Beacon NewsFlashes – January 14, 2013
HHV-6 Infection May Be Common After Stem Cell Transplantation – Results of a retrospective Israeli study indicate that human herpesvirus 6 (HHV-6) infection is common in multiple myeloma patients after own (autologous) stem cell transplantation. HHV-6 is a family of two viruses that are present, but inactive, in most adults. If the virus becomes active in an adult, the resulting infection can cause pneumonia, suppression of blood cell production, and inflammation of the brain. The Israeli researchers found that 16 percent of patients in their study developed an HHV-6 infection after stem cell transplantation. The rate of infection was higher in patients who had received initial therapy with Velcade (bortezomib) and dexamethasone (Decadron) (20 percent) compared to those who received thalidomide (Thalomid) and dexamethasone (10 percent). The researchers recommend further studies to determine if Velcade plays a role in the development infection due to the virus. For more information, please see the study in the journal Bone Marrow Research (full text).
Iron Supplementation May Increase Velcade’s Efficacy – Results of a small Italian preclinical study show that iron supplementation may increase the efficacy of Velcade. The Italian researchers found that iron supplementation promoted protein oxidation and increased myeloma cell death. They concluded that modification of the iron status in multiple myeloma patients may be worth considering to improve the efficacy of proteasome inhibitors such as Velcade. For more information, please see the study in Haematologica (full text).
Phase 1 Clinical Trial To Study SAR650984 Plus Revlimid In Previously-Treated Myeloma Patients – The pharmaceutical company Sanofi-Aventis is starting a Phase 1 trial of SAR650984 in combination with Revlimid (lenalidomide) and dexamethasone in relapsed and refractory multiple myeloma patients. Myeloma patients must have received at least two prior therapies to be able to participate in the trial. SAR650984 belongs to the same class of drugs as elotuzumab and daratumumab, called monoclonal antibodies. Monoclonal antibodies work by identifying proteins on the surface of myeloma cells and signaling for the immune system to destroy the cancer cells. For more information, including trial locations, please see the clinical trial description.
Related Articles:
- Nelfinavir-Velcade Combination Very Active In Advanced, Velcade-Resistant Multiple Myeloma
- Lather, Rinse, Repeat: Will It Work With BCMA-Targeted Therapies For Multiple Myeloma?
- Adding Clarithromycin To Velcade-Based Myeloma Treatment Regimen Fails To Increase Efficacy While Markedly Increasing Side Effects
- Eyelid-Related Complications Of Velcade Therapy: New Insights And Recommendations
- bb2121 Continues To Impress As Potential New Multiple Myeloma Therapy (ASCO 2018)
The abstract about iron regulation and update is very interesting. Iron in the cells has to be taken up by ferritin, or else it is oxidated and toxic to cells. Bortezimib decreases the functioning of ferritin, and adding more iron seems to aid in the proteasomase activity. So far, this seems to be a study in the lab only.
The really thoroughly researched paper on the patients who contracted HHV-6, a herpes virus infection, was very interesting. It is a post transplant problem for both 'allo' and 'auto' patients, and may be linked to the amount of steroids used on already immune suppressed patients, going into the transplant. I can see why acyclovir (an oral anti-viral med) is routinely given after transplant, and learned that there is an intravenous anti-viral drug also, used to treat the HHV-6 infections. wHAT i think I learned from this paper is that patients who are already immune suppressed due to having induction chemo with biological agents, are at greater risk for the infection than those whose induction chemo was of the older type. Thus one would not want to be at low neutrophil or other blood cell levels before going into a transplant, I think.
Hi Nancy,
Thanks for the additional information about the iron study.
About your comments related to the Israeli study, I thought they only had patients with Velcade-dex induction and thal-dex induction. None of those drugs are biologic agents, such as elotuzumab or daratumumab. So I'm a bit confused about your statement where you mention "biological agents."
As to your wondering about whether or not white blood cell levels prior to transplant affect levels after transplant, that would be interesting to confirm somewhere. It's not clear to me it would be true. I believe white blood cells live an average of just a week or so.
Hi Ricardo, in the full paper about HHV-6 infections, thal-dex and bort.-dex, are referred to as 'biologic agents' or 'novel biologic agents'. That's interesting that you consider only the 'antibody' type agents to be biologic agents...I don't know what the definition would be for that. (I only just recently realized that the suffix 'mab' would refer to 'ab', the abbreviation for antibody). I think that what the authors were getting at was that patients who are already immune compromised when going into transplant are more at risk for these serious viral infections. Fortunately they are treatable infections. One isn't necessarily immune compromised at the time of transplant, if one's blood levels have recovered to normal ranges, I think ... am not a doctor though so am guessing.
Neat about the iron study, isn't it?
Hi Nancy,
I think the authors are using the term "biologic agent" in a relatively unconventional way. The definition for "biologic agent" from the US National Cancer Institute is
"A substance that is made from a living organism or its products and is used in the prevention, diagnosis, or treatment of cancer and other diseases. Biologic agents include antibodies, interleukins, and vaccines. Also called biological agent and biological drug."
In other words, drugs that are biologic agents are usually biotech drugs that are so-called "large molecules", such as antibodies and other kinds of proteins, which are produced by human or animal cells.
Drugs like Velcade, Revlimid, and thalidomide are small-molecule drugs that are typically manufactured by chemical processes, much like pharmaceuticals have been being manufactured since the 1800s.
Thanks Ricardo, that is very informative! There is a lot to learn in the field of myeloma and it's treatments, that's for sure!
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