Conclusion: We confirm the importance of pre-existing neuropathic symptoms and the combination partners for BTZ on the development of PN in patients with newly diagnosed MM. We provide first evidence that clinical baseline characteristics, like calcium and hemoglobin levels, might predict the development of PN. This is in line with preclinical studies showing that dysregulation of calcium homeostasis and oxidative stress in the dorsal root ganglion plays a role in the pathogenesis of BiPN. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=00064971 &id=doi:&atitle=Clinical+risk+factors+for+peripheral+neuropathy+in+patients+treated+wi th+subcutaneous+or+intravenous+bortezomib+for+newly+diagnosed+multiple+myelom a&stitle=Blood&title=Blood&volume=126&issue=23&spage=4233&epage=&aulast=Merz &aufirst=Maximilian&auinit=M.&aufull=Merz+M.&coden=&isbn=&pages=4233 &date=2015&auinit1=M&auinitm= RECORD 39 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten Randomized phase 2 study of the all-oral combination of investigational proteasome inhibitor (PI) ixazomib plus cyclophosphamide and low-dose dexamethasone (ICD) in patients (PTS) with newly diagnosed multiple myeloma (NDMM) who are transplant-ineligible (NCT02046070) Dimopoulos M.A., Grosicki S., Jedrzejczak W.W., Nahi H., Gruber A., Hansson M., Byrne C., Labotka R., Hui A.-M., Teng Z., Grzasko N. Blood (2015) 126:23 (26). Date of Publication: 3 Dec 2015 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 56 Background Ixazomib is the first orally administered PI to be studied in the clinic. The feasibility of combining a PI with cyclophosphamide and dexamethasone has been demonstrated with the PI bortezomib (Reeder et al Leukemia 2009; Mai et al Leukemia 2015). This open-label, multicenter, phase 2 study is evaluating the all-oral triplet combination of ICd, with two different doses of cyclophosphamide, as a 12-month induction therapy in previously untreated, transplant-ineligible pts with NDMM, and is the first study to assess ICd for the frontline treatment of MM. Methods Adult pts with previously untreated, symptomatic NDMM who were ineligible for stem cell transplantation due to age and/or comorbidities, had ECOG PS 0-2, and adequate hematologic, hepatic, and renal function, were included. Pts were randomized 1:1 to receive up to 13 x 28-day cycles of induction therapy with ixazomib 4.0 mg PO on days 1, 8, and 15, plus cyclophosphamide 300 mg/m(2) (ICd-300 arm) or 400 mg/m(2) (ICd 400 arm) PO on days 1, 8, and 15, plus dexamethasone 40 mg PO (20 mg in pts aged >75 years) on days 1, 8, 15, and 22. A safety lead-in evaluation of dose-limiting toxicities (DLTs) was performed in 6 evaluable pts in each arm after cycle 1. The primary endpoint was the combined rate of complete response plus very good partial response (CR+VGPR). Secondary endpoints included overall response rate (ORR; CR+VGPR+ partial response [PR]) and safety (adverse events [AEs]). Response was investigator-assessed at the end of every cycle per IMWG criteria. Sample size (n=70) was determined to provide 80% power for the primary endpoint of CR+VGPR rate (1 sided alpha=0.10). Here we present a preliminary analysis of data post-induction (data cut-off: July 1, 2015). Results 70 pts were randomized (36 to ICd-300, 34 to ICd-400): median age 72.5 and 75.5 years; 42% and 53% male; 64% and 59% ISS stage II/III (92% and 79% Durie-Salmon stage II/III), respectively. Mean duration of follow-up was 7.0 months in both arms. Response data are summarized in the Table. Best unconfirmed CR+VGPR rates across all 13 cycles were 27% (ICd-300) and 23% (ICd 400); ORRs were 80% and 73%. Best M-protein reductions are shown in the Figure. Twelve pts (6 ICd-300; 6 ICd-400) were DLT-evaluable; no DLTs were observed in either arm. Pts received a median of 6.0 (1-13) and 6.5 (1-13) cycles in the ICd-300 and ICd-400 arms, respectively. Mean ixazomib relative dose intensity was 90.7% in the ICd-300 arm and 89.8% in the ICd-400 arm. Across all 13 cycles of treatment (ICd-300 and ICd-400, respectively), rates of Gr ≥3 AEs were 53% and 62%, serious AEs 33% and 53%, AEs leading to dose reduction in any study drug 17% and 21%, discontinuation of all study drugs due to AEs 14% and 12%, and on-treatment deaths 2 pts (cardiac arrest; upper gastrointestinal hemorrhage) and 1 pt (pneumonia) which were not deemed as treatment-related. In the ICd-300 and ICd-400 arms, respectively, rates of anti-emetic use were 36% and 44% (8% and 18% for AEs) and G-CSF use 11% and 50% (11% and 35% for AEs); erythropoietin was used in only 1 pt (ICd-300 arm). Thrombocytopenia events occurred in 5 pts (no Gr ≥3) in the ICd-300 arm and 4 pts (3 Gr ≥3) in the ICd-400 arm. Most common AEs (>15% all pts) were anemia (19% and 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 57 29%), neutropenia (17% and 32%), nausea (14% and 24%), peripheral neuropathy (PN; 17% and 21%), diarrhea (19% and 15%), vomiting (14% and 21%), constipation (17% and 15%), and fatigue (14% and 18%). Most common Gr ≥3 AEs were neutropenia (14% and 32%), anemia (11% and 15%), and pneumonia (8% and 9%); no Gr ≥3 PN was observed. Conclusion These preliminary data suggest that the all-oral triplet combination of ICd is tolerable in transplant-ineligible pts with NDMM, with a manageable toxicity profile in line with that previously seen with ixazomib and with manageable myelosuppression. Comparably high response rates were reported in both the ICd-300 and ICd-400 arms. Toxicity rates appeared higher with ICd-400, suggesting that ICd-300 may be a more preferable regimen for elderly NDMM pts. Updated data, including long-term outcomes after additional follow-up will be presented at the meeting. (Figure Presented). OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=00064971 &id=doi:&atitle=Randomized+phase+2+study+of+the+all oral+combination+of+investigational+proteasome+inhibitor+%28PI%29+ixazomib+plus+ cyclophosphamide+and+low dose+dexamethasone+%28ICD%29+in+patients+%28PTS%29+with+newly+diagnosed +multiple+myeloma+%28NDMM%29+who+are+transplant ineligible+%28NCT02046070%29&stitle=Blood&title=Blood&volume=126&issue=23&sp age=26&epage=&aulast=Dimopoulos&aufirst=Meletios+A.&auinit=M.A.&aufull=Dimopo ulos+M.A.&coden=&isbn=&pages=26-&date=2015&auinit1=M&auinitm=A RECORD 40 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten Bortezomib, thalidomide and dexamethasone, with or without cyclophosphamide, for patients with previously untreated multiple myeloma: 5 year follow-up Ludwig H., Greil R., Masszi T., Spicka I., Shpilberg O., Hajek R., Dmoszynska A., Paiva B., Vidriales M.-B., Esteves G., Stoppa A.M., Robinson D., Chaturvedi S., Ataman O., Enny C., Feng H., van de Velde H., Viterbo L. British Journal of Haematology (2015) 171:3 (344-354). Date of Publication: 1 Nov 2015 This follow-up extension of a randomised phase II study assessed differences in long term outcomes between bortezomib-thalidomide-dexamethasone (VTD) and VTD cyclophosphamide (VTDC) induction therapy in multiple myeloma. Newly diagnosed patients (n = 98) were randomised 1:1 to intravenous bortezomib (1·3 mg/m(2); days 1, 4, 8, 11), thalidomide (100 mg; days 1-21), and dexamethasone (40 mg; days 1-4, 9 12), with/without cyclophosphamide (400 mg/m(2); days 1, 8), for four 21-day cycles before stem-cell mobilisation/transplantation. After a median follow-up of 64·8 months, median time-to-next therapy was 51·8 and 47·9 months with VTD and VTDC, 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 58 respectively. Type of subsequent therapy was similar in both arms. After adjusting for asymmetric censoring, median time to progression was not significantly different between VTD and VTDC [35·7 vs. 34·5 months; Hazard ratio (HR) 1·26, 95% confidence interval: 0·76-2·09; P = 0·370]. Five-year survival was 69·1% and 65·3% with VTD and VTDC, respectively. When analysed by minimal residual disease (MRD) status, overall survival was longer in MRD-negative versus MRD-positive patients with bone marrow-confirmed complete response (HR 3·66, P = 0·0318). VTD induction followed by transplantation provides long-term disease control and, consistent with the primary analysis, there is no additional benefit from adding cyclophosphamide. This study was registered at ClinicalTrials.gov (NCT00531453). OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=13652141 &id=doi:10.1111%2Fbjh.13582&atitle=Bortezomib%2C+thalidomide+and+dexamethaso ne%2C+with+or+without+cyclophosphamide%2C+for+patients+with+previously+untreat ed+multiple+myeloma%3A+5-year+follow up&stitle=Br.+J.+Haematol.&title=British+Journal+of+Haematology&volume=171&issue =3&spage=344&epage=354&aulast=Ludwig&aufirst=Heinz&auinit=H.&aufull=Ludwig+H .&coden=BJHEA&isbn=&pages=344-354&date=2015&auinit1=H&auinitm= RECORD 41 Nicht betrachtet, da bereits in Cochrane-Recherche enthalten First line therapy for multiple myeloma Terpos E. Leukemia Research (2015) 39 Supplement 2 (S6). Date of Publication: 1 Oct 2015 Therapy options for newly diagnosed MM (NDMM) focus on disrupting myeloma cell bone marrow stroma interactions, enhancing the immune system response, and specific targeting of myeloma clonal cells. Proteasome inhibitors (PI) have become an integral part of therapy regimens for MM. The combination of the first generation PI, bortezomib and dexamethasone (VD) or bortezomib/thalidomide/dexamethasone (VTD) for use as induction therapy for adult patients with NDMM who are eligible for high-dose chemotherapy with autologous stem cell transplant (ASCT) was approved by the European Commission in 2013. The recommendation to use a bortezomib-based regimen is based on the results of randomized trials, which have been summarized in two meta-analyses and which confirmed the superiority of bortezomib-based regimens over conventional regimens. Sonneveld et al. could show that bortezomib-based induction (PAD) was significantly superior versus non-bortezomib-based induction (VAD) in terms of post-transplantation CR+nCR rates (38% vs 24%, P<0.001), median PFS (35.9 vs 28.6 months, P<0.001) and 3-year OS rates (79.7% vs 74.7%, P=0.04). Despite a lack of regulatory approval, the use of post-transplant therapy, in particular consolidation, defined as a short distinct course of treatment, is increasing across 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 59 Europe in routine practice, with VTD being the predominant regimen used. Bortezomib has also been investigated in the maintenance setting, resulting in significant improvements in PFS; however, in these trials bortezomib was also used during induction therapy. Hence, it is as yet not clear which part of bortezomib exposure contributed to the results. Subcutaneous dosing of bortezomib in MM has been demonstrated to be as active as intravenous dosing with a better toxicity profile in NDMM. Furthermore the combination of bortezomib with melphalan and prednisone (VMP) is considered one of the standards of care for NDMM patients who are not eligible for ASCT. The second generation PI, carfilzomib, has also been tested in NDMM but has not been approved yet for this indication. The combination of carfilzomib, lenalidomide and dexamethasone (KRD) followed by lenalidomide maintenance provides high rates of deep remission and minimal residual disease (MRD) negativity. The combination of KRD with clarithromycinin NDMM was also reported to be safe and active with ORR of 91.7% and very good partial response (VGPR) of 55.6%, which included a majority of patients with high-risk cytogenetics. As an induction therapy, carfilzomib with cyclophosphamide and dexamethasone (KCD) in transplant eligible NDMM was well tolerated with response rates of 87% and VGPR of 48% after 4 6 cycles. The novel PI ixazomib, used in an oral regimen with lenalidomide, has been reported to provide response rates of 23-33% in young and elderly patients with NDMM. Following induction with ixazomib/lenalidomide/dexamethasone, maintenance of up to 1.5 years with ixazomib alone improved response rates with a median duration of response of 26.5 months in NDMM patients not undergoing SCT. Clinical studies assessing single agent ixazomib maintenance after auto-SCT and in combination with lenalidomide after auto-SCT are ongoing. The IMiDs, thalidomide, lenalidomide and now pomalidomide, have changed the landscape in the management of myeloma patients. The combinations of melphalan, prednisone and thalidomide (MPT) and of cyclophosphamide, dexamethasone and thalidomide (CDT) are widely used for NDMM patients who are not eligible for ASCT. The results of the phase III FIRST study showed that continuous Rd is very effective for NDMM patients who are not eligible for ASCT. Compared to MPT, Rd prolonged both PFS (median: 25.5 vs. 21.2 months) and OS (median: 59 vs. 48.5 months). FDA approved Rd for NDMM on the 18th of February 2015. Maintenance therapy with IMiDs has been also investigated in a number of trials in the post-ASCT setting. Of note, none of the available agents is approved for use in maintenance. With thalidomide, the treatment duration is limited by toxicity concerns, in particular peripheral neuropathy (PN), however, if tolerated it can be considered. Interestingly, in patients with adverse risk cytogenetics, thalidomide maintenance was shown to result in shorter OS and should therefore not be used in the presence of these characteristics. Lenalidomide maintenance has been investigated in three randomized trials, all of which demonstrated a PFS benefit with the agent, while OS was improved in two of the studies. In the first studies investigating the long-term administration of 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 60 lenalidomide, an increased risk of second primary malignancies (SPM) was observed, which has been carefully analyzed in different studies in the front-line and relapse settings. It has been demonstrated that the increased risk of developing SPMs is related to melphalan exposure, being more pronounced with the oral administration of melphalan, as well as to advanced age. Of note, the use of lenalidomide plus steroids does not appear to increase the risk of SPM. On the whole, the benefit in prolonged PFS and OS gained with lenalidomide maintenance appears to outweigh the risk of developing an SPM.Single agent lenalidomide has also recently been shown to be beneficial to patients with smoldering MM with more than 50% of study participants achieving stable disease at 17 months. Furthermore, in combination with dexamethasone, disease progression was delayed and improvements to OS were observed compared to observation alone. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=18735835 &id=doi:&atitle=First+line+therapy+for+multiple+myeloma&stitle=Leuk.+Res.&title=Leuk emia+Research&volume=39&issue=&spage=S6&epage=&aulast=Terpos&aufirst=Evan gelos&auinit=E.&aufull=Terpos+E.&coden=&isbn=&pages=S6 &date=2015&auinit1=E&auinitm= RECORD 42 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten Phase III trial of bortezomib, cyclophosphamide and dexamethasone (VCD) versus bortezomib, doxorubicin and dexamethasone (PAd) in newly diagnosed myeloma Mai E.K., Bertsch U., Dürig J., Kunz C., Haenel M., Blau I.W., Munder M., Jauch A., Schurich B., Hielscher T., Merz M., Huegle-Doerr B., Seckinger A., Hose D., Hillengass J., Raab M.S., Neben K., Lindemann H.-W., Zeis M., Gerecke C., Schmidt-Wolf I.G.H., Weisel K., Scheid C., Salwender H., Goldschmidt H. Leukemia (2015) 29:8 (1721-1729). Date of Publication: 7 Aug 2015 We aimed at demonstrating non-inferiority of bortezomib/cyclophosphamide/dexamethasone (VCD) compared to bortezomib/doxorubicin/dexamethasone (PAd) induction therapy with respect to very good partial response rates or better (≥VGPR) in 504 newly diagnosed, transplant eligible multiple myeloma patients. VCD was found to be non-inferior to PAd with respect to ≥VGPR rates (37.0 versus 34.3%, P=0.001). The rates of progressive disease (PD) were 0.4% (VCD) versus 4.8% (PAd; P=0.003). In the PAd arm, 11 of 12 patients with PD had either renal impairment (creatinine ≥2 mg/dl) at diagnosis or the cytogenetic abnormality gain 1q21, whereas no PD was observed in these subgroups in the VCD arm. Leukocytopenia/neutropenia (≥3°) occurred more frequently in the VCD arm (35.2% versus 11.3%, P<0.001). Neuropathy rates (≥2°) were higher in the PAd 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 61 group (14.9 versus 8.4%, P=0.03). Serious adverse events, both overall and those related to thromboembolic events, were higher in the PAd group (32.7 versus 24.0%, P=0.04 and 2.8 versus 0.4%, P=0.04). Stem cell collection was not impeded by VCD. VCD is as effective as PAd in terms of achieving ≥VGPR rates with fewer PD and has a favorable toxicity profile. Therefore, VCD is preferable to PAd as induction therapy. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=14765551 &id=doi:10.1038%2Fleu.2015.80&atitle=Phase+III+trial+of+bortezomib%2C+cyclophos phamide+and+dexamethasone+%28VCD%29+versus+bortezomib%2C+doxorubicin+a nd+dexamethasone+%28PAd%29+in+newly+diagnosed+myeloma&stitle=Leukemia&titl e=Leukemia&volume=29&issue=8&spage=1721&epage=1729&aulast=Mai&aufirst=E.K .&auinit=E.K.&aufull=Mai+E.K.