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  • 1
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2006
    In:  Nephrology Dialysis Transplantation Vol. 21, No. 3 ( 2006-03-01), p. 582-590
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 21, No. 3 ( 2006-03-01), p. 582-590
    Type of Medium: Online Resource
    ISSN: 1460-2385 , 0931-0509
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2006
    detail.hit.zdb_id: 1465709-0
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  • 2
    Online Resource
    Online Resource
    Elsevier BV ; 1982
    In:  Clinics in Haematology Vol. 11, No. 1 ( 1982-02), p. 65-86
    In: Clinics in Haematology, Elsevier BV, Vol. 11, No. 1 ( 1982-02), p. 65-86
    Type of Medium: Online Resource
    ISSN: 0308-2261
    Language: English
    Publisher: Elsevier BV
    Publication Date: 1982
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  • 3
    In: Blood, American Society of Hematology, Vol. 114, No. 22 ( 2009-11-20), p. 51-51
    Abstract: Abstract 51 Background Allogeneic stem cell transplantation (allo SCT), a treatment modality based on transfer of immunocompetent donor lymphocytes offers curative potential to subjects with a variety of hematological cancers. In multiple myeloma (MM), high-dose melphalan followed by autologous stem cell transplantation (auto SCT) is adopted as a standard of care. However, it remains palliative since virtually all patients (pts) relapse and renders allo SCT an option of interest. Deletion of chromosome 13q14 (13q-) in MM has been shown to negatively impact prognosis. Therefore, improvement of therapy for 13q- pts is highly desirable. Patients and methods A prospective two-arm multi-center trial (DSMM V) was set up by our group to compare tandem high-dose melphalan 200 mg/m2 (HD Mel) with a reduced intensity conditioning allo-SCT after one cycle of HD Mel for 13q- MM. Eligibility criteria were 13q- on bone marrow FISH analysis; age up to 60 years; newly diagnosed MM in Salmon and Durie stages II and III; and measurable disease. Allocation to either treatment arm was by availability of an HLA-matched (one mismatch allowed) volunteer related (VRD) or unrelated donor (VUD). Initially, all pts received four cycles of anthracycline/dexamethasone-based induction followed by chemomobilization of peripheral blood stem cells (PBSCT) and one cycle of HD Mel. Allogeneic SCT was performed after preparation with fludarabine (30 mg/m2 for 3 consecutive days) and melphalan 140 mg/m2. ATG was administered for VUD transplants. Results 199 pts with a median age of 53 (range, 30 – 60) years were enrolled between October 2002 and March 2007 and included in this interim analysis. Sixty-seven percent had stage III disease. Allo SCT was performed in 126 of 199 pts (63%), 76 of whom (60%) received VUD allografts. The remaining 73 subjects uniformely received tandem HD Mel. Pts following allo SCT were more likely to achieve CR (59%) when compared to tandem HD Mel (32%; p=.003) within one year after end of therapy. Similarly, overall response rate was significantly higher with allo SCT (91% versus 86%; p=.003). Of note, depth of response to allo SCT was not associated with presence of acute graft-versus-host disease (GVHD): 62% CR with grades II to IV GVHD vs 58% CR with grades 0 and I (p=.75). Treatment-related mortality (TRM) at 2 years from allo SCT was 16/126 (12.7%). At a median follow up of 25 months for tandem HD Mel and 34 months for allo SCT, projected 3-year overall survival is 72% (auto) and 60% (auto/allo SCT; p=0.22), respectively. Conclusions This is the largest trial on first-line allogeneic stem cell transplant in MM so far. Our interim results show a higher CR rate in FISH 13q- subjects undergoing allo SCT when compared to tandem HD Mel. Despite a majority of allografts in our study being delivered from unrelated donors, TRM was comparable to trials confined to sibling transplants. At a relatively short follow-up, there is not yet a difference between both arms regarding OS, albeit longer follow-up may be important as previously described. This as well as analysis of the impact of donor type and chronic GVHD on outcome will be presented at the meeting. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
