21 results on '"I. Vaxman"'
Search Results
2. 'Real-life' data of the efficacy and safety of belantamab mafodotin in relapsed multiple myeloma—the Mayo Clinic experience
- Author
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I. Vaxman, J. Abeykoon, A. Dispenzieri, S. K. Kumar, F. Buadi, M. Q. Lacy, D. Dingli, Y. Hwa, A. Fonder, M. Hobbs, C. Reeder, T. Sher, S. Hayman, T. Kourelis, R. Warsame, E. Muchtar, N. Leung, R. Go, W. Gonsalves, M. Siddiqui, R. A. Kyle, S. V. Rajkumar, McCullough Kristen, P. Kapoor, and M. A. Gertz
- Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Belantamab mafodotin is a highly selective targeted therapy for multiple myeloma. It targets the B cell maturation antigen (BCMA) on plasma cells and showed promising results in several randomized clinical trials. We report the outcomes of 36 patients treated at Mayo Clinic. Our cohort received a median of eight prior lines of therapy. Six patients received belantamab in combination with other medications (pomalidomide, cyclophosphamide, thalidomide), 13 patients (36%) were 70 years or older, two patients had a creatinine of >2.5 mg/dL, and one patient was on dialysis. All three patients with renal failure received full dose belantamab. Chimeric antigen receptor (CAR-T) therapy was used prior to belantamab in seven patients and none of them responded to belantamab therapy. The overall response rate (ORR) was 33% (CR 6%, VGPR 8%, PR 19%), like the ORR reported in the DREAMM-2 trial. Keratopathy developed in 16 patients (43%), grade 1 in six patients, grade 2 in seven patients, and grade 3 in three patients. Eight percent discontinued therapy due to keratopathy. The median PFS and OS was 2 months and 6.5 months, respectively.
- Published
- 2021
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3. P966: DARATUMUMAB, CARFILZOMIB, POMALIDOMIDE AND ELOTUZUMAB FOR THE TREATMENT OF POEMS SYNDROME- THE MAYO CLINIC EXPERIENCE
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I. Vaxman, S. Kumar, F. buadi, M. Lacy, D. Dingli, A. Fonder, M. Hobbs, S. Hayman, L. Y. hwa, T. Kouralis, R. Warsame, E. Muchtar, L. Nelson, P. Kapoor, M. Grogan, R. Go, W. Gonsalves, M. Siddiqi, K. Robert, V. Rajkumar, M. Gertz, and A. Dispenzieri
- Subjects
Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2022
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4. PS1399 REAL WORLD DATA ON THE EFFICACY AND SAFETY OF DARATUMUMAB FOR TREATMENT OF PATIENTS WITH RELAPSED/REFRACTORY AL AMYLOIDOSIS: A MULTI-SITE RETROSPECTIVE STUDY
- Author
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N. Lavie, S. Levi, M. Gatt, I. Avivi, I. Vaxman, T. Shragai, T. Tadmor, M. Zektser, Y.C. Cohen, and O. Rouvio
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Pediatrics ,medicine.medical_specialty ,business.industry ,Relapsed refractory ,medicine ,Multi site ,AL amyloidosis ,Daratumumab ,Retrospective cohort study ,Hematology ,business ,medicine.disease ,Real world data - Published
- 2019
5. P6160Anthracycline cardiotoxicity in patients with acute myeloid leukemia: cardiovascular risk assessment, monitoring and management
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I. Vaxman, Oren Pasvolsky, M Vaturi, Ran Kornowski, P. Raanani, Zaza Iakobishvili, O Morelli, and I. Amitai
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Oncology ,Cardiotoxicity ,medicine.medical_specialty ,business.industry ,Internal medicine ,Medicine ,Myeloid leukemia ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Published
