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      Lebanese Real-World Experience in Treating Multiple Myeloma: A Multicenter Retrospective Study

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          Clinical practice points

          • There is no real-world data in clinical practice for multiple myeloma in Lebanon

          • Despite novel therapies, high dose chemotherapy regimens are still used in the treatment of multiple myeloma.

          • Autologous stem cell transplant improves progression free survival and still a valid option for transplant fit patient despite novel therapeutic novel agents

          • OS and PFS were not affected by type of regimen

          • Hypercalcemia was significantly associated with a shorter mean PFS and OS upon presentation

          • Because most of the time real-world data patients will not meet eligibility criteria for clinical trials such as age and performance status, effort should be multiplied towards developing a Lebanese cancer data base (e.g clinical characteristics, survival outcomes of treatment, statistics…).

          Abstract

          OBJECTIVE

          The present retrospective multicenter study aims at documenting characteristics of multiple myeloma (MM) patients and the effect of autologous stem cell transplant (ASCT) on survival.

          METHODS

          A total of 134 adult patients initiating any new MM therapy from January 2002 till December 2019 were included. Enrollment was stratified by disease subtype, induction protocol and transplant status. The characteristics and survival outcomes were recorded.

          RESULTS

          Mean age at diagnosis was 61.91 ± 10.83 years, with 62.7% male patients. Regarding the prognostic MM International Staging System (ISS), stage 3 was the most common at diagnosis with 50.8% of patients followed by stage 1 (25.4%) and stage 2 (23.8%). Maintenance treatment was given in 88.5% of the patients. 24.6% patients were transplanted, 41% were not and the remaining were unknown or still in induction. 86.1% of patients were alive at data cut off. A significantly higher mean progression free survival (PFS) was found in transplant patients (p=0.016). Using cox regression, creatinine >2 mg/dl (HR3.78) and hypercalcemia >11 mg/dl (HR=6.48) were significantly associated with a shorter PFS1. A significantly shorter overall survival (OS) was associated with hypercalcemia (HR=6.58), as well as male gender though not statistically significant in the latter. Difference in survival distributions by treatment was not statistically significant (bortezomib thalidomide dexamethasone (VTD) (p=0.211), bortezomib cyclophosphamide dexamethasone (VCD) (p=0.111) or bortezomib Revlimid dexamethasone (VRD) (p=0.312)). The interaction between ISS stage on diagnosis and transplant was not significantly associated with the overall survival.

          CONCLUSION

          The results of our retrospective study are in conformity with international data emphasizing the role of transplant in the treatment algorithm of newly diagnosed transplant-eligible multiple myeloma patients.

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          Most cited references25

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          International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma.

          This International Myeloma Working Group consensus updates the disease definition of multiple myeloma to include validated biomarkers in addition to existing requirements of attributable CRAB features (hypercalcaemia, renal failure, anaemia, and bone lesions). These changes are based on the identification of biomarkers associated with near inevitable development of CRAB features in patients who would otherwise be regarded as having smouldering multiple myeloma. A delay in application of the label of multiple myeloma and postponement of therapy could be detrimental to these patients. In addition to this change, we clarify and update the underlying laboratory and radiographic variables that fulfil the criteria for the presence of myeloma-defining CRAB features, and the histological and monoclonal protein requirements for the disease diagnosis. Finally, we provide specific metrics that new biomarkers should meet for inclusion in the disease definition. The International Myeloma Working Group recommends the implementation of these criteria in routine practice and in future clinical trials, and recommends that future studies analyse any differences in outcome that might occur as a result of the new disease definition.
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            Lenalidomide, Bortezomib, and Dexamethasone with Transplantation for Myeloma

            High-dose chemotherapy plus autologous stem-cell transplantation has been the standard treatment for newly diagnosed multiple myeloma in adults up to 65 years of age. However, promising data on the use of combination therapy with lenalidomide, bortezomib, and dexamethasone (RVD) in this population have raised questions about the role and timing of transplantation.
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              Review of 1027 patients with newly diagnosed multiple myeloma.

              To determine the clinical and laboratory features of newly diagnosed multiple myeloma. Records of all patients in whom multiple myeloma was initially diagnosed at the Mayo Clinic in Rochester, Minn, from January 1, 1985, to December 31, 1998, were reviewed. Of the 1027 study patients, 2% were younger than 40 years, and 38% were 70 years or older. The median age was 66 years. Anemia was present initially in 73% of patients, hypercalcemia (calcium level > or = 11 mg/dL) in 13%, and a serum creatinine level of 2 mg/dL or more in 19%. The beta2-microglobulin level was increased in 75%. Serum protein electrophoresis revealed a localized band in 82% of patients, and immunoelectrophoresis or immunofixation showed a monoclonal protein in 93%. A monoclonal light chain was found in the urine in 78%. Nonsecretory myeloma was recognized in 3% of patients, whereas light-chain myeloma was present in 20%. Conventional radiographs showed an abnormality in 79%. The plasma cell labeling index was 1% or more in 34% of patients. Multivariate analysis revealed that age, plasma cell labeling index, low platelet count, serum albumin value, and the log of the creatinine value were the most important prognostic factors. The median duration of survival was 33 months and did not improve from 1985 through 1998.
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                Author and article information

                Contributors
                Journal
                Leuk Res Rep
                Leuk Res Rep
                Leukemia Research Reports
                Elsevier
                2213-0489
                24 May 2021
                2021
                24 May 2021
                : 15
                : 100252
                Affiliations
                [a ]Hotel Dieu de France University Hospital, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
                [b ]Mount Lebanon university Hospital, oncology and hematology department, Hazmieh, Lebanon
                [c ]Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
                Author notes
                [* ]Corresponding author: Oncology hematology department, Mount Lebanon Hospital, Camille Chamoun Boulevard, P.O BOX: 470 Hazmieh-Lebanon nasrfadi@ 123456hotmail.com
                Article
                S2213-0489(21)00019-4 100252
                10.1016/j.lrr.2021.100252
                8188546
                34141564
                a1613931-8fc9-4e6f-9670-ce7d733e96ee
                © 2021 The Authors. Published by Elsevier Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 13 October 2020
                : 29 March 2021
                : 23 May 2021
                Categories
                Article

                transplant,induction protocol,progression free survival,overall survival,plasma cells disorder

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