Lenalidomide (Revlimid), Bortezomib (Velcade) and Dexamethasone (RVD) For The Treatment Of Secondary Plasma Cell Leukaemia
Notice bibliographique
Résumé
Abstract Introduction Secondary plasma cell leukemia (SPCL) is an aggressive variant of multiple myeloma (MM) characterized by the presence of >20% and/or an absolute number of >2 × 109/L circulating PCs cells in the peripheral blood. Recently, combinations of bortezomib (bor) or lenalidomide (len) with conventional cytotoxic drugs have demonstrated very high rates and quality of response in MM, and, based on this data, we aimed to assess the efficacy of len, bor and dexamethasone (RVD) in SPCL. Methods In this retrospective study, we reviewed the records of all patients (pts) with SPCL treated with RVD at Princess Margaret Cancer Center between 03/09 and 06/12. A total of 9 pts were identified. Pts received oral len 10-15 mg/d on days 1-14 (dose adjusted for creatinine clearance), bor 1.0 or 1.3 mg/m2 on days 1, 4, 8, and 11 of 21-day cycles (in 3 pts) and once weekly (in 6 pts) along with dexamethasone (20 mg or 40 mg weekly). Primary endpoints were response rate, progression-free survival (PFS), overall survival (OS), and toxicity. Results Clinical characteristics are showed in Table 1. Pts had received a median of 3 lines of therapy (1-5). Thalidomide, len and bor containing regimens were previously used in 3, 5 and 7 pts respectively. After a median of 3 cycles (1-14), CR was seen in 1, VGPR in 2, PR in 1 and 5 pts progressed while on therapy. Pts who achieved ≥ PR experienced a significantly better PFS (11.67 versus 1.57 months) (p=0.0049). At the time of analysis all of the cases had progressed and died. The median PFS was 5.23 months (range 1.68-31.53) with 2 pts progressing after 27 months. Median OS for the entire group was 5.13 months (range 1.17-32). Furthermore, median OS was significantly longer for pts achieving ≥ PR compared to those who did not (7.93 versus 2.93 months, p=0.0472). The median time to first and best response was 4 and 8 weeks, respectively. Two pts (22.2%) experienced non-hematological grade 3/4 adverse events, including sepsis and pneumonia. Grade 3 and 4 neutropenia and thrombocytopenia occurred in 6 pts, and 3 pts required G-CSF to avoid treatment delays. In conclusion we demonstrated that the combination of RVD is able to obtain responses in 44% of in SPCL cases within one month of therapy. Although the median PFS was only 5.23 months, 2 pts experienced responses exceeding 2 years. Thus, we recommend trying RVD for 1 cycle; if no response is seen, an alternative approach should be utilized. Newer agents such as pomalidomide and carfilzomib should be investigated in this aggressive disease in which the majority of responses are short-lived. Disclosures: Reece: Janssen: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Millennium Pharmaceuticals: Research Funding; Novartis: Honoraria, Research Funding; Merck: Honoraria, Research Funding; BMS: Research Funding; Otsuka: Honoraria, Research Funding; Onyx: Consultancy. Chen:Celgene Corporation: Consultancy, Honoraria, Research Funding. Tiedemann:Celgene: Honoraria; Janssen: Honoraria. Kukreti:Millennium Pharmaceuticals: Research Funding; Onyx: Research Funding.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».