This review focuses on the recent advances utilizing adoptive T-cell immunotherapies for patients after hematopoietic stem cell transplant using T cells after autologous transplant to treat the highest risk patients. The particular emphasis is the use of T cells to treat leukemias and lymphomas with gene transfer and nongene transfer approaches to direct specificity to tumor associated antigens. In this review, we will highlight how these novel therapeutics can be successfully used to prevent or treat high-risk patients who relapse after hematopoietic stem cell transplant.
{"title":"Directed T-cell therapies for leukemia and lymphoma after hematopoietic stem cell transplant: beyond chimeric antigen receptors","authors":"C. Bollard, C. Cruz, A. Barrett","doi":"10.2217/IJH.15.11","DOIUrl":"https://doi.org/10.2217/IJH.15.11","url":null,"abstract":"This review focuses on the recent advances utilizing adoptive T-cell immunotherapies for patients after hematopoietic stem cell transplant using T cells after autologous transplant to treat the highest risk patients. The particular emphasis is the use of T cells to treat leukemias and lymphomas with gene transfer and nongene transfer approaches to direct specificity to tumor associated antigens. In this review, we will highlight how these novel therapeutics can be successfully used to prevent or treat high-risk patients who relapse after hematopoietic stem cell transplant.","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJH.15.11","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68221026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute myeloid leukemia in children is a heterogeneous disease with different morphological and cytogenetic features. New diagnostic tools and treatments, improved supportive care and the use of genomic tissue typing in selecting donors for hematopoietic stem cell transplantation (HSCT) adds to increased survival rates. Candidates to HSCT in first complete remission are patients with cytogenetic or molecular unfavorable prognostic markers, or blasts >15% after first induction. The use of minimal residual disease can also identify children benefiting from HSCT in first complete remission and the patients post HSCT with signs of relapse. The outcome and cure rate of acute myeloid leukemia, still remains poor and new diagnostic tools and treatments strategies need to be evaluated. In this management perspective, future management of novel minimal residual disease tools are discussed, conditioning therapies, as well as different transplantation procedures including haplo-transplantation and haplo-identical nat...
{"title":"Different aspects of stem cell procedures in children with poor responding AML: when is HSCT the best answer?","authors":"B. Gustafsson","doi":"10.2217/IJH.15.10","DOIUrl":"https://doi.org/10.2217/IJH.15.10","url":null,"abstract":"Acute myeloid leukemia in children is a heterogeneous disease with different morphological and cytogenetic features. New diagnostic tools and treatments, improved supportive care and the use of genomic tissue typing in selecting donors for hematopoietic stem cell transplantation (HSCT) adds to increased survival rates. Candidates to HSCT in first complete remission are patients with cytogenetic or molecular unfavorable prognostic markers, or blasts >15% after first induction. The use of minimal residual disease can also identify children benefiting from HSCT in first complete remission and the patients post HSCT with signs of relapse. The outcome and cure rate of acute myeloid leukemia, still remains poor and new diagnostic tools and treatments strategies need to be evaluated. In this management perspective, future management of novel minimal residual disease tools are discussed, conditioning therapies, as well as different transplantation procedures including haplo-transplantation and haplo-identical nat...","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJH.15.10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68220974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ribosme biogenesis can consume up to 80% of the cellular energy in rapidly proliferating cells and thus cells have involved various mechanisms/checkpoints to monitor the integrity of this process, of which the best understood is the
{"title":"A new window on cancer therapy? Targeting the nucleolus and ribosome biogenesis using the small molecule inhibitor of polymerase I transcription, CX-5461","authors":"S. Harrison, Amee J. George, R. Hannan","doi":"10.2217/IJH.15.9","DOIUrl":"https://doi.org/10.2217/IJH.15.9","url":null,"abstract":"Ribosme biogenesis can consume up to 80% of the cellular energy in rapidly proliferating cells and thus cells have involved various mechanisms/checkpoints to monitor the integrity of this process, of which the best understood is the","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJH.15.9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68221650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Allogeneic hematopoietic cell transplantation (HCT) is an important therapeutic option for malignant and non-malignant diseases, but the more widespread application of the therapy remains limited by the occurrence of graft versus host disease (GVHD). GVHD results from immune-mediated injury by donor immune cells against tissues in the HCT recipient, and can be characterized as acute or chronic depending on the time of onset and site of organ involvement. The majority of efforts have focused on GVHD prevention. Calcineurin inhibitors are the most widely used agents and are included in almost all regimens. Despite current prophylaxis strategies, 40-70% of patients remain at risk for developing GVHD. Herein, we review standard and emerging therapies used in GVHD management.
