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Beneficial Effect of Lenalidomide-Dexamethason Treatment in Relapsed/Refractory Multiple Myeloma Patients: Results of Real-Life Data From 11 Hungarian Centers

In Hungary, the cost of lenalidomide-based therapy is covered only for relapsed multiple myeloma (MM) patients, therefore lenalidomide is typically used in the second-line either as part of a triplet with proteasome inhibitors or as a doublet. Lenalidomide-dexamethasone is a standard treatment appro...

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Autores principales: Varga, Gergely, Dávid Tóth, András, Réka Szita, Virág, Csukly, Zoltán, Hardi, Apor, Gaál-Weisinger, Júlia, Nagy, Zsolt, Altai, Elvira, Rencsik, Annamária, Plander, Márk, Szendrei, Tamás, Kórád, Krisztina, Radványi, Gáspár, Rottek, János, Deák, Beáta, Szaleczky, Erika, Schneider, Tamás, Kohl, Zoltán, Kosztolányi, Szabolcs, Alizadeh, Hussain, Lengyel, Zsuzsanna, Modok, Szabolcs, Borbényi, Zita, Lovas, Szilvia, Váróczy, László, Illés, Árpád, Rajnics, Péter, Masszi, Tamás, Mikala, Gábor
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8262242/
https://www.ncbi.nlm.nih.gov/pubmed/34257583
http://dx.doi.org/10.3389/pore.2021.613264
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author Varga, Gergely
Dávid Tóth, András
Réka Szita, Virág
Csukly, Zoltán
Hardi, Apor
Gaál-Weisinger, Júlia
Nagy, Zsolt
Altai, Elvira
Rencsik, Annamária
Plander, Márk
Szendrei, Tamás
Kórád, Krisztina
Radványi, Gáspár
Rottek, János
Deák, Beáta
Szaleczky, Erika
Schneider, Tamás
Kohl, Zoltán
Kosztolányi, Szabolcs
Alizadeh, Hussain
Lengyel, Zsuzsanna
Modok, Szabolcs
Borbényi, Zita
Lovas, Szilvia
Váróczy, László
Illés, Árpád
Rajnics, Péter
Masszi, Tamás
Mikala, Gábor
author_facet Varga, Gergely
Dávid Tóth, András
Réka Szita, Virág
Csukly, Zoltán
Hardi, Apor
Gaál-Weisinger, Júlia
Nagy, Zsolt
Altai, Elvira
Rencsik, Annamária
Plander, Márk
Szendrei, Tamás
Kórád, Krisztina
Radványi, Gáspár
Rottek, János
Deák, Beáta
Szaleczky, Erika
Schneider, Tamás
Kohl, Zoltán
Kosztolányi, Szabolcs
Alizadeh, Hussain
Lengyel, Zsuzsanna
Modok, Szabolcs
Borbényi, Zita
Lovas, Szilvia
Váróczy, László
Illés, Árpád
Rajnics, Péter
Masszi, Tamás
Mikala, Gábor
author_sort Varga, Gergely
collection PubMed
description In Hungary, the cost of lenalidomide-based therapy is covered only for relapsed multiple myeloma (MM) patients, therefore lenalidomide is typically used in the second-line either as part of a triplet with proteasome inhibitors or as a doublet. Lenalidomide-dexamethasone is a standard treatment approach for relapsed/refractory MM, and according to recent large randomized clinical trials (RCT, the standard arm of POLLUX, ASPIRE, TOURMALINE), the progression-free survival (PFS) is expected to be approximately 18 months. We surveyed ten Hungarian centers treating MM and collected data of 278 patients treated predominantly after 2016. The median age was 65 years, and patients were distributed roughly equally over the 3 international staging system groups, but patients with high risk cytogenetics were underrepresented. 15.8% of the patients reached complete response, 21.6% very good partial response, 40.6% partial response, 10.8% stable disease, and 2.5% progressed on treatment. The median PFS was unexpectedly long, 24 months, however only 9 months in those with high risk cytogenetics. We found interesting differences between centers regarding corticosteroid type (prednisolone, methylprednisolone or dexamethasone) and dosing, and also regarding the choice of anticoagulation, but the outcome of the various centers were not different. Although the higher equivalent steroid dose resulted in more complete responses, the median PFS of those having lower corticosteroid dose and methylprednisolone were not inferior compared to the ones with higher dose dexamethasone. On multivariate analysis high risk cytogenetics and the number of prior lines remained significant independent prognostic factors regarding PFS (p < 0.001 and p = 0.005). Our results show that in well-selected patients Lenalidomide-dexamethasone can be a very effective treatment with real-world results that may even outperform those reported in the recent RCTs. This real world information may be more valuable than outdated RCT data when treatment options are discussed with patients.
