Activity with Thalidomide-Based Therapy Following Lenalidomide Plus Dexamethasone in Patients with Relapsed/Refractory Multiple Myeloma.
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.000 | 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".