- 2017
6. Immune Therapies in AL Amyloidosis-A Glimpse to the Future.
- Author
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Haran A, Vaxman I, Gatt ME, and Lebel E
- Abstract
Light-chain (AL) amyloidosis is a rare plasma cell disorder characterized by the deposition of misfolded immunoglobulin light chains in target organs, leading to multi-organ dysfunction. Treatment approaches have historically mirrored but lagged behind those of multiple myeloma (MM). Recent advancements in MM immunotherapy are gradually being evaluated and adopted in AL amyloidosis. This review explores the current state of immunotherapeutic strategies in AL amyloidosis, including monoclonal antibodies, antibody-drug conjugates, bispecific antibodies, and chimeric antigen receptor T-cell therapy. We discuss the unique challenges and prospects of these therapies in AL amyloidosis, including the exposure of frail AL amyloidosis patients to immune-mediated toxicities such as cytokine release syndrome (CRS) and immune effector-cell-associated neurotoxicity syndrome (ICANS), as well as their efficacy in promoting rapid and deep hematologic responses. Furthermore, we highlight the need for international initiatives and compassionate programs to provide access to these promising therapies and address critical unmet needs in AL amyloidosis management. Finally, we discuss future directions, including optimizing treatment sequencing and mitigating toxicities, to improve outcomes for AL amyloidosis patients.
- Published
- 2024
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7. Microvascular cardiac amyloidosis-Cardiac involvement of amyloidosis presenting as typical chest pain.
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Vaxman I, Kaufman C, Lerman A, and Gertz MA
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- Humans, Diagnosis, Differential, Chest Pain etiology, Heart, Angina Pectoris etiology, Angina Pectoris diagnosis, Amyloidosis complications, Amyloidosis diagnosis
- Abstract
Coronary microvascular angina from cardiac amyloidosis., (© 2023 The Authors. American Journal of Hematology published by Wiley Periodicals LLC.)
- Published
- 2023
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8. Delivery of Therapeutic RNA to the Bone Marrow in Multiple Myeloma Using CD38-Targeted Lipid Nanoparticles.
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Tarab-Ravski D, Hazan-Halevy I, Goldsmith M, Stotsky-Oterin L, Breier D, Naidu GS, Aitha A, Diesendruck Y, Ng BD, Barsheshet H, Berger T, Vaxman I, Raanani P, and Peer D
- Subjects
- Humans, Animals, Mice, Bone Marrow, Neoplasm Recurrence, Local, RNA, Small Interfering therapeutic use, Multiple Myeloma drug therapy
- Abstract
Multiple myeloma (MM) is a cancer of differentiated plasma cells that occurs in the bone marrow (BM). Despite the recent advancements in drug development, most patients with MM eventually relapse and the disease remains incurable. RNA therapy delivered via lipid nanoparticles (LNPs) has the potential to be a promising cancer treatment, however, its clinical implementation is limited due to inefficient delivery to non-hepatic tissues. Here, targeted (t)LNPs designed for delivery of RNA payload to MM cells are presented. The tLNPs consist of a novel ionizable lipid and are coated with an anti-CD38 antibody (αCD38-tLNPs). To explore their therapeutic potential, it is demonstrated that LNPs encapsulating small interference RNA (siRNA) against cytoskeleton-associated protein 5 (CKAP5) lead to a ≈90% decrease in cell viability of MM cells in vitro. Next, a new xenograft MM mouse model is employed, which clinically resembles the human disease and demonstrates efficient homing of MM cells to the BM. Specific delivery of αCD38-tLNPs to BM-residing and disseminated MM cells and the improvement in therapeutic outcome of MM-bearing mice treated with αCD38-tLNPs-siRNA-CKAP5 are shown. These results underscore the potential of RNA therapeutics for treatment of MM and the importance of developing effective targeted delivery systems and reliable preclinical models., (© 2023 The Authors. Advanced Science published by Wiley-VCH GmbH.)
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- 2023
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9. The short and long-term characteristics and outcomes of patients with grade 1 myocardial uptake on cardiac scintigraphy.
