Natural history of relapsed myeloma, refractory to immunomodulatory drugs and proteasome inhibitors: a multicenter IMWG study
Kumar SK (1), Dimopoulos MA (2), Kastritis E (2), Terpos E (2), Nahi H (3), Goldschmidt H (4,5), Hillengass J (5), Leleu X (6), Beksac M (7), Alsina M (8), Oriol A (9), Cavo M (10), Ocio EM (11), Mateos MV (12), O'Donnell EK (13), Vij R (14), Lokhorst HM (15), van de Donk NWCJ (16), Min C (17), Mark T (18), Turesson I (9), Hansson M (19), Ludwig H (20), Jagannath S (21), Delforge M (22), Kyriakou C (23), Hari P (24), Mellqvist U (25), Usmani SZ (26), Dytfeld D (27), Badros AZ (28), Moreau P (29), Kim K (30), Otero PR (31), Lee JH (32), Shustik C (33), Waller D (34), Chng WJ (35), Ozaki S (36), Lee JJ (37), de la Rubia J (38), Eom HS (39), Rosinol L (40), Lahuerta JJ (41), Sureda A (42), Kim JS (43), Durie BGM (44).
(1) Department of Hematology, Mayo Clinic Rochester, Rochester, MN, USA.
(2) School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
(3) Division of Hematology, Karolinska Institutet, Karolinska University Hospital at Huddinge, Stockholm, Sweden.
(4) National Center for Tumor Diseases Heidelberg, Heidelberg, Germany.
(5) Department Med. V, University Hospital Heidelberg, Heidelberg, Germany.
(6) Oncologie hematologique et therapie cellulaire, chu de poitiers, Poitiers, France.
(7) Department of Hematology, Ankara University School of Medicine, Ankara, Turkey.
(8) Hematologic Malignancies Program, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
(9) Department of Hematology, Skane University Hospital, Malmö, Sweden.
(10) Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
(11) Department of Hematology, University Hospital of Salamanca (HUS/IBSAL), Salamanca, Spain.
(12) Department of Hematolgy, Hospital Universitario de Salamanca, Salamanca, Spain.
(13) Massachusetts General Hospital, Boston, MA.
(14) Division of Oncology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA.
(15) Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands.
(16) VU University Medical Center, Amsterdam, The Netherlands.
(17) Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, The Republic of Korea.
(18) Weill Cornell Medical College, New York, NY, USA.
(19) Department of Hematology, Skåne University Hospital, Lund University, Lund, Sweden.
(20) Department of Medicine, Center of Oncology, Hematology and Palliative Care, Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria.
(21) Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
(22) Myeloma Study Group, Belgian Hematological Society, Brussels, Belgium.
(23) Department of Haematology, North West London NHS Trust, NPH Hospital, London, UK.
(24) Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
(25) Section of Hematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
(26) Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Carolinas HealthCare System, Charlotte, NC, USA.
(27) Department of Hematology and Bone Marrow Transplantation, University of Medical Sciences in Poznan, Poland, Poznan, Poland.
(28) Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.
(29) Department of Hematology, Nantes University Hospital, Nantes, France.
(30) Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea.
(31) Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain.
(32) Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, The Republic of Korea.
(33) Division of Haematology, McGill University Health Center, Montreal, QC, Canada.
(34) McGill University, Montreal, QC, Canada.
(35) Department of Haematology-Oncology, National University Health Systems, Singapore.
(36) Department of Hematology, Tokushima Prefectural Central Hospital, Tokushima, Japan.
(37) Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Jeollanamdo, The Republic of Korea.
(38) Hospital Dr. Peset, Valencia, Spain.
(39) HematologicOncology Clinic, Center for Specific Organs, National Cancer Center, Goyang, South Korea.
(40) Department of Hematology, Hospital Clinic iProvincial, Barcelona, Spain.
(41) Hospital Universitario 12 de Octubre, Madrid, Spain.
(42) Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain.
(43) Yonsei University College of Medicine, Severance Hospital, Seoul, The Republic of Korea.
(44) Samuel Oschin Comprehensive Cancer Institute, CedarsSinai Outpatient Cancer Center, Los Angeles, CA, USA.
Introduction of new myeloma therapies offers new options for patients refractory to immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs).
In this multicenter study, patients with relapsed multiple myeloma, who have received at least three prior lines of therapy, are refractory to both an IMiD (lenalidomide or pomalidomide) and a PI (bortezomib or carfilzomib), and have been exposed to an alkylating agent were identified.
The time patients met the above criteria was defined as time zero (T0). Five hundred and forty-three patients diagnosed between 2006 and 2014 were enrolled in this study. Median age at T0 was 62 years (range 31-87); 61% were males. The median duration between diagnosis and T0 was 3.1 years. The median number of lines of therapy before T0 was 4 (range 3-13). The median overall survival (OS) from T0 for the entire cohort was 13 (95% confidence interval (CI) 11, 15) months. At least one regimen recorded after T0 in 462 (85%) patients, with a median (95% CI) progression-free survival and OS from T0 of 5 (4, 6), and 15.2 (13, 17) months, respectively.
The study provides the expected outcome of relapsed multiple myeloma that is refractory to a PI and an IMiD, a benchmark for comparison of new therapies being evaluated.
CITATION Leukemia. 2017 May 12. doi: 10.1038/leu.2017.138