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    • In MM the optimal sequence or combination

    2019-06-06

    In MM, the optimal sequence or combination of the different therapeutic regimens available remains unclear and information is needed on the efficacy of each treatment after various prior therapies. Although a substantial number of different regimens and schedules were used for the treatment of first relapse, lenalidomide-based were the most commonly used combinations for treatment at relapse (53.8% of patients) and 17.3% were retreated with bortezomib at time of relapse. The overall response rate was higher among patients receiving rescue therapy with lenalidomide when compared with bortezomib combinations (67% and 44%, respectively; P=0.04) but similar CR rate in both groups of patients. Interestingly, no differences in PFS were observed among both groups of patients despite the fact that every patient had been previously exposed to bortezomib. These findings suggest that, retreatment with the same class of drugs on which patients have previously responded may be effective and represents a feasible and effective treatment option for patients with relapsed MM who previously responded to these drugs and a potential alternative to initiating subsequent line therapy with a different class of agents. In our study, OS after relapse was also significantly prolonged in those patients receiving front-line therapy with VMP, confirming the superiority of this exportin regimen when compared with VTP, a finding previously reported for the whole series of patients [11]. It is well-recognized that relapse can take different forms, and several groups have described various relapse patterns. However, the majority of these reports focused on patients relapsing after conventional chemotherapy or autologous stem cell transplantation and data about relapse patterns in elderly patients receiving front-line treatment with new drugs are limited [6,7]. Our results, however, showed a significantly shorter OS among patients with more aggressive forms of relapse (7.6 months) when compared with those patients presenting clinical (18.1 months) or biological (28.6 months) relapse suggesting the utility of these classifications and that alternative, more efficacious rescue therapies are clearly needed for these subgroups of patients. This study has some limitations. We investigated only the type of regimen administered at relapse and no data about doses or schedule of the drugs used were available. In this regard, heterogeneity of the ageing process is characterized by marked variability in the rate of functional deterioration, both between and within individuals. Therefore, individualized management, tailored to differences in functional capacity, life expectancy, and social and economic support, is needed to better define and optimal treatment strategy for these patients [22,23].
    Authors contributions
    Chronic Myelomonocytic Leukemia (CMML) with eosinophilia has been historically associated with rearrangements of or . Although this entity has now been reclassified as distinct from CMML by the World Health Organization (WHO) , clinicians reserve routine evaluation of rearrangements in suspected CMML cases with eosinophilia because this genetic lesion predicts response to imatinib. A recent article by Cheah et al. report durable long-term remissions with the use of imatinib in a collection of patients with myeloid malignancies bearing fusions . They confirm that the formation of fusion genes secondary to rearrangement of at 5q31-33 constitutively activates the receptor tyrosine kinase and are exquisitely sensitive to treatment with imatinib All patients in this report had eosinophilia at diagnosis which likely triggered the evaluation for a possible fusion. Given the limited armamentarium available for CMML, we perform broad spectrum genomic profiling to include analysis of in those cases that have failed standard therapies and have no clinical trial options. Using this strategy, we report a refractory CMML case for which a novel fusion was identified by next generation sequencing in a refractory CMML case eosinophilia that achieved a favorable response with imatinib.