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Itzhaki Ben Zadok O, Ruhrman-Sahar N, Mats I, Vaxman I, Shiyovich A, Aviv Y, Vaturi M, Wiessman M, Shochat T, Kandinov I, Kornowski R, and Hamdan A
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- Female, Humans, Retrospective Studies, Heart, Radionuclide Imaging, Myocardium, Amyloid Neuropathies, Familial diagnostic imaging
- Abstract
Aims: This study aimed to characterize the final diagnosis and prognosis of patients with grade 1 myocardial scintigraphy uptake, which is an unequivocal result for the diagnosis of transthyretin cardiac amyloidosis (ATTR-CA) requiring further invasive investigation with tissue biopsy., Methods and Results: We retrospectively compared the clinical and imaging parameters of patients suspected for ATTR-CA (based on clinical and echocardiographic parameters) with grade 1 vs. grades 2/3 technetium pyrophosphate uptake on cardiac scintigraphy. Prospectively, grade 1 patients underwent re-evaluation for ATTR-CA at long term. Of the 132 ATTR-CA suspected patients, 89 (67%) were diagnosed as grade 1 and 43 (33%) as grades 2/3 uptake. Grade 1 vs. grades 2/3 patients were younger and female predominant with lower biomarker levels and left ventricular mass. Based on available imaging and pathology findings, only 6 out of the 89 patients with grade 1 uptake (7%) were finally diagnosed with light-chain cardiac amyloidosis, whereas no patient was diagnosed with ATTR-CA. At 2 [interquartile range (IQR) 0.75, 3.25] years of follow-up, the survival of patients with grade 1 vs. grades 2/3 uptake was significantly better [hazard ratio 0.271 (95% confidence interval 0.130 to 0.563, P = 0.0005)]. Prospectively, 30 patients with grade 1 uptake were re-evaluated at a median follow-up of 3.2 (IQR 2.2, 3.9) years. Their New York Heart Association class, biomarker levels, and echocardiography findings remained stable. No patient (0/25) demonstrated grades 2/3 uptake at repeated long-term scintigraphy., Conclusions: Patients with suspected ATTR-CA and a grade 1 scintigraphy uptake demonstrate a stable clinical, laboratory, imaging, and scintigraphy phenotype along with a benign survival profile at long-term follow-up. Larger studies should define the optimal evaluation strategy in this population., (© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
- Published
- 2023
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10. Daratumumab, carfilzomib, and pomalidomide for the treatment of POEMS syndrome: The Mayo Clinic Experience.
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Vaxman I, Kumar SK, Buadi F, Lacy MQ, Dingli D, Hayman S, Kourelis T, Warsame R, Hwa Y, Fonder A, Hobbs M, Muchtar E, Leung N, Kapoor P, Go R, Lin Y, Gonsalves W, Siddiqui M, Kyle RA, Rajkumar SV, Gertz MA, and Dispenzieri A
- Subjects
- Humans, Antineoplastic Combined Chemotherapy Protocols, Thalidomide therapeutic use, Multiple Myeloma drug therapy, POEMS Syndrome
- Published
- 2023
- Full Text
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11. Venetoclax in Relapse/Refractory AL Amyloidosis-A Multicenter International Retrospective Real-World Study.
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Lebel E, Kastritis E, Palladini G, Milani P, Theodorakakou F, Aumann S, Lavi N, Shargian L, Magen H, Cohen Y, Gatt ME, and Vaxman I
- Abstract
Therapeutic options in relapsed refractory (R/R) light-chain (AL) amyloidosis patients are limited. Given the encouraging results in t(11;14) multiple myeloma and the high prevalence of t(11;14) in AL amyloidosis, venetoclax is an attractive treatment option in this setting. We report here the results of a multi-center retrospective study on 26 R/R AL amyloidosis patients treated off-label with venetoclax. The median lines of therapy prior to venetoclax was 3.5 (range 1-7), and 88% of our cohort had t (11;14). Twenty-two patients (85%) were previously treated with daratumumab. The overall hematologic response rate was 88%, 35% achieved a CR, and 35% achieved VGPR. The median event-free survival was 25 months (m) (95% CI 9.7 m-not reached), and the median overall survival was 33 m (95% CI 25.9-39.2 m). Most of the patients in this cohort are in ongoing deep responses and continuing venetoclax therapy. The treatment was relatively safe. One patient died due to infection, and there were two grade 3 infections in our cohort. Tumor lysis syndrome (TLS) was not seen in any patient. Dose reductions were frequent but did not affect the efficacy. These promising results require confirmation in a randomized controlled trial.
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- 2023
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12. How I approach smoldering multiple myeloma.
