A marketing systems approach to stakeholders has never been more important in an increasingly interconnected world. Recognising the inherent limitations of a firm-centric stakeholder stance, this paper proposes a dynamic stakeholders framework to examine the interacting nature of interrelated and interdependent stakeholder effects from a societal perspective. It presents a systemic stakeholders framework that incorporates several defining features and core propositions based on Layton’s MAS mechanisms and Coleman’s Boat. The contribution of a dynamic stakeholders’ marketing system framework is not so much in identifying or defining the appropriate marketing mechanisms at work but in understanding the continuous feedback nature of the macro-micro-macro everyday dynamics which stakeholders listen to, learn about and leverage to act, react and interact.

Background: The adoption of systems thinking within social marketing is illustrated by the emerging literature relating to systems social marketing and macro-social marketing. Systems social marketing and macro-social marketing signal a shift from singular level behavior change toward a more holistic, multilevel change mode of operandi for complex and wicked problems. In recognition of this broadening perspective, Truong et al. took the first steps to describe the relationship between systems thinking and social marketing through a critical appraisal. However, their analysis stopped short of defining systems social marketing and macro-social marketing, examining how the concepts have been applied, and the impact this has on our change methodologies. Focus: This article is related to research and evaluation of the social marketing field. Research Question: This study aims to (a) examine the causality looseness surrounding the descriptions of systems social marketing and macro-social marketing, (b) conceptualize systems social marketing and macro-social marketing, and (c) develop a taxonomy for classifying and interpreting the systems-based social marketing–related literature. Methods: Following best practice protocols, a systematic review was conducted to identify systems social marketing and macro-social marketing literature and interventions published prior to March 2020. Five databases were searched using a combination of relevant search terms. Results: Sixteen thousand and forty-seven title and abstracts were screened, resulting in 45 articles being reviewed, 8 of which were interventions. Analysis of the findings indicated both systems social marketing and macro-social marketing use nonlinear causality and seeks to understand the structural and behavioral dynamics in a system to leverage change. Moreover, the findings suggest that systems social marketing focuses on evolutionary dynamics and a “whole system in the room” approach, pursuing top-down, bottom-up iterative processes with macro-social marketing pursuing institutional dynamics and “inside the system” top-down processes. Importance to Social Marketing Field: This article is one of the first efforts to examine the inner anatomy of systems social marketing and macro-social marketing for causality and definitional clarity. In drawing a distinction between the two orientations, social marketers can begin to understand in what contexts and settings these perspectives are most applicable. Recommendations: The taxonomy and search strategy can be adopted in other reviews as they offer a rich and diverse basis for further conceptual analysis of systems-based social marketing–related literature. Limitation: Community-based prevention marketing, community-based social marketing, and community-led assets-based social marketing articles were excluded from this review. Hence, further research could include these approaches and uncover their features, analogies, and differences versus systems social marketing and macro-social marketing.

Purpose With the explosion of digital technologies in contemporary daily life, fuelled by a pandemic and remote working, online learning and shopping and the proliferation of social platforms, much remains nebulous about the opportunities these technologies hold for social marketers beyond their previously documented use as communication and promotion tools. This paper aims to provide a rich examination of the variety of digital technologies used within social marketing and establish the scale of integration between digital technologies and social marketing. Design/methodology/approach Following systematic literature review procedures, a systematic literature review through eight databases was conducted. The systematic review focussed on the assessment of social marketing studies that incorporated a wide range of mature and emerging digital technologies such as the internet, mobile platforms and social media channels. A total of 50 social marketing studies (2014–2020) were analysed. Findings The review found that there have been major advancements in the technologies available to social marketers in recent years. Furthermore, the adoption of digital technologies by social marketers has evolved from a communication or promotion function where generic information is pushed to the citizen, towards the use of these technologies for a more personalised design, content and behaviour change intervention. In some studies, the digital technologies were the primary means for interactions and collaborations to take place. The review also found that digital technologies target more than the individual citizen. Digital technologies are used to target multi-level stakeholders, policy makers and partners as part of behavioural change interventions. Originality/value Only two previous reviews have synthesised digital technologies and their use in social marketing. This review provides a recent depiction of the range and scale of integration within social marketing. Specifically, it demonstrates the expansion beyond a persuasive application to their use for research, segmentation and targeting, collaboration and co-creation, the product and facilitator of service delivery. Finally, this review provides a heat map to illustrate the integration between digital technologies and key concepts and criteria within social marketing.

