-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
- Cosmetic Ingredient
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
This article is reproduced from: Dr.
Elias K.
Mai, Director of the Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Professor of Springer Healthcare The following research background for myeloma patients is the intensive pre-treatment of newly diagnosed multiple myeloma (MM), including induction therapy (IT), high-dose melphalan (MEL200) and autologous blood stem cell transplantation (ASCT), followed by consolidation and/or Maintenance treatment, these treatment research data focus on patients under 65 years of age
.
There is no prospective phase III trial data for patients under 70 years of age
.
Research methods GMMG-MM5 trial included 601 patients aged 18 to 70 years old, divided into three groups: ≤60 years old (S1, n=353), 61-65 years old (S2, n=107) and 66-70 years old (S3) , N=141)
.
Treatment includes induction therapy of bortezomib, MEL200, ASCT, maintenance and consolidation of lenalidomide
.
The compliance of patients in the three age groups to treatment is similar
.
The results of the study compared with S1, S2 and S3 have increased overall toxicity in all treatment stages (any adverse event/any serious adverse event: S1: 81.
7/41.
8% vs S2: 90.
7/56.
5% vs S3: 87.
2/68.
1 %, P=0.
05/<0.
001)
.
Among the three age groups, no difference was found in progression-free survival (P=0.
73), overall survival (P=0.
54), time to progression (P=0.
83) and recurrence-free mortality (P=0.
25)
.
Figure: The KM curve of the three groups of patients with progression-free survival, overall survival, disease progression time, and non-relapse mortality.
Conclusions containing bortezomib induction therapy, MEL200, ASCT, lenalidomide consolidation and maintenance therapy should be applied to 70 Transplantable multiple myeloma patients under the age of
.
Expert opinion Professor Chen Wenming 1.
There is a big difference in the age of onset between Chinese and foreign patients, and whether bone marrow transplantation is more relevant to their physique.
There is a big difference in the age of onset between Chinese and foreign patients.
The median age of onset of myeloma patients in foreign countries is 69-70, China The median age of onset of myeloma patients is 59-60
.
Based on the large differences in the age of onset between Chinese and foreign patients, it is common for myeloma patients in foreign countries to undergo bone marrow transplantation under the age of 70.
The age range for bone marrow transplantation for myeloma patients in the United States can be extended to 75 years
.
I think the ability to do bone marrow transplantation has nothing to do with age, but with physique
.
Compared with Chinese patients, patients in European and American countries generally have better physique, and bone marrow transplantation is also available for 65-70 years old
.
2.
Considering the conditions for patients to be able to undergo stem cell transplantation.
Foreign countries have a corresponding score sheet for whether patients can do bone marrow transplantation.
According to the score, domestic doctors use the American score sheet more often, which is more clinically popular
.
I judge whether the patient has the conditions for clinical stem cell transplantation: ① Heart function: below grade II, no heart failure, no heart insufficiency; ② Liver function: transaminase <200 IU/L; ③ Lung function: blood oxygen saturation> 95 %; ④ Renal function: blood creatinine <300 μmol/L
.
Dialogue between Chinese and Foreign Scholars Professor Chen Wenming<60 years old, 60-65 years old, 65-70 years old.
How many patients are suitable for bone marrow transplantation and actual bone marrow transplantation in different age groups, especially the sample size in the 65-70 age group is 141 cases , What is the proportion of the total number of diseases in this age group in Germany? Compared with younger patients (60-65 years old, <60 years old), the article emphasizes the feasibility of HDM/ASCT in 66-70 years old patients
.
Since there is no pre-screening of data on these subjects before the trial, it is impossible to provide data on the proportion of eligible patients in each age group
.
However, prospective and registry-based data can prove that HDM/ASCT has benefits in PFS and OS in some patients in eligible patients, so it should be performed in the pretreatment of MM
.
The important thing is that whether HDM/ASCT can be performed depends on each patient's own conditions
.
Including but not limited to: patient’s health status, limitations of MM disease, further medication, organ function (eg kidney, liver), weakness (scoring), quality of life, and patient’s wishes/informed consent
.
It even includes clinical infrastructure (experience in HDM/ASCT treatment, stem cell collection, side-effect management and combination medication)
.
The author, Dr.
Elias K.
Mai, Professor Wenming Chen, the upper age limit of the trial is 70 years old.