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Vaxman I and Gertz MA
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- Disease Progression, Humans, Risk Factors, Multiple Myeloma drug therapy, Multiple Myeloma therapy, Smoldering Multiple Myeloma diagnosis, Smoldering Multiple Myeloma therapy
- Abstract
The current standard of care in smoldering multiple myeloma (SMM) is close surveillance, outside of clinical trials. Efforts are being made to understand the pathobiologic process that leads to the progression of SMM to active MM. This review provides a critical description of available data, including risk factors and risk models of progression, as well as clinical trials investigating interventions for this patient population. We describe 2 cases in which patients were seen before the concept of a myeloma-defining event was established. Today, based on the International Myeloma Working Group criteria, both patients would have been identified as experiencing myeloma-defining events, and therapy would have been initiated. These cases show that occasionally, patients can undergo observation only, even when they exceed criteria for high-risk SMM., (© 2022 by The American Society of Hematology.)
- Published
- 2022
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13. "Real-life" data of the efficacy and safety of belantamab mafodotin in relapsed multiple myeloma-the Mayo Clinic experience.
- Author
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Vaxman I, Abeykoon J, Dispenzieri A, Kumar SK, Buadi F, Lacy MQ, Dingli D, Hwa Y, Fonder A, Hobbs M, Reeder C, Sher T, Hayman S, Kourelis T, Warsame R, Muchtar E, Leung N, Go R, Gonsalves W, Siddiqui M, Kyle RA, Rajkumar SV, Kristen M, Kapoor P, and Gertz MA
- Subjects
- Adult, Aged, Aged, 80 and over, Antibodies, Monoclonal, Humanized adverse effects, Antineoplastic Agents, Immunological adverse effects, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Antibodies, Monoclonal, Humanized therapeutic use, Antineoplastic Agents, Immunological therapeutic use, Multiple Myeloma drug therapy, Neoplasm Recurrence, Local drug therapy
- Abstract
Belantamab mafodotin is a highly selective targeted therapy for multiple myeloma. It targets the B cell maturation antigen (BCMA) on plasma cells and showed promising results in several randomized clinical trials. We report the outcomes of 36 patients treated at Mayo Clinic. Our cohort received a median of eight prior lines of therapy. Six patients received belantamab in combination with other medications (pomalidomide, cyclophosphamide, thalidomide), 13 patients (36%) were 70 years or older, two patients had a creatinine of >2.5 mg/dL, and one patient was on dialysis. All three patients with renal failure received full dose belantamab. Chimeric antigen receptor (CAR-T) therapy was used prior to belantamab in seven patients and none of them responded to belantamab therapy. The overall response rate (ORR) was 33% (CR 6%, VGPR 8%, PR 19%), like the ORR reported in the DREAMM-2 trial. Keratopathy developed in 16 patients (43%), grade 1 in six patients, grade 2 in seven patients, and grade 3 in three patients. Eight percent discontinued therapy due to keratopathy. The median PFS and OS was 2 months and 6.5 months, respectively., (© 2021. The Author(s).)
- Published
- 2021
- Full Text
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14. The Efficacy and Safety of Chemotherapy-Based Stem Cell Mobilization in Multiple Myeloma Patients Who Are Poor Responders to Induction: The Mayo Clinic Experience.
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Vaxman I, Muchtar E, Jacob E, Kapoor P, Kumar S, Dispenzieri A, Buadi F, Dingli D, Gonsalves W, Kourelis T, Warsame R, Lacy M, Hogan W, and Gertz MA
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- Hematopoietic Stem Cell Mobilization, Humans, Transplantation, Autologous, Hematopoietic Stem Cell Transplantation, Heterocyclic Compounds adverse effects, Multiple Myeloma drug therapy
- Abstract
We report the outcomes of 117 patients with newly diagnosed multiple myeloma who received novel agent induction, had a poor response to induction, and were mobilized using intravenous intermediate-dose cyclophosphamide (82%) or VD-PACE (18%) plus granulocyte colony-stimulating factor (G-CSF) and on-demand plerixafor. The median progression-free survival and overall survival of the chemo-mobilized cohort were 21 months (95% confidence interval [CI], 15-71) and 58 months (95% CI, 47-80), respectively. We compared our cohort to a 117-patient cohort matched by the level of response at pretransplant evaluation. The matched patients were mobilized with G-CSF and on-demand plerixafor without chemotherapy. Patients receiving chemo-mobilization had higher stem cell yields than the growth-factor-only cohort (median, 10.7 × 10
6 cells/kg vs. 8.77 × 106 cells/kg, respectively; P < .001). The safety profile of chemo-mobilization was favorable, and there was no difference between the two groups in length of hospitalization during autologous stem cell transplantation (P = .95), days to neutrophil engraftment (P = .22), days to platelet engraftment (P = .27), or risk of bacteremia (P = .52). Twenty-nine percent of the chemo-mobilized cohort and 65% of the matched cohort required plerixafor for adequate mobilization (P < .001). Chemo-mobilization enhances stem cell collection without adversely impacting the post-transplant clinical course., (Copyright © 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)- Published
- 2021
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15. Differences in the characteristics and contemporary cardiac outcomes of patients with light-chain versus transthyretin cardiac amyloidosis.
