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Previous studies have shown that allogeneic hematopoietic stem cell transplantation (allo-HCT) can overcome the poor prognosis of multiple myeloma (MM) high-risk (HR) cytogenetics.
Despite its potential curative effect, the use of allo-HCT in MM is still controversial due to the high incidence of non-recurring mortality (NRM), chronic graft-versus-host disease (cGVHD), and disease recurrence.
Jean Roy et al.
hypothesized that the use of bortezomib (BTZ) maintenance therapy after allo-HCT could reduce the recurrence rate and the incidence of cGVHD in high-risk, young MM patients, and conducted clinical studies to try to determine the effect of bone marrow measurable residual disease (MRD) The impact of future disease progression.
The results of the study will be announced at the 47th Annual Meeting of the European Association of Blood and Marrow Transplantation (EBMT 2021) in 2021.
The editor organizes the main content as follows for readers.
Research Methods This prospective trial included newly diagnosed MM patients ≤65 years of age.
The enrolled patients had 8/8 matched siblings/irrelevant donors, and had high-risk cytogenetics, ISS score 3 points, and primary plasma cells Sexual leukemia or age ≤50 years (regardless of whether there is a biological risk).
After receiving BTZ-based induction therapy and auto-HCT (auto-HCT), outpatient non-myeloablative allo-HCT was performed, and BTZ was started 120 days after transplantation (every 2 weeks, 1.
3 times each time) mg/m2) Maintenance treatment for 1 year.
Evaluate remission through the International Myeloma Working Group (IMWG) standards.
Before allo-HCT, before BTZ maintenance treatment, and every 3 months for 2 years, the second-generation flow cytometry (NGF; sensitivity <10-5) was used for MRD assessment.
The quantification and limit of detection (LOD) of MRD for NGF detection are calculated based on abnormal plasma cells (aPCs; if <30 aPCs, MRD negative) ≥50 and ≥30 (3x10-6).
The results of the study were between November 2014 and September 2018, 39 patients received allo-HCT (median age 54 years; 59% were unrelated donors).
44% of patients had an ISS score of 3, and 65% of patients had high-risk cytogenetics.
Thirty-six patients received BTZ maintenance treatment (median dose of 26 doses; range: 1-26), which was well tolerated, with almost no adverse events related to BTZ and no deaths.
The median follow-up time was 4 years (range: 2.
0-5.
5), and the NRM, disease progression rate, OS rate, and PFS rate at 5 years were 12% (95% CI: 2-29) and 48% (95% CI) : 28-65), 80% (95% CI: 58-91) and 41% (95% CI: 21-60) (Figure 1).
The incidence of moderate/severe cGVHD in Figure 1 was 46% (Figure 2), which was significantly better than the previous control group (69%, p=0.
008).
Before allo-HCT, before BTZ maintenance treatment, and 3 months after BTZ maintenance treatment, 33%, 44%, and 67% of patients achieved strict complete remission (sCR), respectively, and the MRD negative rate was 41%.
, 39% and 64%.
Figure 2 In the multivariate analysis, the risk of disease progression is closely related to the MRD status before allo-HCT, before the start of BTZ, and 3 months thereafter (adjusted HRs were 3.
7, 11.
3, and 9.
7, respectively, p=0.
037, 0.
018, and 0.
001 ).
None of the 4 patients with 17p deletion showed disease progression after allo-HCT.
Research conclusions For high-risk, young MM patients, the first-line auto-HCT sequential allo-HCT followed by BTZ maintenance therapy is safe, and it may cure about 40% of patients.
Patients in the 17p deletion subgroup particularly benefited from this therapy and did not experience disease progression.
In MM, the study reported that the use of MRD negative (NGF detection aPCs<30) can predict a significant improvement in the outcome of patients after allo-HCT, and this threshold can be used for further research.
Reference source: J.
Roy, I.
Ahmad, R.
Terra, et al.
ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION FOLLOWED BY BORTEZOMIB IN MULTIPLE MYELOMA: FINAL RESULTS OF A PROSPECTIVE TRIAL HIGHLIGHTING A STRONG PROGNOSTIC ROLE OF MEASURABLE RESIDUAL DISEASE of The 47th Annual Meeting.
the EBMT.