{"title":"Approaches for the prevention of graft-versus-host disease following hematopoietic cell transplantation.","authors":"Erin Gatza, Sung Won Choi","doi":"10.2217/ijh.15.13","DOIUrl":"https://doi.org/10.2217/ijh.15.13","url":null,"abstract":"<p><p>Allogeneic hematopoietic cell transplantation (HCT) is an important therapeutic option for malignant and non-malignant diseases, but the more widespread application of the therapy remains limited by the occurrence of graft versus host disease (GVHD). GVHD results from immune-mediated injury by donor immune cells against tissues in the HCT recipient, and can be characterized as acute or chronic depending on the time of onset and site of organ involvement. The majority of efforts have focused on GVHD prevention. Calcineurin inhibitors are the most widely used agents and are included in almost all regimens. Despite current prophylaxis strategies, 40-70% of patients remain at risk for developing GVHD. Herein, we review standard and emerging therapies used in GVHD management.</p>","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/ijh.15.13","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34485985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biomarkers may improve diagnosis and prognosis, monitoring of response to treatment, allowing for treatment that are customized to the patients, and overall leading to reduce healthcare costs. In the near future, biomarkers will be included in all clinical trials and decisions for a personalized medicine. The biomarker field
{"title":"Graft-versus-host disease in children after hematopoietic cell transplantation: potential clinical utility of biomarkers","authors":"S. Paczesny","doi":"10.2217/IJH.15.8","DOIUrl":"https://doi.org/10.2217/IJH.15.8","url":null,"abstract":"Biomarkers may improve diagnosis and prognosis, monitoring of response to treatment, allowing for treatment that are customized to the patients, and overall leading to reduce healthcare costs. In the near future, biomarkers will be included in all clinical trials and decisions for a personalized medicine. The biomarker field","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJH.15.8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68221642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with acute leukemia (AL) are at high risk for developing bacterial, viral and fungal infections during chemotherapy. Because these infections cause considerable morbidity and mortality, prevention is attractive. In recent decades, several trials have established the benefit of prophylactic antimicrobials in patients with AL. Administration of prophylactic fluoroquinolone, acyclovir and triazole is recommended in neutropenic patients with AL by both the USA and European national guidelines. The potential for antimicrobial resistance as a long-term consequence of prophylaxis, however, is a concern. The recent development of nonculture-based diagnostic tests for invasive fungal infections has made early diagnosis and targeted treatment a promising future strategy as an alternative to mold-active prophylaxis.