- Author
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Itzhaki Ben Zadok O, Vaturi M, Vaxman I, Iakobishvili Z, Rhurman-Shahar N, Kornowski R, and Hamdan A
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- Aged, Aged, 80 and over, Cardiomyopathies etiology, Cardiomyopathies pathology, Echocardiography, Female, Follow-Up Studies, Heart Failure etiology, Heart Failure pathology, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Survival Rate, Ventricular Function, Left, Amyloid Neuropathies, Familial complications, Cardiomyopathies mortality, Heart Failure mortality, Immunoglobulin Light-chain Amyloidosis complications
- Abstract
Aims: To compare the baseline cardiovascular characteristics of immunoglobulin light-chain (AL) and amyloid transthyretin (ATTR) cardiac amyloidosis (CA) and to investigate patients' contemporary cardiac outcomes., Methods: Single-center analysis of clinical, laboratory, echocardiographic and cardiac magnetic resonance imaging (CMRi) characteristics of AL and ATTR-CA patients' cohort (years 2013-2020)., Results: Included were 67 CA patients of whom 31 (46%) had AL-CA and 36 (54%) had ATTR-CA. Patients with ATTR-CA versus AL-CA were older (80 (IQR 70, 85) years versus 65 (IQR 60, 71) years, respectively, p<0.001) with male predominance (p = 0.038). Co-morbidities in ATTR-CA patients more frequently included diabetes mellitus (19% versus 3.0%, respectively, p = 0.060) and coronary artery disease (39% versus 10%, respectively, p = 0.010). By echocardiography, patients with ATTR-CA versus AL-CA had a trend to worse left ventricular (LV) ejection function (50 (IQR 40, 55)% versus 60 (IQR 45, 60)%, respectively, p = 0.051), yet comparable LV diastolic function. By CMRi, left atrial area (31 (IQR 27, 36)cm2 vs. 27 (IQR 23, 30)cm2, respectively, p = 0.015) and LV mass index (109 (IQR 96, 130)grams/m2 vs. 82 (IQR 72, 98)grams/m2, respectively, p = 0.011) were increased in patients with ATTR-CA versus AL-CA. Nevertheless, during follow-up (median 20 (IQR 10, 38) months), patients with AL-CA were more frequently admitted with heart failure exacerbations (HR 2.87 (95% CI 1.42, 5.81), p = 0.003) and demonstrated increased mortality (HR 2.51 (95%CI 1.19, 5.28), p = 0.015)., Conclusion: Despite the various similarities of AL-CA and ATTR-CA, these diseases have distinct baseline cardiovascular profiles and different heart failure course, thus merit tailored-cardiac management., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2021
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16. Identification of resistance pathways and therapeutic targets in relapsed multiple myeloma patients through single-cell sequencing.