&coden=LEUKE&isbn=&pages=1721 1729&date=2015&auinit1=E&auinitm=K RECORD 43 Nicht eingeschlossen, da retrospektive Analyse Predicting poor peripheral blood stem cell collection in patients with multiple myeloma receiving pre-transplant induction therapy with novel agents and mobilized with cyclophosphamide plus granulocyte-colony stimulating factor: Results from a Gruppo Italiano Malattie EMatologiche dell'Adulto Multiple Myeloma Working Party study Musto P., Simeon V., Grossi A., Gay F., Bringhen S., Larocca A., Guariglia R., Pietrantuono G., Villani O., D'Arena G., Cuomo C., Musto C., Morabito F., Petrucci M.T., Offidani M., Zamagni E., Tacchetti P., Conticello C., Milone G., Palumbo A., Cavo M., Boccadoro M. Stem Cell Research and Therapy (2015) 6:1 Article Number: 64. Date of Publication: 17 Apr 2015 Introduction: A still not well defined proportion of patients with multiple myeloma (MM) and eligible for autologous stem cell transplantation (AuSCT) fails to mobilize CD34+ peripheral blood stem cells (PBSC) at all or to collect an adequate number for a safe procedure or sufficient for multiple transplants. These so-called "poor-mobilizers" are difficult to be predicted, due to marked difference across previous heterogeneous studies. Methods: We aimed to develop a method based on simple clinical parameters for predicting unsuccessful (<2×10(6)/kg) or sub-optimal (<5×10(6)/kg) collections of CD34+ PBSC in newly diagnosed MM patients eligible for AuSCT, treated with novel agents and receiving an homogeneous mobilizing therapy with cyclophosphamide and granulocyte-colony stimulating factor (G-CSF). To this purpose, 1,348 patients enrolled in five consecutive Italian clinical trials were retrospectively analysed. Age, baseline low peripheral blood cell counts, use of lenalidomide, and haematological toxicity developed during induction were taken into account as possible factors associated with poor 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 62 mobilization. Results: Overall, 280 patients (20.8%) showed either sub-optimal (167 patients, 12.4%) or unsuccessful (113 patients, 8.4%) collections. All analysed parameters negatively influenced the procedure, but only age and haematological toxicity during induction maintained their significance at multivariate analysis. Based on ordinal logistic regression model, we constructed a risk heat-map where the four parameters were pooled and weighted according to their relevance as single or combined variables. This model was predictive for different probabilities of failure, suboptimal or optimal outcomes. Conclusions: We found that about one fifth of newly diagnosed MM fails to collect an adequate number of PBSC. Our model, based on a large group of patients treated frontline with novel agents and receiving the most popular mobilizing approach currently employed in Europe, is applicable in individual subjects and may contribute to the early identification of "poor mobilizer" phenotypes. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=17576512 &id=doi:10.1186%2Fs13287-015-0033 1&atitle=Predicting+poor+peripheral+blood+stem+cell+collection+in+patients+with+mult iple+myeloma+receiving+pre transplant+induction+therapy+with+novel+agents+and+mobilized+with+cyclophosphami de+plus+granulocyte colony+stimulating+factor%3A+Results+from+a+Gruppo+Italiano+Malattie+EMatologich e+dell%27Adulto+Multiple+Myeloma+Working+Party+study&stitle=Stem+Cell+Res.+Th er.&title=Stem+Cell+Research+and+Therapy&volume=6&issue=1&spage=&epage=&au last=Musto&aufirst=Pellegrino&auinit=P.&aufull=Musto+P.&coden=&isbn=&pages= &date=2015&auinit1=P&auinitm= RECORD 44 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten Subcutaneous versus intravenous bortezomib in two different induction therapies for newly diagnosed multiple myeloma: An interim analysis from the prospective GMMG-MM5 trial Merz M., Salwender H., Haenel M., Mai E.K., Bertsch U., Kunz C., Hielscher T., Blau I.W., Scheid C., Hose D., Seckinger A., Jauch A., Hillengass J., Raab M.S., Schurich B., Munder M., Schmidt-Wolf I.G.H., Gerecke C., Lindemann H.-W., Zeis M., Weisel K., Duerig J., Goldschmidt H. Haematologica (2015) 100:7 (964-969). Date of Publication: 6 Jul 2015 We investigated the impact of subcutaneous versus intravenous bortezomib in the MM5 trial of the German- Speaking Myeloma Multicenter Group which compared bortezomib, doxorubicin, and dexamethasone with bortezomib, cyclophosphamide, and dexamethasone induction therapy in newly diagnosed multiple myeloma. Based on data from relapsed myeloma, the route of administration for bortezomib was changed from 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 63 intravenous to subcutaneous after 314 of 604 patients had been enrolled. We analyzed 598 patients who received at least one dose of trial medication. Adverse events were reported more frequently in patients treated with intravenous bortezomib (intravenous=65%; subcutaneous=56%, P=0.02). Rates of grade 2 or more peripheral neuropathy were higher in patients treated with intravenous bortezomib during the third cycle (intravenous=8%; subcutaneous= 2%, P=0.001). Overall response rates were similar in patients treated intravenously or subcutaneously. The presence of International Staging System stage III disease, renal impairment or adverse cytogenetic abnormalities did not have a negative impact on overall response rates in either group. To our knowledge this is the largest study to present data comparing subcutaneous with intravenous bortezomib in newly diagnosed myeloma. We show better tolerance and similar overall response rates for subcutaneous compared to intravenous bortezomib. The clinical trial is registered at eudract.ema.europa.eu as n. 2010-019173-16. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15928721 &id=doi:10.3324%2Fhaematol.2015.124347&atitle=Subcutaneous+versus+intravenous +bortezomib+in+two+different+induction+therapies+for+newly+diagnosed+multiple+my eloma%3A+An+interim+analysis+from+the+prospective+GMMG MM5+trial&stitle=Haematologica&title=Haematologica&volume=100&issue=7&spage=9 64&epage=969&aulast=Merz&aufirst=Maximilian&auinit=M.&aufull=Merz+M.&coden=H AEMA&isbn=&pages=964-969&date=2015&auinit1=M&auinitm= RECORD 45 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten CyBorD induction therapy in clinical practice Areethamsirikul N., Masih-Khan E., Chu C.-M., Jimenez-Zepeda V., Reece D.E., Trudel S., Kukreti V., Tiedemann R., Chen C. Bone Marrow Transplantation (2015) 50:3 (375-379). Date of Publication: 1 Mar 2015 Cyclophosphamide, bortezomib and dexamethasone (CyBorD) is a highly active three drug induction regimen for untreated transplant-eligible multiple myeloma patients. Although CyBorD has been evaluated only in the phase 2 setting in a limited number of patients, its high efficacy and ease of administration have led to its widespread use. Given that clinical trial efficacy can overestimate real-life effectiveness, we reviewed our institutional experience with 109 newly diagnosed patients who were treated with CyBorD in a non-clinical trial setting. After a median of four cycles, overall response rate (ORR) and very good partial response rate or better (≥VGPR) were 95 and 66%, respectively, comparable to phase 2 studies of CyBorD and other three/four-drug induction regimens. All patients subsequently underwent successful stem cell collection and upgraded responses to ORR 98% and ≥VGPR 79% post transplant. At a median follow-up of 19.8 months after diagnosis, the 2-year OS probability was 95.3% (95%CI: 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 64 89- 98). The presence of concurrent plasmacytoma at diagnosis was the only prognostic factor predicting poorer survival (HR = 5.56; 95%CI: 0.92-33.74; P = 0.03). CyBorD was well-tolerated, with no severe peripheral neuropathy and minimal hematologic toxicity. Therefore, CyBorD is a convenient, well-tolerated, highly effective induction regimen in preparation for autologous SCT in real-life clinical practice. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=14765365 &id=doi:10.1038%2Fbmt.2014.288&atitle=CyBorD+induction+therapy+in+clinical+practi ce&stitle=Bone+Marrow+Transplant.&title=Bone+Marrow+Transplantation&volume=50& issue=3&spage=375&epage=379&aulast=Areethamsirikul&aufirst=N.&auinit=N.&aufull= Areethamsirikul+N.&coden=BMTRE&isbn=&pages=375 379&date=2015&auinit1=N&auinitm= RECORD 46 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Virtual karyotype reconstruction by SNPs array of newly diagnosed multiple myeloma (MM) patients enrolled in the EMN02 clinical trial Terragna C., Dico A.F., Martello M., Callea V., Catania G., Spadano T., Di Toritto T.C., Testoni N., Waage A., Borsi E., Palumbo A., Zweegman S., Cafro A., Palmas A.D., Volpe S., Prete M., Vigna E., De Rosa L., Cellini C., Sonneveld P., Cavo M. Blood (2014) 124:21. Date of Publication: 6 Dec 2014 Background. Array-based technology has been showing a great impact on clinical cancer cytogenetic, especially on genetically heterogeneous disease, such as MM, where relevant lesions might be the hallmarks of different patients' subgroups, thus becoming of clinical relevance as well We present herein the results of a molecular sub study of the EMN02 phase III study (EMN02-HOVON95) which was designed to compare consolidation therapy Bortezomib, Melphalan and Prednisone versus upfront autologous stem cell transplantation, both applied after induction therapy with bortezomib-cyclophosphamide-dexamethasone (VCD) The sub-study was aimed at developing a comprehensive, high throughput genomic profile to be used to stratify uniformly treated MM patients according to their genomic background at baseline and to perform correlations with response to induction therapy Patients and methods. Data obtained from 170 patients who consecutively entered the study and received three 21 day cycles of VCD induction therapy were analyzed. Baseline patients' characteristics, including cytogenetic abnormalities, were comparable with those of 717 patients enrolled by participating Italian centres. Highly purified CD138+ bone marrow plasma cells were profiled by SNPs array (Affymetrix 6.0 and CytoScanHD® chip). ChAS (Affymetrix) and Nexus Copy NumberTM 7.5 (Biodiscovery) software were used to perform Copy Number Alterations (CNAs) analyses and clinical correlations, respectively Results. After induction therapy, 66 out of 170 (38.8%) patients achieved a 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 65 very good partial response (VGPR) or better, including 15 (8,8%) who attained a complete response (CR). On the contrary, 104/170 (61.1%) patients achieved <=partial response (PR), including 28 with stable disease (SD) Presenting MM cases were studied by SNPs array in order to compute CNAs and acquired loss of heterozygosity (LOH) in the tumor. The frequency distribution of the more relevant CNAs is summarized in table 1. A subgroup of 13/170 (7.6%) patients was characterized by the absence of any macro CNAs (either gains or losses): these cases were mainly characterized by LOH events on chr. 1, 8 and 16, where putative tumor suppressor genes are located (e.g. PLEKOH1 and SIAH1 on chr.1 and 16, respectively). In order to identify novel chromosomal lesions potentially influencing response to induction therapy, we compared the CNAs profile of the extreme response categories, i.e. CR and SD. Neither the absence of CNAs nor the presences of any of those that are prognostically relevant were significantly linked to response to induction therapy. On the contrary, the following two novel lesions resulted highly significant. A 42.9 Kb CN gain on chr.11q22.1-22.2, which only includes the Hippo pathway mediator YAP1, significantly characterized 6% of patients in CR, as compared to 54% of patients with SD (p=0.002). An extended CN loss on chr.14q13.1-13.3, including genes implicated in the progression on cancer (e.g. NKX2-8), significantly characterized 62.5% of patients who achieved CR, as compared to 4% of those with SD (p<0.001) Conclusions. The reconstruction of high-throughput virtual karyotype by SNPs array in a cohort of homogeneously treated, newly diagnosed, MM patients offered the opportunity to obtain a comprehensive overlook of each patient's sub-chromosomal anatomy. This allowed both to perform a detailed patients' stratification at diagnosis and to identify, among the whole spectrum of CNAs, those having an impact on response to induction therapy. (Figure Presented). OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=00064971 &id=doi:&atitle=Virtual+karyotype+reconstruction+by+SNPs+array+of+newly+diagnosed +multiple+myeloma+%28MM%29+patients+enrolled+in+the+EMN02+clinical+trial&stitle =Blood&title=Blood&volume=124&issue=21&spage=&epage=&aulast=Terragna&aufirst =Carolina&auinit=C.&aufull=Terragna+C.&coden=&isbn=&pages= &date=2014&auinit1=C&auinitm= RECORD 47 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Bortezomib/cyclophosphamide/dexamethasone (VCD) is equally effective and has a favorable toxicity profile compared to bortezomib/doxorubicin/dexamethasone (PAd) as induction therapy in newly diagnosed, transplant-eligible myeloma patients: Results from the multicenter, phase III clinical trial GMMG-MM5 Mai E.K., Bertsch U., Duerig J., Kunz C., Haenel M., Blau I.W., Munder M., Jauch A., 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 66 Schurich B., Hielscher T., Merz M., Huegle-Doerr B., Seckinger A., Hose D., Hillengass J., Raab M.S., Neben K., Lindemann H.-W., Zeis M., Gerecke C., Schmidt-Wolf I.G.H., Weisel K., Scheid C., Salwender H., Goldschmidt H. Oncology Research and Treatment (2014) 37 SUPPL. 5 (150-151). Date of Publication: October 2014 Purpose: To investigate non-inferiority of bortezomib/cyclophosphamide/ dexamethasone (VCD) compared to bortezomib/doxorubicin/dexamethasone (PAd) induction therapy (IT) with respect to response rates in newly diagnosed, transplant eligible multiple myeloma (MM). Patients and Methods: 504 MM patients were randomly assigned to receive three cycles of either PAd or VCD IT followed by subsequent response assessment. The primary analysis compared proportions of patients achieving at least very good partial response or better (≥VGPR) after PAd or VCD treatment. Further, the toxicity profile and data on stem cell collection were analyzed. Results: There were no differences regarding ≥VGPR rates in both arms (VCD: 37.0% vs. PAd: 34.3%). Non-inferiority of VCD was shown (P = < 0.01). Overall response rates (ORR, ≥ partial response) were in favor for VCD (78.1% and 72.1%, p = 0.15). Progressive disease occurred more frequently in PAd than VCD arm (PAd: 4.8% vs. VCD: 0.4%, p = < 0.01). In the PAd group, 91.7% of PD occurred in patients with either initial renal insufficiency (creatinine ≥2mg/dl) or cytogenetic aberration (gain 1q21 >2 copies), whereas no PD was observed for these subgroups in the VCD arm. The proportion of patients with any AE (≥2) during IT was not significantly different between the two arms (PAd 61.3% vs. VCD 64.0%, p = 0.58). In VCD group, significantly higher rates of leukocytopenia/ neutropenia were observed (CTCAE ≥3, VCD: 35.2% vs. PAd: 11.3%, P = < 0.01). Infection rates (CTCAE ≥2) were comparable (VCD 22.4% vs. PAd 24.6%, P = 0.60). Neuropathy rates were higher in PAd vs. VCD group (14.9% vs. 8.4%, P = 0.03) as were serious adverse events (SAE) related to thromboembolic events (2.8% vs. 0.4%, p = 0.04). Additionally, the number of patients with at least one serious adverse event (SAE) during IT was significantly higher in the PAd group (32.7% vs. 24.0%, p = 0.04). Stem cell collection was not encumbered by either VCD or PAd. Conclusion: VCD is equally effective to PAd in terms of ≥VGPR response rates. In the VCD group, PD rate was significantly lower. Progressive disease in PAd arm occurred mostly in patients with baseline creatinine ≥ 2mg/dl or gain 1q21 (>2 copies). Therefore, PAd might not be beneficial for these subgroups. Further, VCD has a favorable toxicity profile. Therefore, VCD should be preferred to PAd as IT in newly diagnosed, transplant-eligible MM patients. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=22965270 &id=doi:10.1159%2F000368945&atitle=Bortezomib%2Fcyclophosphamide%2Fdexamet 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 67 mpared+to+bortezomib%2Fdoxorubicin%2Fdexamethasone+%28PAd%29+as+inductio n+therapy+in+newly+diagnosed%2C+transplant eligible+myeloma+patients%3A+Results+from+the+multicenter%2C+phase+III+clinical+ trial+GMMG MM5&stitle=Oncol.+Res.+Treat.&title=Oncology+Research+and+Treatment&volume=3 7&issue=&spage=150&epage=151&aulast=Mai&aufirst=E.K.&auinit=E.K.&aufull=Mai+E .K.&coden=&isbn=&pages=150-151&date=2014&auinit1=E&auinitm=K RECORD 48 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Cybord is an active, well tolerated, cost-effective induction regimen in newly diagnosed multiple myeloma-a single centre experience Krawczyk J., Khan S., Ahsan B., Eltom S., Saeed K.A., Gibbons C., Maloney K., Meenaghan T., Walpole G., Abdelrahmen M., Hayat A., Hodgson A., Murray M., O'Dwyer M.E. Haematologica (2014) 99 SUPPL. 1 (656). Date of Publication: 1 Jun 2014 Background: Background: Based on evidence from clinical trials there is a growing consensus that a three drug regimen involving at least one novel agent (proteasome inhibitor or immunomodulatory drug) should be used as initial induction in patients with newly diagnosed multiple myeloma (NDMM), usually for 3-4 cycles, prior to harvesting stem cells and proceeding to autologous stem cell transplantation (ASCT). Three drug regimens achieve deeper responses both before and after ASCT and this has been shown to translate into superior progression free survival (PFS). CR rates with the three drug regimens prior to ASCT are reported to be in the range of 20-30% with correspondingly high rates of very good partial response (VGPR) (50-60%). One such regimen is the combination of bortezomib with cyclophosphamide and dexamethasone (CyBorD). The published overall response rates (ORR) from phase II trials with CyBorD are approximately 90%, with at least 60% of patients achieving VGPR. At our center, CyBorD has been used as front line therapy since 2008. Aims: In this report we analyse our experience using CyBorD regimen as initial therapy in transplant eligible patients. Methods: Methods: We retrospectively analysed clinical and laboratory records for 31 NDMM patients treated with CyBorD at our institution between 2008 and 2013, all of whom subsequently proceeded to ASCT. The standard protocol consisted of bortezomib 1.3 mg/m(2) i.v. twice a week, cyclophosphamide orally at a dose of 300 mg/m(2) weekly, and dexamethasone orally of 40 mg daily given in 4 days long blocks weekly. Since November 2009 we have also used weekly CyBorD. Results: Results: The median age was 57 years (range from 45 to 65), including 24 males and 7 females. According to ISS, 45% patients were classified as stage I, 5% stage II, and 50% as stage III. The ORR was 90% post cycle I and increased to 96% post cycle IV. At least VGPR was observed in 13% of patients after cycle 1 and 56% after cycle IV. 