Introduction Lenalidomide, bortezomib, and dexamethasone (RVD) is a standard first-line regimen for patients with newly diagnosed multiple myeloma and is associated with high response rates and improvement in progression-free survival and overall survival compared to traditional chemotherapy regimens. Traditional (RVD Classic, RVD Lite) and non-traditional (RVD Premium Lite, RVD Ultra Lite) variations of the RVD regimen are utilized at Dana-Farber Cancer Institute (DFCI) and have not been fully evaluated in terms of safety and tolerability. RVD Premium Lite is administered in a 28-day cycle with weekly bortezomib; whereas, RVD Ultra Lite administers three weekly doses of bortezomib instead of four (Table 1). These two regimens have not been fully evaluated in terms of safety, tolerability, and efficacy. Selection is based on provider preference in addition to flexibility of dosing schedule. The regimens also allow for convenience of weekly dosing while keeping dose intensity. This retrospective, descriptive analysis is the first study to explore the safety, tolerability, and efficacy of four different RVD regimens used at DFCI. Methods This single-center, retrospective, descriptive analysis identified 90 newly diagnosed patients with multiple myeloma treated at DFCI main campus for >2 cycles of an RVD-based regimen in the front-line setting. We reviewed patients started on treatment from January 2017 to December 2019. Patients were excluded if treated primarily at an outside institution or satellite campus. Results A total of 90 patients were included between January 2017 to December 2019, and median age was 69.5 years (range 44-87). Most patients had either standard-risk or unknown cytogenetics. Of the 44 patients with available International Staging System (ISS) information, the majority were R-ISS/ISS I or II. The most common M-protein type at diagnosis was IgG (56.7%), followed by light chain restricted disease (25.6%). In terms of traditional and non-traditional RVD regimens, most patients received RVD Classic (33.3%) or RVD Ultra Lite (32.2%), followed by RVD Lite (23.3%) and RVD Premium Lite (11.1%). Patients in RVD Lite and RVD Ultra Lite groups were of older age when compared to the RVD Classic group (P<0.001). Lenalidomide dosing delays and reductions trended higher in the RVD Classic regimen at 14.3%, followed by RVD Ultra Lite at 12.3%. Bortezomib dosing delays and reductions were similar between the RVD Lite and RVD Classic regimens at 11.8% and 11.2%, respectively. Overall, combined lenalidomide and bortezomib dosing delays/reductions trended higher in the RVD Classic (14.3%/11.2%) and RVD Lite (11.0%/11.8%) compared to RVD Ultra Lite (12.3%/9%) and RVD Premium Lite (10.8%/9.6%). The most common toxicities noted with all variations of the RVD regimen were peripheral neuropathy, cutaneous toxicity, infection, diarrhea, and constipation. The highest rates of adverse events among all RVD regimens were infection and peripheral neuropathy. Peripheral neuropathy was slightly higher in the RVD Premium Lite and RVD Classic regimen at 8.43% and 8.70%, respectively, compared to RVD Lite and RVD Ultra Lite at 7.1% and 7.7%, respectively. No significant difference in toxicities were seen when regimens were compared (p=0.1369). Intolerance leading to therapy change trended higher in the RVD Lite group at 23.8%, followed by RVD Classic and RVD Ultra Lite at 16.7% and 10.3%, respectively. Nineteen percent of patients in the RVD Lite group had minimal response or progression leading to therapy change, which was highest among all RVD regimens. Rate of transplant was highest in the RVD Classic group at 36.7%, followed by RVD Premium Lite at 20%. There was no significant difference in intolerance, minimal response or progression, maintenance, continued induction or planned change, transplant, and death between regimens (p=0.089). In terms of progression-free survival, no differences were seen between the groups (p=0.36). Conclusion In conclusion, the current investigation allowed us to assess the safety, tolerability, and efficacy of traditional and non-traditional variations of the RVD regimen in multiple myeloma used at our institution. There are minimal differences between each regimen when toxicities are managed appropriately. Disclosures Richardson: Celgene/BMS, Oncopeptides, Takeda, Karyopharm: Research Funding. Mo:Celgene/BMS: Membership on an entity's Board of Directors or advisory committees.

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