Why is it not included in the study? I don’t know the exact number of 66-70 year old patients receiving HDM/ASCT in Germany
.
As mentioned above, this requires pre-screening of subjects before the start of the experiment
.
Until 2020, German health insurance will not reimburse the treatment of HDM/ASCT patients in this age group
.
Our current analysis is very important for helping patients eligible for HDM/ASCT obtain German medical insurance
.
More registered data and information on HDM/ASCT treatment of elderly MM patients can be found here: https://pubmed.
ncbi.
nlm.
nih.
gov/27185572/.
Author Elias K.
Mai, Dr.
Chen Wenming 65- Does the dose of melphalan in 70-year-old patients need to be reduced? The general age limit for HDM/ASCT is 65 years old, so extending the scope of patients to 70 years old is an improvement and needs to be balanced in terms of safety
.
In addition, induction therapy was also considered intensive therapy at the time, and there are few studies on the safety of nallidomide maintenance therapy after HDM/ASCT
.
Therefore, the safety of patients is of paramount importance
.
However, a retrospective study of a cohort of patients over 70 years of age shows that HDM/ASCT (including reduced-dose HDM) is feasible (see text/discussion section for references)
.
If the patient meets the trial inclusion criteria, renal function, and general eligibility criteria (see question 1), the HDM dose can be 200 mg/m2
.
However, based on the doctor’s experience, a corresponding reduction in the dose of HDM can provide the same effect (see references in the discussion)
.
Author Dr.
Elias K.
Mai Editing Perspective Dr.
Martin Chopra, Editor-in-Chief of Oncology and Hematology Therapy of Springer Nature's Targeted Oncology and Adis series of journals Key Points: The study we look at today reports on the outcomes of standard intensive treatment in older patients with newly -diagnosed multiple myeloma.
The authors conclude that while toxicity increases with older age, efficacy outcomes are not different, indicating that standard treatment can be used to an age of up to 70 years.
The authors also found that performance status, rather than chronological age is a predictor of adverse events in this setting.
There is a good discussion in the article of how this data fits into the current treatment landscape.
And important limitations of the study are properly acknowledged.
These limitations include selection bias of the older patient group, and that because the study was initiated in 2009,the treatment regimens that were used are not the best available today.
Demonstrating that standard intensive treatment, including autologous stem cell transplantation is effective and (relatively) safe in older patients is important information for the field, despite the limitations of the study.
Furthermore, it can be speculated that the use of novel triplet or quadruplet induction regimens should not negatively influence the feasibility of using high-dose melphalan and autologous stem cell transplantation for these patients.
Article source: Mai, EK, Miah, K.
, Bertsch, U .
et al.
Bortezomib-based induction, high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976 -9Demonstrating that standard intensive treatment, including autologous stem cell transplantation is effective and (relatively) safe in older patients is important information for the field, despite the limitations of the study.
Furthermore, it can be speculated that the use of novel triplet or quadruplet induction regimens should not negatively influence the feasibility of using high-dose melphalan and autologous stem cell transplantation for these patients.
Article source: Mai, EK, Miah, K.
, Bertsch, U.
et al.
Bortezomib-based induction, high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976-9Demonstrating that standard intensive treatment, including autologous stem cell transplantation is effective and (relatively) safe in older patients is important information for the field, despite the limitations of the study.
Furthermore, it can be speculated that the use of novel triplet or quadruplet induction regimens should not negatively influence the feasibility of using high-dose melphalan and autologous stem cell transplantation for these patients.
Article source: Mai, EK, Miah, K.
, Bertsch, U.
et al.
Bortezomib-based induction, high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976-9Despite the limitations of the study.
Furthermore, it can be speculated that the use of novel triplet or quadruplet induction regimens should not negatively influence the feasibility of using high-dose melphalan and autologous stem cell transplantation for these patients.
Article source: Mai, EK , Miah, K.
, Bertsch, U.
et al.
Bortezomib-based induction, high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976-9Despite the limitations of the study.
Furthermore, it can be speculated that the use of novel triplet or quadruplet induction regimens should not negatively influence the feasibility of using high-dose melphalan and autologous stem cell transplantation for these patients.
Article source: Mai, EK , Miah, K.
, Bertsch, U.
et al.
Bortezomib-based induction, high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976-9high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976-9high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976-9
Elias K.
