TY - JOUR A1 - Bachmann, Friederike A1 - Schreder, Martin A1 - Engelhardt, Monika A1 - Langer, Christian A1 - Wolleschak, Denise A1 - Mügge, Lars Olof A1 - Dürk, Heinz A1 - Schäfer-Eckart, Kerstin A1 - Blau, Igor Wolfgang A1 - Gramatzki, Martin A1 - Liebisch, Peter A1 - Grube, Matthias A1 - Metzler, Ivana v. A1 - Bassermann, Florian A1 - Metzner, Bernd A1 - Röllig, Christoph A1 - Hertenstein, Bernd A1 - Khandanpour, Cyrus A1 - Dechow, Tobias A1 - Hebart, Holger A1 - Jung, Wolfram A1 - Theurich, Sebastian A1 - Maschmeyer, Georg A1 - Salwender, Hans A1 - Hess, Georg A1 - Bittrich, Max A1 - Rasche, Leo A1 - Brioli, Annamaria A1 - Eckardt, Kai-Uwe A1 - Straka, Christian A1 - Held, Swantje A1 - Einsele, Hermann A1 - Knop, Stefan T1 - Kinetics of renal function during induction in newly diagnosed multiple myeloma: results of two prospective studies by the German Myeloma Study Group DSMM JF - Cancers N2 - Background: Preservation of kidney function in newly diagnosed (ND) multiple myeloma (MM) helps to prevent excess toxicity. Patients (pts) from two prospective trials were analyzed, provided postinduction (PInd) restaging was performed. Pts received three cycles with bortezomib (btz), cyclophosphamide, and dexamethasone (dex; VCD) or btz, lenalidomide (len), and dex (VRd) or len, adriamycin, and dex (RAD). The minimum required estimated glomerular filtration rate (eGFR) was >30 mL/min. We analyzed the percent change of the renal function using the International Myeloma Working Group (IMWG) criteria and Kidney Disease: Improving Global Outcomes (KDIGO)-defined categories. Results: Seven hundred and seventy-two patients were eligible. Three hundred and fifty-six received VCD, 214 VRd, and 202 RAD. VCD patients had the best baseline eGFR. The proportion of pts with eGFR <45 mL/min decreased from 7.3% at baseline to 1.9% PInd (p < 0.0001). Thirty-seven point one percent of VCD versus 49% of VRd patients had a decrease of GFR (p = 0.0872). IMWG-defined “renal complete response (CRrenal)” was achieved in 17/25 (68%) pts after VCD, 12/19 (63%) after RAD, and 14/27 (52%) after VRd (p = 0.4747). Conclusions: Analyzing a large and representative newly diagnosed myeloma (NDMM) group, we found no difference in CRrenal that occurred independently from the myeloma response across the three regimens. A trend towards deterioration of the renal function with VRd versus VCD may be explained by a better pretreatment “renal fitness” in the latter group. KW - multiple myeloma KW - renal failure KW - kidney KW - bortezomib KW - lenalidomide KW - induction regimen Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234139 SN - 2072-6694 VL - 13 IS - 6 ER - TY - JOUR A1 - Merz, Maximilian A1 - Dechow, Tobias A1 - Scheyt, Mithun A1 - Schmidt, Christian A1 - Knop, Stefan T1 - The clinical management of lenalidomide-based therapy in patients with newly diagnosed multiple myeloma JF - Annals of Hematology N2 - Lenalidomide is an integral, yet evolving, part of current treatment pathways for both transplant-eligible and transplant-ineligible patients with newly diagnosed multiple myeloma (NDMM). It is approved in combination with dexamethasone as first-line therapy for transplant-ineligible patients with NDMM, and as maintenance treatment following autologous stem cell transplantation (ASCT). Although strong clinical trial evidence has supported the integration of lenalidomide into current treatment paradigms for NDMM, applying those paradigms to individual patients and determining which patients are most likely to benefit from lenalidomide treatment are more complex. In this paper, we utilize the available clinical trial evidence to provide recommendations for patient selection and lenalidomide dosing in both the first-line setting in patients ineligible for ASCT and the maintenance setting in patients who have undergone ASCT. In addition, we provide guidance on management of those adverse events that are most commonly associated with lenalidomide treatment, and consider the optimal selection and sequencing of next-line agents following long-term frontline or maintenance treatment with lenalidomide. KW - adverse events KW - lenalidomide KW - multiple myeloma KW - newly diagnosed KW - safety Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-231862 SN - 0939-5555 VL - 99 ER - TY - JOUR A1 - Hose, Dorothea A1 - Schreder, Martin A1 - Hefner, Jochen A1 - Bittrich, Max A1 - Danhof, Sophia A1 - Strifler, Susanne A1 - Krauth, Maria-Theresa A1 - Schoder, Renate A1 - Gisslinger, Bettina A1 - Einsele, Hermann A1 - Gisslinger, Heinz A1 - Knop, Stefan T1 - Elotuzumab, pomalidomide, and dexamethasone is a very well tolerated regimen associated with durable remission even in very advanced myeloma: a retrospective study from two academic centers JF - Journal of Cancer Research and Clinical Oncology N2 - Background The anti-SLAMF7 monoclonal antibody, elotuzumab (elo), plus lenalidomide (len) and dexamethasone (dex) is approved for relapsed/refractory MM in the U.S. and Europe. Recently, a small phase 2 study demonstrated an advantage in progression-free survival (PFS) for elo plus pomalidomide (pom)/dex compared to pom/dex alone and resulted in licensing of this novel triplet combination, but clinical experience is still limited. Purpose To analyze the efficacy and safety of elo/pom/dex in a “real world” cohort of patients with advanced MM, we queried the databases of the university hospitals of Würzburg and Vienna. Findings We identified 22 patients with a median number of five prior lines of therapy who received elo/pom/dex prior to licensing within an early access program. Patients received a median number of 5 four-week treatment cycles. Median PFS was 6.4 months with 12-month and 18-month PFS rates of 35% and 28%, respectively. The overall response rate was 50% and 64% of responding patients who achieved a longer PFS with elo/pom/dex compared to their most recent line of therapy. Objective responses were also seen in five patients who had been pretreated with pomalidomide. Low tumor burden was associated with improved PFS (13.5 months for patients with ISS stage I/II at study entry v 6.4 months for ISS III), although this difference did not reach statistical significance. No infusion-related reactions were reported. The most frequent grade 3/4 adverse events were neutropenia and pneumonia. Conclusion Elo/pom/dex is an active and well-tolerated regimen in highly advanced MM even after pretreatment with pomalidomide. KW - multiple myeloma KW - elotuzumab KW - SLAMF7 KW - pomalidomide KW - lenalidomide Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235762 SN - 0171-5216 VL - 147 ER - TY - THES A1 - Hoffmann, Carolin T1 - Lenalidomid und Dexamethason in Kombination mit verschiedenen Zytostatika bei intensiv vortherapierten Patienten mit refraktärem oder rezidiviertem multiplem Myelom und primär systemischer Amyloidose T1 - Lenalidomide and dexamethason in combination with intensely pretreated patients with refractory or relapsed multiple myeloma and primary systemic amyloidosis N2 - Das multiple Myelom ist eine Erkrankung der Plasmazellen mit einer unkontrollierten Produktion an Immunglobulinen und macht etwa 10% aller hämatologischen Erkrankungen aus. Bisher stellt die Stammzelltransplantation für die jüngeren Patienten und die Chemotherapie für die älteren Erkrankten die Standardtherapie für diese unheilbare Krankheit dar. Fast immer kommt es allerdings zu einem Rezidiv. Für eine solche Situation gibt es bisher kein festes Behandlungsschema. In den letzten Jahren ist es jedoch gelungen, neue Medikamente zu entwickeln, die sowohl effektiver als auch nebenwirkungsärmer sind. Zu diesen zählen unter anderem die sogenannten IMiDs (immun modulatory drugs), denen auch Lenalidomid (Revlimid®) angehört. In dieser klinischen, retrospektiven Arbeit werden die Wirkung und die nicht- hämatotoxischen Nebenwirkungen von Lenalidomid und Dexamethason in Kombination mit verschiedenen Zytostatika bei intensiv vortherapierten, refraktären oder rezidivierten Myelom- Patienten und einem an einer primär systemischen Amyloidose Erkrankten analysiert. Da diese Untersuchung in einer sehr frühen Entwicklungsphase des Immunmodulators Revlimid® stattfand, war die Substanz noch nicht auf dem deutschen Markt zugelassen. Deswegen wurde die Studie mit insgesamt 21 Teilnehmern im Rahmen eines sogenannten „named patient programme“ in Zusammenarbeit mit der Europäische Arzneimittelagentur (EMEA) noch vor der Zulassung der Substanz durchgeführt. Insgesamt wurde eine Ansprechrate von 42% und ein durchschnittliches EFS- Intervall von 8,3 Monaten erreicht. Weiterhin stellte die Analyse, wie schon viele Studien davor, fest, dass Lenalidomid von diesem Patientenkollektiv alles in allem gut toleriert wurde. Mit einer ausreichenden Supportivtherapie gelang es in den meisten Fällen die aufgetretenen Nebenwirkungen schnell unter Kontrolle