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  • 4
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 43-43
    Abstract: Background In multiple myeloma (MM), the introduction of novel compounds into first-line intensive treatment pathways has clearly improved patients’ prognosis. Very recently however, specific molecular cytogenetic abnormalities, lactate dehydrogenase elevation and International Staging System 3 disease were identified to be associated with dismal prognosis despite upfront autologous (auto) stem cell transplant (SCT). Consolidative allogeneic (allo) following initial auto SCT was shown to extend progression-free survival (PFS) as well as overall survival (OS) in some prospective studies on newly diagnosed MM patients (pts). Relatively little is known on the impact of cytogenetic features other than chromosome 13q deletion (del13q) on the outcomes of pts undergoing upfront auto followed by allo (auto/allo) SCT. Patients and methods When the DSMM V treatment program was designed del13q detected by fluorescence in situ hybridisation (FISH) was accepted as one of the distinct risk factors in MM. We therefore used FISH del13q to define the study’s “high-risk” group and aimed to compare tandem high-dose melphalan 200 mg/m² (Mel) with one cycle of Mel followed by reduced-intensity conditioning (RIC) allo SCT. Allocation to either transplant regimen was by availability of an HLA-matched (at least 9/10 matches) related (MRD) or unrelated donor (MUD). Initially, all pts underwent non-novel compound cytoreduction and chemomobilization of peripheral blood stem cells (PBSC). RIC allo SCT was prepared by fludarabine and melphalan (plus ATG in MUD cases). PFS was the primary endpoint. The study was powered to detect an improvement of 2-year PFS from 20% (tandem Mel) to 40.3% (HR, 1.769). Results 199 out of 225 del13q pts with a median age of 53 (range, 30 – 60) yrs who had been enrolled between 10/2001 and 03/2007, were included in the intent-to treat population. Allo SCT was performed in 126/199 pts (63%), 74 of whom (59%) received MUD allografts. At a median follow-up of 49.2 months (mo), 2-year PFS (calculated from day 1 of second SCT) was 59% with auto/allo SCT versus 47% with tandem Mel. Median PFS with auto/allo SCT was 34.5 mo versus 21.8 mo, respectively (p=.005). Two-year non-relapse mortality (NRM) associated with auto/allo SCT was 11.9%. As of yet, there is no difference in OS between the groups, with the median not yet reached for either transplant modality. PFS/OS in auto/allo SCT were independent of donor source (MRD vs MUD). As definitions of cytogenetic risk have evolved over time, we analyzed further FISH abnormalities in pts’ baseline samples: in addition to uniform del13q, 13.6% of pts displayed del17p. Median PFS for del13q/del17p pts after HD Mel was 6 mo versus not reached with auto/allo SCT, respectively (p=.0002). Median OS in del13q/del17p after HD Mel was 23.4 mo versus not reached, respectively (p=.011). In translocation (4;14)/del13q pts (20.7%), median PFS with tandem Mel was 19.3 mo versus 19.1 with auto/allo SCT, respectively (p=.251). Conclusions This prospective trial shows auto/allo SCT to significantly extend PFS when compared to tandem HD Mel in a large cohort of del13q MM pts. It is the first study to demonstrate allo SCT in MM can be safely performed from matched unrelated donors at a reasonable rate of NRM. Utilizing a comprehensive set of FISH cytogenetics, our data for the first time demonstrate allo SCT to specifically benefit patients with high-risk features (del13q/del17p). Incremental gain of PFS when compared to tandem Mel was more than 20 months. Extended OS data on the whole study will be presented. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
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  • 5
    In: SSRN Electronic Journal, Elsevier BV
    Type of Medium: Online Resource
    ISSN: 1556-5068
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
