Causes of early death in multiple myeloma patients who are ineligible for high‐dose therapy with hematopoietic stem cell support: A study based on the nationwide Danish Myeloma Database

Abstract

Brentuximab vedotin in combination with extended field radiotherapy as salvage treatment for primary refractory Hodgkin lymphoma To the Editor:Hodgkin lymphoma (HL) is a B-cell derived lymphoid malignancy that accounts for about 10% of all lymphomas. Despite most of patients being cured by modern regimens of chemotherapy and radiotherapy (RT), nearly 20% show primary refractoriness or relapse after initial remission. In these cases second-line chemotherapy followed by autologous stem cell transplantation (ASCT) consolidation leads in nearly 50% of patients to a long lasting remission.For patients with HL relapsed/refractory (R/R) to more than two lines of therapy, there is no standard approach and prognosis is generally dismal. Therapeutic options include palliative chemotherapy, radiotherapy, and transplant procedures. More recently, Brentuximab Vedotin (BV), an anti-CD30 monoclonal antibody conjugated with Auristatin, showed therapeutic activity in 75% of patients with HL R/R to ASCT, with 35% complete response (CR) and median progression-free survival (PFS) of nearly 6 months [1]. Limited data are available regarding the combination of BV with chemotherapeutic agents while, the combination of BV with RT has not been reported so far.A 45-year-old male, with no significant comorbidities, was referred at our Centre on August 2013 for onset of multiple lympho-adenopaties (size varying from 2 to 7 cm and involving bilateral the cervical area and the right axillary) associated with fever, night sweats, fatigue, mild cough, and mild skin itching. Total white blood cell count was 39 3 10 9 /L (90% neutrophils, 4% lymphocytes), while hemoglobin and platelet count were 98 g/L and 635 3 10 9 /L, respectively; erythrocyte sedimentation rate was 91 mm/hr. After lateral cervical lymphonode biopsy and standard staging, the patient was diagnosed to have a sclero-nodular, classic HL, stage IIIs (spleen) B. The patient was started on standard ABVD chemotherapy program (Dacarbazine, Bleomycin, Vinblastine, and Doxorubicin) with rapid resolution of systemic symptoms and lymphonodes disappearance. A CT-PET evaluation after two cycles showed a picture of response with FDG uptake lower than liver (Deauville Score 3).After the fourth planned ABVD course, the patient had evidence of supradiaphragmatic progression with recurrence of right supraclavicular, axilla, and mediastinal involvement. A lymphonode biopsy confirmed the initial diagnosis of scleronodular classic HL. The patient was

Early mortality in multiple myeloma: the time‐dependent impact of comorbidity: A population‐based study in 621 real‐life patients

“…Until now, only a few studies have focused on EM in MM [15][16][17][18][19][20][21][22][23][24]. Supporting Information Table III highlights the results of these studies, emphasizing the differences in the type of study and the cutoff used to assess EM.…”

“…The Greek Myeloma Study Group showed that renal failure is associated with EM2, ranging from 12% in patients with severe renal failure to 3% in patients with mild or no renal failure. More recently, Holmstr€ om et al [19] presented a nationwide Danish MM database of patients ineligible for high-dose therapy, showing 22% EM6 associated with performance status, ISS, and lactate dehydrogenase. The most common causes of death were infections, cardiovascular failure and renal failure.…”

The Danish National Multiple Myeloma Registry

“…A skilled trainee reviewed all cases on-site. The majority of early deaths (50.9%) were caused by infections 14. As a consequence of these findings, DMSG started, in 2013, a randomized, controlled clinical trial to study the efficacy of prophylactic antibiotics within the first 6 months of diagnosis in elderly patients with MM (EudraCT number: 2012-004424-38).…”

Risk factors for blood stream infections in multiple myeloma: A population‐based study of 1154 patients in Denmark

“…1 Studies have revealed that infections are the leading cause of early deaths in MM patients. [2][3][4] The majority of infections in MM patients consists of pneumonia and sepsis/septicemia. 1,2,5-8 However, besides results from clinical trials, few studies have addressed the risk factors for serious infections in the era of proteasome inhibitors and IMiDs.Recent single-center studies have analyzed blood stream infections (BSI) in MM; Huang et al 9 showed that the incidence of BSI within 3 months from MM diagnosis was 11.7% and that International Scoring System (ISS) stage III and poor performance status (PS) were independent risk factors for a BSI.…”