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4. Presenting Symptoms in Newly Diagnosed Myeloma, Relation to Organ Damage, and Implications for Symptom-Directed Screening: A Secondary Analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) Trial

Author

Bowcock, Stella, primary, Atkin, Catherine, additional, Iqbal, Gulnaz, additional, Pratt, Guy, additional, Yong, Kwee, additional, Neal, Richard D., additional, Planche, Tim, additional, Karunanithi, Kamaraj, additional, Jenkins, Stephen, additional, Stern, Simon, additional, Arnott, Sarah, additional, Toth, Peter, additional, Wandroo, Farooq, additional, Dunn, Janet, additional, and Drayson, Mark T., additional

Published
2023
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5. Patient-reported symptoms and diagnostic journey in Multiple Myeloma.

Author

Vijjhalwar, Rohit, Kaiyang Song, Shrestha, Roshi, Bowcock, Stella, Sanchez-Santos, Maria T., Ramasamy, Karthik, and Javaid, Muhammad Kassim

Subjects
MEDICAL personnel, CHEST pain, MULTIPLE myeloma, ALLIED health personnel, RIB fractures, SYMPTOMS, MUSCULOSKELETAL system diseases
Abstract

Introduction: Late presentation of multiple myeloma (MM) heightens the risk of complication risks, including end-organ damage. This study aimed to: 1) detail the diagnostic journey of MM patients, encompassing symptoms, initial diagnoses, and healthcare professionals met; 2) establish the median duration from symptom onset to MM diagnosis; and 3) examine factors linked to timely MM diagnosis within 12 weeks. Methods: A total of 300 adults self-reporting MM were analysed from the Rare and Undiagnosed Diseases cohort Study (RUDY). The RUDY study is a web-based platform, where participants provide dynamic consent and self-report their MM diagnosis and information about their diagnostic journey. This includes the estimated date of initial potential first symptoms, descriptions of these symptoms, the healthcare professionals they consulted, and other diagnoses received before the MM diagnosis. Descriptive statistics, combinatorial analyses and logistic regression analyses were used to describe and examine the diagnostic journey of individuals with MM. Results: Overall, 52% of the participants reported other diagnoses before MM diagnosis, with musculoskeletal disorders (47.8%), such as osteoporosis, costochondritis, or muscle strains, being the most common. The most prevalent initial reported symptom was back pain/vertebral fractures (47%), followed by chest/shoulder pain, including rib pain and fractures (20%), and fatigue/tiredness (19.7%). 40% of participants were diagnosed by direct referral from primary care to haematology without seeing other healthcare professionals whilst 60% consulted additional specialists before diagnosis. The median time from symptom onset to MM diagnosis was 4 months (IQR 2-10 months, range 0-172). Seeing an Allied Healthcare Professional such as a physiotherapist, chiropractor or an osteopath (OR = 0.25, 95% CI [0.12, 0.47], p <0.001), experiencing infection symptoms (OR = 0.32, 95% CI [0.13, 0.76], p = 0.013), and having chest or shoulder pain (OR = 0.45, 95% CI [0.23, 0.86], p = 0.020) were associated with a lower likelihood of being diagnosed with MM within 12 weeks. Older age (OR = 1.04, 95% CI [1.02, 1.07], p = 0.001) was associated with a higher likelihood of diagnosis within 12 weeks. Discussion: Developing resources for allied health professionals may improve early recognition of MM. [ABSTRACT FROM AUTHOR]

Published
2023
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7. Frailty-adjusted therapy in Transplant Non-Eligible patients with newly diagnosed Multiple Myeloma (FiTNEss (UK-MRA Myeloma XIV Trial)): a study protocol for a randomised phase III trial

Author

Coulson, Amy Beth, primary, Royle, Kara-Louise, additional, Pawlyn, Charlotte, additional, Cairns, David A, additional, Hockaday, Anna, additional, Bird, Jennifer, additional, Bowcock, Stella, additional, Kaiser, Martin, additional, de Tute, Ruth, additional, Rabin, Neil, additional, Boyd, Kevin, additional, Jones, John, additional, Parrish, Christopher, additional, Gardner, Hayley, additional, Meads, David, additional, Dawkins, Bryony, additional, Olivier, Catherine, additional, Henderson, Rowena, additional, Best, Phillip, additional, Owen, Roger, additional, Jenner, Matthew, additional, Kishore, Bhuvan, additional, Drayson, Mark, additional, Jackson, Graham, additional, and Cook, Gordon, additional

