Deepening responses associated with improved progression-free survival with ixazomib versus placebo as posttransplant maintenance in multiple myeloma

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Quality of life and symptoms among patients with relapsed/refractory AL amyloidosis treated with ixazomib-dexamethasone versus physician's choice

Patient-reported outcomes in AL amyloidosis have not been well-studied. We analyzed health-related quality of life (HRQOL) and AL amyloidosis symptoms data from the phase 3 TOURMALINE-AL1 trial (NCT01659658) (ixazomib-dexamethasone, n = 85; physician's choice of chemotherapy [PC], n = 83). HRQOL and symptom burden were measured with the SF-36v2, Functional Assessment of Cancer Therapy/Gynecologic Oncology Group Neurotoxicity subscale (FACT/GOG-Ntx), and an amyloidosis symptom questionnaire (ASQ). Score changes during treatment were analyzed descriptively and using repeated-measures linear mixed models; analyses were not adjusted for multiplicity. Least-squares (LS) mean changes from baseline were significantly higher (better HRQOL) for ixazomib-dexamethasone at several cycles for SF-36v2 Role Physical and Vitality subscales (p <.05); no subscales demonstrated significant differences favoring PC. For FACT/GOG-Ntx, small but significant differences in LS mean changes favored ixazomib-dexamethasone over PC at multiple cycles for seven items and both summary scores; significant differences favored PC for one item (trouble hearing) at multiple cycles. ASQ total score trended downward (lower burden) in both arms; significant LS mean differences favored ixazomib-dexamethasone over PC at some cycles (p <.05). Patients with relapsed/refractory AL amyloidosis treated with ixazomib-dexamethasone experienced HRQOL and symptoms that were similar to or trended better than patients treated with PC despite longer duration of therapy

A phase 1/2 trial of HQK-1001, an oral fetal globin inducer, in sickle cell disease

Therapeutics which reduce the pathology in sickle cell syndromes are needed, particularly non-cytotoxic therapeutics. Fetal hemoglobin (HbF, α2γ2) is established as a major regulator of disease severity; increased HbF levels correlate with milder clinical courses and improved survival. Accordingly, sodium dimethylbutyrate (HQK-1001), an orally-bioavailable, promoter-targeted fetal globin gene-inducing agent, was evaluated in a randomized, blinded, dose-ranging Phase I/II trial in 24 adult patients with HbSS or S/β thalassemia, to determine safety and tolerability of three escalating dose levels. The study therapeutic was administered once daily for two 6-week cycles, with a 2-week interim dose holiday. Twenty-one patients completed the study. Five patients received study drug at 10 or 20 mg/kg doses, seven patients received study drug at 30 mg/kg/dose, and 4 patients received placebo. HQK-1001 was well-tolerated with no unexpected drug-related adverse events; a dose-limiting toxicity was not identified. Plasma drug levels were sustained above targeted levels for 24 hours. Increases in HbF above baseline were observed particularly with 30 mg/kg/day doses; in five of seven treated patients, a mean absolute increase in HbF of 0.2 g/dl and a mean increase in total hemoglobin (Hgb) of 0.83 g/dl above baseline were observed, whereas no increases occurred in placebo-treated controls. These findings of favorable PK profiles, tolerability, early rises in HbF and total Hgb indicate that trials of longer duration appear warranted to more definitively evaluate the therapeutic potential of HQK-1001 in sickle cell disease

Timing of detachment faulting in the Bullfrog Hills and Bare Mountain area, southwest Nevada: Inferences from 40Ar/39Ar, K-Ar, U-Pb and fission track thermochronology

Crustal extension in the Bullfrog Hills and Bare Mountain area of southwest Nevada is associated with movement along a regional detachment fault. Normal faulting in the upper plate and rapid cooling (denudation) of the lower plate were coeval with Miocene silicic volcanism and with west-northwest transport along the detachment fault. A west-northwest progression of tilting along upper plate normal faults is indicated by ages of the volcanic rocks in relation to angular unconformities. Near the breakaway, tilting in the upper plate occurred between 12.7 and 11.6 Ma, continued less strongly past 10.7 Ma, and was over by 8.2 Ma. Ten to 20 km west of the breakaway, tilting occurred between 10.7 and 10.33 Ma, continued less strongly after 10.33 Ma, and was over by 8.1 Ma. The cooling histories of the lower plate metamorphic rocks were determined by thermochronologic dating methods: K-Ar and Ar-40/(39)A on muscovite, biotite, and hornblende, Ar-40/(39)A on K-feldspar, U-Pb on apatite, zircon, and sphene, and fission track on apatite, zircon, and sphene. Lower plate rocks 10 km west of the breakaway cooled slowly from Early Cretaceous lower-amphibolite facies conditions through 350+/-50 degrees to 300+/-50 degrees C between 57 and 38 Ma, then cooled rapidly from 205+/-50 degrees to 120+/-5O degrees C between 12.6+/-1.6 and 11.1+/-1.9 Ma. Lower plate rocks 20 km west of the breakaway cooled slowly from Early Cretaceous upper-amphibolite facies conditions through 500+/-50 degrees C at 78-67 Ma, passed through 350+/-50 degrees to 300+/-50 degrees C between 16.3+/-0.4 and 10.5+/-0.3 Ma, then cooled rapidly from 285+/-50 degrees to 120+/-50 degrees C between 10.2 and 8.6 Ma. Upper plate tilting and rapid cooling (denudation) of the lower plate occurred simultaneously in the respective areas. The early slow-cooling part of the lower plate thermal histories was probably related to erosion at the Earth's surface, which stripped off about 9 km of material in 50 to 100 m.y. The results indicate an initial fault dip greater than or equal to 30 degrees and a 12 mm yr(-1) west-northwest migration of the locus of rapid tilting in the upper plate

