Lenalidomide (Revlimid®) +/− Corticosteroids in Elderly Patients with Relapsed/Refractory Multiple Myeloma.
Notice bibliographique
Résumé
Abstract The combination of lenalidomide (Revlimid®) and dexamethasone (dex) is highly effective in multiple myeloma (MM) patients (pts) with relapsed/refractory disease. As MM is a disease of elderly individuals, we evaluated the outcome of pts 65 yrs and older who received Rev-based regimens through Celgene’s Expanded Access Program in Canada which commenced in 12/05; the results were compared with younger pts on this study. Our center has treated 69 pts who progressed after at least 1 prior regimen. Pts were required to have a minimum baseline neutrophil count of 1.0 x 109/L and platelet count of 30 x 109/L; serum creatinine level needed to be ≤220 umol/L unless a waiver was obtained. The median age was 60 yrs (35–79); 24 pts (35%) were 65 or older, 13 (19%) 70 or older and 4 (0.6%) 75 yrs or older. Fifty-two % were male; median baseline creatinine level was 91 umol/L (52–412); median β2-microglobulin was 214 nm/L (114–1420); Ig subtype was IgG in 42, IgA in 12, IgM in 1 and light chain only in 14. Prior therapy included ASCT in 59 pts (86%), thalidomide in 51 (74%), bortezomib in 21 (30%) and oral cyclophosphamide in 52 (75%); the median number of prior regimens was 2 (1–5). Rev was given with pulse dex in 44 pts (64%), prednisone in 7 (10%), dex and prednisone at different time points in 5 (7%) or as a single agent in 13 (19%); pts not receiving dex had a history of significant steroid toxicity. RESULTS: The older and younger pt groups were well-balanced with respect to baseline characteristics, with the exception that fewer older pts had undergone prior ASCT (54% vs. 80%; p=0.04). Rev + dex was given in 54% of the older pts, compared to 69% of the younger pts; 13% vs. 9% received Rev + prednisone, 4% vs. 9% received Rev + both dex and prednisone at different time points, and 29% vs. 13% received Rev alone in older and younger pts, respectively (p= 0.37). Median follow-up is 4 mos (0.5–8). To date, the median number of cycles of Rev +/− steroids was 4 (1–8) in both age groups. Among older pts, 46% remain on Rev +/− steroids; 54% have discontinued the trial due to disease progression (21%), toxicity (12.5%), pt withdrawal (12.5%) or death (8%). In the younger age group, 49% remain on Rev therapy, while 51% have stopped due to progression (31%), toxicity (4%), withdrawal (7%) or death (9%) (p= 0.62). Table 1 summarizes toxicity seen in the 2 age groups. Using standard EBMT criteria, the partial response rate was 58%, including 1 near CR, in the older pt group, compared with 56% in younger pts (p=0.15). The actuarial progression free survival (PFS) was 43% (95% CI 26–60%) and overall survival (OS) 74% (19–65%) in older pts, compared with 43% (26–60%) and 76% (52–87%), respectively, in younger individuals. CONCLUSION: The incidence of higher grade side-effects is not increased in older pts with relapsed/refractory MM treated with Rev +/− steroids; older MM pts achieve comparable response rates (approximately 60%); in this preliminary analysis, the PFS and OS in older vs. younger pts are identical. Table 1 Age N G 3–4 neutropenia G-CSF given Gr 3–4 thrombocytopenia Febrile neutropenia Any infection Gr 3–4 fatigue None of the differences were statistically significant. 65 or older 24 46% 54% 38% 12% 25% 13% Less than 65 45 44% 64% 24% 9% 16% 11%
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) | 0,001 | 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 ».