Infectious Complications in Advanced Relapsed/Refractory Multiple Myeloma Patients Treated with Lenalidomide (Revlimid +/- Corticosteroids).
Bibliographic record
Abstract
Abstract Abstract 2876 Poster Board II-852 Multiple myeloma (MM) patients (pts) are immunosuppressed given the underlying disease, previous treatments and myelosuppression seen on lenalidomide (Revlimid, Rev). We evaluated the infectious complications seen on Celgene's Expanded Access Rev program at Princess Margaret Hospital. We have treated 75 pts who had progressed after at least one prior therapy as part of a national study in Canada. At entry, pts were required to have a neutrophil count of ≥1.0 ×109/L. The median age was 61 yrs (range 35-79); 52% were males. Prior therapy included stem cell transplant in 65, thalidomide in 54 and bortezomib in 24. Number of lines of prior therapy were as follows: 24 (one), 29 (two), 16 (three), 8 (four) and one (five). Neupogen was used liberally (63%) after a patient had a dose delay on trial due to neutropenia. Patients were treated with full dose lenalidomide at entry onto clinical trial and were maintained on full dosing unless platelet counts were <30×109/L or ANC was <1.0×109/L. No other dose adjustments were made for renal dysfunction. Results: There were 32 pts (43%) who had a clinically evident infection; the majority (91%) was on prophylactic antibiotics (septra/ciprofloxacin) at the time. There were two deaths due to infection and 23 pts (72%) required hospitalization (range 2-27 days). The majority of infections occurred within the first 4 cycles of treatment (26 pts) and seemed to occur more in pts with several lines of prior therapy – 7/24 (29%) with 1 prior therapy, 14/29 (48%) with 2, 9/16 (56%) with 3 and 2/8 (25%) with 4 prior therapies. Sixteen were neutropenic of which 7 had febrile neutropenia (9%). The types of infections were: respiratory in 14 (1 with pneumocystis pneumonia), cellulitis in 4, herpes simplex and herpes zoster in 2 pts each. These included streptococcus pneumoniae (1), staphylococcus aureus (3), respiratory syncitial virus (1) and mycobacterium chelonae (1). Rev was held during the infection in 23 pts (72%). Conclusions: 1) Infections are frequent in this patient population (43%) and often lead to hospitalization (72%); respiratory infections accounted for a large majority (43%). 2) Early aggressive growth factor support and broader antibiotic prophylaxis may be of benefit especially in heavily pretreated patients. 3) Dose reduction of Rev in the context of serious infections should be further evaluated. Disclosures: Kukreti: Celgene: Honoraria. Trudel:Celgene: Honoraria, Speakers Bureau; Ortho Biotech: Honoraria. Chen:Celgene: Honoraria.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".