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 68 Transplantation had improved the responses and 79% had at least VGPR post transplant versus 63% prior, and 24% patients achieved CR post ASCT in comparison to 16% prior ASCT (Figure 1). The therapy was well tolerated. Haematological adverse events were acceptable and no patient required significant dose reduction or experienced treatment delay due to haematological toxicity. Importantly, no patients developed > grade 3 peripheral neuropathy and no patients required dose reduction or discontinuation of bortezomib due to neurological complications. Stem cell mobilisation was performed using a combination of cyclophosphamide 1.5g/m(2) and G-CSF. All patients mobilized successfully without requirement for plerixafor. The medium CD34+ yield after 2 collection days was 8.2 x10(6)/kg (range 1.8 -19.4). The PFS at 2 years was 75% and 64% at three years of follow up. At 2 years post transplant, the patients achieving at least a VGPR had a longer median PFS in comparison to patients with PR (91% vs 76%, p=NS). The cost analysis has shown that on average, the drug only cost of 4 cycles of CyBorD was 18 000€. This compares to 38 000€ for 4 cycles of bortezomib, lenalidomide, dexamethasone (VRD). Summary and Conclusions: Conclusions: Our data confirm the safety and efficacy of the CyBorD protocol and its applicability to routine clinical practice outside of large academic myeloma centres. CyBorD is an active, well tolerated and cost effective option for patients with NDMM, which could be an ideal backbone for the incorporation of new modalities, such as monoclonal antibodies in induction therapy. A randomized comparison with other triple drug regimens are required to fully establish its place in the treatment of newly diagnosed multiple myeloma. (Figure Presented). OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=03906078 &id=doi:&atitle=Cybord+is+an+active%2C+well+tolerated%2C+cost effective+induction+regimen+in+newly+diagnosed+multiple+myeloma a+single+centre+experience&stitle=Haematologica&title=Haematologica&volume=99&i ssue=&spage=656&epage=&aulast=Krawczyk&aufirst=J.&auinit=J.&aufull=Krawczyk+J. &coden=&isbn=&pages=656-&date=2014&auinit1=J&auinitm= RECORD 49 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten European myeloma network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma Engelhardt M., Terpos E., Kleber M., Gay F., Wäsch R., Morgan G., Cavo M., van de Donk N., Beilhack A., Bruno B., Johnsen H.E., Hajek R., Driessen C., Ludwig H., Beksac M., Boccadoro M., Straka C., Brighen S., Gramatzki M., Larocca A., Lokhorst H., Magarotto V., Morabito F., Dimopoulos M.A., Einsele H., Sonneveld P., Palumbo A. Haematologica (2014) 99:2 (232-242). Date of Publication: 1 Feb 2014 Multiple myeloma management has undergone profound changes in the past thanks to 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 69 advances in our understanding of the disease biology and improvements in treatment and supportive care approaches. This article presents recommendations of the European Myeloma Network for newly diagnosed patients based on the GRADE system for level of evidence. All patients with symptomatic disease should undergo risk stratification to classify patients for International Staging System stage (level of evidence: 1A) and for cytogenetically defined high- versus standard-risk groups (2B). Novel-agent-based induction and up-front autologous stem cell transplantation in medically fit patients remains the standard of care (1A). Induction therapy should include a triple combination of bortezomib, with either adriamycin or thalidomide and dexamethasone (1A), or with cyclophosphamide and dexamethasone (2B). Currently, allogeneic stem cell transplantation may be considered for young patients with high-risk disease and preferably in the context of a clinical trial (2B). Thalidomide (1B) or lenalidomide (1A) maintenance increases progression-free survival and possibly overall survival (2B). Bortezomib-based regimens are a valuable consolidation option, especially for patients who failed excellent response after autologous stem cell transplantation (2A). Bortezomib-melphalan-prednisone or melphalan-prednisone thalidomide are the standards of care for transplant-ineligible patients (1A). Melphalan prednisone-lenalidomide with lenalidomide maintenance increases progression-free survival, but overall survival data are needed. New data from the phase III study (MM 020/IFM 07-01) of lenalidomide-low-dose dexamethasone reached its primary end point of a statistically significant improvement in progression-free survival as compared to melphalan-prednisone-thalidomide and provides further evidence for the efficacy of lenalidomide-low-dose dexamethasone in transplant-ineligible patients (2B). © 2013 Ferrata Storti Foundation. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=03906078 &id=doi:10.3324%2Fhaematol.2013.099358&atitle=European+myeloma+network+reco mmendations+on+the+evaluation+and+treatment+of+newly+diagnosed+patients+with+ multiple+myeloma&stitle=Haematologica&title=Haematologica&volume=99&issue=2&sp age=232&epage=242&aulast=Engelhardt&aufirst=Monika&auinit=M.&aufull=Engelhardt +M.&coden=HAEMA&isbn=&pages=232-242&date=2014&auinit1=M&auinitm= RECORD 50 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten Early response-based intensification of primary therapy in newly diagnosed multiple myeloma patients who are eligible for autologous stem cell transplantation: Phase II study Ahn S.-Y., Jung S.-H., Joo Y.D., Lee W.S., Lee S.M., Choi C.W., Kim S.J., Kim K., Lee J.-J. Annals of Hematology (2014) 93:9 (1571-1577). Date of Publication: September 2014 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 70 This phase II study prospectively evaluated the efficacy and tolerability of an early change in induction therapy before autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients who failed to achieve more than a partial response (PR) after two cycles of a cyclophosphamide, thalidomide, and dexamethasone (CTD) regimen. Patients aged 18-65 years received two cycles of CTD therapy, and then the patients who achieved more than a PR received two additional cycles of CTD therapy, while those who failed to achieve more than a PR were given intensified therapy with four cycles of a Vel-CD regimen (bortezomib, cyclophosphamide, and dexamethasone). After completing primary chemotherapy, the patients underwent ASCT. This study initially enrolled 64 patients, although four were excluded. Of the patients, 60 were treated with CTD regimen and 8 patients also had the intensified Vel-CD regimen, of whom five showing improved responses. The overall response rate before ASCT in 59 patients was 94.9 %, including 27.1 % with a stringent complete response/complete response, 23.7 % with a very good partial response (VGPR), and 44.1 % with a PR. The median time to progression (TTP) was 33.2 months (95 % CI, 26.6-34.8). Patients who attained a VGPR or better after ASCT tended to have a longer TTP than the patients who did not (not reached vs. 24.2 months, P=0.04). In conclusion, early response adapted intensification with a Vel-CD regimen was a well-tolerated, effective strategy for improving the response before ASCT in patients with newly diagnosed MM. © 2014 Springer-Verlag. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=14320584 &id=doi:10.1007%2Fs00277-014-2067-3&atitle=Early+response based+intensification+of+primary+therapy+in+newly+diagnosed+multiple+myeloma+pat ients+who+are+eligible+for+autologous+stem+cell+transplantation%3A+Phase+II+stud y&stitle=Ann.+Hematol.&title=Annals+of+Hematology&volume=93&issue=9&spage=157 1&epage=1577&aulast=Ahn&aufirst=Seo-Yeon&auinit=S.-Y.&aufull=Ahn+S. Y.&coden=ANHEE&isbn=&pages=1571-1577&date=2014&auinit1=S&auinitm=-Y RECORD 51 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten Bortezomib-Cyclophosphamide-Dexamethasone (VCD) versus Bortezomib Thalidomide-Dexamethasone (VTD) -based regimens as induction therapies in newly diagnosed transplant eligible patients with multiple myeloma: A meta analysis Leiba M., Kedmi M., Duek A., Freidman T., Weiss M., Leiba R., Nagler A., Avigdor A. British Journal of Haematology (2014) 166:5 (702-710). Date of Publication: September 2014 Three-drug induction regimens have become the standard of care in newly diagnosed transplant-eligible multiple myeloma patients. Two frequently used protocols are 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 71 bortezomib, cyclophosphamide and dexamethasone (VCD) and bortezomib, thalidomide and dexamethasone (VTD). Comparisons between the two are lacking. The present study aimed to identify the differences in response rate and toxicity between the two regimens. Databases were searched using the terms 'VTD' or 'VCD' and 'induction regimens for newly diagnosed multiple myeloma'. Prospective trials evaluating initial response in transplant eligible patients were included. The main outcome measures were response rates and adverse events. Eight clinical trials were eligible for analysis. Overall 672 patients were treated with either VCD (n = 157) or VTD (n = 515) as induction therapy. Patients treated with VTD presented with a significantly higher complete/near complete response (34% vs. 6%, P = 0·002) as well as a higher very good partial response rate or better, following induction therapy (62% vs. 27%, P < 0·0001). Although grade 3-4 neurotoxicity was more frequent during VTD therapy (11% vs. 6%, P = 0·057), a higher incidence of overall grade 3-4 adverse events was found in the VCD-treated patients (74% vs. 51%, P < 0·001). VTD induction therapy may be superior in achieving deeper response rate following induction therapy, and is better tolerated. © 2014 John Wiley & Sons Ltd. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=13652141 &id=doi:10.1111%2Fbjh.12946&atitle=Bortezomib-Cyclophosphamide Dexamethasone+%28VCD%29+versus+Bortezomib-Thalidomide Dexamethasone+%28VTD%29+ based+regimens+as+induction+therapies+in+newly+diagnosed+transplant+eligible+pati ents+with+multiple+myeloma%3A+A+meta analysis&stitle=Br.+J.+Haematol.&title=British+Journal+of+Haematology&volume=166& issue=5&spage=702&epage=710&aulast=Leiba&aufirst=Merav&auinit=M.&aufull=Leiba +M.&coden=BJHEA&isbn=&pages=702-710&date=2014&auinit1=M&auinitm= RECORD 52 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten Long-term survival with cyclophosphamide, bortezomib and dexamethasone induction therapy in patients with newly diagnosed multiple myeloma Reeder C.B., Reece D.E., Kukreti V., Mikhael J.R., Chen C., Trudel S., Laumann K., Vohra H., Fonseca R., Bergsagel P.L., Leis J.F., Tiedemann R., Stewart A.K. British Journal of Haematology (2014) 167:4 (563-565). Date of Publication: 1 Nov 2014 OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=13652141 &id=doi:10.1111%2Fbjh.13004&atitle=Long term+survival+with+cyclophosphamide%2C+bortezomib+and+dexamethasone+inductio n+therapy+in+patients+with+newly+diagnosed+multiple+myeloma&stitle=Br.+J.+Haem atol.&title=British+Journal+of+Haematology&volume=167&issue=4&spage=563&epage =565&aulast=Reeder&aufirst=Craig+B.&auinit=C.B.&aufull=Reeder+C.B.&coden=BJHE 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 72 A&isbn=&pages=563-565&date=2014&auinit1=C&auinitm=B RECORD 53 Nicht eingeschlossen, da keine VCD-Therapie Bortezomib-containing induction regimens in transplant-eligible myeloma patients: A meta-analysis of phase 3 randomized clinical trials Nooka A.K., Kaufman J.L., Behera M., Langston A., Waller E.K., Flowers C.R., Gleason C., Boise L.H., Lonial S. Cancer (2013) 119:23 (4119-4128). Date of Publication: 1 Dec 2013 BACKGROUND The objective of this meta-analysis in patients with myeloma was to test the hypothesis that the addition of bortezomib to induction therapy not only improves the depth of response but also improves post-transplant progression-free survival (PFS) and overall survival (OS) outcomes. METHODS Phase 3 trials that randomized newly diagnosed, transplant-eligible patients with myeloma to receive either a bortezomib-containing induction regimen (BCIR) or a nonbortezomib-containing induction regimen (NBCIR) were identified. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adapted for data synthesis, and comprehensive meta-analysis software was used to report pooled data as hazard ratios or odds ratios under a random-effects model. RESULTS Four published phase 3 trials that included 2169 patients were analyzed. The postinduction and post-transplant pooled odds ratio for achieving a complete response/near complete response or a very good partial response or better and the overall response rate were higher with BCIR. The pooled hazard ratios for 3-year PFS and OS were 0.71 (95% confidence interval, 0.60-0.83; P <.00,001) and 0.79 (95% confidence interval, 0.66-0.96; P =.014), respectively, favoring BCIR. The odds of developing selected grade ≥3 toxicities (peripheral neuropathy and varicella-zoster virus reactivation) also were higher with BCIR. CONCLUSIONS The current meta-analysis demonstrated that BCIR results in an improved depth of response, which translates into improved post-transplant PFS and OS outcomes despite a higher incidence of toxicity. This analysis supports the concept that the choice of induction regimen can influence post-transplant outcomes such as PFS and OS. © 2013 American Cancer Society. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=0008543X &id=doi:10.1002%2Fcncr.28325&atitle=Bortezomib containing+induction+regimens+in+transplant-eligible+myeloma+patients%3A+A+meta analysis+of+phase+3+randomized+clinical+trials&stitle=Cancer&title=Cancer&volume= 119&issue=23&spage=4119&epage=4128&aulast=Nooka&aufirst=Ajay+K.&auinit=A.K. &aufull=Nooka+A.K.&coden=CANCA&isbn=&pages=4119 4128&date=2013&auinit1=A&auinitm=K RECORD 54 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 73 RECORD 54 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Cybord is an active, well tolerated, cost-effective induction regimen in newly diagnosed multiple myeloma-a single centre experience Krawczyk J., Khan S., Ahsan B., Higgins L., McGowan E., Eltom S., Saeed K.A., Gibbons C., Maloney K., Meenaghan T., Walpole G., Collins C., Snedker R., Abdelrahmen M., Hayat A., Hodgson A., Murray M., O'Dwyer M.E. Blood (2013) 122:21. Date of Publication: 21 Oct 2013 Background Based on evidence from clinical trials there is a growing consensus that a three drug regimen involving at least one novel agent (proteasome inhibitor or immunomodulatory drug) should be used as initial induction in patients with newly diagnosed multiple myeloma (NDMM), usually for 3-4 cycles, prior to harvesting stem cells and proceeding to autologous stem cell transplantation (ASCT). Three drug regimens achieve deeper responses both before and after ASCT and this has been shown to translate into superior progression free survival (PFS). CR rates with the three drug regimens prior to ASCT are reported to be in the range of 20-30% with correspondingly high rates of very good partial response (VGPR) (50-60%). One such regimen is the combination of bortezomib with cyclophosphamide and dexamethasone (CyBorD). The published overall response rates (ORR) from phase II trials with CyBorD are approximately 90%, with at least 60% of patients achieving VGPR. At our center, CyBorD has been used as front line therapy since 2008. In this report we present our experience using this regimen as initial therapy in transplant eligible patients. Methods We retrospectively analysed clinical and laboratory records for 31 NDMM patients treated with CyBorD at our institution between 2008 and 2013, all of whom subsequently proceeded to ASCT. The standard protocol consisted of bortezomib 1.3 mg/m(2) i.v. twice a week, cyclophosphamide orally at a dose of 300 mg/m(2)weekly dexamethasone orally of 40 mg daily given in 4 days long blocks weekly. Since November 2009 we have also used weekly CyBorD. Results The median age was 57 years (range from 45 to 65), including 24 males and 7 females. According to ISS, 45% patients were classified as stage I, 5% stage II 50% as stage III The ORR was 90% post cycle I and increased to 96% post cycle IV. At least VGPR was observed in 13% of patients after cycle 1 and 56% after cycle IV. Transplantation had improved the responses and 79% had at least VGPR post transplant versus 63% prior 24% patients achieved CR post ASCT in comparison to 16% prior ASCT (Fig. 1). The therapy was well tolerated. Haematological adverse events were acceptable and no patient required significant dose reduction or experienced treatment delay due to haematological toxicity. Importantly, no patients developed > grade 3 peripheral neuropathy and no patients required dose reduction or discontinuation of bortezomib due to neurological complications. Stem cell mobilisation was performed using a combination of cyclophosphamide 1.5g/m(2) and G-CSF. All patients mobilized successfully without 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 74 requirement for plerixafor. The medium CD34+ yield after 2 collection days was 8.2 x106/kg (range 1.8 -19.4). The PFS at 2 years was 75% and 64% at three years of follow up. At 2 years post transplant, the patients achieving at least a VGPR had a longer median PFS in comparison to patients with PR (91% vs 76%, p=NS) (Fig. 2). The cost analysis has shown that on average, the drug only cost of 4 cycles of CyBorD was 18 000€. This compares to 38 000€ for 4 cycles of bortezomib, lenalidomide, dexamethasone (VRD). Conclusions Our data confirm the safety and efficacy of the CyBorD protocol and its applicability to routine clinical practice outside of large academic myeloma centres. CyBorD is an active, well tolerated and cost effective option for patients with NDMM, which could be an ideal backbone for the incorporation of new modalities, such as monoclonal antibodies in induction therapy. A randomized comparison with other triple drug regimens are required to fully establish its place in the treatment of newly diagnosed multiple myeloma. (Figure presented). OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=00064971 &id=doi:&atitle=Cybord+is+an+active%2C+well+tolerated%2C+cost effective+induction+regimen+in+newly+diagnosed+multiple+myeloma a+single+centre+experience&stitle=Blood&title=Blood&volume=122&issue=21&spage= &epage=&aulast=Krawczyk&aufirst=Janusz&auinit=J.