Published
2022
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8. Fitness, a UK Myeloma Research Alliance (UK-MRA) Frailty-Adjusted Therapy Study, Supports the Feasibility of Recruiting Frail Newly Diagnosed Myeloma Patients to Large Clinical Trials

Author

Cook, Gordon, primary, Pawlyn, Charlotte, additional, Royle, Kara-Louise, additional, Coulson, Amy Beth, additional, Bird, Jennifer, additional, Bowcock, Stella, additional, Jenner, Matthew W, additional, Kishore, Bhuvan, additional, Parrish, Christopher, additional, Rabin, Neil K, additional, Best, Phillip, additional, Gillson, Sharon, additional, Henderson, Rowena, additional, Olivier, Catherine, additional, Kaiser, Martin F., additional, de Tute, Ruth M., additional, Owen, Roger G, additional, Drayson, Mark T, additional, Jones, John R, additional, Dawkins, Bryony, additional, Meads, David, additional, Cairns, David, additional, and Jackson, Graham, additional

Published
2021
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10. Health-Related Quality of Life (HRQoL) in Fit, Unfit and Frail Patients Enrolled in Fitness (UK-MRA Myeloma XIV): A Cross Sectional Study

Author

McCourt, Orla, Cairns, David Allan, Moore, Sally, Parrish, Christopher, Pawlyn, Charlotte, Seymour, Frances, Senior, Ethan R, Royle, Kara-Louise, Bird, Jennifer, Bowcock, Stella J., Chant, Alan, Drayson, Mark, Gardner, Hayley, Jenner, Matthew W., Jones, John R, Kaiser, Martin F., Kishore, Bhuvan, Owen, Roger, Rabin, Neil, de Tute, Ruth M, Dawkins, Bryony, Meads, David, Gillson, Sharon, Jackson, Sharon, Olivier, Catherine, Jackson, Graham, and Cook, Gordon

Published
2023
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11. Real-World Mobilization, Harvest, and Transplant Outcomes in Newly Diagnosed Multiple Myeloma Patients Receiving D-VTd: A UK Centre Experience

Author

Bourlon, Christianne, Bailey, Katharine Elizabeth, Benjamin, Reuben, Cuthill, Kirsty, Gunawan, Arief, Kazmi, Majid, Krishnamurthy, Pramila, Potter, Victoria, Sanderson, Robin, Kenyon, Michelle, Shah, Mili, Streetly, Matthew, Serpenti, Fabio, Bowcock, Stella J., Banerjee, Lalita, Jones, John Robert, Rashid, Sabia, Duran Maestre, Ana Isabel, Sahu, Satyajit, Gurung, Sudarshan, Chia, Lianwea, Cui, Haili, Pratt, Alison, Ahsan, Maheen, and Bouziana, Stella

Published
2023
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13. Levofloxacin prophylaxis in patients with newly diagnosed myeloma (TEAMM): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial

Author

Drayson, Mark T, Bowcock, Stella, Planche, Tim, Iqbal, Gulnaz, Pratt, Guy, Yong, Kwee, Wood, Jill, Raynes, Kerry, Higgins, Helen, Dawkins, Bryony, Meads, David, Hulme, Claire T, Monahan, Irene, Whittaker, Anna C, and Karunanithi, Kamaraj

Subjects
deaths, myeloma, antibiotic prophylaxis, placebo controlled randomised trial, febrile episodes, infection, health care associated infections
Abstract