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spelling pubmed-82622422021-07-12 Beneficial Effect of Lenalidomide-Dexamethason Treatment in Relapsed/Refractory Multiple Myeloma Patients: Results of Real-Life Data From 11 Hungarian Centers Varga, Gergely Dávid Tóth, András Réka Szita, Virág Csukly, Zoltán Hardi, Apor Gaál-Weisinger, Júlia Nagy, Zsolt Altai, Elvira Rencsik, Annamária Plander, Márk Szendrei, Tamás Kórád, Krisztina Radványi, Gáspár Rottek, János Deák, Beáta Szaleczky, Erika Schneider, Tamás Kohl, Zoltán Kosztolányi, Szabolcs Alizadeh, Hussain Lengyel, Zsuzsanna Modok, Szabolcs Borbényi, Zita Lovas, Szilvia Váróczy, László Illés, Árpád Rajnics, Péter Masszi, Tamás Mikala, Gábor Pathol Oncol Res Society Journal Archive In Hungary, the cost of lenalidomide-based therapy is covered only for relapsed multiple myeloma (MM) patients, therefore lenalidomide is typically used in the second-line either as part of a triplet with proteasome inhibitors or as a doublet. Lenalidomide-dexamethasone is a standard treatment approach for relapsed/refractory MM, and according to recent large randomized clinical trials (RCT, the standard arm of POLLUX, ASPIRE, TOURMALINE), the progression-free survival (PFS) is expected to be approximately 18 months. We surveyed ten Hungarian centers treating MM and collected data of 278 patients treated predominantly after 2016. The median age was 65 years, and patients were distributed roughly equally over the 3 international staging system groups, but patients with high risk cytogenetics were underrepresented. 15.8% of the patients reached complete response, 21.6% very good partial response, 40.6% partial response, 10.8% stable disease, and 2.5% progressed on treatment. The median PFS was unexpectedly long, 24 months, however only 9 months in those with high risk cytogenetics. We found interesting differences between centers regarding corticosteroid type (prednisolone, methylprednisolone or dexamethasone) and dosing, and also regarding the choice of anticoagulation, but the outcome of the various centers were not different. Although the higher equivalent steroid dose resulted in more complete responses, the median PFS of those having lower corticosteroid dose and methylprednisolone were not inferior compared to the ones with higher dose dexamethasone. On multivariate analysis high risk cytogenetics and the number of prior lines remained significant independent prognostic factors regarding PFS (p < 0.001 and p = 0.005). Our results show that in well-selected patients Lenalidomide-dexamethasone can be a very effective treatment with real-world results that may even outperform those reported in the recent RCTs. This real world information may be more valuable than outdated RCT data when treatment options are discussed with patients. Frontiers Media S.A. 2021-04-22 /pmc/articles/PMC8262242/ /pubmed/34257583 http://dx.doi.org/10.3389/pore.2021.613264 Text en Copyright © 2021 Varga, Dávid Tóth, Réka Szita, Csukly, Hardi, Gaál-Weisinger, Nagy, Altai, Rencsik, Plander, Szendrei, Kórád, Radványi, Rottek, Deák, Szaleczky, Schneider, Kohl, Kosztolányi, Alizadeh, Lengyel, Modok, Borbényi, Lovas, Váróczy, Illés, Rajnics, Masszi and Mikala. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Society Journal Archive
Varga, Gergely
Dávid Tóth, András
Réka Szita, Virág
Csukly, Zoltán
Hardi, Apor
Gaál-Weisinger, Júlia
Nagy, Zsolt
Altai, Elvira
Rencsik, Annamária
Plander, Márk
Szendrei, Tamás
Kórád, Krisztina
Radványi, Gáspár
Rottek, János
Deák, Beáta
Szaleczky, Erika
Schneider, Tamás
Kohl, Zoltán
Kosztolányi, Szabolcs
Alizadeh, Hussain
Lengyel, Zsuzsanna
Modok, Szabolcs
Borbényi, Zita
Lovas, Szilvia
Váróczy, László
Illés, Árpád
Rajnics, Péter
Masszi, Tamás
Mikala, Gábor
Beneficial Effect of Lenalidomide-Dexamethason Treatment in Relapsed/Refractory Multiple Myeloma Patients: Results of Real-Life Data From 11 Hungarian Centers
title Beneficial Effect of Lenalidomide-Dexamethason Treatment in Relapsed/Refractory Multiple Myeloma Patients: Results of Real-Life Data From 11 Hungarian Centers
title_full Beneficial Effect of Lenalidomide-Dexamethason Treatment in Relapsed/Refractory Multiple Myeloma Patients: Results of Real-Life Data From 11 Hungarian Centers
title_fullStr Beneficial Effect of Lenalidomide-Dexamethason Treatment in Relapsed/Refractory Multiple Myeloma Patients: Results of Real-Life Data From 11 Hungarian Centers
title_full_unstemmed Beneficial Effect of Lenalidomide-Dexamethason Treatment in Relapsed/Refractory Multiple Myeloma Patients: Results of Real-Life Data From 11 Hungarian Centers
title_short Beneficial Effect of Lenalidomide-Dexamethason Treatment in Relapsed/Refractory Multiple Myeloma Patients: Results of Real-Life Data From 11 Hungarian Centers
title_sort beneficial effect of lenalidomide-dexamethason treatment in relapsed/refractory multiple myeloma patients: results of real-life data from 11 hungarian centers
topic Society Journal Archive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8262242/
https://www.ncbi.nlm.nih.gov/pubmed/34257583
http://dx.doi.org/10.3389/pore.2021.613264
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