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  • 6
    Online Resource
    Online Resource
    Elsevier BV ; 1989
    In:  The Lancet Vol. 333, No. 8628 ( 1989-1), p. 51-
    In: The Lancet, Elsevier BV, Vol. 333, No. 8628 ( 1989-1), p. 51-
    Type of Medium: Online Resource
    ISSN: 0140-6736
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 1989
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    detail.hit.zdb_id: 3306-6
    detail.hit.zdb_id: 1476593-7
    SSG: 5,21
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  • 7
    Online Resource
    Online Resource
    Elsevier BV ; 1984
    In:  Leukemia Research Vol. 8, No. 4 ( 1984-1), p. 701-711
    In: Leukemia Research, Elsevier BV, Vol. 8, No. 4 ( 1984-1), p. 701-711
    Type of Medium: Online Resource
    ISSN: 0145-2126
    Language: English
    Publisher: Elsevier BV
    Publication Date: 1984
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  • 8
    In: Blood, American Society of Hematology, Vol. 110, No. 11 ( 2007-11-16), p. 728-728
    Abstract: Background Myeloablative chemotherapy with support of autologous peripheral blood stem cells (APBSC) has widely been accepted as a standard of care in patients (pts) with newly diagnosed multiple myeloma (MM). High-dose (HD) melphalan (Mel) 200 mg/m2 was considered superior to total-body irradiaton (TBI) plus Mel 140 mg/m2 for toxicity reasons. Since MM plasma cells are inherently responsive to irradiation, our group evaluated TBI aimed at reduced organ toxicity by shielding lungs and liver (total-marrow irradiation [TMI], 9 Gy) combined with busulfan (Bu, 12 mg/kg) and cyclophosphamide (Cy, 120 mg/kg) in a previous phase I/II trial (Einsele et al, Bone Marrow Transplant, 2003). Patients and methods In the current study (DSMM I), subjects with previously untreated MM in Durie-Salmon stages II/III were randomly assigned to either receive one course of TMI/Bu/Cy versus two cycles of HD Mel 200 mg/m2 each with APBSC transplantation if having had an adequate number of stem cells collected and at least stable disease. Primary end point was event-free survival (EFS), secondary end points overall (OS) and disease-free survival (DFS). Results A total of 294 pts (median age, 54 years), 246 of whom completed stem cell harvest were enrolled between 8/1998 and 1/2002 by 46 centres. Eventually, 198 (n=100 TMI/Bu/Cy and n=98 HD Mel) pts were randomized and included into the ITT population. The safety population (n=80 TMI and n=118 HD Mel, due to 18 pts switching to Mel) was analyzed for toxicity and response. CR rate before HD therapy was 7.0% (7/100) in the TMI and 6.1% (6/98) in the Mel arm respectively. Significantly more pts receiving TMI/Bu/Cy experienced WHO grades 3 and 4 pulmonary and gastrointestinal toxicity and pain. Following HDT, CR rate increased to 17.5% (14/80, TMI) and 32.2% (38/118, HD Mel; p=.022) respectively. After a median follow-up of 1447 days, median EFS in the TMI group was 1161 days versus 1090 days for HD Mel (p=.812). Probability of 4-year OS was 72.7% (95%-CI: 62.1–80.7) with TMI and also 72.7% (95%-CI: 61.7–81.1) after HD Mel (p=.754). For pts in CR following HD therapy, probability of 4 year DFS was 62.4% (95%-CI: 33.6–81.6) for TMI vs. 50.4% (95%-CI: 30.6–67.3) for HD-Mel (p=.138). Conclusion In this randomized trial on pts with newly diagnosed MM, the irradiation-based regimen was associated with more pulmonary and GI toxicity when compared to HD Mel. Incidences of other toxicities including hepatotoxicity, however, were not different between the two treatment arms. CR rate was superior for HD-Mel, while there was no difference in OS and EFS between the two treatment arms. Subjects achieving CR may be more likely to enjoy prolonged DFS after TMI/Bu/Cy.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2007
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  • 9
    Online Resource
    Online Resource
    American Society of Hematology ; 2005
    In:  Blood Vol. 106, No. 11 ( 2005-11-16), p. 3373-3373
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 3373-3373