&aufull=Krawczyk+J.&coden=&isb n=&pages=-&date=2013&auinit1=J&auinitm= RECORD 55 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Long-term survival with cybord induction therapy in newly diagnosed multiple myeloma Reeder C.B., Reece D.E., Kukreti V., Mikhael J., Chen C.I., Trudel S., Laumann K., Hentz J., Piza G., Fonseca R., Bergsagel P.L., Leis J.F., Tiedemann R.E., Spong J., Mayo A., Stewart K. Blood (2013) 122:21. Date of Publication: 21 Oct 2013 Introduction We piloted an induction regimen of cyclophosphamide, bortezomib and dexamethasone (CyBorD)(CBD) in 2006 and showed rapid and deep responses after 4 cycles in patients with newly diagnosed multiple myeloma (MM).1 We subsequently reported equal responses and less toxicity with weekly bortezomib dosing.2 Triplet therapy has since become common in both standard and high risk patients and no other triplet combination has shown results superior to CyBorD.3 We report long-term f/u data for all 63 patients treated on both cohorts at MCA and PMH. Methods Sixty-three patients with newly diagnosed and symptomatic myeloma were enrolled between 2006 and 2008 on a phase II trial of weekly oral cyclophosphamide 300mg/m(2), IV bortezomib 1.3 mg/m(2) d1, 4, 8, 11 (Cohort1) or 1.5mg/m(2) d1, 8, 15, 22 (Cohort2) and dexamethasone in high dose (Cohort 1) or high dose for 2 cycles, then low dose for 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 75 2 cycles (Cohort2). Cycles were 28 days and patients received prophylactic acyclovir and a quinolone antibiotic. Response after 4 cycles was the primary goal and secondary goals were PFS, OS and toxicity of this regimen. Patients were stratified to high risk or standard risk by mSMART criteria. Results The overall response for all patients (n=63) was 89% with 62% VGPR or better. The 5 year PFS and OS rates were 42% (95%CI: 31-57) and 70% (95%CI: 59-82) for the entire group (Figure 1). Twenty-four of the 63 patients were high risk (38%). Patients considered high risk had a lower 5 year PFS (33% (95%CI: 19-59) vs 48% (95%CI: 33-69)) and OS rate (54% (95%CI: 37-78) vs 81% (95%CI: 69-95) compared to standard risk. Most patients underwent auto stem cell transplant after completing the induction trial and most did not utilize maintenance therapy post SCT. Conclusions Early and deep responses are needed for long-term disease control in MM. CyBorD maximizes responses and allows for stem cell collection and transplantation which can further consolidate response and improve outcome. This combination is more cost effective than other triplet options while yielding equivalent responses and preserving the opportunity for future IMiD therapy. CyBorD employed in a once weekly schedule is not associated with thrombosis or severe neuropathy. The result is excellent survival for patients with standard risk multiple myeloma. Eighty-one percent of standard risk patients are alive at 5 years. High risk MM patients respond well but survival data confirm the need for ongoing consolidation and or maintenance therapy. CyBorD induction should be considered a standard regimen for transplant eligible patients with newly diagnosed MM. (Table Presented). OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=00064971 &id=doi:&atitle=Long term+survival+with+cybord+induction+therapy+in+newly+diagnosed+multiple+myeloma &stitle=Blood&title=Blood&volume=122&issue=21&spage=&epage=&aulast=Reeder&a ufirst=Craig+B.&auinit=C.B.&aufull=Reeder+C.B.&coden=&isbn=&pages= &date=2013&auinit1=C&auinitm=B RECORD 56 Nicht eingeschlossen, da keine Studienergebnisse zu VCD-Therapie berichtet werden How lenalidomide is changing the treatment of patients with multiple myeloma Dimopoulos M.A., Terpos E., Niesvizky R. Critical Reviews in Oncology/Hematology (2013) 88:SUPPL.1 (S23-S35). Date of Publication: 1 Oct 2013 Lenalidomide is a distinct second-generation immunomodulatory drug with multiple anticancer and immunomodulatory effects against hematologic malignancies, in particular multiple myeloma (MM). Dexamethasone synergistically enhances the anticancer effects of lenalidomide, and the combination of lenalidomide and dexamethasone (Len/Dex) is approved for the treatment of patients with relapsed and/or 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 76 refractory MM. Results from pivotal phase III trials in this setting have demonstrated that Len/Dex extends overall survival compared with dexamethasone alone. Optimal clinical benefits are seen when Len/Dex is initiated at first relapse and continued, beyond best treatment response, until disease progression. Lenalidomide based regimens are also effective as induction therapy in patients with newly diagnosed MM. Importantly, lenalidomide has a predictable and manageable tolerability profile, with minimal neurotoxicity, allowing long-term administration. As the paradigm of myeloma disease continues to change, future studies will determine the efficacy of lenalidomide in novel combinations with potentially complimentary agents. © 2013 Elsevier Ireland Ltd. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=10408428 &id=doi:10.1016%2Fj.critrevonc.2013.05.013&atitle=How+lenalidomide+is+changing+th e+treatment+of+patients+with+multiple+myeloma&stitle=Crit.+Rev.+Oncol.+Hematol.&ti tle=Critical+Reviews+in+Oncology%2FHematology&volume=88&issue=SUPPL.1&spag e=&epage=&aulast=Dimopoulos&aufirst=Meletios+A.&auinit=M.A.&aufull=Dimopoulos+ M.A.&coden=CCRHE&isbn=&pages=-&date=2013&auinit1=M&auinitm=A RECORD 57 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Bortezomib, non-pegylated liposomal doxorubicin, dexamethasone (PAD) regimen and autologous stem cell transplant in newly diagnosed multiple myeloma: Preliminary results of a pilot study Falcone A., Rossi G., Bodenizza C., Carella A., Dell'Olio M., Greco M., La Sala A., Mantuano S., Melillo L., Merla E., Nobile M., Sanpaolo G., Scalzulli P., Cascavilla N. Haematologica (2013) 98 SUPPL. 1 (604). Date of Publication: 1 Jun 2013 Background: Induction therapy followed by Autologous Stem Cell Transplant (ASCT) is considered the standard approach in newly diagnosed young patients with Multiple Myeloma (MM). It has been previously reported substantial activity in the front-line setting with Bortezomib, Doxorubicin and Dexamethasone (PAD) induction therapy, which was based on the scientific rationale of dual apoptotic signaling leading to in vitro synergy between bortezomib and doxorubicin (Ma et al, 2003) and additive activity with dexamethasone (Hideshima et al, 2001). In a phase II study, the combination of Bortezomib, Pegylated liposomal Doxorubicin and Dexamethasone was evaluated as induction before ASCT a high response rate was obtained: 58% of very good partial response (VGPR) including 13% of Complete Remission (CR). The treatment-related mortality was 3% and grade 3 to 4 adverse events (AEs) included thrombocytopenia (17%), neutropenia (10%), peripheral neuropathy (16%), and pneumonia (10%) (Palumbo A et al. 2010). Aims: A phase IIb pilot open label trial in newly diagnosed MM patients (pts) was planned as Bortezomib, Non-pegylated Liposomal Doxorubicin and Dexamethasone induction therapy followed by consolidation with ASCT and 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 77 maintenance with Bortezomib. Aims of our study were efficacy and safety in terms of ORR, toxicities and both overall and progression free survivals. Methods: From January 2009 to February 2013, 29 pts (M/F: 15/14) with a median age of 63 years (range: 48 73) were enrolled in the study; twelve pts (41,4%) were more than 65 yrs. At diagnosis 55% of pts had Durie and Salmon staging II and 45% of them had the staging III. Patients showing ISS 1 were 7%, ISS 2 were 35% and ISS 3 were 58% of. Five pts had a renal impairment, extensive bone disease was documented in 19 cases and 3 patients showing extramedullary disease. Fourty-eight percent of pts had IgG, 21% IgA, 24% light chain and 7% non secretory MM. Unfavorable cytogenetic was recorded in 38% of cases. Planned treatment: Bortezomib1,3 mg/mq iv d1,4,8,11; Dexamethasone orally at the dose of 40 mg/d on days1,4,8,11, in pts 65-70 yrs old and at the dose of 20 mg on d1,4,8,11; Non-Pegylated Liposomal Doxorubicin 30 mg/mq on d 1 of a 28-day cycle up to 4 cycles. After PAD regimen pts underwent to high-dose cyclophosphamide (4 g/m(2)) with G-CSF support, peripheral stem cell harvest and ASCT (MEL 200 and 100 in pts over or above 65 years, respectively). After ASCT, all pts received maintenance with Bortezomib alone twice a month. Results: Twenty-six pts were treated with PAD regimen and 22 of them underwent to ASCT. Majority of pts (93%) achieved more than a PR including 58% (15/26) of CR and 35% of VGPR (9/26 after 4 courses of PAD. Two pts (7%) achieved a PR. After ASCT all pts achieved at least VGPR including 86% (19/22) of CR. After a median follow-up of 22 months (range 3-50), PFS and OS are 91% and 100%, respectively. PAD regimen resulted well tolerated and WHO grade 1-3 AEs included neuropathy (19%), hematologic toxicities (42%), infections (9%), gastrointestinal toxicities (18%). No case of cardiac toxicity was observed Summary / Conclusion: Sequential PAD, ASCT and Bortezomib as maintenance is an attractive regimen to maximize the efficacy of ASCT. PAD in frontline setting is a highly effective and well tolerated regimen. Our results from this promising pilot study need further testing in randomized phase III trials. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=03906078 &id=doi:&atitle=Bortezomib%2C+non pegylated+liposomal+doxorubicin%2C+dexamethasone+%28PAD%29+regimen+and+a utologous+stem+cell+transplant+in+newly+diagnosed+multiple+myeloma%3A+Prelimin ary+results+of+a+pilot+study&stitle=Haematologica&title=Haematologica&volume=98&i ssue=&spage=604&epage=&aulast=Falcone&aufirst=A.&auinit=A.&aufull=Falcone+A.& coden=&isbn=&pages=604-&date=2013&auinit1=A&auinitm= RECORD 58 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Cybor-D induction therapy for multiple myeloma in clinical practice Areethamsirikul N., Masih-Khan E., Chu C.M., Jimenez-Zepeda V., Reece D.E., Trudel S., Tiedemann R., Kukreti V., Chen C. 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 78 Clinical Lymphoma, Myeloma and Leukemia (2013) 13 SUPPL. 1 (S140). Date of Publication: April 2013 CyBorD is a highly active induction regimen for newly diagnosed multiple myeloma (MM) patients (pts) preparing for ASCT. From phase 2 trial data, CyBorD (bortezomib 1.3mg/ m2 IV on days 1,4,8,11, weekly cyclophosphamide 300mg/m2 orally, and dexamethasone (DEX) 40mg days 1-4, 9-12, 17- 20, given for four 28-day cycles) achieved an overall response rate (ORR) of 88% (>/=VGPR 61%). In an expanded cohort using weekly bortezomib 1.5mg/m2 IV and DEX 40mg dropped to once weekly for cycles 3-4, similar responses were attained (ORR 93%, >/=VGPR 60%). Given that clinical trial efficacy can significantly overestimate real-life effectiveness, we reviewed our institutional experience with CyBorD in a non-clinical trial setting. Eighty-three ASCT-eligible MM pts who received CyBorD induction during September 2007-April 2012 were reviewed. Median age was 59 years (range 37-71). MM subtypes included: IgG 55%, IgA 20%, light chains only 22%, other 3%. After a median of 4 cycles, responses were high (ORR 93%; >/=VGPR 70%). Grade 3-4 neutropenia (3.6%) and thrombocytopenia (<1%) were uncommon, with no grade 3-4 neuropathy. Dose delays/reductions of any agents were required in 18%. Stem cell mobilization was not compromised. All patients, except 3, proceeded to ASCT. ORR at day +100 post-ASCT was 97% (>/=VGPR 79%). Weekly CyBorD induction is highly effective in clinical practice, with comparable response and toxicity profiles to phase 2 trial data. CyBorD has been widely adopted in Canada and can be considered as a standard comparator for future novel induction regimens. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=21522650 &id=doi:&atitle=Cybor D+induction+therapy+for+multiple+myeloma+in+clinical+practice&stitle=Clin.+Lymphom a+Myeloma+Leukemia&title=Clinical+Lymphoma%2C+Myeloma+and+Leukemia&volum e=13&issue=&spage=S140&epage=&aulast=Areethamsirikul&aufirst=N.&auinit=N.&auf ull=Areethamsirikul+N.&coden=&isbn=&pages=S140-&date=2013&auinit1=N&auinitm= RECORD 59 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten Induction therapy for newly diagnosed multiple myeloma Lonial S., San Miguel J.F. JNCCN Journal of the National Comprehensive Cancer Network (2013) 11:1 (19-28). Date of Publication: 1 Jan 2013 Treatment options for patients with newly diagnosed myeloma have evolved significantly over the past 10 years. Although response rates after induction for older or younger patients were limited, with few patients achieving complete remission, more recent 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 79 Haematologica (2012) 97 SUPPL. 1 (347). Date of Publication: 1 Jun 2012 Background. Three drug induction regimens have become the standard of care in patients with multiple myeloma (MM). Two of the most frequently used protocols are Velcade-Cytoxan-Dexamethasone (VCD) and Velcade-Thalidomide- Dexamethasone (VTD). These regimens differ in their response rate, toxicity profile and cost. However, prospective “head to head”comparisons between the two are lacking. Aims. In this study we attempted to identify the differences in response and toxicity between the VCD and VTD regimens by reviewing the relevant literature and conducting meta-analysis of the eligible studies. Methods. We thoroughly searched MEDLINE, Cochrane library, and the web sites of the American Society of Hematology, the American Society of Clinical Oncology and the European Hematology Association for clinical trials in which VTD or VCD were used as first line induction regimens for newly diagnosed MM patients. A meta-analysis using the Chi square for testing homogeny and oddsration (OR) with 95% confidence interval to estimate adverse events, overall response rate (ORR), complete remission (CR) rate and near complete remission (nCR) rate, was performed. Results. Twelve clinical trials were proved eligible. Overall 807 patients were treated with either VCD (n=170) or VTD (n=637) as induction therapy. After a median of 4 induction cycles the ORR didn't differ between the groups: 85.3% in the VTD and 86.5 % in the VCD group (OR =0.90, CI= 0.52-1.56). VCD protocol was found to be slightly superior in terms of CR/nCR rate: 45% vs. 34% in the VTD arm (p= 0.05). Grade 3-4 adverse events of any type were documented in 68% of patients treated with VCD, compared with only 51% in the VTD group (p=0.01). Interestingly, there was no statistically significant difference in the incidence of grade 3-4 neuropathy (5.4% vs. 5.9%) between the two groups. Conclusions. Both VCD and VTD induction regimens in patients with MM are efficacious in term of ORR. VCD regimen may be superior in its ability to achieve CR/nCR; however, grade 3-4 adverse events are more frequently observed with this regimen. Surprisingly, the incidence of grade 3-4 neuropathy was comparable between the two groups. Due to the limited number of trials and their heterogeneity, randomized controlled trials are needed to confirm these results. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=03906078 &id=doi:&atitle=Velcade+cytoxan+dexamethasoe+%28VCD%29+or+velcade+thalidomi de+dexamethasone+%28VTD%29+induction+regimens+for+newly+diagnosed+multiple +myeloma which+regimen+should+we+prefer%3F&stitle=Haematologica&title=Haematologica&vol ume=97&issue=&spage=347&epage=&aulast=Leiba&aufirst=M.&auinit=M.&aufull=Leib a+M.