Refining the value of secretory phospholipase A2 as a predictor of acute chest syndrome in sickle cell disease: results of a feasibility study (PROACTIVE)

Acute chest syndrome (ACS) is defined as fever, respiratory symptoms and a new pulmonary infiltrate in an individual with sickle cell disease (SCD). Nearly half of ACS episodes occur in SCD patients already hospitalized, potentially permitting pre-emptive therapy in high-risk patients. Simple transfusion of red blood cells may abort ACS if given to patients hospitalized for pain who develop fever and elevated levels of secretory phospholipase A2 (sPLA2). In a feasibility study (PROACTIVE; ClinicalTrials.gov NCT00951808), patients hospitalized for pain who developed fever and elevated sPLA2 were eligible for randomization to transfusion or observation; all others were enrolled in an observational arm. Of 237 enrolled, only 10 were randomized; one of the four to receive transfusion had delayed treatment. Of 233 subjects receiving standard care, 22 developed ACS. A threshold level of sPLA2 ≥ 48 ng/ml gave optimal sensitivity (73%), specificity (71%) and accuracy (71%), but a positive predictive value of only 24%. The predictive value of sPLA2 was improved in adults and patients with chest or back pain, lower haemoglobin concentration and higher white blood cell counts; and those receiving less than two-thirds maintenance fluids. The hurdles identified in PROACTIVE should facilitate design of a larger, definitive, phase 3 randomized controlled trial

Effects of negatively charged shift reagents on red blood cell morphology, lithium ion transport, and membrane potential

Lanthanide shift reagents have been used extensively in multinuclear magnetic resonance (NMR) applications in order to obtain information regarding ion distribution and transport in cellular systems. The aqueous reagents used in this study were Dy(PPP)J-, Tm( PPP)J-, Dy(TTHA)’-, Dy(PcPcP);-, and Dy(DOTP)’-, where Dy3+ and Tm3+ represent dysprosium and thulium ions and PPPs-, TTHA6-, PcPcPs-, and DOTP*- denote the triphosphate, triethylenetetraminehexaacetate, bis(dihydroxyphosphiny1- methyl)phosphinate, and I ,4,7,1 O-tetrazacyclododecane-N,N’,N”,N”’-tetrakis(methanephosphonate) ligands, respectively. The apparent size and shape of Li+-free RBCs (red blood cells), studied by both scanning electron microscopy and Coulter counter methods, were unchanged by the presence of the above shift reagents at concentrations lower than 10 mM. However, Li+ incubation changed both the shape and size of RBCs. The rates of Na+-Li+ exchange in Li+-loaded RBCs measured by 7Li NMR spectroscopy in the presence of Dy(PPP);-, TI~(PPP),~o-r, D~(PcPcP),~w-e re significantly higher than the rates measured in the absence of shift reagents by atomic absorption or in the presence of DY(TTHA)~o-r DY(DOTP)~b-y 7Li NMR spectroscopy. 31P and I9F NMR measurements of the membrane potential of Li+-free RBCs revealed that the shift reagents studied (except for Dy(TTHA)”) do change the membrane potential, with the most negatively charged reagents having the largest effect. Thus, shift reagents must be used with caution in physiological NMR studies and in particular RBC applications

Impact of ixazomib-lenalidomide-dexamethasone therapy on overall survival in multiple myeloma patients: Analysis of the emerging-markets subgroup of the TOURMALINE-MM1 trial.

10.1002/jha2.548EJHaem341241-125

All-oral ixazomib, cyclophosphamide, and dexamethasone for transplant-ineligible patients with newly diagnosed multiple myeloma

Background: Novel efficacious treatments with long-term tolerability are needed for transplant-ineligible, newly diagnosed multiple myeloma (NDMM) patients. This phase 2 study evaluated the safety and efficacy of all-oral ixazomib-cyclophosphamide-dexamethasone (ICd) followed by single-agent ixazomib maintenance. Patients and methods: Patients were randomised (1:1) to receive 4.0 mg of ixazomib, 300 (Arm A) or 400 (Arm B) mg/m2 of cyclophosphamide (days 1, 8, and 15), and 40 mg of dexamethasone (days 1, 8, 15, and 22) as induction (up to 13 × 28-day cycles), followed by single-agent ixazomib maintenance (28-day cycles) until progressive disease, death, or unacceptable toxicity. Primary end-point was complete response (CR) + very good partial response (VGPR) rate for ICd induction. Results: Seventy patients were enrolled (n = 36 Arm A; n = 34 Arm B); median age was 73 years (range, 61–87). At data cut-off, 66% of patients had completed 13 induction cycles followed by ixazomib maintenance. Median overall treatment duration was 19 cycles (range, 1–29); 21% of patients discontinued treatment during induction and 3% during maintenance due to adverse events (AEs). During induction, among 67 response-evaluable patients, CR+VGPR rate was 25%, and overall response rate (ORR) was 73%. Including the maintenance phase, CR+VGPR rate was 33%, and ORR was 76%. Median progression-free survival was 23.5 months (median follow-up: 26.1 months). The most common all-grade AE was neutropenia (31%). Grade ≥3 AEs were reported by 73% of patients. Five on-study deaths occurred (not treatment-related). Conclusions: ICd treatment followed by ixazomib maintenance is tolerable and active in elderly, transplant-ineligible NDMM patients. Trial registration number: NCT02046070. © 201