zu bringen. Dieser Erfolg war auch in Spezialfällen, wie zum Beispiel bei Patienten mit vorbestehender Niereninsuffizienz oder einer zusätzlichen Faktor V- Leiden- Mutation, zu beobachten. Außerdem schien der Zusatz von weiteren Chemotherapeutika keine Potenzierung der Nebenwirkungen hervorzurufen. Im Gegenteil, die Grunderkrankung konnte damit noch effektiver zurückgedrängt werden. Der Patient mit der primär systemischen Amyloidose, der zuvor keine Vorbehandlungen erhalten hatte, vertrug die Behandlung trotz der ausgeprägten gastroenterologischen und kardialen Mitbeteiligung ein Jahr lang sehr gut. Ansonsten ist dieses neuere IMiD auch für ältere Patienten geeignet. Diese wiesen trotz ihrer multiplen Komorbiditäten eine gute Verträglichkeit und Wirkung auf. Auch eine Vortherapie mit Thalidomid und der häufig damit assoziierten PNP, stellt keine Kontraindikation für die Behandlung dar. Im Unterschied zur Zulassungsstudie wurde in dieser Untersuchung ein reales Patientenkolletiv untersucht. Das bedeutet, dass die Probanden beispielsweise bereits mehr als drei Vortherapien hatten und zum Teil deutlich älter als 65 Jahre waren. Trotz dieser erschwerten Bedingungen konnten abermals objektive Remissionen erreicht werden. Die zusätzliche Erfassung des sogenannten „QoL (Quality of Life)- Indexes“ wäre wünschenswert gewesen. Dadurch wäre zu evaluieren gewesen, ob neben einer objektiven Reduktion der Myelom- Parameter auch eine Symptomverbesserung eingetreten ist. N2 - Multiple myeloma is a clonal plasma cell malignancy with an uncontrolled production of immunoglobulins that accounts for slightly more than 10% of all hematologic diseases. Currently, the standard treatment for this incurable However, in most cases the relaps occur and no guidelines exist for treatment of relapses. But during the last few years, new drugs for the treatment of myeloma have become available which are more effective and have fewer side effects compared to older drug treatments. One of these new substrates is the immune modulatory drug (IMiD) lenalidomide (revlimid®). This clinical, retrospective study analyses the efficacy and non- hematologic adverse events of lenalidomide and dexamethasone in combination with several cytostatic drugs at intensively pretreated, refractory or relapsed myeloma patients and a patient with primary systemic amyloidosis. Due to the fact that this analysis as conducted at an early stage of the development of the IMiD revlimid®, the drug was not approved in germany. Therefore, the study with a total of 21 patients was based on a so called “named patient programme” and conducted in cooperation with the European Medicines Agency (EMA). Overall, a response rate of 42% and an average event-free survival of 8,3 months was achieved. Tolerability of the drug was good, which is in line with numerous previous publications. Eventual adverse events could be controlled by suffient supportive therapy. This success was also seen in special cases like patients with a preexisting renal insuffiency or an additional factor V Leiden mutation. Moreover, adding another cytostatic drug did not obviously increase in side effects, but helped control the disease more effectively. The patient with the primary systemic amyloidosis, who was not pretreated, tolerated the treatment very well for one year despite of the gastrointestinal and cardiac involvement. Apart from that this new IMiD is also a treatment option for older patients. They showed good tolerability and effects despite of the underlying multimorbidity. Also the pretreatment with thalidomide and its often associated polyneuropathy was no contraindication for the therapy with lenalidomide. In contrast to the pivotal study, this analysis investigated a real patient group, e.g. including patients with more than three pretreatments or being older than 65 years of age. Nevertheless, also in this study group a good objective remission was achieved. An additional evaluation of the “quality of life”- index would have been desirable, helping to conclude if an objective remission of the paraprotein level coincides with a considerable improvement. KW - Plasmozytom KW - Amyloidose KW - Lenalidomid KW - multiples Myelom KW - refraktär und rezidiviert KW - primär systemische Amyloidose KW - lenalidomide KW - multiple myeloma KW - refractory or relapsed KW - primary systemic amyloidosis Y1 - 2010 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-57195 ER -