{"title":"Role of antimicrobial prophylaxis during treatment of adults with acute leukemia","authors":"N. Cohen, S. Seo","doi":"10.2217/IJH.15.7","DOIUrl":"https://doi.org/10.2217/IJH.15.7","url":null,"abstract":"Patients with acute leukemia (AL) are at high risk for developing bacterial, viral and fungal infections during chemotherapy. Because these infections cause considerable morbidity and mortality, prevention is attractive. In recent decades, several trials have established the benefit of prophylactic antimicrobials in patients with AL. Administration of prophylactic fluoroquinolone, acyclovir and triazole is recommended in neutropenic patients with AL by both the USA and European national guidelines. The potential for antimicrobial resistance as a long-term consequence of prophylaxis, however, is a concern. The recent development of nonculture-based diagnostic tests for invasive fungal infections has made early diagnosis and targeted treatment a promising future strategy as an alternative to mold-active prophylaxis.","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJH.15.7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68221601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Through the effectiveness of combination chemotherapy and allogeneic stem cell transplantation (ASCT), the cure of acute lymphoblastic leukemia (ALL) in children evolved from the 1970s from an anecdotal wonder to a quantifiable reality. Although giving less spectacular results than those seen in children, these therapeutic approaches have been applied to adults over the last two decades, leading to an improved response rate and survival [1]. Retrospective comparisons demonstrating that adolescents with ALL significantly benefit from pediatric rather than adult chemotherapy regimens yielded to the recent development of pediatric-inspired regimens for adult ALL involving greater dose densities of many chemotherapeutic agents, such as l-asparaginase, vincristine, corticosteroids and methotrexate [2]. However, additional gains are unlikely to be achieved by simply intensifying therapy further, due to the offset of unacceptable toxicities. Furthermore, new procedures for ASCT modestly improve the outcome of adult ALL, while introducing higher risks of acute and late complications. There was therefore a clear and compelling rationale for developing therapies that specifically target the molecular abnormalities that cause leukemia. Encouraging signs have recently emerged with the development of novel therapeutic agents, opening a new era of treatment in adult ALL. Several points of intervention have been identified that may respond to targeted drugs. Concomitantly, the biology of leukemia stem cell (eradication of which is considered as the relevant goal of leukemia therapy) was better understood. Several primary studies with targeted agents have demonstrated impressive clinical activity, even in heavily pretreated patients. Others have demonstrated synergistic effects with chemotherapy and the feasibility of such combinations in clinical trials. The era of targeted therapy for ALL started about 15 years ago with the development of the first inhibitor of tyrosine kinase (TKI), imatinib mesylate [3]. Imatinib mesylate and then the other inhibitors of the ABL tyrosine kinase activity of the fusion protein BCR-ABL have revolutionized the treatment of Philadelphia chromosome-positive (Ph) ALL [4,5]. TKIs are now integral components of therapy for Ph ALL. The current consensus is that they improve patient
{"title":"Toward effective targeted therapy for the treatment of adult acute lymphoblastic leukemia","authors":"X. Thomas","doi":"10.2217/IJH.15.1","DOIUrl":"https://doi.org/10.2217/IJH.15.1","url":null,"abstract":"Through the effectiveness of combination chemotherapy and allogeneic stem cell transplantation (ASCT), the cure of acute lymphoblastic leukemia (ALL) in children evolved from the 1970s from an anecdotal wonder to a quantifiable reality. Although giving less spectacular results than those seen in children, these therapeutic approaches have been applied to adults over the last two decades, leading to an improved response rate and survival [1]. Retrospective comparisons demonstrating that adolescents with ALL significantly benefit from pediatric rather than adult chemotherapy regimens yielded to the recent development of pediatric-inspired regimens for adult ALL involving greater dose densities of many chemotherapeutic agents, such as l-asparaginase, vincristine, corticosteroids and methotrexate [2]. However, additional gains are unlikely to be achieved by simply intensifying therapy further, due to the offset of unacceptable toxicities. Furthermore, new procedures for ASCT modestly improve the outcome of adult ALL, while introducing higher risks of acute and late complications. There was therefore a clear and compelling rationale for developing therapies that specifically target the molecular abnormalities that cause leukemia. Encouraging signs have recently emerged with the development of novel therapeutic agents, opening a new era of treatment in adult ALL. Several points of intervention have been identified that may respond to targeted drugs. Concomitantly, the biology of leukemia stem cell (eradication of which is considered as the relevant goal of leukemia therapy) was better understood. Several primary studies with targeted agents have demonstrated impressive clinical activity, even in heavily pretreated patients. Others have demonstrated synergistic effects with chemotherapy and the feasibility of such combinations in clinical trials. The era of targeted therapy for ALL started about 15 years ago with the development of the first inhibitor of tyrosine kinase (TKI), imatinib mesylate [3]. Imatinib mesylate and then the other inhibitors of the ABL tyrosine kinase activity of the fusion protein BCR-ABL have revolutionized the treatment of Philadelphia chromosome-positive (Ph) ALL [4,5]. TKIs are now integral components of therapy for Ph ALL. The current consensus is that they improve patient","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJH.15.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68220921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Multiple myeloma (MM) is a hematologic malignancy associated with heterogeneous treatment and survival outcomes due in part to the ability of MM to evade and suppress the immune system. Research has focused on finding ways to modulate and enhance immunity while targeting the bone marrow microenvironment. Contemporary therapies include immunomodulatory drugs, proteasome inhibitors and autologous and allogeneic stem cell transplant and have improved outcomes for patients with MM. Future therapies, including monoclonal antibodies, chimeric antigen receptor cells and MM vaccines, show promise to further improved outcomes, particularly when used in combination with existing therapies. This review covers the mechanism of action of currently available and future therapies and explores ways in which treatment may be more specifically directed in the future.