Background Myeloma causes profound immunodeficiency and recurrent, serious infections. Around 5500 new cases of myeloma are diagnosed per year in the UK, and a quarter of patients will have a serious infection within 3 months of diagnosis. We aimed to assess whether patients newly diagnosed with myeloma benefit from antibiotic prophylaxis to prevent infection, and to investigate the effect on antibiotic-resistant organism carriage and health care-associated infections in patients with newly diagnosed myeloma. Methods TEAMM was a prospective, multicentre, double-blind, placebo-controlled randomised trial in patients aged 21 years and older with newly diagnosed myeloma in 93 UK hospitals. All enrolled patients were within 14 days of starting active myeloma treatment. We randomly assigned patients (1:1) to levofloxacin or placebo with a computerised minimisation algorithm. Allocation was stratified by centre, estimated glomerular filtration rate, and intention to proceed to high-dose chemotherapy with autologous stem cell transplantation. All investigators, patients, laboratory, and trial co-ordination staff were masked to the treatment allocation. Patients were given 500 mg of levofloxacin (two 250 mg tablets), orally once daily for 12 weeks, or placebo tablets (two tablets, orally once daily for 12 weeks), with dose reduction according to estimated glomerular filtration rate every 4 weeks. Follow-up visits occurred every 4 weeks up to week 16, and at 1 year. The primary outcome was time to first febrile episode or death from all causes within the first 12 weeks of trial treatment. All randomised patients were included in an intention-to-treat analysis of the primary endpoint. This study is registered with the ISRCTN registry, number ISRCTN51731976, and the EU Clinical Trials Register, number 2011-000366-35. Findings Between Aug 15, 2012, and April 29, 2016, we enrolled and randomly assigned 977 patients to receive levofloxacin prophylaxis (489 patients) or placebo (488 patients). Median follow-up was 12 months (IQR 8–13). 95 (19%) first febrile episodes or deaths occurred in 489 patients in the levofloxacin group versus 134 (27%) in 488 patients in the placebo group (hazard ratio 0·66, 95% CI 0·51–0·86; p=0·0018. 597 serious adverse events were reported up to 16 weeks from the start of trial treatment (308 [52%] of which were in the levofloxacin group and 289 [48%] of which were in the placebo group). Serious adverse events were similar between the two groups except for five episodes (1%) of mostly reversible tendonitis in the levofloxacin group. Interpretation Addition of prophylactic levofloxacin to active myeloma treatment during the first 12 weeks of therapy significantly reduced febrile episodes and deaths compared with placebo without increasing health care-associated infections. These results suggest that prophylactic levofloxacin could be used for patients with newly diagnosed myeloma undergoing anti-myeloma therapy.

Published
2019

14. Stratifying risk of infection and response to therapy in patients with myeloma: a prognostic study

Author

Chicca, Ilaria J, primary, Heaney, Jennifer LJ, additional, Iqbal, Gulnaz, additional, Dunn, Janet A, additional, Bowcock, Stella, additional, Planche, Tim, additional, Pratt, Guy, additional, Yong, Kwee, additional, Low, Eric, additional, Wood, Jill, additional, Raynes, Kerry, additional, Higgins, Helen, additional, and Drayson, Mark T, additional

Published
2020
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15. Frailty-Adjusted Therapy in Transplant Non-Eligible Patients with Newly Diagnosed Multiple Myeloma (FiTNEss): A UK Myeloma Research Alliance Study, Myeloma XIV

Author

Cairns, David, primary, Pawlyn, Charlotte, additional, Royle, Kara-Louise, additional, Best, Phillip, additional, Bird, Jenny, additional, Bowcock, Stella, additional, Boyd, Kevin, additional, Dawkins, Bryony, additional, Drayson, Mark T, additional, Henderson, Rowena, additional, Jenner, Matthew, additional, Jones, John R, additional, Kaiser, Martin F., additional, Kishore, Bhuvan, additional, Meads, David, additional, Mottram, Rebecca, additional, Rabin, Neil K, additional, Owen, Roger G., additional, Jackson, Graham, additional, and Cook, Gordon, additional

Published
2019
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16. Prophylactic levofloxacin to prevent infections in newly diagnosed symptomatic myeloma: the TEAMM RCT

Author

Drayson, Mark T, primary, Bowcock, Stella, additional, Planche, Tim, additional, Iqbal, Gulnaz, additional, Pratt, Guy, additional, Yong, Kwee, additional, Wood, Jill, additional, Raynes, Kerry, additional, Higgins, Helen, additional, Dawkins, Bryony, additional, Meads, David, additional, Hulme, Claire T, additional, Whittaker, Anna C, additional, Hawkey, Peter, additional, Low, Eric, additional, and Dunn, Janet A, additional

Published
2019
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18. Elective Vs Non-Elective Hospital Admissions By Patients with Multiple Myeloma in England 2014 - 2018

Author

Ramasamy, Karthik, primary, Kolovos, Spyros, additional, Nador, Guido, additional, Finley, Rosemarie, additional, Streetly, Matthew, additional, Kishore, Bhuvan, additional, Rabin, Neil K, additional, Chantry, Andrew D, additional, Yong, Kwee, additional, Ashcroft, John, additional, Bowcock, Stella, additional, Drayson, Mark T, additional, Prieto-Alhambra, Daniel, additional, Cooper, Cyrus, additional, Javaid, Muhammad Kassim, additional, and Pinedo-Villanueva, Rafael, additional

