From June 11 to 14, 2015, the congress of the “European Hematology Association” took place in Vienna. Among many other news, there were of course also updates on multiple myeloma. We present four studies that were discussed at the Congress.
The bortezomib-dexamethasone combination is widely used in clinical practice for multiple myeloma (MM) relapse, but comparative data to bortezomib monotherapy are scarce. In a retrospective matched analysis, Meletios Dimopoulos and colleagues compared 109 pairs of patients, one of whom had been treated with combination therapy and the other with monotherapy [1].
Combination of bortezomib and dexamethasone works better than monotherapy
Patients had participated in the MMY-2045, APEX, and DOXIL-MMY-3001 trials. In the trials, patients received bortezomide i.v. at 1.3 mg/m2 on days 1, 4, 8, and 11, alone or with 20 mg dexamethasone p.o., in cycles of 21 days. In the patient group receiving combination therapy, the response rate was greater (75 vs. 41%) and the median time to disease progression was longer (13.6 vs. 7.0 months). Progression-free survival (PFS) was also longer in patients receiving combination therapy than in patients receiving monotherapy (11.9 vs. 6.4 months). In both patient groups, the rate of side effects and complications was the same, as was the rate of patients who had to discontinue therapy because of side effects. These data show that the combination of bortezomib/dexamethasone is superior to monotherapy as first-line therapy for relapse of MM.
Improved quality of life during therapy with lenalidomide
In the study by Delforge et al. the quality of life of patients who had participated in the FIRST trial was investigated [2]. Study participants had been newly diagnosed with MM and were over 65 years of age or otherwise not treatable with transplantation. In the trials, patients received one of three therapies: Lenalidomide (continuous) and low-dose dexamethasone until disease progression (group 1), lenalidomide (fixed cycles) and low-dose dexamethasone for 18 months (group 2), or fixed cycles of melphalan, prednisone, and thalidomide for 18 months (group 3). Quality of life data were collected using validated questionnaires (QLQ-MY20, QLQ-C30, EQ-5D). In all groups, patients’ quality of life improved in all predetermined areas throughout the study period. Evaluation of the QLQ-MY20 showed a significantly greater reduction in disease symptoms in the lenalidomide and dexamethasone groups than in group 3. Side effects of therapy were also rated as significantly lower in groups 1 and 2 than in group 3.
Compared with thalidomide therapy, continuous administration of lenalidomide and low-dose dexamethasone prolongs the time to disease progression and improves health-associated quality of life. These results establish the continuous administration of lenalidomide and low-dose dexamethasone as the new “standard of care” in the initial therapy of MM.
Infections threaten MM patients
Infections are a major cause of morbidity and mortality in MM patients. A study from Sweden investigated the risk of MM patients for bacterial and viral infections [3]. The study relied on data from all patients who received a diagnosis of MM in Sweden between 1988 and 2004 (follow-up to 2007) and on data from 34931 matched control patients.
Patients with MM had a sevenfold increased risk of bacterial infections (HR = 7.1; 95% confidence interval = 6.8-7.4) and an even tenfold increased risk of viral infections (HR = 10.0; 95% CI = 8.9-11.4). MM patients diagnosed with the disease in the last calendar years of the study also had a significantly higher risk of infection than control patients (p<0.001). One-year follow-up showed that infections were responsible for death in 22% of patients who had since died. Mortality due to infections remained constant during the study period.
These results show that infectious diseases remain a real threat for MM patients. In MM therapy with new drugs, the impact on possible infectious complications needs to be studied in more detail and prophylactic measures should be established.
MRI score for prognosis in MM patients.
Diffuse and focal patterns of bone marrow infiltration, as can be visualized by MRI, have great significance in the prognosis of MM. The aim of this retrospective analysis was to develop a score for prognosis based on information from MRI scans [4]. The effects of different infiltration patterns on progression-free survival (PFS) and overall survival (OS) in 161 MM patients were investigated. Compared with minimal-diffuse infiltration, moderate resp. severe diffuse infiltration had a negative prognostic impact on both PFS (p <0.001) and OS (p=0.003). Also associated with a worse prognosis were more than 25 focal lesions on whole-body MRI or more than seven focal lesions on axial MRI.
In the newly developed scoring system, the scoring of diffuse and focal infiltration patterns was combined. The score identified high-risk patients with a median PFS of 23.4 months and OS of 55.9 months (based on whole-body MRI). The authors recommend using the MRI-based scoring system for prognostic evaluation of patients with MM; the authors evaluate the system as robust, accessible, and easy to interpret.
Source: EHA Congress, June 11-14, 2015, Vienna
Literature:
- Dimopoulos M, et al: Retrospective matched-pairs analysis of bortezomib plus dexamethasone versus bortezomib monotherapy in relapsed multiple myeloma. Haematologica 2015 Jan; 100(1): 100-106. doi: 10.3324/haematol.2014.112037.
- Delforge M, et al: Health-related quality-of-life in patients with newly diagnosed multiple myeloma in the FIRST trial: lenalidomide plus low-dose dexamethasone versus melphalan, prednisone, thalidomide. Haematologica 2015 Jun; 100(6): 826-833. doi: 10.3324/haematol.2014.120121. epub 2015 Mar 13.
- Blimark C, et al: Multiple myeloma and infections: a population-based study on 9253 multiple myeloma patients. Haematologica 2015 Jan; 100(1): 107-113. doi: 10.3324/haematol.2014.107714. epub 2014 Oct 24.
- May EK, et al: A magnetic resonance imaging-based prognostic scoring system to predict outcome in transplant-eligible patients with multiple myeloma. Haematologica 2015 Jun; 100(6): 818-825. doi: 10.3324/haematol. 2015.124115. epub 2015 Mar 20.
InFo ONCOLOGY & HEMATOLOGY 2015; 3(7): 25-26.