- Author
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Cohen YC, Zada M, Wang SY, Bornstein C, David E, Moshe A, Li B, Shlomi-Loubaton S, Gatt ME, Gur C, Lavi N, Ganzel C, Luttwak E, Chubar E, Rouvio O, Vaxman I, Pasvolsky O, Ballan M, Tadmor T, Nemets A, Jarchowcky-Dolberg O, Shvetz O, Laiba M, Shpilberg O, Dally N, Avivi I, Weiner A, and Amit I
- Subjects
- Adult, Aged, Aged, 80 and over, Antibodies, Monoclonal administration & dosage, Case-Control Studies, Dexamethasone administration & dosage, Drug Resistance, Neoplasm, Female, Humans, Lenalidomide administration & dosage, Male, Middle Aged, Neoplasm Recurrence, Local, Oligopeptides administration & dosage, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Multiple Myeloma drug therapy, Multiple Myeloma pathology, Single-Cell Analysis methods
- Abstract
Multiple myeloma (MM) is a neoplastic plasma-cell disorder characterized by clonal proliferation of malignant plasma cells. Despite extensive research, disease heterogeneity within and between treatment-resistant patients is poorly characterized. In the present study, we conduct a prospective, multicenter, single-arm clinical trial (NCT04065789), combined with longitudinal single-cell RNA-sequencing (scRNA-seq) to study the molecular dynamics of MM resistance mechanisms. Newly diagnosed MM patients (41), who either failed to respond or experienced early relapse after a bortezomib-containing induction regimen, were enrolled to evaluate the safety and efficacy of a daratumumab, carfilzomib, lenalidomide and dexamethasone combination. The primary clinical endpoint was safety and tolerability. Secondary endpoints included overall response rate, progression-free survival and overall survival. Treatment was safe and well tolerated; deep and durable responses were achieved. In prespecified exploratory analyses, comparison of 41 primary refractory and early relapsed patients, with 11 healthy subjects and 15 newly diagnosed MM patients, revealed new MM molecular pathways of resistance, including hypoxia tolerance, protein folding and mitochondria respiration, which generalized to larger clinical cohorts (CoMMpass). We found peptidylprolyl isomerase A (PPIA), a central enzyme in the protein-folding response pathway, as a potential new target for resistant MM. CRISPR-Cas9 deletion of PPIA or inhibition of PPIA with a small molecule inhibitor (ciclosporin) significantly sensitizes MM tumor cells to proteasome inhibitors. Together, our study defines a roadmap for integrating scRNA-seq in clinical trials, identifies a signature of highly resistant MM patients and discovers PPIA as a potent therapeutic target for these tumors.
- Published
- 2021
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17. Outcomes of multiple myeloma patients with del 17p undergoing autologous stem cell transplantation.
- Author
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Vaxman I, Visram A, Kapoor P, Kumar S, Dispenzieri A, Buadi F, Dingli D, Muchtar E, Gonsalves W, Rajkumar V, Kourelis T, Warsame R, Lacy M, and Gertz MA
- Subjects
- Adult, Aged, Autografts, Chromosomes, Human, Pair 17, Disease-Free Survival, Female, Humans, Male, Middle Aged, Survival Rate, Chromosome Deletion, Hematopoietic Stem Cell Transplantation, Multiple Myeloma genetics, Multiple Myeloma mortality, Multiple Myeloma therapy, Smith-Magenis Syndrome
- Published
- 2021
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18. Acute Liver Rejection in a Multiple Myeloma Patient Treated with Lenalidomide.
- Author
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Vaxman I, Eaton J, Lee HE, and Gertz MA
- Abstract
Herein we present a patient that underwent a liver transplant due to primary biliary cholangitis (PBC) and after 9 years developed multiple myeloma. Following the cessation of mycophenolate mofetil and 2 weeks after lenalidomide treatment was started, the patient experienced acute cellular rejection. The patient recovered after treatment with corticosteroids, resumption of mycophenolate mofetil, and cessation of lenalidomide. Lenalidomide-associated allograft rejection has been reported in other organs. However, this is the first case report of liver rejection induced by lenalidomide., Competing Interests: Dr. Gertz reports personal fees from Ionis/Akcea, personal fees from Alnylam, personal fees from Prothena, personal fees from Janssen, grants and personal fees from Spectrum, personal fees from Annexon, personal fees from Appellis, personal fees from Amgen, personal fees from Medscape, personal fees from Physicians Education Resource, personal fees for Data Safety Monitoring board from Abbvie and Celgene, personal fees from Research to Practice, workforce training Sanofi, speaker fees from Teva, speaker fees from Johnson and Johnson, speaker fees from Medscape, and speaker fees from DAVA oncology; Advisory Board for Pharmacyclics Advisory Board for Proclara; Development of educational materials for i3Health.Royalties from Springer Publishing, Stock Options Aurora Bio., (Copyright © 2020 Iuliana Vaxman et al.)