    Abstract: Multiple myeloma (MM) is a fatal hematologic malignancy associated with disruption of RAS-to MAP kinase (ERK) signaling. The IL-6 cytokine family and growth factors such as IGF-1 have been demonstrated to promote malignant plasma cell proliferation through stimulation of ERK and PI-3 kinase/AKT signaling. Prenylation inhibitors such as farnesyltransferase inhibitors (FTIs), geranylgeranyl transferase inhibitors (GGTIs) and the competitive HMG-CoA reductase inhibitor lovastatin have been shown to block RAS post-translational modification and disrupt RAS signaling. To assess efficacy of prenylation inhibitors (e.g. FTI L-744,832, GGTI-2147 and lovastatin) to attenuate MM cell responses to IL-6 and IGF-1, inhibitor-treated cells were analyzed by proliferation/viability assays (MTS) and Western blotting to determine phosphorylated MEK-1/2 and ERK-1/2. FTI L-744,832 was found to inhibit growth of MM cells cultured with IL-6 or IGF-1 even more potently than in cytokine/growth factor-free medium (IC50s 1.3 μM, 1.8 μM and 4.2 μM, respectively). IL-6 moderately protected MM cells from inhibitory effects of GGTI-2147, while IGF-1 had no effect (IC50s 1.1 μM and 0.5 μM vs. 0.5 μM, respectively). IL-6 and IGF-1 protected MM cells from lovastatin-induced growth inhibition (IC50s 4.7 μM and 5.0 μM vs. 1.4 μM, respectively). Furthermore, co-treating MM cells with FTI L-744,832 and GGTI-2147 or lovastatin synergistically inhibited proliferation of MM cells regardless of the presence or absence of IL-6 or IGF-1. Western blotting demonstrated that FTI/GGTI or FTI/lovastatin co-treatment more completely blocked activation of MEK-1/2 and ERK-1/2 in NCI-H929 cells than treatment with any of the compounds alone. Co-treatment also elicited greater inhibition of IL-6 and IGF-1 induced MEK-1/2 and ERK-1/2 activation in NCI-H929 cells. IL-6, IGF-1 and prenylation inhibitors had no effects on AKT phosphorylation status in NCI-H929 cells. To evaluate the clinical relevance of these observations, primary MM cells were obtained from bone marrow aspirates (n=6) or from peripheral blood of a patient with plasma cell leukemia/MM (PCL/MM). Primary MM cells were isolated by magnetic cell sorting using CD138-coupled microbeads, titrated with prenylation inhibitors in the presence of IL-6 and synergy was calculated using the CalcSyn program. Activating RAS mutations (4 K-RAS, 1 N-RAS) were found in 4/7 (57%) MM patient samples, with one sample harboring both K- and N-RAS mutations. FTI L-744,832 elicited anti-myeloma effects only at concentrations much higher than those found to inhibit healthy donor CD34+ cells (IC50’s 51–396 μM vs. 8.2μM) or MM cell lines (1.1–23.8μM) and thus may be ineffective or cause non-specific toxicity when used as a single agent. However, IC50’s calculated for GGTI-2147 and lovastatin were generally higher for CD34+ cells as compared to primary MM cells, supporting specificity of these compounds. Furthermore, combination of FTI with GGTI or lovastatin synergistically inhibited primary MM cell proliferation (IC50’s 0.6–23.1 μM). Our results support that inhibition of RAS down-stream signaling is a major mechanism through which FTI/GGTI and FTI/lovastatin co-treatment synergistically inhibit MM cell proliferation, even in the presence of IL-6 and IGF-1. Incomplete response to FTI treatment may be explained by alternative prenylation of K- and N-RAS by GGTase I in the presence of FTIs. As the majority of RAS mutations in MM occur in K- and N-RAS, FTI-resistance due to alternative geranylgeranylation may have therapeutic consequences.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
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  • 10
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 1989
    In:  Cancer Immunology, Immunotherapy Vol. 30, No. 4 ( 1989-7), p. 227-232
    In: Cancer Immunology, Immunotherapy, Springer Science and Business Media LLC, Vol. 30, No. 4 ( 1989-7), p. 227-232
    Type of Medium: Online Resource
    ISSN: 0340-7004 , 1432-0851
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 1989
    detail.hit.zdb_id: 1458489-X
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