Autologous Stem Cell Transplantation in Multiple Myeloma Patients Over 60 Years Old

The incidence of Multiple myeloma (MM) increases with age; two-thirds of the patients are older than 65 years. Induction treatment, including new agents such as thalidomide, bortezomib, and lenalidomide followed by a conditioning regimen and upfront autologous stem cell transplantation (ASCT), has been accepted the standard treatment approach for newly diagnosed fit MM patients. We aimed to search the real-life data, the efficacy and safety of upfront ASCT following induction in patients with MM over 60 years old retrospectively. The data of MM patients who were ≥60 years old during autologous stem cell transplantation and treated at our center between 2010 and 2018 retrospectively analyzed. The study results were 63 patients included at the age of ≥ 60 years who underwent upfront ASCT. Median PFS was 15.5±2.6 months, and the median overall survival (OS) was 28.15±5 months. According to age groups, median PFS was 12±2.3 months in the 60-64 age group, 18.4±6 months in the 65-69 age group, and 26±15 months in the ≥70 age group. Median OS was 26.5±6.1 months in the 60-64 age group, 39.66±8.9 months in the 65-69 age group, and 18 months in the ≥70 age group. A significant relationship between the quantity of infused CD34+ stem cells and PFS and OS (p:0.05 and

Does the Combination of a Proteasome Inhibitor, Lenalidomide, and Dexamethasone Reduce Fatigue in Patients with Relapsed or Refractory Multiple Myeloma?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not “the combination of a proteasome inhibitor, lenalidomide, and dexamethasone reduce fatigue in patients with relapsed or refractory multiple myeloma (RRMM)?” STUDY DESIGN: A systematic review of three English language open-label clinical trials with one published in 2013 and two published in 2016. DATA SOURCES: Two randomized open-label, phase 3 clinical trials and one open-label phase 2 cohort study found using PubMed and Cochrane Library. All sources were published in peer-reviewed journals. OUTCOME MEASURED: Fatigue was the outcome measured in all three studies utilizing Common Terminology Criteria for AEs (version 3.0) or European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire core 30 module (EORTC QLQ-C30) and myeloma-specific module (QLQ-MY20). RESULTS: In the cohort study conducted by Wang et al. (Blood. 2013;122(18):3122–3128. doi:10.1182/blood-2013-07-511170.), showed no reduction in fatigue in the maximum planned dose (MPD) of carfilzomib, lenalidomide, and dexamethasone group compared to the other cohorts. The MPD group reported fatigue 69.2% compared to 65.5% overall. The RCT performed by Stewart et al. (J Clin Oncol. 2016;34(32):3921–3930. doi:10.1200/JCO.2016.66.9648.) found no statistical significance in reduction of fatigue between the carfilzomib, lenalidomide, and dexamethasone (KRd) group and control group (-0.46 in favor of KRd, p=0.71); however, both groups had statistically significant mean change from baseline of worsening fatigue in multiple cycles (p\u3c0.05). Lastly, in a double-blind RCT by Moreau et al. (N Engl J Med. 2016;374(17):1621–1634. doi:10.1056/NEJMoa1516282.), there was no significant difference in fatigue reduction between the ixazomib group and placebo group. CONCLUSIONS: Based on analysis of these studies, the combination of a proteasome inhibitor, lenalidomide, and dexamethasone does not reduce fatigue in patients with relapsed or refractory multiple myeloma. Future studies need to be designed in order to evaluate the effectiveness in fatigue reduction in patient with relapsed or refractory multiple myeloma

Effectiveness of an Algorithm-Based Approach to the Utilization of Plerixafor in Patients Undergoing Chemotherapy-Based Stem Cell Mobilization

AbstractAutologous stem cell transplantation remains a mainstay of therapy for diseases such as multiple myeloma and relapsed lymphoma. The use of plerixafor has been shown to augment the ability to collect adequate stem cells, but the optimal use of this agent when used with chemotherapy is not yet clear. We utilized an algorithm-based approach with the addition of plerixafor to 54 patients undergoing chemomobilization with reduced-dose etoposide who had a less than optimal preapheresis CD34+ cell count. We used a CD34+ precount of 20 cells/μL as a threshold to initiate stem cell apheresis. Ninety-four percent of patients were successfully collected and proceeded to transplantation. Fourteen of 51 (28%) patients who successfully collected required plerixafor to augment stem cell yield. Of the patients who successfully collected, 94% (89% of the entire population) were able to collect in 2 or fewer days. Compared with previous data from our institution, the rate of patients collecting > 4 × 106 CD34+ cells/kg in a single collection was increased from 39% to 69%. The safety profile of this approach was acceptable. The use of this algorithm-based method to determine when and whether to add plerixafor to chemomobilization was shown to be a successful and cost-effective approach to stem cell collection

Candidemia in Acute Leukemia Patients

Fungal infections are an important cause of morbidity and mortality in patients with acute leukemia (AL). Candidemia, once rare, is now a common nosocomial infection because of the intensity of chemotherapy, prolonged neutropenia, administration of broad-spectrum antibiotics and use of central venous catheters (CVC). We retrospectively identified patients treated for AL from 6/86 to 6/95 who also had candidemia. We describe 28 patients (incidence 6.3%) with a median age of 39 years, 24 of whom were on remission induction and 4 on postremission chemotherapy. All patients had CVC and empiric antimicrobial therapy, 4 had been given prophylactic antifungal drugs, and 2 had parenteral nutrition. Neutropenia was profound (median leukocyte nadir 200/microliters, median duration 19 days). Candida was isolated in blood cultures 10 days (median) after the start of neutropenia. The clinical presentation included fever (100%), respiratory symptoms (71.4%), skin lesions (39.2%) and septic shock (17.8%). Amphotericin B was given to 17 patients and liposomal amphotericin to 5 patients. Infection resolved in 18 patients (64.2%). 10 of whom were in complete remission. Mortality from candidemia was 17.8% (5/28). In conclusion, fungal infections are responsible for death in a significant number of patients. In our series treatment success was related to its rapid onset and to the recovery of neutropenia