- Published
- 2020
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19. Correlation between urine ACR and 24-h proteinuria in a real-world cohort of systemic AL amyloidosis patients.
- Author
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Visram A, Al Saleh AS, Parmar H, McDonald JS, Lieske JC, Vaxman I, Muchtar E, Hobbs M, Fonder A, Hwa YL, Buadi FK, Dingli D, Lacy MQ, Dispenzieri A, Kapoor P, Hayman SR, Warsame R, Kourelis TV, Siddiqui M, Gonsalves WI, Lust JA, Kyle RA, Vincent Rajkumar S, Gertz MA, Kumar SK, and Leung N
- Subjects
- Aged, Albuminuria therapy, Female, Humans, Immunoglobulin Light-chain Amyloidosis therapy, Male, Middle Aged, Retrospective Studies, Albuminuria urine, Immunoglobulin Light-chain Amyloidosis urine
- Abstract
A 24-h urine protein collection (24hUP), the gold standard for measuring albuminuria in systemic AL amyloidosis, is cumbersome and inaccurate. We retrospectively reviewed 575 patients with systemic AL amyloidosis to assess the correlation between a urine albumin to creatinine ratio (uACR) and the 24hUP. The uACR correlated strongly with 24hUP at diagnosis (Pearson's r = 0.87, 95% CI 0.83-0.90) and during the disease course (Pearson's r = 0.88, 95% CI 0.86-0.90). A uACR ≥300 mg/g estimated a 24hUP ≥ 500 mg with a sensitivity of 92% and specificity of 97% (area under the receiver operating curve = 0.938, 95% CI 0.919-0.957). A uACR cutoff of 3600 mg/g best predicted a 24hUP > 5000 g (sensitivity 93%, specificity 94%), and renal stage at diagnosis was strongly concordant using either 24hUP or uACR as the proteinuria measure (k = 0.823, 95% CI 0.728-0.919). In patients with serial urine collections, a > 30% decrease in uACR predicted a > 30% decrease in 24hUP with a sensitivity of 94%. In conclusion, the uACR is a reliable and convenient method for ruling out proteinuria >500 mg per day, prognosticating renal outcomes, and assessing renal response to therapy. Further studies are needed to validate the uACR cutoffs proposed in this study.
- Published
- 2020
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20. Colon perforation in multiple myeloma patients - A complication of high-dose steroid treatment.
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Vaxman I, Al Saleh AS, Kumar S, Nitin M, Dispenzieri A, Buadi F, Dingli D, Lacy M, Muchtar E, Hobbs M, Fonder A, Hwa L, Visram A, Kapoor P, Siddiqui M, Lust J, Kyle R, Rajkumar V, Hayman S, Leung N, Gonsalves W, Kourelis T, Warsame R, and Gertz MA
- Subjects
- Adult, Aged, Aged, 80 and over, Colonic Diseases diagnostic imaging, Colonic Diseases surgery, Colostomy, Dexamethasone administration & dosage, Diverticulitis, Colonic complications, Female, Humans, Intestinal Perforation diagnostic imaging, Intestinal Perforation surgery, Male, Middle Aged, Retrospective Studies, Risk Assessment, Risk Factors, Steroids administration & dosage, Tomography, X-Ray Computed, Treatment Outcome, United States, Colonic Diseases chemically induced, Dexamethasone adverse effects, Intestinal Perforation chemically induced, Multiple Myeloma drug therapy, Steroids adverse effects
- Abstract
Gastrointestinal complications of multiple myeloma (MM) treatment are common and include nausea, constipation, and diarrhea. However, acute gastrointestinal events like perforations are rare. We aimed to describe the characteristics and outcomes of patients with MM that had colonic perforations during their treatment. This is a retrospective study that included patients from all three Mayo Clinic sites who had MM and developed a colonic perforation. All patients were diagnosed with colonic perforations based on CT scans and were surgically treated. Patients diagnosed with AL amyloidosis, a perforated colon complicating neutropenic colitis during ASCT and those with perforation due to colonic cancer were excluded. A high dose of dexamethasone was defined as ≥40 mg dexamethasone once a week. Thirty patients met inclusion criteria. All patients received steroids at doses ≥10 mg once weekly prior to the perforation, while four (11%) were on high-dose dexamethasone without chemotherapy. Fourteen patients were given high doses of dexamethasone. Twenty-five patients required ostomies with all surviving surgery. Twenty-four perforations (80%) were associated with diverticulitis. Treatment with steroids was resumed in 23 patients with no further gastrointestinal complications. The median OS was 20 months following perforation (IQR 8-59). Within the same timeframe 5854 patients were treated at Mayo Clinic for MM, making the risk of bowel perforation 0.5%. Intestinal perforations in MM are rare and, in our series, always occurred with dexamethasone ≥10 mg per week. Urgent surgery is lifesaving and resumption of anti-myeloma treatment appears to be safe., (© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)
- Published
- 2020
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21. Antibacterial prophylaxis with ciprofloxacin for patients with multiple myeloma and lymphoma undergoing autologous haematopoietic cell transplantation: a quasi-experimental single-centre before-after study.