Abstract OS21-5.
Stamp "read the original text", we make progress together
Despite its potential curative effect, the use of allo-HCT in MM is still controversial due to the high incidence of non-recurring mortality (NRM), chronic graft-versus-host disease (cGVHD), and disease recurrence.
Jean Roy et al.
hypothesized that the use of bortezomib (BTZ) maintenance therapy after allo-HCT could reduce the recurrence rate and the incidence of cGVHD in high-risk, young MM patients, and conducted clinical studies to try to determine the effect of bone marrow measurable residual disease (MRD) The impact of future disease progression.
The results of the study will be announced at the 47th Annual Meeting of the European Association of Blood and Marrow Transplantation (EBMT 2021) in 2021.
The editor organizes the main content as follows for readers.
Research Methods This prospective trial included newly diagnosed MM patients ≤65 years of age.
The enrolled patients had 8/8 matched siblings/irrelevant donors, and had high-risk cytogenetics, ISS score 3 points, and primary plasma cells Sexual leukemia or age ≤50 years (regardless of whether there is a biological risk).
After receiving BTZ-based induction therapy and auto-HCT (auto-HCT), outpatient non-myeloablative allo-HCT was performed, and BTZ was started 120 days after transplantation (every 2 weeks, 1.
3 times each time) mg/m2) Maintenance treatment for 1 year.
Evaluate remission through the International Myeloma Working Group (IMWG) standards.
Before allo-HCT, before BTZ maintenance treatment, and every 3 months for 2 years, the second-generation flow cytometry (NGF; sensitivity <10-5) was used for MRD assessment.
The quantification and limit of detection (LOD) of MRD for NGF detection are calculated based on abnormal plasma cells (aPCs; if <30 aPCs, MRD negative) ≥50 and ≥30 (3x10-6).
The results of the study were between November 2014 and September 2018, 39 patients received allo-HCT (median age 54 years; 59% were unrelated donors).
44% of patients had an ISS score of 3, and 65% of patients had high-risk cytogenetics.
Thirty-six patients received BTZ maintenance treatment (median dose of 26 doses; range: 1-26), which was well tolerated, with almost no adverse events related to BTZ and no deaths.
The median follow-up time was 4 years (range: 2.
0-5.
5), and the NRM, disease progression rate, OS rate, and PFS rate at 5 years were 12% (95% CI: 2-29) and 48% (95% CI) : 28-65), 80% (95% CI: 58-91) and 41% (95% CI: 21-60) (Figure 1).
The incidence of moderate/severe cGVHD in Figure 1 was 46% (Figure 2), which was significantly better than the previous control group (69%, p=0.
008).
Before allo-HCT, before BTZ maintenance treatment, and 3 months after BTZ maintenance treatment, 33%, 44%, and 67% of patients achieved strict complete remission (sCR), respectively, and the MRD negative rate was 41%.
, 39% and 64%.
Figure 2 In the multivariate analysis, the risk of disease progression is closely related to the MRD status before allo-HCT, before the start of BTZ, and 3 months thereafter (adjusted HRs were 3.
7, 11.
3, and 9.
7, respectively, p=0.
037, 0.
018, and 0.
001 ).
None of the 4 patients with 17p deletion showed disease progression after allo-HCT.
Research conclusions For high-risk, young MM patients, the first-line auto-HCT sequential allo-HCT followed by BTZ maintenance therapy is safe, and it may cure about 40% of patients.
Patients in the 17p deletion subgroup particularly benefited from this therapy and did not experience disease progression.
In MM, the study reported that the use of MRD negative (NGF detection aPCs<30) can predict a significant improvement in the outcome of patients after allo-HCT, and this threshold can be used for further research.
Reference source: J.
Roy, I.
Ahmad, R.
Terra, et al.
ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION FOLLOWED BY BORTEZOMIB IN MULTIPLE MYELOMA: FINAL RESULTS OF A PROSPECTIVE TRIAL HIGHLIGHTING A STRONG PROGNOSTIC ROLE OF MEASURABLE RESIDUAL DISEASE of The 47th Annual Meeting.
the EBMT.
Abstract OS21-5.
Stamp "read the original text", we make progress together