&coden=&isbn=&pages=347-&date=2012&auinit1=M&auinitm= RECORD 62 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 81 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten A comparison of lenalidomide/dexamethasone versus cyclophosphamide/lenalidomide/dexamethasone versus cyclophosphamide/bortezomib/dexamethasone in newly diagnosed multiple myeloma Khan M.L., Reeder C.B., Kumar S.K., Lacy M.Q., Reece D.E., Dispenzieri A., Gertz M.A., Greipp P., Hayman S., Zeldenhurst S., Dingli D., Lust J., Russell S., Laumann K.M., Mikhael J.R., Leif Bergsagel P., Fonseca R., Vincent Rajkumar S., Keith Stewart A. British Journal of Haematology (2012) 156:3 (326-333). Date of Publication: February 2012 Novel agents are considered standard components of induction therapy for newly diagnosed patients with multiple myeloma. We retrospectively compared the results of three consecutive phase 2 clinical trials; RD (lenalidomide/dexamethasone, n=34), CRD (cyclophosphamide/lenalidomide/dexamethasone, n=53) and CyBorD (cyclophosphamide/bortezomib/dexamethasone, n=63) (N=150). Response rates after four cycles of treatment were: ≥near complete response (nCR), 12% vs. 2% vs. 41%, P<0·0001 and very good partial response or better, 35% vs. 30% vs. 65%, P=0·0003, respectively. W ith all cycles of therapy considered, ≥nCR was 35%, 15% and 41%, P=0·006. However, there is no evidence that one regimen produced superior progression-free survival (PFS) (median: 3·2 vs. 2·3 vs. 2·7years, P=0·11) or overall survival (3-year: 88% vs. 79% vs. 88%, P=0·23). Transplantation did not impact PFS (median: 2·7 vs. 2·3years, P=0·41) but was associated with improved OS (3-year: 93% vs. 75%, P≤0·001). High genetic risk patients (n=40) had earlier relapse despite lenalidomide or bortezomib (median: 2·1 vs. 2·7years, P=0·45). Grade 3/4 toxicities were least with CyBorD while CRD had most toxicity. In conclusion, CyBorD demonstrated superior responses and less frequent serious toxicity but more neuropathy when compared to RD and CRD. Importantly, 80% of patients treated with modern therapeutic approaches are alive at 4 years. © 2011 Blackwell Publishing Ltd. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=00071048 &id=doi:10.1111%2Fj.1365 2141.2011.08949.x&atitle=A+comparison+of+lenalidomide%2Fdexamethasone+versus +cyclophosphamide%2Flenalidomide%2Fdexamethasone+versus+cyclophosphamide% 2Fbortezomib%2Fdexamethasone+in+newly+diagnosed+multiple+myeloma&stitle=Br.+ J.+Haematol.&title=British+Journal+of+Haematology&volume=156&issue=3&spage=32 6&epage=333&aulast=Khan&aufirst=Meaghan+L.&auinit=M.L.&aufull=Khan+M.L.&code n=BJHEA&isbn=&pages=326-333&date=2012&auinit1=M&auinitm=L RECORD 63 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 82 Newly diagnosed multiple myeloma (MM) patients (pts) with t(4;14) identified by FISH who undergo a single ASCT after older induction regimens have a median progression free survival (PFS) of only 8-9 months (mos) and median overall survival (OS) of 18 mos (Chang H, et al. Bone Marrow Transplan t 2005; 36: 793; Gertz M, et al. Blood 2005; 106: 2837). Given the efficacy of bortezomib in t(4;14) disease, we designed a phase II study based on this agent in which ASCT was not performed as part of first-line therapy. Pts received induction therapy with four 21-day cycles of pegylated liposomal doxorubicin 30 mg/m(2)on day 4, bortezomib 1.3 mg/m(2)on days 1, 4, 8, 11 and dexamethasone 40 mg on days 1-4, 8-11, 15-18 of cycle 1 and on days 1-4 and 11-14 of cycles 2-4 (DBD), followed by post-induction therapy with eight 28-day cycles of oral cyclophosphamide 300 mg/m(2)on days 1, 8, 15, 22, bortezomib 1.5 mg/m(2) on days 1,8,15 and prednisone 100 mg q 2 days (CyBor-P). Maintenance therapy with dexamethasone 40 mg/weekly was then administered until disease progression. Although elective stem cell collection was recommended after induction therapy, routine ASCT was not performed in the absence of disease progression. Between February 2008-May 2011, 383 newly diagnosed MM pts were screened for t(4;14) in 8 Canadian centers, and 43 (11.2%) were found to be positive by FISH. Five did not meet the CRAB criteria for symptomatic MM, 7 were ineligible, 3 declined participation and 28 were entered onto study. One of these was later determined to have a variant abnormality of chromosome 4, but not t(4;14), and underwent ASCT after induction therapy; this pt is included in the safety analysis only. The median age was 60 years (range 42-69) and 63% were male. The median percent of nuclei positive for t(4;14) by FISH in the initial bone marrow (unpurified) was 26% (range 2-62), serum β2-microglobulin 239 nmol/L (range 43-1695) and albumin 36 g/L (range 28-48); ten pts had ISS stage 1,10 had stage 2 and 7 had stage 3 MM. Immunoglobulin subtype included IgGκ in 7, IgAκ in 6, IgAλ in 6, IgGλ in 5 and IgMλ in 1. Using modified uniform criteria, the best response in 23 evaluable pts includes: sCR in 6 (26%), CR in 4 (17%), VGPR in 9 (39%), PR in 2 (9%) and SD in 2 (9%). Median F/U is 13.5 mos (range 1.2-35); 6 have progressed at median of 3 mos on study (range 1-11). Four pts have died (due to progression in 3 and complex medical problems/consent withdrawal in 1 in VGPR). SAEs were reported in 7 pts; only 6 pts (21%) developed grade 2 peripheral neuropathy, which necessitated dose reductions of bortezomib in 4. The actuarial 2-yr PFS is 47.7% (95%CI 25.9 87.9%), median PFS is 23. 2 months and 2-yr OS is 76.8% (95%CI 58.3-100%); the median OS has not yet been reached. We conclude: 1) the incidence of t(4;14) by FISH in newly-diagnosed MM pts is 11.2%; which appears to be lower than the 15% anticipated 2) 11.6% of these are asymptomatic; 3) this bortezomib-based regimen is well-tolerated; 4) the overall response rate (sCR + CR + VGPR + PR) is 91% with 82% achieving ≥ VGPR and 43% ≥ CR; 5) the PFS and OS with this approach compare favorably with those seen with older studies of single or double ASCT, and even with some recently reported trials using more modern induction regimens before ASCT, in 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 84 pts with t(4;14); and 6) the use of more effective maintenance therapy, including agents targeting the aberrations associated with t(4;14), would be of interest in future trials. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=00064971 &id=doi:&atitle=Bortezomib based+therapy+without+autologous+stem+cell+transplantation+for+newly+diagnosed+ multiple+myeloma+patients+with+t%284%3B14%29%3A+A+Canadian+national+trial&s title=Blood&title=Blood&volume=118&issue=21&spage=&epage=&aulast=Reece&aufirs t=Donna+E.&auinit=D.E.&aufull=Reece+D.E.&coden=&isbn=&pages= &date=2011&auinit1=D&auinitm=E RECORD 65 Nicht eingeschlossen, da keine VCD-Therapie Bortezomib with thalidomide plus dexamethasone compared with thalidomide plus dexamethasone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma: A randomised phase 3 study Cavo M., Tacchetti P., Patriarca F., Petrucci M.T., Pantani L., Galli M., Di Raimondo F., Crippa C., Zamagni E., Palumbo A., Offidani M., Corradini P., Narni F., Spadano A., Pescosta N., Deliliers G.L., Ledda A., Cellini C., Caravita T., Tosi P., Baccarani M. The Lancet (2010) 376:9758 (2075-2085). Date of Publication: December 18-31, 2010 Background Thalidomide plus dexamethasone (TD) is a standard induction therapy for myeloma. We aimed to assess the efficacy and safety of addition of bortezomib to TD (VTD) versus TD alone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma. Methods Patients (aged 18-65 years) with previously untreated symptomatic myeloma were enrolled from 73 sites in Italy between May, 2006, and April, 2008, and data collection continued until June 30, 2010. Patients were randomly allocated (1:1 ratio) by a web-based system to receive three 21-day cycles of thalidomide (100 mg daily for the first 14 days and 200 mg daily thereafter) plus dexamethasone (40 mg daily on 8 of the first 12 days, but not consecutively; total of 320 mg per cycle), either alone or with bortezomib (1•3 mg/m(2) on days 1, 4, 8, and 11). The randomisation sequence was computer generated by the study coordinating team and was stratified by disease stage. After double autologous stem-cell transplantation, patients received two 35-day cycles of their assigned drug regimen, VTD or TD, as consolidation therapy. The primary endpoint was the rate of complete or near complete response to induction therapy. Analysis was by intention to treat. Patients and treating physicians were not masked to treatment allocation. This study is still underway but is not recruiting participants, and is registered with ClinicalTrials.gov, number NCT01134484, and with EudraCT, number 2005-003723-39. Findings 480 patients were enrolled and randomly assigned to receive 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 85 VTD (n=241 patients) or TD (n=239). Six patients withdrew consent before start of treatment, and 236 on VTD and 238 on TD were included in the intentionto- treat analysis. After induction therapy, complete or near complete response was achieved in 73 patients (31%, 95% CI 25•0-36•8) receiving VTD, and 27 (11%, 7•3-15•4) on TD (p<0•0001). Grade 3 or 4 adverse events were recorded in a significantly higher number of patients on VTD (n=132, 56%) than in those on TD (n=79, 33%; p<0•0001), with a higher occurrence of peripheral neuropathy in patients on VTD (n=23, 10%) than in those on TD (n=5, 2%; p=0•0004). Resolution or improvement of severe peripheral neuropathy was recorded in 18 of 23 patients on VTD, and in three of five patients on TD. Interpretation VTD induction therapy before double autologous stem-cell transplantation significantly improves rate of complete or near complete response, and represents a new standard of care for patients with multiple myeloma who are eligible for transplant. Funding Seràgnoli Institute of Haematology at the University of Bologna, Bologna, Italy. © 2010 Elsevier Ltd. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=01406736 &id=doi:10.1016%2FS0140-6736%2810%2961424 9&atitle=Bortezomib+with+thalidomide+plus+dexamethasone+compared+with+thalidom ide+plus+dexamethasone+as+induction+therapy+before%2C+and+consolidation+thera py+after%2C+double+autologous+stem cell+transplantation+in+newly+diagnosed+multiple+myeloma%3A+A+randomised+phas e+3+study&stitle=Lancet&title=The+Lancet&volume=376&issue=9758&spage=2075&e page=2085&aulast=Cavo&aufirst=Michele&auinit=M.&aufull=Cavo+M.&coden=LANCA &isbn=&pages=2075-2085&date=2010&auinit1=M&auinitm= Nicht eingeschlossen, da Duplikat oder Neuauflage einer anderen RECORD 66 begutachteten Arbeit Bortezomib in the upfront treatment of multiple Myeloma San Miguel J.F., Mateos M.-V. Milestones in Drug Therapy (2010) (53-68). Date of Publication: 2010 Drugs for HER-2-positive Breast Cancer, Book Series Title: Although multiple myeloma (MM) remains a disease that is incurable with conventional treatments, important changes have recently been introduced in the management of the disease as a result of advances in our knowledge of its pathogenesis and the availability of novel agents. Bortezomib is a first-in-class proteasome inhibitor that targets not only the MM cell but also its interaction with the bone marrow microenvironment. It represents an excellent example of a novel class of agents that have quickly moved from the bench to the bedside. Four randomised trials have evaluated the role of bortezomib-based combinations as an induction therapy in transplant candidate myeloma patients, revealing a high efficacy (>80% response rate, with 20-30% 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 86 complete response (CR)) that increased after autologous stem cell transplant, confirming the results of numerous pilot studies of various bortezomib-based combinations. In patients who are not candidates for transplant, bortezomib in combination with melphalan and prednisone has also proved to be superior to conventional therapy, with high overall and CR rates and a significantly longer time to progression and overall survival. Moreover, new strategies are being explored in patients who are not candidates for transplant based on the optimisation of the VISTA schedule and using weekly doses of bortezomib to improve tolerability. Overall, these results have established bortezomib-based combinations as key treatment options for newly diagnosed myeloma patients. © Springer Basel AG 2011. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=&id=doi:1 0.1007%2F978-3-7643-8948 2 4&atitle=Bortezomib+in+the+upfront+treatment+of+multiple+Myeloma&stitle=Milesto nes+Drug+Ther.&title=Milestones+in+Drug+Therapy&volume=&issue=&spage=53&epa ge=68&aulast=San+Miguel&aufirst=Jes%C3%BAs+F.&auinit=J.F.&aufull=San+Miguel+ J.F.&coden=&isbn=volume9783034600934&pages=53 68&date=2010&auinit1=J&auinitm=F RECORD 67 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Frontline therapy with bortezomib, lenalidomide, and dexamethasone (VRD) induction followed by autologous stem cell transplantation, VRD consolidation and lenalidomide maintenance in newly diagnosed multiple myeloma patients: Primary results of the IFM 2008 phase II study Roussel M., Avet-Loiseau H., Moreau P., Huynh A., Benboubker L., Hulin C., Marit G., Leleu X., Pegourie B., Fruchart C., Caillot D., Stoppa A.-M., Facon T., Harousseau J.-L., Attal M. Blood (2010) 116:21. Date of Publication: 19 Nov 2010 Background: Autologous Stem Cell Transplantation (ASCT) is a standard of care for eligible MM patients (pts). Introduction of new drugs in this setting have markedly increased survival rates within the last 10 years. Efforts to further improve response and survival in those pts are still needed, mainly by increasing the depth of tumor reduction and the duration of response through more effective induction, consolidation and maintenance therapies. Therefore, the IFM (Intergroupe Francophone du Myèlome) decided to evaluate the Bortezomib (Bor), Lenalidomide (Len) and Dexamethasone (Dex) regimen as induction and consolidation therapy followed by Len maintenance in the transplant setting for newly diagnosed pts. Methods: This open-label phase II study was conducted at 10 IFM transplant centers, with enrollment between September and December 2009. Pts under 65 with symptomatic de novo MM were enrolled to receive 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 87 three 21-day induction cycles of VRD= Bor 1.3 mg/m(2) (days 1, 4, 8, 11), Len 25 mg (days 1-14), and oral Dex 40 mg (days 1, 8 and 14). Stem cell collection was planned for all pts after high dose cyclophosphamide (3g/m2). All pts then proceeded to intensification prepared with melphalan 200 mg/m(2) followed by ASCT. Two months after hematological recovery, pts could receive two 21-day consolidation cycles of VRD (same schedule) followed by 1 year of maintenance with Len at 10-15 mg/day. All patients received, unless contraindicated, aspirin prophylaxis or alternative anticoagulation for prevention of deep-vein thrombosis (DVT), anti-viral therapy (valacyclovir) for herpes zoster prevention. Pts with grade 2 peripheral neuropathy (PNY) were excluded. The primary endpoint was the best response achieved 1 month after consolidation. The secondary endpoints were the response rate after 3 cycles of VRD, after ASCT and after consolidation; the safety profile of the program, the feasibility and quality of stem cell collection and dthe uration of response (DOR), PFS, OS. Response was assessed according to International Uniform Response Criteria including stringent Complete Response (sCR). Flow cytometric analysis of bone marrow plasma cells was performed before and after ASCT, and after consolidation. Toxicities were graded using the CTCAEv4. Patients: Thirty-one pts with symptomatic MM were enrolled. Baseline characteristics of the pts were: median age = 58 (range 33-65); 55% were women; 55%/32%/13% had IgG/IgA/light chain MM; ISS= 1 in 52%, 2 in 32% and 3 in 16% of pts; chromosome 13q deletion in 41% over 27 assessable pts; chromosome 17p del in 18% and t(4;14) translocation in 11%. Results: All pts but one remain on study program at data cut-off (01/08/10). The one pt had discontinued treatment at time of ASCT due to mobilization failure. Therefore, 31 pts are evaluable for response rates after induction therapy, 30 after ASCT and 13 after consolidation. All results are summarized in table 1. In Intent To Treat analysis, the overall response rate (ORR) after ASCT was 94%, including 32% VGPR, 13% CR and 23% sCR. Nine serious AEs were reported. There was no treatment-related mortality. The most common toxicities were: sensory PNY (45%), including 29% grade 1 and 16% grade 2; neuropathic pain (13%); GI tract symptoms (42%) including diarrhea (16%) and constipation (10%); fatigue (10%) and erythrodermia (9%). There was no grade 3/4 PNY. Grade 3/4 hematological toxicities included neutropenia (26%), and thrombocytopenia (6%). No DVT or pulmonary embolism was reported.Six of 31 pts (19%) have had difficulty with mobilization but only 1 pt did not undergo ASCT. Stem cell collection with plerixafor was successful in 4 pts. Median stem cell collection was 7.7 × 10(6) CD34(+) cells/kg. (Table Presented) Conclusions: VRD induction followed by ASCT and VRD consolidation produce high quality responses and is well tolerated in newly diagnosed MM pts under 65. Updated efficacy and safety data will be presented at the meeting. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=00064971 &id=doi:&atitle=Frontline+therapy+with+bortezomib%2C+lenalidomide%2C+and+dexa 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 88 methasone+%28VRD%29+induction+followed+by+autologous+stem+cell+transplantati on%2C+VRD+consolidation+and+lenalidomide+maintenance+in+newly+diagnosed+mu ltiple+myeloma+patients%3A+Primary+results+of+the+IFM+2008+phase+II+study&stitl e=Blood&title=Blood&volume=116&issue=21&spage=&epage=&aulast=Roussel&aufirst =Murielle&auinit=M.&aufull=Roussel+M.