- Author
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Yeshurun M, Vaxman I, Shargian L, Yahav D, Bishara J, Pasvolsky O, Wolach O, Lahav M, Gurion R, Magen H, Vidal L, Herscovici C, Peck A, Moshe M, Sela-Navon M, Naparstek E, Raanani P, and Rozovski U
- Subjects
- Adult, Aged, Anti-Bacterial Agents therapeutic use, Bacteremia etiology, Bacteremia microbiology, Bacteremia prevention & control, Controlled Before-After Studies, Febrile Neutropenia etiology, Febrile Neutropenia prevention & control, Female, Humans, Israel, Male, Middle Aged, Pneumonia etiology, Pneumonia microbiology, Pneumonia prevention & control, Postoperative Complications microbiology, Retrospective Studies, Young Adult, Antibiotic Prophylaxis, Ciprofloxacin therapeutic use, Hematopoietic Stem Cell Transplantation adverse effects, Lymphoma surgery, Multiple Myeloma surgery, Postoperative Complications prevention & control, Transplantation, Autologous adverse effects
- Abstract
Objectives: We aimed to study whether ciprofloxacin prophylaxis reduces infectious complications in patients undergoing autologous haematopoietic cell transplantation (AHCT)., Methods: This is a quasi-experimental, retrospective, before-after study. We compared the incidence of bacterial-related complications among 356 patients with multiple myeloma (MM) (n = 202) and lymphoma (n = 154) who underwent AHCT with (n = 177) or without (n = 179) ciprofloxacin prophylaxis between 03/2007 and 10/2012 and between 10/2012 and 07/2016, respectively, at a single centre., Results: Febrile neutropaenia, bacteraemia, and pneumonia were significantly more common among patients who underwent AHCT during the second study period and did not receive antibacterial prophylaxis compared with patients who underwent AHCT during the first study period and received antibacterial prophylaxis (89.9% (161/179) vs. 83.1% (147/177), difference 6.9%, 95% CI 0-14.1%, P = 0.002; 15.1% (27/179) vs. 4.5% (8/177), difference 10.6%, 95% CI 4.4-16.9%, p < 0.0001; 12.3% (22/179) vs. 6.2% (11/177), difference 6.1%, 95% CI 0-12.3%, p = 0.04, respectively). The number-needed-to-treat to prevent one episode of bacteraemia, pneumonia, and febrile neutropaenia was 8.6, 8.5, and 13.7, respectively. Patients with ciprofloxacin prophylaxis had higher rates of ciprofloxacin-resistant bacteraemia (62.5% (5/8) vs. 18.5% (5/27), difference 44%, 95% CI 7-70%, p = 0.01). In multivariate analysis, ciprofloxacin prophylaxis significantly decreased the odds of bacteraemia (OR 0.19, 95% CI 0.07-0.52; p < 0.0001) and pneumonia (OR 0.37, 95% CI 0.16-0.85, p = 0.02)., Conclusion: According to our single-centre experience, patients with MM and lymphoma undergoing AHCT may benefit from antibacterial prophylaxis with ciprofloxacin., (Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2018
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