Lucila Nassif Kerbauy1, Simrit Parmar2, José Mauro Kutner3, Breno Moreno de Gusmão1, Nelson Hamerschlak3. 1. MD. Attending Physician at the Oncology and Hematology Center Família Dayan-Daycoval, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. 2. MD, MSCI. Associate Professor of Medicine, Department of Stem Cell Transplant and Cellular Therapy, University of Texas at MD Anderson Cancer Center, Houston, Texas. United States. 3. MD, PhD. Attending physician at the Oncology and Hematology Center Família Dayan-Daycoval, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Abstract
CONTEXT AND OBJECTIVE: For the last nine years, hematologists and oncologists have gathered annually at an educational symposium organized by a Brazilian and an American hospital. During the 2015 Board Review, a survey among the attendees evaluated the differences in management and treatment methods for multiple myeloma (MM). DESIGN AND SETTING: Cross-sectional study during an educational hematology symposium in São Paulo, Brazil. METHODS: Hematologists present at the symposium gave responses to an electronic survey by means of mobile phone. RESULTS: Among the 350 attendees, 217 answered the questionnaire. Most of the participants believed that immunotargeting agents (iTA) might be effective for slowing MM progression in heavily pretreated patients (67%) and that continued exposure to therapy might lead to emergence of resistant clones in patients with MM (76%). Most of the physicians use maintenance therapy after hematopoietic stem cell transplantation (95%) and 45% of them would further restrict it to post-transplantation patients with underlying high-risk disease. The first-line drugs used for transplantation-ineligible patients (TI-MM) were bortezomib-thalidomide-dexamethasone (31%), bortezomib-dexamethasone (28%), lenalidomide-dexamethasone (Rd; 17%) and melphalan-based therapy (10%). Lenalidomide was the drug of choice for post-transplantation maintenance for half of the participants. No significant differences were observed regarding age or length of experience. CONCLUSION: The treatment choices for TI-MM patients were highly heterogenous and the melphalan-based regimen represented only 10% of the first-line options. Use of maintenance therapy after transplantation was a common choice. Some results from the survey were divergent from the evidence in the literature.
CONTEXT AND OBJECTIVE: For the last nine years, hematologists and oncologists have gathered annually at an educational symposium organized by a Brazilian and an American hospital. During the 2015 Board Review, a survey among the attendees evaluated the differences in management and treatment methods for multiple myeloma (MM). DESIGN AND SETTING: Cross-sectional study during an educational hematology symposium in São Paulo, Brazil. METHODS: Hematologists present at the symposium gave responses to an electronic survey by means of mobile phone. RESULTS: Among the 350 attendees, 217 answered the questionnaire. Most of the participants believed that immunotargeting agents (iTA) might be effective for slowing MM progression in heavily pretreated patients (67%) and that continued exposure to therapy might lead to emergence of resistant clones in patients with MM (76%). Most of the physicians use maintenance therapy after hematopoietic stem cell transplantation (95%) and 45% of them would further restrict it to post-transplantation patients with underlying high-risk disease. The first-line drugs used for transplantation-ineligible patients (TI-MM) were bortezomib-thalidomide-dexamethasone (31%), bortezomib-dexamethasone (28%), lenalidomide-dexamethasone (Rd; 17%) and melphalan-based therapy (10%). Lenalidomide was the drug of choice for post-transplantation maintenance for half of the participants. No significant differences were observed regarding age or length of experience. CONCLUSION: The treatment choices for TI-MM patients were highly heterogenous and the melphalan-based regimen represented only 10% of the first-line options. Use of maintenance therapy after transplantation was a common choice. Some results from the survey were divergent from the evidence in the literature.
Authors: Naoto T Ueno; Jose Rodrigo Espinosa Fernandez; Massimo Cristofanilli; Beth Overmoyer; Dan Rea; Fedor Berdichevski; Mohamad El-Shinawi; Jennifer Bellon; Huong T Le-Petross; Anthony Lucci; Gildy Babiera; Sarah M DeSnyder; Mediget Teshome; Edward Chang; Bora Lim; Savitri Krishnamurthy; Michael C Stauder; Simrit Parmar; Mona M Mohamed; Angela Alexander; Vicente Valero; Wendy A Woodward Journal: J Cancer Date: 2018-04-06 Impact factor: 4.207