Published
2018
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19. 149. Immunogenicity, Safety, and Post-hoc Efficacy Assessment of the Adjuvanted Recombinant Zoster Vaccine in Adults with Hematologic Malignancies: A Phase 3, Randomized Clinical Trial

Author

Dagnew, Alemnew F, primary, Ilhan, Osman, additional, Lee, Won-Sik, additional, Woszczyk, Dariusz, additional, Kwak, Jae-Yong, additional, Bowcock, Stella, additional, Sohn, Sang Kyun, additional, Rodriguez Macías, Gabriela, additional, Chiou, Tzeon-Jye, additional, Quiel, Dimas, additional, Aoun, Mickael, additional, Matilla, Maria Belen Navarro, additional, De La Serna, Javier, additional, Milliken, Samuel, additional, Murphy, John, additional, McNeil, Shelly A, additional, Salaun, Bruno, additional, Paolo, Emmanuel Di, additional, Campora, Laura, additional, López-Fauqued, Marta, additional, El Idrissi, Mohamed, additional, Schuind, Anne, additional, Heineman, Thomas C, additional, Van Den Steen, Peter, additional, and Oostvogels, Lidia, additional

Published
2018
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20. Tackling Early Morbidity and Mortality in Myeloma (TEAMM): Assessing the Benefit of Antibiotic Prophylaxis and Its Effect on Healthcare Associated Infections in 977 Patients

Author

Drayson, Mark T, primary, Bowcock, Stella, additional, Planche, Tim, additional, Iqbal, Gulnaz, additional, Wood, Jill, additional, Raynes, Kerry, additional, Pratt, Guy, additional, Yong, Kwee, additional, Hawkey, Peter, additional, Higgins, Helen, additional, and Dunn, Janet, additional

Published
2017
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23. Dynamic Frailty Assessment in Transplant Non-Eligible Newly Diagnosed Myeloma Patients: Initial Data from UK Myeloma Research Alliance (UK-MRA) Myeloma XIV (FiTNEss): A Frailty-Adjusted Therapy Study

Author

Cook, Gordon, Pawlyn, Charlotte, Royle, Kara-Louise, Senior, Ethan R, Everritt, Dax, Bird, Jenny, Bowcock, Stella J., Dawkins, Bryony, Drayson, Mark, Gillson, Sharon, Olivier, Catherine, Chant, Alan, Jenner, Matthew W., Jones, John Robert, Kaiser, Martin F., Kishore, Bhuvan, Meads, David, Rabin, Neil, Owen, Roger, de Tute, Ruth M, Parrish, Christopher, Cairns, David Allan, and Jackson, Graham

Abstract

Background

Published
2023
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31. Manual of Haematology (Book Review).

Author

Bowcock, Stella

Subjects
MANUAL of Haematology (Book), BAUGHAN, A. S., HUGHES, A. S., PATTERSON, K. G.
Abstract

Reviews the book 'Manual of Haematology,' by A.S.J. Baughan, A.S.B. Hughes, K.G. Patterson and L. Stirling.

Published
1986

32. Longitudinal dynamics and clinically available predictors of poor response to COVID-19 vaccination in multiple myeloma.

Author

Agarwal G, Moore S, Sadler R, Varghese S, Turner A, Chen LY, Larham J, Gray N, Carty O, Barrett J, Koshiaris C, Kothari J, Bowcock S, Oppermann U, Gamble V, Cook G, Kyriakou C, Drayson M, Basu S, McDonald S, McKinley S, Gooding S, Javaid MK, and Ramasamy K

Subjects
Humans, Male, Female, Aged, Middle Aged, Longitudinal Studies, Multiple Myeloma immunology, Multiple Myeloma therapy, COVID-19 prevention & control, COVID-19 epidemiology, COVID-19 Vaccines administration & dosage, COVID-19 Vaccines immunology, SARS-CoV-2 immunology, Vaccination
Published
2024
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33. F railty-adjusted therapy i n T ransplant N on- E ligible patient s with newly diagno s ed Multiple Myeloma (FiTNEss (UK-MRA Myeloma XIV Trial)): a study protocol for a randomised phase III trial.