Mai, Director of the Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Professor of Springer Healthcare The following research background for myeloma patients is the intensive pre-treatment of newly diagnosed multiple myeloma (MM), including induction therapy (IT), high-dose melphalan (MEL200) and autologous blood stem cell transplantation (ASCT), followed by consolidation and/or Maintenance treatment, these treatment research data focus on patients under 65 years of age
.
There is no prospective phase III trial data for patients under 70 years of age
.
Research methods GMMG-MM5 trial included 601 patients aged 18 to 70 years old, divided into three groups: ≤60 years old (S1, n=353), 61-65 years old (S2, n=107) and 66-70 years old (S3) , N=141)
.
Treatment includes induction therapy of bortezomib, MEL200, ASCT, maintenance and consolidation of lenalidomide
.
The compliance of patients in the three age groups to treatment is similar
.
The results of the study compared with S1, S2 and S3 have increased overall toxicity in all treatment stages (any adverse event/any serious adverse event: S1: 81.
7/41.
8% vs S2: 90.
7/56.
5% vs S3: 87.
2/68.
1 %, P=0.
05/<0.
001)
.
Among the three age groups, no difference was found in progression-free survival (P=0.
73), overall survival (P=0.
54), time to progression (P=0.
83) and recurrence-free mortality (P=0.
25)
.
Figure: The KM curve of the three groups of patients with progression-free survival, overall survival, disease progression time, and non-relapse mortality.
Conclusions containing bortezomib induction therapy, MEL200, ASCT, lenalidomide consolidation and maintenance therapy should be applied to 70 Transplantable multiple myeloma patients under the age of
.
Expert opinion Professor Chen Wenming 1.
There is a big difference in the age of onset between Chinese and foreign patients, and whether bone marrow transplantation is more relevant to their physique.
There is a big difference in the age of onset between Chinese and foreign patients.
The median age of onset of myeloma patients in foreign countries is 69-70, China The median age of onset of myeloma patients is 59-60
.
Based on the large differences in the age of onset between Chinese and foreign patients, it is common for myeloma patients in foreign countries to undergo bone marrow transplantation under the age of 70.
The age range for bone marrow transplantation for myeloma patients in the United States can be extended to 75 years
.
I think the ability to do bone marrow transplantation has nothing to do with age, but with physique
.
Compared with Chinese patients, patients in European and American countries generally have better physique, and bone marrow transplantation is also available for 65-70 years old
.
2.
Considering the conditions for patients to be able to undergo stem cell transplantation.
Foreign countries have a corresponding score sheet for whether patients can do bone marrow transplantation.
According to the score, domestic doctors use the American score sheet more often, which is more clinically popular
.
I judge whether the patient has the conditions for clinical stem cell transplantation: ① Heart function: below grade II, no heart failure, no heart insufficiency; ② Liver function: transaminase <200 IU/L; ③ Lung function: blood oxygen saturation> 95 %; ④ Renal function: blood creatinine <300 μmol/L
.
Dialogue between Chinese and Foreign Scholars Professor Chen Wenming<60 years old, 60-65 years old, 65-70 years old.
How many patients are suitable for bone marrow transplantation and actual bone marrow transplantation in different age groups, especially the sample size in the 65-70 age group is 141 cases , What is the proportion of the total number of diseases in this age group in Germany? Compared with younger patients (60-65 years old, <60 years old), the article emphasizes the feasibility of HDM/ASCT in 66-70 years old patients
.
Since there is no pre-screening of data on these subjects before the trial, it is impossible to provide data on the proportion of eligible patients in each age group
.
However, prospective and registry-based data can prove that HDM/ASCT has benefits in PFS and OS in some patients in eligible patients, so it should be performed in the pretreatment of MM
.
The important thing is that whether HDM/ASCT can be performed depends on each patient's own conditions
.
Including but not limited to: patient’s health status, limitations of MM disease, further medication, organ function (eg kidney, liver), weakness (scoring), quality of life, and patient’s wishes/informed consent
.
It even includes clinical infrastructure (experience in HDM/ASCT treatment, stem cell collection, side-effect management and combination medication)
.
The author, Dr.
Elias K.
Mai, Professor Wenming Chen, the upper age limit of the trial is 70 years old.
Why is it not included in the study? I don’t know the exact number of 66-70 year old patients receiving HDM/ASCT in Germany
.