{"title":"Current and future immunotherapeutic approaches to multiple myeloma therapy","authors":"Shakthi T Bhaskar, D. Benson","doi":"10.2217/IJH.14.43","DOIUrl":"https://doi.org/10.2217/IJH.14.43","url":null,"abstract":"SUMMARY Multiple myeloma (MM) is a hematologic malignancy associated with heterogeneous treatment and survival outcomes due in part to the ability of MM to evade and suppress the immune system. Research has focused on finding ways to modulate and enhance immunity while targeting the bone marrow microenvironment. Contemporary therapies include immunomodulatory drugs, proteasome inhibitors and autologous and allogeneic stem cell transplant and have improved outcomes for patients with MM. Future therapies, including monoclonal antibodies, chimeric antigen receptor cells and MM vaccines, show promise to further improved outcomes, particularly when used in combination with existing therapies. This review covers the mechanism of action of currently available and future therapies and explores ways in which treatment may be more specifically directed in the future.","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJH.14.43","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68220933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ISSN 2045-1393 Int. J. Hematol. Oncol. (2015) 4(1), 5–8 The chronic myeloproliferative neoplasms (MPN), polycythemia vera (PV), essential thrombocytosis (ET) and primary myelofibrosis (PMF) are a unique group of hematopoietic stem cell disorders, characterized by the increased production of morphologically normal red cells, white cells and platelets alone or in combination and a tendency to develop myelofibrosis, extramedullary hematopoiesis with bone marrow failure or leukemic transformation, albeit at varying frequencies. These shared clinical features not only result in phenotypic mimicry among these three disorders but also between them, their companion myeloid neoplasms (MN) and certain benign disorders of hematopoiesis as well. In this regard, although they are clonal stem cell disorders, the chronic MPN differ from their companion MN because with supportive therapy alone, survival in PV, ET and PMF is usually measured not in years but decades. This makes diagnostic accuracy essential. However, until the 2005 discovery of a mutation (V617F) in JAK2 [1], a tyrosine kinase essential for hematopoietic progenitor cell proliferation and differentiation, the diagnosis of a specific MPN was largely based on clinical phenotype and, in particular exclusion of absolute erythrocytosis [2], the hall mark of PV, the most common MPN and the one in which the risk of thrombosis or hemorrhage is greatest. The development of a clinical assay for JAK2 V617F and subsequently, for mutations in JAK2 exon 12, redefined the MPN on a molecular basis with approximately 95% of PV patients expressing JAK2 V617F and 3% expressing JAK2 exon 12 mutations. By contrast, only 50–60% of ET and PMF patients expressed JAK2 V617F; the discovery of MPL mutations primarily in 4% of ET and 8% of PMF patients still left approximately 30–40% of MPN patients, including some with PV, without an identified molecular basis for their disease. In 2007, taking advantage of these molecular findings, the WHO proposed new diagnostic criteria for the MPN, relying on the use of molecular assays for JAK2 and MPL mutations together with stipulated values for the hemoglobin or hematocrit value, the use of the serum erythropoietin (EPO) level, endogenous erythroid colony formation, bone marrow histology, cytogenetics and flow cytometry
{"title":"Diagnostic and treatment guidelines for the chronic myeloproliferative neoplasms: current challenges","authors":"J. Spivak","doi":"10.2217/IJH.15.2","DOIUrl":"https://doi.org/10.2217/IJH.15.2","url":null,"abstract":"ISSN 2045-1393 Int. J. Hematol. Oncol. (2015) 4(1), 5–8 The chronic myeloproliferative neoplasms (MPN), polycythemia vera (PV), essential thrombocytosis (ET) and primary myelofibrosis (PMF) are a unique group of hematopoietic stem cell disorders, characterized by the increased production of morphologically normal red cells, white cells and platelets alone or in combination and a tendency to develop myelofibrosis, extramedullary hematopoiesis with bone marrow failure or leukemic transformation, albeit at varying frequencies. These shared clinical features not only result