Author

Coulson AB, Royle KL, Pawlyn C, Cairns DA, Hockaday A, Bird J, Bowcock S, Kaiser M, de Tute R, Rabin N, Boyd K, Jones J, Parrish C, Gardner H, Meads D, Dawkins B, Olivier C, Henderson R, Best P, Owen R, Jenner M, Kishore B, Drayson M, Jackson G, and Cook G

Subjects
Aged, Clinical Trials, Phase III as Topic, Humans, Lenalidomide adverse effects, Lenalidomide therapeutic use, Multicenter Studies as Topic, Quality of Life, Randomized Controlled Trials as Topic, United Kingdom, Frailty chemically induced, Multiple Myeloma diagnosis, Multiple Myeloma drug therapy
Abstract

Introduction: Multiple myeloma is a bone marrow cancer, which predominantly affects older people. The incidence is increasing in an ageing population.Over the last 10 years, patient outcomes have improved. However, this is less apparent in older, less fit patients, who are ineligible for stem cell transplant. Research is required in this patient group, taking into account frailty and aiming to improve: treatment tolerability, clinical outcomes and quality of life., Methods and Analysis: Frailty-adjusted therapy in Transplant Non-Eligible patients with newly diagnosed Multiple Myeloma is a national, phase III, multicentre, randomised controlled trial comparing standard (reactive) and frailty-adjusted (adaptive) induction therapy delivery with ixazomib, lenalidomide and dexamethasone (IRD), and to compare maintenance lenalidomide to lenalidomide+ixazomib, in patients with newly diagnosed multiple myeloma not suitable for stem cell transplant. Overall, 740 participants will be registered into the trial to allow 720 and 478 to be randomised at induction and maintenance, respectively.All participants will receive IRD induction with the dosing strategy randomised (1:1) at trial entry. Patients randomised to the standard, reactive arm will commence at the full dose followed by toxicity dependent reactive modifications. Patients randomised to the adaptive arm will commence at a dose level determined by their International Myeloma Working Group frailty score. Following 12 cycles of induction treatment, participants alive and progression free will undergo a second (double-blind) randomisation on a 1:1 basis to maintenance treatment with lenalidomide+placebo versus lenalidomide+ixazomib until disease progression or intolerance., Ethics and Dissemination: Ethical approval has been obtained from the North East-Tyne & Wear South Research Ethics Committee (19/NE/0125) and capacity and capability confirmed by local research and development departments for each participating centre prior to opening to recruitment. Participants are required to provide written informed consent prior to trial registration. Trial results will be disseminated by conference presentations and peer-reviewed publications., Trial Registration Number: ISRCTN17973108, NCT03720041., Competing Interests: Competing interests: ABC, K-LR, DAC, AH, CO, RH and PB report grants and non-financial support from BMS/Celgene, grants and non-financial support from Merck Sharpe & Dohme, grants and non-financial support from Amgen, grants and non-financial support from Takeda, during the conduct of the trial. DAC also reports travel support from Celgene Corporation. CPawlyn reports receiving honoraria and/or travel support from Amgen, BMS/Celgene, Janssen, Sanofi and Takeda. MK consultancy: AbbVie, Amgen, BMS/Celgene, GSK, Janssen, Karyopharm, Seattle Genetics, Takeda; honoraria: BMS/Celgene, Janssen, Takeda; Research funding: BMS/Celgene; Travel/educational support: BMS/Celgene, Janssen, Takeda. SB reports receiving research funding from Takeda. KB—Advisory Boards Janssen: BMS/Celgene, Takeda, Novartis. Speaker Honoraria: Janssen, BMS/Celgene, Sanofi, Takeda. Support to attend educational meetings: Janssen, BMS/Celgene, Takeda, GSK. GJ reports research funding from Takeda, Onyx, MSD & BMS/Celgene with consultancy from Janssen, Takeda, Sanofi, Oncopeptides, Karyopharm, Pfizer, Roche & BMS/Celgene. GC reports research funding from Janssen, Takeda, Amgen & BMS/Celgene with consultancy from Janssen, Takeda, Sanofi, Oncopeptides, Karyopharm, Pfizer, Roche & BMS/Celgene. MD reports Stock held in Abingdon Health. JB, RdT, NR, JJ, CParrish, HG, DM, BD, RO, MJ and BK have no declared competing interests., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Published
2022
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35. Chemotherapy for cancer patients who present late.

Author

Bowcock SJ, Shee CD, Rassam SM, and Harper PG

Subjects
Antineoplastic Agents adverse effects, Humans, Patient Acceptance of Health Care, Quality of Life, Survivors, Time Factors, Antineoplastic Agents therapeutic use, Neoplasms drug therapy
Published
2004
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