&coden=&isbn=&pages= &date=2010&auinit1=M&auinitm= Nicht eingeschlossen, da VCD-Therapie nur am Rande betrachtet wird und RECORD 68 auf Artikel verwiesen wird, die an anderer Stelle separat begutachtet werden Therapeutic approaches for newly diagnosed multiple myeloma patients in the era of novel drugs Morabito F., Gentile M., Mazzone C., Bringhen S., Vigna E., Lucia E., Recchia A.G., Raimondo F.D., Musto P., Palumbo A. European Journal of Haematology (2010) 85:3 (181-191). Date of Publication: September 2010 The treatment of newly diagnosed multiple myeloma (MM) has evolved rapidly over recent years. The availability of new effective drugs with novel mechanisms of action, such as thalidomide, lenalidomide and bortezomib in the last decade, has resulted in a new scenario expected to impact favorably on the outcome of patients with MM. The introduction of new drugs in the treatment of patients eligible for autologous stem cell transplantation (ASCT) has allowed for a significant increase of complete response rate with a positive impact on progression-free survival. In patients not eligible for ASCT, randomized trials have shown that both thalidomide and bortezomib when combined with melphalan and prednisone (MP) are superior to MP and are now considered the standard of care. Ongoing trials are assessing whether MP plus lenalidomide or the combination of lenalidomide plus dexamethasone should be considered an attractive treatment option, while additional studies are needed to determine the role of routine maintenance or consolidation therapy with these new drugs. This new therapeutic armamentarium in light of adequate prophylaxis and supportive care allows clinicians to greatly improve the survival perspectives for both young and elderly patients. In this review, we report updated data for the front-line therapy of MM, examining the role of new drugs either when administered as induction therapy before ASCT in younger patients or when combined with alkylating agents for the treatment of older patients. The most relevant articles on therapy of MM published from November 1982 to January 2010 (selected through PubMed), and recent meeting abstracts were used as sources for this review. © 2010 John Wiley & Sons AS. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=09024441 &id=doi:10.1111%2Fj.1600 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 89 of grade 3 to 4 adverse events [AEs]) and efficacy (response rate). Results: A total of 102 patients were enrolled. In a per-protocol analysis, after PAD, 58% of patients had very good partial response (VGPR) or better, including 13% with complete response (CR); after MEL100, 82% of patients had at least VGPR and 38% had CR; and after LP L, 86% of patients had at least VGPR and 66% had CR. After median follow-up time of 21 months, the 2-year progression-free survival rate was 69%, and the 2-year overall survival rate was 86%. During induction, treatment-related mortality was 3%; grade 3 to 4 AEs included thrombocytopenia (17%), neutropenia (10%), peripheral neuropathy (16%), and pneumonia (10%). During consolidation- maintenance, grade 3 to 4 AEs were neutropenia (16%), thrombocytopenia (6%), pneumonia (5%), and cutaneous rash (4%). Conclusion: Bortezomib as induction before autologous transplantation, followed by lenalidomide as consolidation-maintenance, is an effective regimen. © 2010 by American Society of Clinical Oncology. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=0732183X &id=doi:10.1200%2FJCO.2009.22.7561&atitle=Bortezomib+as+induction+before+autol ogous+transplantation%2C+followed+by+lenalidomide+as+consolidation maintenance+in+untreated+multiple+myeloma+patients&stitle=J.+Clin.+Oncol.&title=Jo urnal+of+Clinical+Oncology&volume=28&issue=5&spage=800&epage=807&aulast=Pal umbo&aufirst=Antonio&auinit=A.&aufull=Palumbo+A.&coden=JCOND&isbn=&pages=8 00 807&date=2010&auinit1=A&auinitm= RECORD 71 Nicht betrachtet, da bereits in Pubmed-Recherche enthalten Phase 2 study of two sequential three-drug combinations containing bortezomib, cyclophosphamide and dexamethasone, followed by bortezomib, thalidomide and dexamethasone as frontline therapy for multiple myeloma Bensinger W.I., Jagannath S., Vescio R., Camacho E., Wolf J., Irwin D., Capo G., McKinley M., Potts P., Vesole D.H., Mazumder A., Crowley J., Becker P., Hilger J., Durie B.G.M. British Journal of Haematology (2010) 148:4 (562-568). Date of Publication: February 2010 Novel sequential combination therapy for induction may improve the quality of response and therefore prolong survival in newly diagnosed multiple myeloma (MM) patients. We report results from a phase 2 study of two sequential three-drug combinations. Forty four previously untreated, symptomatic MM patients received: Bortezomib 1·3 mg/m(2) (days 1, 4, 8, 11), cyclophosphamide 300 mg/m(2) (days 1, 8), plus dexamethasone 40 mg (day of and day after bortezomib) for three 21-day cycles, followed by bortezomib 1·0 mg/m(2), dexamethasone 40 mg and thalidomide 100 mg daily for three cycles. Overall response rate for 42 evaluable patients was 95%, including 19% stringent 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 91 complete response (sCR), 26% CR, and 57%≥ very good partial response. Twenty-two patients have undergone stem-cell transplantation. After a median follow-up of 20·9 months, five patients have died; none was induction therapy-related. Median event-free survival (EFS) and overall survival (OS) have not been reached; estimated 1-year EFS and OS rates were 81% and 91% respectively. Both three-drug combinations were well tolerated; 82% of patients completed all six cycles. Toxicities were predictable and manageable; the most-commonly reported grade 3/4 toxicity was neuropathy (11%). This novel sequential three-drug combination therapy is effective and well-tolerated in previously untreated MM patients. © 2009 Blackwell Publishing Ltd. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=00071048 &id=doi:10.1111%2Fj.1365 2141.2009.07981.x&atitle=Phase+2+study+of+two+sequential+three drug+combinations+containing+bortezomib%2C+cyclophosphamide+and+dexamethas one%2C+followed+by+bortezomib%2C+thalidomide+and+dexamethasone+as+frontline +therapy+for+multiple+myeloma&stitle=Br.+J.+Haematol.&title=British+Journal+of+Hae matology&volume=148&issue=4&spage=562&epage=568&aulast=Bensinger&aufirst= William+I.&auinit=W.I.&aufull=Bensinger+W.I.&coden=BJHEA&isbn=&pages=562 568&date=2010&auinit1=W&auinitm=I RECORD 72 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Bortezomib, thalidomide, and dexamethasone (VTD) versus VTD plus cyclophosphamide as induction therapy in previously untreated multiple myeloma patients eligible for HDT-ASCT: A randomized phase 2 trial Ludwig H., Viterbo L., Greil R., Masszi T., Spicka I., Shpilberg O., Hajek R., Dmoszynska A., Cakana A., Enny C., Feng H., Van De Velde H., Harousseau J.-L. Blood (2009) 114:22. Date of Publication: 20 Nov 2009 Bortezomib (Velcade®) has shown substantial activity and manageable toxicity in newly diagnosed multiple myeloma (MM) in combination with thalidomide (Thalomid®) and dexamethasone (VTD) in a phase 3 study (Cavo et al, ASH 2008), and with cyclophosphamide and dexamethasone (VCD) in a phase 2 study (Knop et al, ASCO 2009). Four-drug combinations may be more effective than 3-drug regimens, but may also be associated with increased toxicity. This randomized, non-comparative, open label, multicenter, phase 2 study was designed to evaluate the efficacy and safety of VTD and VTD plus cyclophosphamide (VTDC) as induction therapy prior to high-dose therapy plus autologous stem cell transplant (HDT-ASCT). A total of 98 previously untreated MM patients with measurable disease who were candidates for HDT-ASCT were enrolled. Additional eligibility criteria included: age 18-70 years, Karnofsky Performance Status (KPS) ≤60%, adequate hematologic, hepatic, and renal function, 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 92 and no grade ≥ 2 peripheral neuropathy (PN)/neuropathic pain. Patients were randomized (1:1), stratified by International Staging System (ISS) disease stage (I / II / III), to receive four 21-day cycles of bortezomib 1.3 mg/m2 on days 1, 4, 8, and 11, thalidomide 100 mg daily, and dexamethasone 40 mg on days 1-4 and 9-12 (VTD), or VTD plus cyclophosphamide 400 mg/m2 IV on days 1 and 8, as induction therapy prior to HDT-ASCT. All patients received antithrombotic prophylaxis. Patients who became ineligible for HDT-ASCT or had a complete response (CR) after induction therapy could receive an additional 4 cycles of treatment. Responses were categorized using modified IMWG Uniform Response Criteria (stringent CR [sCR] were unconfirmed by immunohistochemistry) through blinded review by the principal investigator and medical monitor, using central laboratory M-protein data and local bone marrow data. The primary efficacy endpoint was combined CR rate (sCR + CR + near-CR) following induction therapy. Secondary objectives included combined CR rate post-HDT-ASCT, overall response rate (ORR: ≤partial response) post-induction and post-HDT-ASCT, time to progression (TTP), overall survival (OS), and safety. Adverse events (AEs) were graded using NCI CTCAE v3.0. Forty nine patients were randomized to each arm; median age was 57 and 58 years in the VTD and VTDC arms, respectively, 53% and 51% of patients were male, 49% and 43% had KPS ≤80%, and 24 / 45 / 31% and 18 / 47 / 35% had ISS stage I / II / III MM. All but 7 patients completed induction; these patients discontinued due to AEs (3 [6%] each arm) and disease progression (1 [2%] VTDC). Four VTDC patients received additional cycles of treatment. One patient (VTDC arm) was not evaluable for response. Response rates following induction are shown in the table. Median CD34+ stem cell yields were 8.16 (VTD; n=48) and 8.13 (VTDC; n=40) x 106/kg. At data cut-off (April 10, 2009), 47 VTD and 35 VTDC patients had undergone HDT-ASCT; response rates post-HDT-ASCT in 38 and 27 evaluable patients are shown in the table. Time-to-event data are not mature (median follow-up: 9.8 months). The 1-year survival rate was estimated to be 94% in each arm. At least one AE was reported in 98% and 96% of patients on the VTD and VTDC arms, with at least one grade ≤3 AE reported in 47% and 59%, respectively. The most common non hematologic grade 3/4 AEs included fatigue (2% and 8%) and constipation (6% and 2%); analyses of hematology laboratory values indicated grade 3/4 AEs of lymphopenia (39% and 77%), anemia (8% and 18%), neutropenia (14% and 18%), and thrombocytopenia (6% each). PN was reported in 35% (VTD) and 29% (VTDC) of patients, including 8% grade 3 in each arm and 2% grade 4 in the VTD arm. Two patients (1 [2%] each arm) had deep vein thrombosis; one (VTDC arm) was a grade 3 SAE. At least one serious AE (SAE) was reported in 22% (VTD) and 41% (VTDC) of patients, including 6% and 14% with SAEs of infections (MedDRA SOC), and 2% and 14% with musculoskeletal-related pain. In conclusion, both VTD and VTDC are highly active induction regimens, with CR rates and ORRs among the highest reported; the efficacy profiles were similar between the arms, but there were higher rates of toxicity in 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 93 the VTDC arm compared with the VTD arm (Table presented). OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=00064971 &id=doi:&atitle=Bortezomib%2C+thalidomide%2C+and+dexamethasone+%28VTD%29 +versus+VTD+plus+cyclophosphamide+as+induction+therapy+in+previously+untreated +multiple+myeloma+patients+eligible+for+HDT ASCT%3A+A+randomized+phase+2+trial&stitle=Blood&title=Blood&volume=114&issue =22&spage=&epage=&aulast=Ludwig&aufirst=Heinz&auinit=H.&aufull=Ludwig+H.&cod en=&isbn=&pages=-&date=2009&auinit1=H&auinitm= RECORD 73 Nicht eingeschlossen, da Abstract (keine Vollpublikation) Thalidomide-dexamethasone as induction therapy prior to autologous stem-cell transplantation in patients with newly diagnosed multiple myeloma and renal failure Tosi P., Zamagni E., Tacchetti P., Ceccolini M., Perrone G., Brioli A., Pantani L., Petrucci A., Baccarani M., Cavo M. Blood (2009) 114:22. Date of Publication: 20 Nov 2009 Multiple myeloma (MM) patients presenting with renal feature at disease onset should not be excluded from high-dose therapy programs; seeking novel effective and non nephrotoxic induction regimens is thus mandatory in order to maximize the reduction of tumor burden prior to transplant. From May 2002 to February 2008, 31 newly diagnosed MM patients (18 male, 13 female, median age 60 years) with symptomatic MM and renal failure, defined as creatinine clearance '50ml/min, were enrolled in a clinical trial aimed at evaluating the efficacy and the feasibility of a thalidomide-based regimen as induction therapy in preparation to autologous stem cell transplantation. Sixteen patients had a more severe renal impairment (creatinine clearance '30ml/min) and 7 of them were in chronic hemodyalisis. After informed consent, patients received four months of combined oral thalidomide (thal) (100mg/day for two weeks and 200mg/day thereafter) and dexamethasone (dex) (40mg/day on day 1-4, 9-11,17-20/28 days on odd cycles and on day 1-4 on even cycles); peripheral blood stem cell collection was thus to be performed after priming with high-dose cyclophosphamide + G-CSF or G-CSF alone; a single or double autologous stem cell transplantation was then to follow, upon preparation with high-dose melphalan. After induction, a PR or better was obtained in 23 patients (74%), with 8 patients (26%) achieving a VGPR or better. No difference in response rate was observed in patients with a baseline creatinine clearance >30rnl/rnin (86%) or < 30rrn/min (62%). An improvement in renal function was more frequently observed in patients achieving 1 PR (82% vs. 37% in patients obtaining < PR, p =0.04). Twenty-six patients underwent peripheral blood stem cell mobilization; in 17 of them (65%) the procedure was successful resulting in the collection of > 4 x 106 CD34+ 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 94 cells/kg. Fifteen patients received a double autologous stem cell transplantation while a single transplant was performed in four patients. Overall, median event-free survival was 30 months, and median survival has not been reached, upon 32 months median follow-up. Toxicity profile of thal-dex was comparable to that observed in patients with a normal renal function. In conclusion, our data show that thal-dex can be safely administered in patients with newly diagnosed MM and renal failure. given the relationship between recovery of renal function and response to induction treatment, more intensive thal + bortezomib-including regimens could be potentially useful in order to rescue a higher number of patients. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=00064971 &id=doi:&atitle=Thalidomide dexamethasone+as+induction+therapy+prior+to+autologous+stem cell+transplantation+in+patients+with+newly+diagnosed+multiple+myeloma+and+renal +failure&stitle=Blood&title=Blood&volume=114&issue=22&spage=&epage=&aulast=Tos i&aufirst=Patrizia&auinit=P.&aufull=Tosi+P.&coden=&isbn=&pages= &date=2009&auinit1=P&auinitm= RECORD 74 Nicht eingeschlossen, da Arbeit nur auf preliminary data bzw. Abstracts verweist Emerging combination treatment strategies containing novel agents in newly diagnosed multiple myeloma Lonial S., Cavenagh J. British Journal of Haematology (2009) 145:6 (681-708). Date of Publication: June 2009 Treatment strategies for multiple myeloma have changed substantially over the past 10 years following the introduction of bortezomib and the immunomodulatory drugs thalidomide and lenalidomide. In the front-line setting, combination regimens incorporating these novel agents are demonstrating substantial activity, which is translating into improved outcomes compared with previous standards of care. Response rates and depth of response that were previously only seen with high-dose therapy plus stem-cell transplantation (HDT-SCT) can now be achieved with new induction regimens utilizing these novel agents. This has raised the need for trials that will determine the clinical benefit of early SCT in patients that have already achieved a high quality of response. Here, we review the improvements in response and outcome that are seen with these novel-agent regimens, both as induction therapy prior to HDT SCT and in non-transplant patients, and highlight the latest data from key studies of various novel combinations, including regimens featuring bortezomib plus thalidomide or lenalidomide. We also review data on response and outcomes in patients with poor prognostic characteristics that indicate that the adverse impact typically seen with these factors may be overcome using novel-agent therapy. © 2009 Blackwell Publishing Ltd. 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 95 2009 Purpose and basic procedure of the study: The availability of new targeted therapies has revolutionised the treatment of multiple myeloma (MM), for both the newly diagnosed and the relapsed and refractory settings. A panel of Italian experts provided guidelines for optimal clinical practice in the treatment of MM. Main findings and conclusions: The panel recommended that treatment should only be initiated in symptomatic patients. Autologous stem cell transplantation (ASCT) with melphalan is the treatment of choice in patients younger than 65 yr, and induction therapy including new drugs seems the most suitable preparatory regimen before ASCT. In patients who fail to achieve at least a very good partial response (VGPR) after transplant, a consolidation with a second transplant is of clinical benefit. Also, there is evidence that maintenance with thalidomide after ASCT in young patients failing to reach at least VGPR could prolong survival. In elderly patients, the combination of an alkylating drug with a novel agent should be considered as standard approach. Relapsed MM should be retreated after the reappearance of symptoms and signs of organ and tissue damage. Salvage regimens should include corticosteroids plus bortezomib, thalidomide or lenalidomide. © 2008 The Authors. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=09024441 &id=doi:10.1111%2Fj.1600 0609.2008.01179.x&atitle=Considerations+in+the+treatment+of+multiple+myeloma%3A +A+consensus+statement+from+Italian+experts&stitle=Eur.+J.+Haematol.&title=Europe an+Journal+of+Haematology&volume=82&issue=2&spage=93&epage=105&aulast=Pat riarca&aufirst=Francesca&auinit=F.&aufull=Patriarca+F.&coden=EJHAE&isbn=&pages =93-105&date=2009&auinit1=F&auinitm= Nicht eingeschlossen, da Arbeit auf Artikel verweist, die an anderer Stelle RECORD 77 separat begutachtet werden International Myeloma Working Group guidelines for the management of multiple myeloma patients ineligible for standard high-dose chemotherapy with autologous stem cell transplantation Palumbo A., Sezer O., Kyle R., Miguel J.S., Orlowski R.Z., Moreau P., Niesvizky R., Morgan G., Comenzo R., Sonneveld P., Kumar S., Hajek R., Giralt S., Bringhen S., Anderson K.C., Richardson P.G., Cavo M., Davies F., Bladé J., Einsele H., Dimopoulos M.A., Spencer A., Dispenzieri A., Reiman T., Shimizu K., Lee J.H., Attal M., Boccadoro M., Mateos M., Chen W., Ludwig H., Joshua D., Chim J., Hungria V., Turesson I., Durie B.G.M., Lonial S. Leukemia (2009) 23:10 (1716-1730). Date of Publication: 2009 In 2005, the first guidelines were published on the management of patients with multiple 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 97 myeloma (MM). An expert panel reviewed the currently available literature as the basis for a set of revised and updated consensus guidelines for the diagnosis and management of patients with MM who are not eligible for autologous stem cell transplantation. Here we present recommendations on the diagnosis, treatment of newly diagnosed non-transplant-eligible patients and the management of complications occurring during induction therapy among these patients. These guidelines will aid the physician in daily clinical practice and will ensure optimal care for patients with MM. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=14765551 &id=doi:10.1038%2Fleu.2009.122&atitle=International+Myeloma+Working+Group+guid elines+for+the+management+of+multiple+myeloma+patients+ineligible+for+standard+hi gh dose+chemotherapy+with+autologous+stem+cell+transplantation&stitle=Leukemia&title =Leukemia&volume=23&issue=10&spage=1716&epage=1730&aulast=Palumbo&aufirst =A.&auinit=A.&aufull=Palumbo+A.&coden=LEUKE&isbn=&pages=1716 1730&date=2009&auinit1=A&auinitm= RECORD 78 Nicht eingeschlossen, da Arbeit nur auf Abstracts verweist Bortezomib in the front-line treatment of multiple myeloma Richardson P.G., Mitsiades C., Schlossman R., Ghobrial I., Hideshima T., Munshi N., Anderson K.C. Expert Review of Anticancer Therapy (2008) 8:7 (1053-1072). Date of Publication: 2008 Front-line therapy for multiple myeloma is rapidly evolving with the development of new, highly active regimens based on novo agents such as bortezomib. Bortezomib-based regimens are demonstrating substantial efficacy both as induction prior to stem cell transplantation and as treatment for patients ineligible for transplant, offering rapid and durable responses with consistently high rates of complete response, a surrogate end point for improved overall survival. Combinations of bortezomib plus established and novel agents, such as melphalan-prednisone, dexamethasone, doxorubicin, thalidomide-dexamethasone and, most recently, lenalidomide-dexamethasone, are proving superior to or more promising than previous standards of care. Importantly, these regimens are demonstrating enhanced activity across the front-line population, including patients with renal impairment, high-risk cytogenetics and advanced bone disease. impressive Phase 3 results with bortezomib-melphalan-prednisone, bortezomib-dexamethasone and bortezomib-thalidomide-dexamethasone should facilitate the establishment of these highly effective regimens as key therapies for newly diagnosed myeloma. © 2008 Expert Reviews Ltd. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=14737140 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 98 dexamethasone (VAD). These combinations provided response rates of 45-55%, with complete remission rates of up to 10%. With the advent of thalidomide- and bortezomib based combinations, response rates to induction therapy have risen to 85-95% in previously untreated patients and are associated with complete remission rates up to 25%. However, these agents are associated with such side-effects as somnolence, constipation and neuropathy. Lenalidomide, a thalidomide analog, was developed with the hope of improving both the efficacy and toxicity profile of thalidomide, and has subsequently shown significant clinical activity in patients with multiple myeloma. We describe the role of lenalidomide in patients with symptomatic multiple myeloma that is newly diagnosed, relapsed and/or refractory to other therapies, or concurrent with primary amyloidosis. © 2007. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15216926 &id=doi:10.1016%2Fj.beha.2007.09.002&atitle=Lenalidomide+in+multiple+myeloma&sti tle=Best+Pract.+Res.+Clin.+Haematol.&title=Best+Practice+and+Research+in+Clinical +Haematology&volume=20&issue=4&spage=717&epage=735&aulast=Thomas&aufirst =Sheeba+K.&auinit=S.K.&aufull=Thomas+S.K.&coden=BPRCA&isbn=&pages=717 735&date=2007&auinit1=S&auinitm=K RECORD 81 Nicht eingeschlossen, da keine VCD-Therapie Review of thalidomide in the treatment of newly diagnosed multiple myeloma Cavallo F., Boccadoro M., Palumbo A. Therapeutics and Clinical Risk Management (2007) 3:4 (543-552). Date of Publication: 2007 The role of thalidomide has been well established in the setting of relapsed or refractory multiple myeloma (MM). More recently, studies have been focused on upfront induction therapy. In newly diagnosed MM patients, thalidomide improved the response rates and the event-free survival induced by both high-dose and conventional chemotherapy regimens. The effect on survival needs to be further investigated. The efficacy of this drug is counterbalanced by a significant rate of both acute and long-term toxicities. Thus best timing of initiation, dosing schemes and duration of therapy is still unclear. Evidence is now emerging that clinical response can be achieved also at lower doses with minimal long term toxicity. © 2007 Dove Medical Press Limited. All rights reserved. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=11766336 &id=doi:&atitle=Review+of+thalidomide+in+the+treatment+of+newly+diagnosed+multipl e+myeloma&stitle=Ther.+Clin.+Risk+Manage.&title=Therapeutics+and+Clinical+Risk+M anagement&volume=3&issue=4&spage=543&epage=552&aulast=Cavallo&aufirst=Fed erica&auinit=F.&aufull=Cavallo+F.&coden=&isbn=&pages=543 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 100 Recent advances in the understanding of the molecular and biological aspects of multiple myeloma have opened new horizons in the management and treatment of this hitherto incurable disease. With better understanding of the pathobiological 'web' responsible for triggering plasma cells to develop into myeloma, scientists have been able to develop therapeutic strategies that target not only the myeloma cell, but its microenvironment as well. This article will review novel agents commonly used to treat multiple myeloma, either alone or in combination. The role of these agents as induction therapy in newly diagnosed, relapsed and/or refractory disease will also be evaluated. Finally, an overview of novel therapies moving from the bench to the bedside will be provided. © 2006 Future Drugs Ltd. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=14737140 &id=doi:10.1586%2F14737140.6.10.1483&atitle=New+horizons+in+multiple+myeloma+ therapy&stitle=Expert+Rev.+Anticancer+Ther.&title=Expert+Review+of+Anticancer+The rapy&volume=6&issue=10&spage=1483&epage=1501&aulast=Santos&aufirst=Edgardo +S.&auinit=E.S.&aufull=Santos+E.S.&coden=ERATB&isbn=&pages=1483 1501&date=2006&auinit1=E&auinitm=S RECORD 84 Nicht eingeschlossen, da VCD-Therapie nicht betrachtet Emerging role of novel combinations for induction therapy in multiple myeloma Voorhees P.M., Orlowski R.Z. Clinical Lymphoma and Myeloma (2006) 7:1 (33-41). Date of Publication: July 2006 Although multiple myeloma (MM) remains an incurable disease, there has been a concerted effort toward understanding its molecular pathogenesis, which has paved the way for the development of highly effective, novel therapeutic agents such as the immunomodulatory agents thalidomide and lenalidomide, and the proteasome inhibitor bortezomib. A better understanding of the molecular basis of chemotherapy resistance and the molecular sequelae of conventional cytotoxic and novel agents on MM cells and the bone marrow microenvironment has afforded the opportunity to study novel, rationally designed combination therapies in the clinic. These regimens have shown impressive activity in relapsed/refractory MM, and recent work has demonstrated unprecedented response rates in the first-line setting rivaling those seen with autologous stem cell transplantation. Recently presented results of 2 phase III clinical trials comparing melphalan/prednisone (MP) with MP and thalidomide (MP-Thal) in older patients with newly diagnosed MM have demonstrated superior progression-free survival and overall survival rates with MP-Thal, thus providing the first evidence that the improved response rates to these novel combination regimens will translate into better patient outcomes. Herein we review the early promising clinical activity of these 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 102 Multiple myeloma (MM) remains an incurable disease for most patients, with a median survival of 4 to 5 years. High-dose chemotherapy followed by transplantation has resulted in improvement in response rates and survival compared with conventional therapy, but relapse is nearly universal and not all patients are candidates for this option of aggressive treatment. Standard therapeutic strategies for newly diagnosed patients not eligible for transplantation include pulsed high-dose dexamethasone, melphalan with prednisone, and vincristine in combination with doxorubicin and dexamethasone, as well as other combinations of alkylating agents. Emerging therapies under clinical investigation for first-line therapy include thalidomide, the thalidomide analog lenalidomide, and the proteasome inhibitor bortezomib alone and in combination with other agents, particularly dexamethasone. At an interim analysis, thalidomide combined with melphalan and prednisone was shown to induce a complete or near complete remission (CR) rate of 28% and overall (complete + partial) response rate of 77% in elderly patients generally not eligible for transplantation. These results are comparable to those obtained with high-dose therapy and may obviate transplantation in these patients. Induction therapy with bortezomib-based combinations induces complete and near complete remissions in a similar proportion of patients. These regimens include bortezomib and dexamethasone alone and in combination with doxorubicin, thalidomide, or melphalan. Use of thalidomide or bortezomib does not preclude stem cell harvest. Survival benefits need to be firmly established before these novel regimens emerge as the new standard of care for newly diagnosed disease. However, front-line treatment with combinations involving these agents is a promising strategy that may improve the standard of care for patients both eligible and ineligible for stem cell transplantation. Copyright © 2005 by Current Science Inc. OPEN URL LINK http://resolver.ebscohost.com/openurlAll/?sid=EMBASE&sid=EMBASE&issn=15272729 &id=doi:10.1007%2Fs11864-005-0007 0&atitle=Treatment+of+myeloma+in+patients+not+eligible+for+transplantation&stitle=C urr.+Treat.+Options+Oncol.&title=Current+Treatment+Options+in+Oncology&volume=6 &issue=3&spage=241&epage=253&aulast=Jagannath&aufirst=Sundar&auinit=S.&aufull =Jagannath+S.&coden=CTOOB&isbn=&pages=241 86 Records downloaded - Fri 4 26 09:28:10 UTC 2019 Page 104 Extraktionsbogen A Nr. Feld Stand der Bearbeitung 29.04.2019 1 Quelle Mai et al.: Phase III trial of bortezomib, cyclophosphamide and dexamethasone (VCD) versus bortezomib, doxorubicin and dexamethasone (PAd) in newly diagnosed myeloma. Leukemia (2015) 29, 1721–1729. 2 Studientyp vom Autor Prospective, open-label, randomized multicenter phase III clinical trial bezeichnet als (EudraCT No. 2010-019173-16) 3 Studientyp nach Zuordnung zu einem der folgenden Studientypen: Durchsicht □ Metaanalyse □ Systematischer Review □ Selektiver Review x Therapiestudie mit randomisierter Gruppenzuteilung □ Therapiestudie mit nicht-randomisierter Gruppenzuteilung □ Therapiestudie mit externen Vergleichen (z. B. historische Kontrollen) □ Therapiestudie ohne Vergleichsgruppen (auch Beobachtungsstudien und Anwendungsbeobachtungen) □ Fall-Kontrollstudien □ Fallserie □ Fallbericht / Kasuistik (case report) □ Nicht eindeutig zuzuordnen Falls Therapiestudie: □ mit Placebokontrolle(n) x mit Aktivkontrolle(n) □ mit Dosisgruppen □ sonstige Kontrollgruppe(n): Nennen 4 Formale Evidenzkriterien x 1++: Qualitativ hochwertige Metaanalyse bzw. systematischer Review gemäß SIGN von RCTs oder RCT mit sehr geringem Risiko von Bias □ 1+: Gut durchgeführte Metaanalyse bzw. systematischer Review von RCTs oder RCT mit geringem Risiko von Bias □ 1-: Metaanalyse bzw. systematischer Review von RCTs oder RCT mit hohem Risiko von Bias □ 2++: Qualitativ hochwertiger systematischer Review von Fallkontroll oder Kohortenstudien oder qualitativ hochwertige Fallkontroll- oder Kohortenstudie mit sehr geringem Risiko von Confounding, Bias oder Zufallsschwankungen und hoher Wahrscheinlichkeit, so dass der Zusammenhang kausal ist □ 2+: Gut durchgeführte Fallkontroll- oder Kohortenstudie mit niedrigem Risiko von Confounding, Bias oder Zufallsschwankungen und einer mittleren Wahrscheinlichkeit, so dass der Zusammenhang kausal ist □ 2-: Fallkontroll- oder Kohortenstudie mit hohem Risiko von Confounding, Bias oder Zufallsschwankungen und einem signifikanten Risiko, so dass der Zusammenhang nicht kausal ist □ 3: Andere Studien wie Einzelfallberichte, Fallserien □ 4: Expertenmeinung 5 Bezugsrahmen Sponsor: Universitätsklinikum Heidelberg Korrespondenz der Publikationdurch H. Goldschmidt: Department of Internal Medicine V, University Hospital Heidelberg and National Center for Tumor Diseases (NCT) Heidelberg on behalf of the German- Speaking Myeloma Multicenter Group (GMMG), Heidelberg, Germany Unterstützung der Studie durch Celgene, Janssen-Cilag und The Binding Site kein offensichtlicher Hinweis auf relevante Interessenkonflikte. 6 Indikation Neu diagnostiziertes Multiples Myelom (MM) Behandlungsziel: very good partial response (VGPR) or better, ⩾ VGPR 7 Primäre Fragestellung / Nachweis der Nicht-Unterlegenheit von Induktionstherapie mit primäre Zielsetzung(en) Bortezomib / Cyclophosphamide / Dexamethasone (VCD) im Vergleich zu Induktionstherapie mit Bortezomib / Doxorubicin / Dexamethasone (PAd) bzgl. ⩾ VGPR 8 Relevante Ein- und Einschlusskriterien: (i) Alter 18-70 Jahre, (ii) Chemotherapie Ausschlusskriterien erforderlich gem. CRAB-Kriterien, (iii) WHO Performance Status 0-2 oder 3, falls MM-bezogen (iv) Measurable Disease Ausschlusskriterien: (i) systemische Leichtketten-Amyloidose, (ii) Periphere Neuropathie / Neuropathischer Schmerz ⩾ 2° 9 Prüfintervention Induktionstherapie wie folgt: Bortezomib 1.3 mg/m2 an Tagen 1, 4, 8 und 11; Cyclophosphamid 900 mg/m2 zunächst intravenös, später subkutan an Tag 1; Dexamethason 40 mg oral an Tagen 1–2, 4–5, 8–9 und 11–12 (Wiederholung alle 21 Tage) Zusätzlich antibiotische und antivirale Prophylaxe (Cotrimoxazole bzw. Acyclovir, verpflichtend) und intravenöse Vergabe von Bisphosphonat (empfohlen alle 4 Wochen) Umstellung der Bortezomib-Vergabe von intravenös auf subkutan nach Rekrutierung von insgesamt 314 PatientInnen 10 Vergleichsintervention Induktionstherapie wie folgt: Bortezomib 1.3 mg/m2 an Tagen 1, 4, 8 und 11; Doxorubicin 9 mg/m2 zunächst intravenös, später subkutan an Tagen 1–4; Dexamethasone 20 mg oral an Tagen 1–4, 9–12 und 17–20 (240 mg/Zyklus), Wiederholung alle 28 Tage Zusätzlich antibiotische und antivirale Prophylaxe (Cotrimoxazole bzw. Acyclovir, verpflichtend) und intravenöse Vergabe von Bisphosphonate (empfohlen alle 4 Wochen) Umstellung der Bortezomib-Vergabe von intravenös auf subkutan nach insgesamt 314 PatientInnen 11 Evtl. weitere - Behandlungsgruppen 12 Subgruppen Analysiert die Studie Subgruppen, die für die Fragestellung an die Kommission relevant sind? □ keine relevanten Subgruppen □ prospektiv geplante Subgruppenauswertung x post hoc definierte oder in Auswertung gefundene Subgruppen Serum-Kreatinin ⩾2 mg/dl, Adverse cytogenetics, ISS-Stadien 13 Studiendesign x Parallelgruppendesign □ Cross-Over Design □ Prae-Post-Vergleich □ Sonstige:...... Zwei Behandlungsarme Angaben zu geplanter Fallzahl und Power-Kalkulation finden sich im Studienprotokoll (Supplement), geplante Zwischenauswertung nach Behandlung von 75 PatientInnen pro Behandlungsarm 14 Zentren 31 Studienzentren für Transplantation und 75 assoziierte Zentren Vergleichbarkeit der Studiendurchführung in den einzelnen Zentren ist schwer zu beurteilen. Heterogenität ist vermutlich gering, da die meisten Zentren laut Studienprotokoll (Supplement) zur GMMG gehörten. 