Treatment of relapsed refractory multiple myeloma: which new PI-based combination treatments do patients prefer?

Thomas Wilke,1 Sabrina Mueller,2 Sabine Bauer,2 Silvia Pitura,3 Leona Probst,3 Boris A Ratsch,3 Hans Salwender4 1Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), 23966 Wismar, Germany; 2Ingress-Health, 23966 Wismar, Germany; 3Takeda Pharma Vertrieb GmbH & Co. KG, 10117 Berlin, Germany; 4Asklepios Kliniken Hamburg GmbH, 22763 Hamburg, Germany Background and objectives: This study describes preferences of German relapsed refractory multiple myeloma (RRMM) patients with novel proteasome inhibitor-based combination treatments.Methods: Patients with a minimum age of 18 years and a diagnosis of RRMM were included. Their preferences were assessed using a discrete choice experiment design, which was developed based on a literature review and two patient focus group discussions. The final discrete choice experiment design consisted of four attributes, namely “therapy application regimen,” “time without progression of disease,” “possibility of grade ≥3 adverse events (AEs) affecting the blood,” and “possibility of grade ≥3 AE heart failure.”Results: Analysis was based on 84 patients (36.9% females, mean age 62.7 years, mean multiple myeloma disease duration 5.5 years). Among the tested attributes, “therapy application regimen” was assigned the highest importance for treatment decisions (38.8%), the second important attribute was “time without progression of disease” (38.7%), followed by “possibility of AE heart failure” (13.9%) and “possibility of AEs affecting the blood” (8.6%). Patients preferred oral intake once a day and once a week over other application modes such as oral intake once a day and once a week plus twice-weekly infusions. Furthermore, they preferred longer disease progression-free time and lower risk of grade ≥3 AEs. The highest overall utility was derived for ixazomib + lenalidomide + dexamethasone (utility: 3.218), compared with lenalidomide + dexamethasone (2.769), and carfilzomib + lenalidomide + dexamethasone (1.928).Conclusion: RRMM patients prefer treatments with an all-oral application, a longer disease-progression-free time, and a lower probability of AEs. If patients face tradeoffs, they accept a lower progression-free time and/or higher AE rates to get an all-oral therapy. Keywords: MM patient’s treatment preferences, relapsed refractory multiple myeloma, RRMM, discrete choice experiment, DC

Impact of growing conditions and foliar nutrition on growth and development of Spanish bluebell (Hyacinthoides hispanica (Mill.) Rothm.)

Hyacinthoides hispanica (Mill.) Rothm. is a valuable bulbous ornamental plant grown in parks and gardens. It comes from the Iberian Peninsula, hence its cultivation under Polish conditions may be inefficient. The purpose of the study was to determine the effect of growing conditions and foliar feeding using phosphorous fertilizer on the growth and decorative qualities of H. hispanica. It was found that the pine bark layer effectively protected the plants from freezing, which had a beneficial effect on their growth and flowering characteristics. Flowering of plants grown without the mulch was minimal, which clearly indicates that mulching of the soil under H. hispanica can be necessary. Plants grown using the mulch produced more and longer leaves, and also formed more inflorescences and fruits as well as longer inflorescence stems. The addition of peat to the soil did not favour the growth and decorative qualities of H. hispanica, while foliar nutrition with phosphorous had a positive effect. In addition, the decorative values of H. hispanica were influenced by the interaction of soil mulching with bark and foliar feeding. Plants grown in this combination had more inflorescences, which were higher, composed of more flowers in the inflorescence and reached a greater diameter than non-fertilized ones. Tested cultivars of H. hispanica differed in their features of growth and flowering