Activity with Thalidomide-Based Therapy Following Lenalidomide Plus Dexamethasone in Patients with Relapsed/Refractory Multiple Myeloma.
Notice bibliographique
Résumé
Abstract Abstract 3855 Poster Board III-791 The optimal sequence of therapy in multiple myeloma (MM) remains unknown. Thalidomide (Thal) is the first immunomodulatory agent used for treating MM with anti-angiogenic properties and anti-inflammatory effects. Thereafter, Thal derived immunomodulatory compounds (IMiDs®) such as lenalidomide and pomalidomide were developed. These drugs are more potent than Thal with respect to stimulating T-cell proliferation and augmenting IL-2 and IFN-γ production. We know from previous MM clinical trials that lenalidomide is still effective after prior Thal exposure (Weber, Bloor 2007) but the use of Thal post lenalidomide based-therapy is unknown. At Princess Margaret Hospital (PMH), we have evaluated the use of Thal based therapy following treatment with lenalidomide plus dexamethasone (Len/Dex) for relapsed/refractory (rel/ref) disease. These patients were identified from PMH patients seen in the Expanded Access Program (MM016) and clinical trials for rel/ref disease. All patients were treated with Thal based treatment as the next therapy following progression on Len/Dex. Between December 2005 and May 2009, we identified 16 patients (10 males, 6 females); median age was 67 (range 44-83) years. With regards to previous therapy, 14 had undergone autologous stem cell transplantation (ASCT). Importantly, 4 patients had Thal induction therapy pre-ASCT for short duration of time at initial diagnosis while 12 patients had no prior Thal exposure. Before current Thal treatment, 3 patients had 2 prior lines of therapy, 5 had 3 prior lines of therapy; 4 had 4 prior lines of therapy and 4 with greater than 5 prior lines of therapy. With respect to immunoglobulin subtype, 6 were IgG, 7 with IgA and 3 with light chain disease only. At initial presentation, prognostic factors included a median β2m of 245 nmol/L, albumin of 39 g/L and creatinine of 88 μmol/L. Seven patients presented with ISS stage 1 disease, 7 with stage 2 and 2 with stage 3. With regards to Len/Dex therapy, the median duration of response was 8.7 months (range 1.4 to 45 months). The best haematological response to Len/Dex included CR for 1 patient, nCR for 3 patients, VGPR for 5 patients, PR for 5 patients and MR for 2 patients. Thereafter, Thal based therapy included steroids for 6 patients and alkylators with steroids in 10. The median follow up from start of Thal was 6.1 months (range 1.0 to 14.8). The median duration of Thal based therapy was 2.4 months (range 1.0 to 10.7). Best response to Thal based therapy was 3 (18%) PR, 4 (25%) MR and 7 (44%) with SD. Two patients had progressive disease. At time of analysis, only one patient remains on Thal with the rest having progressed on therapy. Only 4 patients remain alive at analysis. In conclusion, the use of Thal based therapy post Len/Dex therapy results in a short median duration of response of 2.4 months with at best a partial response of 18% in this heavily treated population. Thalidomide maybe considered as a therapeutic option although this needs to be evaluated in a larger randomized study. Disclosures: Trudel: Celgene: Honoraria, Speakers Bureau; Ortho Biotech: Honoraria. Reece:Ortho Biotech: Honoraria, Research Funding. Chen:Celgene: Honoraria. Kukreti:Celgene: Honoraria.
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 | 0,001 |
| 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 | 0,001 |
| 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 ».