As mentioned above, this requires pre-screening of subjects before the start of the experiment
.
Until 2020, German health insurance will not reimburse the treatment of HDM/ASCT patients in this age group
.
Our current analysis is very important for helping patients eligible for HDM/ASCT obtain German medical insurance
.
More registered data and information on HDM/ASCT treatment of elderly MM patients can be found here: https://pubmed.
ncbi.
nlm.
nih.
gov/27185572/.
Author Elias K.
Mai, Dr.
Chen Wenming 65- Does the dose of melphalan in 70-year-old patients need to be reduced? The general age limit for HDM/ASCT is 65 years old, so extending the scope of patients to 70 years old is an improvement and needs to be balanced in terms of safety
.
In addition, induction therapy was also considered intensive therapy at the time, and there are few studies on the safety of nallidomide maintenance therapy after HDM/ASCT
.
Therefore, the safety of patients is of paramount importance
.
However, a retrospective study of a cohort of patients over 70 years of age shows that HDM/ASCT (including reduced-dose HDM) is feasible (see text/discussion section for references)
.
If the patient meets the trial inclusion criteria, renal function, and general eligibility criteria (see question 1), the HDM dose can be 200 mg/m2
.
However, based on the doctor’s experience, a corresponding reduction in the dose of HDM can provide the same effect (see references in the discussion)
.
Author Dr.
Elias K.
Mai Editing Perspective Dr.
Martin Chopra, Editor-in-Chief of Oncology and Hematology Therapy of Springer Nature's Targeted Oncology and Adis series of journals Key Points: The study we look at today reports on the outcomes of standard intensive treatment in older patients with newly -diagnosed multiple myeloma.
The authors conclude that while toxicity increases with older age, efficacy outcomes are not different, indicating that standard treatment can be used to an age of up to 70 years.
The authors also found that performance status, rather than chronological age is a predictor of adverse events in this setting.
There is a good discussion in the article of how this data fits into the current treatment landscape.
And important limitations of the study are properly acknowledged.
These limitations include selection bias of the older patient group, and that because the study was initiated in 2009,the treatment regimens that were used are not the best available today.
Demonstrating that standard intensive treatment, including autologous stem cell transplantation is effective and (relatively) safe in older patients is important information for the field, despite the limitations of the study.
Furthermore, it can be speculated that the use of novel triplet or quadruplet induction regimens should not negatively influence the feasibility of using high-dose melphalan and autologous stem cell transplantation for these patients.
Article source: Mai, EK, Miah, K.
, Bertsch, U .
et al.
Bortezomib-based induction, high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976 -9Demonstrating that standard intensive treatment, including autologous stem cell transplantation is effective and (relatively) safe in older patients is important information for the field, despite the limitations of the study.
Furthermore, it can be speculated that the use of novel triplet or quadruplet induction regimens should not negatively influence the feasibility of using high-dose melphalan and autologous stem cell transplantation for these patients.
Article source: Mai, EK, Miah, K.
, Bertsch, U.
et al.
Bortezomib-based induction, high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976-9Demonstrating that standard intensive treatment, including autologous stem cell transplantation is effective and (relatively) safe in older patients is important information for the field, despite the limitations of the study.
Furthermore, it can be speculated that the use of novel triplet or quadruplet induction regimens should not negatively influence the feasibility of using high-dose melphalan and autologous stem cell transplantation for these patients.
Article source: Mai, EK, Miah, K.
, Bertsch, U.
et al.
Bortezomib-based induction, high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976-9Despite the limitations of the study.
Furthermore, it can be speculated that the use of novel triplet or quadruplet induction regimens should not negatively influence the feasibility of using high-dose melphalan and autologous stem cell transplantation for these patients.
Article source: Mai, EK , Miah, K.
, Bertsch, U.
et al.
Bortezomib-based induction, high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976-9Despite the limitations of the study.
Furthermore, it can be speculated that the use of novel triplet or quadruplet induction regimens should not negatively influence the feasibility of using high-dose melphalan and autologous stem cell transplantation for these patients.
Article source: Mai, EK , Miah, K.
, Bertsch, U.
et al.
Bortezomib-based induction, high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976-9high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976-9high-dose melphalan and lenalidomide maintenance in myeloma up to 70 years of age.
Leukemia 35, 809–822 (2021).
https://doi.
org/10.
1038/s41375-020-0976-9