15 Randomisierung Randomisierung wird im Studienprotokoll (Supplement) beschrieben, allerdings wird nicht angegeben, ob die Blockgröße fest oder variabel war. Studiennummern der PatientInnen und Randomisierungsergebnisse wurden den Behandlern per Fax mitgeteilt. 16 Verblindung der x Keine Verblindung (offene Behandlung) Behandlung □ Patienten verblindet □ Behandler verblindet □ Beurteiler verblindet ( z.B. bei Bildgebung) 17 Beobachtungsdauer Rekrutierung zwischen Juli 2010 und Oktober 2012. Die Gesamtstudie zur Induktion, ASCT, Konsolidierung und Ergaltung war zum Zeitpunkt der Analyse der Daten der Publikation noch nicht abgeschlossen. Die Auswertung der Induktionsphase basiert auf Studiendaten von Juli 2013 (keine laufende Induktionstherapie mehr zum Zeitpunkt der Analyse) und umfasst insgesamt 504 randomisierte Patienten. 18 Primäre Zielkriterien Erstes primäres Zielkriterium: Nichtunterlegenheit von Induktionstherapie mit VCD im Vergleich zu Induktionstherapie mit (PAd) bzgl. ⩾ VGPR) für ITT und PPPopulation. Zweites primäres Zielkriterium (in der vorliegenden Publikation nicht untersucht): Vergleich von 4 Behandlungsstrategien (VCD/Pad mit Standard-Intensivierungstherapie (HDM+ASCT) und Lenalidomide- Konsolidierung, anschließend Erhaltungstherapie mit entweder (i) Lenalidomide (2 Jahre) oder (ii) Lenalidomide bis zur Erreichung von complete response (CR). Erfassung der Zielkriterien lokal durch BehandlerInnen, Verifizierung durch Monitore gem. Kriterien der International Myeloma Working Group. Zusätzlich Erfassung von minimal response gem. Kriterien der European Society for Blood and Marrow Transplantation. Bestätigung von CR durch negative Serum- und Urin-Immunfixierung und zytologische Untersuchung des Knochenmarks. Analyse von angereicherten CD138+ Plasmazellen mit Hilfe der iFISH-Prozedur. 19 Sekundäre Zielkriterien Sekundäre Zielkriterien gem. Studienprotokoll (Supplement) u.a.: (i) Overall survival, (ii) Toxizität während Induktionstherapie 20 Statistische Methoden für Signifikanzniveau für erstes primäres Zielkriterium: 1.2% einseitig die Analyse der primären (Nicht-Unterlegenheit, 1.25% abzgl. 0.05% für Zwischenauswertung) Endpunkte Test der Nicht-Unterlegenheit von VCD mit Hilfe von Farrington Manning-Test für ⩾ VGPR, Nicht-Unterlegenheits-Margin 10% Berechnung von Konfidenzintervallen für ⩾ VGPR mit Hilfe von Newcombe’s-Hybrid-Score-Intervallen 21 Fallzahlplanung Erreichte Fallzahl: 504 PatientInnen randomisiert (Rekrutierungsziel gem. Fallzahlplanung erreicht), 502 PatientInnen in Intention-to-Treat (ITT)-Population Studie dauerte zum Zeitpunkt der Analyse noch an 22 Zahl und Charakteristika Differenzierte Darstellung nach Behandlungsgruppen vorhanden? ja der eingeschlossenen und Darstellung des Patientenflusses nach CONSORT? ja ausgewerteten Patienten Sind die Ausfälle von Studienteilnehmern (Drop-outs) dokumentiert und begründet? ja Erfolgte eine Intention-to-treat- (ITT-) Analyse? ja Erfolgte eine Per Protocol- (PP-) Analyse? ja Gibt es Hinweise auf systematische und relevante Unterschiede zwischen den Drop-outs und den gemäß Studienprotokoll behandelten Patienten? Hierzu finden sich keine Angaben im Artikel, allerdings ist die Zahl der Drop-outs relativ gering (ITT-Population: n=502, Per Protocol-(PP)-Population: n=473) 23 Vergleichbarkeit der Gibt es relevante Unterschiede zwischen den Behandlungsgruppen Behandlungsgruppen x bei Studienbeginn (Baseline)? Etwas niedrigere Werte in der VCD- Gruppe bzgl. WHO-Performance-Status, ansonsten keine relevanten Unterschiede □ in der Durchführung der Intervention? Keine relevanten Unterschiede 24 Ergebnisse und ihre Siehe Ergebnisdarstellung unten Darstellung 25 Unerwünschte Sind unerwünschte Ereignisse (UEs/AEs) berichtet? ja Therapiewirkung Sind schwerwiegende UEs (SUEs/SAEs) berichtet? ja Wurde der Bezug zur Behandlung beurteilt? ja 26 Fazit der Autoren VCD-Induktionstherapie ist genauso effektiv wie PAd- Induktionstherapie bzgl. der Erreichung einer ⩾ VGPR-Rate, bei einer geringeren Progressive-Disease-(PD)-Rate, 0.4% vs. 4.8%, p = 0.003 und einem günstigeren Toxizitätsprofil (SAE-Rate 24,0% vs. 32,7%, p=0,04). Aus diesem Grund ist die VCD-Induktionstherapie der PAd- Induktionstherapie vorzuziehen. 27 Abschließende Bewertung Die Studie besitzt eine hohe Relevanz aufgrund ihres prospektiven durch den Bearbeiter u.a. randomisiert-kontrollierten Designs und der vergleichsweise hohen Bewertung des Fallzahl. Die Methodik ist angemessen und die Validität der Ergebnisse Verzerrungspotentials für für die Fragestellung daher hoch. Da in Deutschland rekrutiert wurde klinisch relevante und die Einschlusskriterien relativ breit gefasst waren, sind die Endpunkte, Auswertung Ergebnisse auf den deutschen Versorgungskontext übertragbar. der Ergebnisse nach dem „Intention To Treat“ (ITT)-Prinzip Zu Feld 24 Ergebnisdarstellung für das erste primäre Zielkriterium Prüftherapie (VCD) Kontrolle (PAd) p-Wert Schätzer und 95% Maß für (10% Konfidenzintervall Zielkriterium Gruppen- non für n % SD n % SD unterschied inferiority Gruppenunterschied margin) ⩾ VGPR- 251 37.0 251 34.3 Differenz 2.8% 0.001 Rate (ITT) (VCD-PAd) (-6.8% ; 12.3%) ⩾ VGPR- 240 38.3 233 36.9 Differenz 1.4% 0.005 Rate (PP) (VCD-PAd) (-8.6% ; 11.4%) Ergebnisdarstellung für die PD-Rate Prüftherapie (VCD) Kontrolle (PAd) Maß für Zielkriterium Gruppen- p-Wert N % n % unterschied PD-Rate 251 0.4 251 4.8 Differenz 0.003 (ITT) (VCD-PAd) Ergebnisdarstellung für die AE-, SAE- und Sterberaten Prüftherapie (VCD) Kontrolle (PAd) Maß für Zielkriterium Gruppen- p-Wert N % n % unterschied Any-AE- 250 64.0 248 61.3 Differenz 2.7 0.58 Rate (Safety (VCD-PAd) Population) Any-SAE- 250 24.0 248 32.7 Differenz -8.7 0.04 Rate (Safety (VCD-PAd) Population) Sterberate 250 0.4 248 2.4 Differenz -2.0 - (Safety (VCD-PAd) Population) Extraktionsbogen B Nr. Feld Stand der Bearbeitung 06.05.2019 1 Quelle Moreau et al.: VTD is superior to VCD prior to intensive therapy in multiple myeloma: results of the prospective IFM2013-04 trial. Blood (2016) 127: 2569-74. 2 Studientyp vom Autor Open-label phase 3 prospective randomized trial bezeichnet als 3 Studientyp nach Zuordnung zu einem der folgenden Studientypen: Durchsicht □ Metaanalyse □ Systematischer Review □ Selektiver Review x Therapiestudie mit randomisierter Gruppenzuteilung □ Therapiestudie mit nicht-randomisierter Gruppenzuteilung □ Therapiestudie mit externen Vergleichen (z. B. historische Kontrollen) □ Therapiestudie ohne Vergleichsgruppen (auch Beobachtungsstudien und Anwendungsbeobachtungen) □ Fall-Kontrollstudien □ Fallserie □ Fallbericht / Kasuistik (case report) □ Nicht eindeutig zuzuordnen Falls Therapiestudie: □ mit Placebokontrolle(n) x mit Aktivkontrolle(n) □ mit Dosisgruppen □ sonstige Kontrollgruppe(n): Nennen 4 Formale Evidenzkriterien □ 1++: Qualitativ hochwertige Metaanalyse bzw. systematischer Review gemäß SIGN von RCTs oder RCT mit sehr geringem Risiko von Bias x 1+: Gut durchgeführte Metaanalyse bzw. systematischer Review von RCTs oder RCT mit geringem Risiko von Bias □ 1-: Metaanalyse bzw. systematischer Review von RCTs oder RCT mit hohem Risiko von Bias □ 2++: Qualitativ hochwertiger systematischer Review von Fallkontroll oder Kohortenstudien oder qualitativ hochwertige Fallkontroll- oder Kohortenstudie mit sehr geringem Risiko von Confounding, Bias oder Zufallsschwankungen und hoher Wahrscheinlichkeit, so dass der Zusammenhang kausal ist □ 2+: Gut durchgeführte Fallkontroll- oder Kohortenstudie mit niedrigem Risiko von Confounding, Bias oder Zufallsschwankungen und einer mittleren Wahrscheinlichkeit, so dass der Zusammenhang kausal ist □ 2-: Fallkontroll- oder Kohortenstudie mit hohem Risiko von Confounding, Bias oder Zufallsschwankungen und einem signifikanten Risiko, so dass der Zusammenhang nicht kausal ist □ 3: Andere Studien wie Einzelfallberichte, Fallserien □ 4: Expertenmeinung 5 Bezugsrahmen Sponsor: Centre Hospitalier Universitaire (CHU) de Nantes (EudraCT No. 2013-003174-27) Korrespondenz der Publikation durch P. Moreau: Centre Hospitalier Iniversitaire (CHU) de Nantes, Place Alexis Ricordeau, 44093 Nantes, France kein offensichtlicher Hinweis auf relevante Interessenkonflikte. 6 Indikation Neu diagnostiziertes Multiples Myelom (MM) Behandlungsziel: very good partial response (VGPR) or better, ⩾ VGPR 7 Primäre Fragestellung / Vergleich von Bortezomib-Thalidomid-Dexamethason-(VTD) primäre Zielsetzung(en) Induktionstherapie mit Bortezomib-Cyclophosphamide-Dexamethason (VCD)-Induktionstherapie vor Hochdosis-Chemotherapie (HDT) und autologer Stammzelltransplantation (ASCT) bzgl. ⩾ VGPR 8 Relevante Ein- und Einschlusskriterien: (i) Alter 18-65 Jahre, (ii) unbehandeltes Ausschlusskriterien symptomatisches MM, Paraprotein messbar in Serum (> 1 g/dL) oder Urin (> 0.2 g/24 h), (iii) Eastern Cooperative Oncology Group performance status ≤ 2, (iv) adäquate Nierenfunktion Ausschlusskriterien: (i) Amyloidose (bestätigt), (ii) HIV-positiv, (iii) zuvor aufgetretene andere Malignome (außer Basalzellkarzinom und Zervixkarzinom in situ), (iv) Diabetes (nicht kontrolliert), (v) Periphere Neuropathie vom Grad ⩾ 2 (National Cancer Institute Common Toxicity Kriterien, Version 4.0) 9 Prüfintervention VTD-Induktionstherapie wie folgt: Bortezomib 1.3 mg/m2 subkutan an Tagen 1, 4, 8 und 11; Dexamethason 40 mg an Tagen 1-4 und 9-12; Thalidomid 100 mg/Tag oral (insg. vier dreiwöchige Zyklen) Empfohlene Begleitmedikation: Bisphosphonate, Antibiotika, antivirale Prophylaxe, Enoxaparin Stammzellmobilisierung mit 3 g/m2 Cyclophosphamide + 10 mg/kg Granulozyten-Makrophagen-Kolonie-stimulierender Faktor nach Zyklus 3 und vor Zyklus 4 Wahl von Konditionierung und/oder Erhaltungstherapie wurde den Zentren bzw. den behandelnden ÄrztInnen überlassen Anmerkung: Festlegung von Prüf- und Vergleichsintervention ist hier schwierig, da diese Terminologie im Manuskript nicht verwendet wird und die Therapiearme in der Studie „gleichberechtigt“ behandelt wurden. Aufgrund der arzneimittelrechtlichen Zulassung ist VTD als Standardarm einzuordnen. 10 Vergleichsintervention VCD-Induktionstherapie wie folgt: Bortezomib 1.3 mg/m2 subkutan an Tagen 1, 4, 8 und 11; Dexamethason 40 mg an Tagen 1-4 und 9-12; Cyclophosphamide 500 mg/m2 oral an Tagen 1, 8 und 15 (insg. vier dreiwöchige Zyklen) Empfohlene Begleitmedikation: Bisphosphonate, Antibiotika, antivirale Prophylaxe, Stammzellmobilisierung mit 3 g/m2 Cyclophosphamide + 10 mg/kg Granulozyten-Makrophagen-Kolonie-stimulierender Faktor nach Zyklus 3 und vor Zyklus 4 Wahl von Konditionierung und/oder Erhaltungstherapie wurde den Zentren bzw. den behandelnden ÄrztInnen überlassen 11 Evtl. weitere - Behandlungsgruppen 12 Subgruppen Analysiert die Studie Subgruppen, die für die Fragestellung an die Kommission relevant sind? x keine relevanten Subgruppen □ prospektiv geplante Subgruppenauswertung □ post hoc definierte oder in Auswertung gefundene Subgruppen 13 Studiendesign x Parallelgruppendesign □ Cross-Over Design □ Prae-Post-Vergleich □ Sonstige:...... Zwei Behandlungsarme Angaben zu geplanter Fallzahl und Power-Kalkulation finden sich im Statistik-Teil des Artikels, keine geplanten Zwischenauswertungen Stratifikation nach ISS, und Zytogenetik 14 Zentren 56 Zentren Vergleichbarkeit der Studiendurchführung in den einzelnen Zentren ist schwer zu beurteilen. Heterogenität ist vermutlich gering, da alle Zentren zur Intergroupe Francophone du Myelome (IFM) gehörten 15 Randomisierung Randomisierung wird kurz beschrieben; allerdings werden keine Angaben zur Randomisierungssequenz gemacht. Randomisierung erfolgte zentral, so dass von Concealment ausgegangen werden kann. 16 Verblindung der x Keine Verblindung (offene Behandlung) Behandlung □ Patienten verblindet □ Behandler verblindet □ Beurteiler verblindet (z.B. bei Bildgebung) 17 Beobachtungsdauer Durchführung der Studie zwischen November 2013 und März 2015 Auswertung basiert auf Studiendaten von August 2015 (keine laufende Induktionstherapie mehr zum Zeitpunkt der Analyse) Angaben zu Dauern von Behandlung und Beobachtung und zur Zeit bis zur Beurteilung der (mindestens) VGPR fehlen. Dosisintensität war im VCD Arm etwas höher als im VTD Arm. 18 Primäre Zielkriterien Primäres Zielkriterium n.A. der Autoren: Vergleich von Induktionstherapie mit VTD im Vergleich zu Induktionstherapie mit VCD bzgl. VGPR (Anm.: die statistische Analyse erfolgte tatsächlich nicht bzgl. VGPR, sondern bzgl. ≥ VGPR) Erfassung des primären Zielkriteriums zentral gem. Kriterien der International Myeloma Working Group. Keine Angabe zu Qualifikation und/oder Schulung des erfassenden Personals. 19 Sekundäre Zielkriterien Sekundäre Zielkriterien u.a.: (i) complete response (CR), (ii) overall response (≥ partial response), (iii) Sicherheit von Induktionstherapie und Stammzellentnahme 20 Statistische Methoden für Signifikanzniveau für erstes primäres Zielkriterium: 5% zweiseitig die Analyse der primären Test auf Unterschiede zwischen VTD und VCD bzgl. VGPR mit Hilfe Endpunkte von Chi-Quadrat-Tests (Anm.: die statistische Analyse erfolgte tatsächlich nicht bzgl. VGPR, sondern bzgl. ≥ VGPR) Berechnung von 95%-Konfidenzintervallen für Differenzen der VGPR- Raten (ohne genaue Angabe der Methodik). Prüfhypothese war ein Vorteil in der VGPR-Rate (tatsächlich gemeint als Ansprechen > VGPR) von 15% bei einer angenommenen VGPR- Rate von 45% bei VCD und 60% bei VTD. Die Fallzahlplanung (340 Fälle) war ausgerichtet auf eine Power von 80% für den Nachweis dieser Differenz im zwei seitigen Test auf dem 5% Niveau (Chi-Square Test). 21 Fallzahlplanung Erreichte Fallzahl: 340 PatientInnen randomisiert (Rekrutierungsziel gem. Fallzahlplanung erreicht), 338 PatientInnen in Intention-to-Treat (ITT)-Population Studie dauerte zum Zeitpunkt der Analyse noch an 22 Zahl und Charakteristika Differenzierte Darstellung nach Behandlungsgruppen vorhanden? ja der eingeschlossenen und Darstellung des Patientenflusses nach CONSORT? ja ausgewerteten Patienten Sind die Ausfälle von Studienteilnehmern (Drop-outs) dokumentiert und begründet? ja Erfolgte eine Intention-to-treat- (ITT-) Analyse? ja Erfolgte eine Per Protocol- (PP-) Analyse? ja Gibt es Hinweise auf systematische und relevante Unterschiede zwischen den Drop-outs und den gemäß Studienprotokoll behandelten Patienten? nein 23 Vergleichbarkeit der Gibt es relevante Unterschiede zwischen den Behandlungsgruppen Behandlungsgruppen x bei Studienbeginn (Baseline)? Etwas höhere Blutplättchen-Zahlen in der VTD-Gruppe, ansonsten keine Hinweise auf relevante Unterschiede □ in der Durchführung der Intervention? 24 Ergebnisse und ihre Siehe Ergebnisdarstellung unten Darstellung 25 Unerwünschte Sind unerwünschte Ereignisse (UEs/AEs) berichtet? ja Therapiewirkung Sind schwerwiegende UEs (SUEs/SAEs) berichtet? ja, es werden ausschließlich AEs vom Grad 3-4 tabellarisch dargestellt Wurde der Bezug zur Behandlung beurteilt? ja 26 Fazit der Autoren Die Ergebnisse der Studie zeigen, dass sowohl VTD- als auch VCD- Induktionstherapie wirksame Therapieregimes sind (PR-Raten > 80%, VGPR-Raten > 50%). Die Toxizitäten der Regimes sind handhabbar, bei Nachteilen in der Hämatotoxizität für VCD (vornehmlich Anämie, Thrombozytopoenie und Neutropoenie) und Nachteilen bei periphere Neuropathie unter VTD. Gleichzeitig legen die 10%igen Unterschiede zugunsten der VTD- Induktionstherapie sowohl bzgl. der PR- als auch der VGPR-Rate nahe, dass die Kombination eines Proteasom-Inhibitors mit Dexamethason und einem immunmodulatorischen Medikament die beste Option vor Intensivtherapie und ASCT darstellt. Die Autoren bemerken , daß die > VGPR Raten dieser Studie deutlich höher waren als diejenigen der Mai et al Studie und sie verweisen auf die Gabe von 4 Zyklen statt 3 Zyklen und eine höhere Dosis von Dexamethason in ihrer Studie. 27 Abschließende Bewertung Die Studie besitzt eine hohe Relevanz aufgrund ihres prospektiven durch den Bearbeiter u.a. randomisierten Designs und der vergleichsweise hohen Fallzahl. Die Bewertung des (etwas knapp und z.T. auch unvollständig dargestellte) Methodik Verzerrungspotentials für erscheint grundsätzlich angemessen und die Validität der Ergebnisse klinisch relevante für die Fragestellung daher hoch. Da in Frankreich rekrutiert wurde und Endpunkte, Auswertung die Einschlusskriterien relativ breit gefasst waren, dürften die der Ergebnisse nach dem Ergebnisse zu einem gewissen Grad auch auf den deutschen „Intention To Treat“ Versorgungskontext übertragbar sein. (ITT)-Prinzip Allerdings unterscheiden sich die Dosierungen von Cyclophosphamid mit 500 mg oral an Tag 1,8 und 15 von derjenigen der Studien in Deutschland. Das Schema von Dexamethason unterscheidet sich mit das Tag 1-4 und 9-12 geringfügig. Zu Feld 24 Ergebnisdarstellung für das primäre Zielkriterium Prüftherapie (VTD) Kontrolle (VCD) Schätzer und 95% Maß für Konfidenzintervall Zielkriterium Gruppen- p-Wert für n % SD n % SD unterschied Gruppenunterschied ⩾ VGPR 169 66.3 169 56.2 Differenz 10.1% 0.05* Rate (ITT) (VTD (1% ; 18%) VCD) ⩾ VGPR 157 70.7 154 60.4 Differenz 10.3% 0.05* Rate (PP) (VTD (2% ; 21%) VCD) * Anm.: Aus den Konfidenzintervallen lässt sich schließen, dass die p-Werte < 0.05 sind (→ Rundungsfehler). Ergebnisdarstellung für die AE/SAE- und Sterberaten Prüftherapie (VTD) Kontrolle (VCD) Maß für Zielkriterium Gruppen- p-Wert N % N % unterschied Any-AE- 169 63.9 169 68.2 Differenz -4.3 0.4 Rate (grade (VTD 3-4, ITT VCD) Population) Sterberate 169 1.2 169 1.8 Differenz -0.6 - (ITT (VTD Population) VCD) Periphere 7,7 2,9 0,05 Neuropathie Grad 3/4 PN 21,9 12,9 0,008 Grad 2 - 4 Neurozytop 18,9 33,3 0,003 enie Grad 3/4 Infektion 7,7 10,1 0,45 Grad 3/4