in phenotypic mimicry among these three disorders but also between them, their companion myeloid neoplasms (MN) and certain benign disorders of hematopoiesis as well. In this regard, although they are clonal stem cell disorders, the chronic MPN differ from their companion MN because with supportive therapy alone, survival in PV, ET and PMF is usually measured not in years but decades. This makes diagnostic accuracy essential. However, until the 2005 discovery of a mutation (V617F) in JAK2 [1], a tyrosine kinase essential for hematopoietic progenitor cell proliferation and differentiation, the diagnosis of a specific MPN was largely based on clinical phenotype and, in particular exclusion of absolute erythrocytosis [2], the hall mark of PV, the most common MPN and the one in which the risk of thrombosis or hemorrhage is greatest. The development of a clinical assay for JAK2 V617F and subsequently, for mutations in JAK2 exon 12, redefined the MPN on a molecular basis with approximately 95% of PV patients expressing JAK2 V617F and 3% expressing JAK2 exon 12 mutations. By contrast, only 50–60% of ET and PMF patients expressed JAK2 V617F; the discovery of MPL mutations primarily in 4% of ET and 8% of PMF patients still left approximately 30–40% of MPN patients, including some with PV, without an identified molecular basis for their disease. In 2007, taking advantage of these molecular findings, the WHO proposed new diagnostic criteria for the MPN, relying on the use of molecular assays for JAK2 and MPL mutations together with stipulated values for the hemoglobin or hematocrit value, the use of the serum erythropoietin (EPO) level, endogenous erythroid colony formation, bone marrow histology, cytogenetics and flow cytometry","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJH.15.2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68221463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Inclusion of new active drugs, such as IMiDs, proteasome inhibitors and soon the monoclonal antibodies, in first-line therapy has and will significantly enhance the response rate and depth of response, with the consequence of prolongation of the progression free and overall survivals. One of the greatest challenges faced in myeloma in recent years was to demonstrate the impact of prolonged therapy in the form of consolidation and/or maintenance. To date, this concept has almost always improved duration of response and progression free survival, but infrequently overall survival. Furthermore, this concept is associated to a certain cost, with not always predictable mid- and long-term adverse events along with the economic cost accompanying these events. As patients with myeloma live significantly longer, physicians need to discuss the risk/benefit of this approach at the individual level, and remain aware of the potential consequences as more knowledge becomes available.
{"title":"Consolidation and maintenance in de novo first-line multiple myeloma with modern agents","authors":"A. Stoppa, D. Coso, G. Fouquet, X. Leleu","doi":"10.2217/IJH.15.3","DOIUrl":"https://doi.org/10.2217/IJH.15.3","url":null,"abstract":"SUMMARY Inclusion of new active drugs, such as IMiDs, proteasome inhibitors and soon the monoclonal antibodies, in first-line therapy has and will significantly enhance the response rate and depth of response, with the consequence of prolongation of the progression free and overall survivals. One of the greatest challenges faced in myeloma in recent years was to demonstrate the impact of prolonged therapy in the form of consolidation and/or maintenance. To date, this concept has almost always improved duration of response and progression free survival, but infrequently overall survival. Furthermore, this concept is associated to a certain cost, with not always predictable mid- and long-term adverse events along with the economic cost accompanying these events. As patients with myeloma live significantly longer, physicians need to discuss the risk/benefit of this approach at the individual level, and remain aware of the potential consequences as more knowledge becomes available.","PeriodicalId":14166,"journal":{"name":"International Journal of Hematologic Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJH.15.3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68221553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：