Therapy for metastatic colorectal cancer with hepatic artery infusion chemotherapy using a subcutaneous implanted pump.

Sixty-two patients with metastatic colorectal carcinoma involving the liver were treated by hepatic intra-arterial chemotherapy using an implantable infusion pump. The 53 patients with metastases confined to the liver had a median survival (MS) of 17 months and an objective response rate of 32%. Four patients (8%) demonstrated a complete response (CR), with normal abdominal computed tomography (CT) scan results and plasma carcinoembryonic antigen (CEA) levels, and 13 patients (25%) demonstrated a partial response (PR), with at least a 50% decrease in the liver lesions by CT scan and at least a 50% decrease in CEA levels. Thirty patients (57%) had stable disease (S), and six patients (11%) had no response (NR). Nine patients with extrahepatic tumor plus hepatic metastases had an MS of only 4.9 months. None of these patients had an objective response, and only four patients had S. Quality of response was clearly associated with longevity. Forty patients treated with floxuridine (FUDR) and mitomycin (M) (F + M) showed a 20% objective response rate, while the 13 patients treated with FUDR and dichloromethotrexate (DCMTX) (F + D) attained a 69% objective response rate. Although F + D treatment appears to be superior, there may have been selection biases that make such an observation only preliminary. Twenty-six (49%) of the 53 patients developed hepatitis during infusion chemotherapy, which resolved after temporary cessation of the chemotherapy. Of the 17 patients with CR or PR, 12 patients (71%) had hepatitis, whereas only 14 (39%) of the 36 patients with S or NR had hepatitis. Eleven patients had evidence of peptic ulceration by endoscopic examination during the infusion chemotherapy. All the ulcers healed after chemotherapy was discontinued.

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The Effects on Liver Metastases of Circadian Patterned Continuous Hepatic Artery Infusion of FUDR

HPB Surgery ◽

10.1155/1994/54058 ◽

1994 ◽

Vol 7 (3) ◽

pp. 219-224 ◽

Cited By ~ 7

Author(s):

M. Margaret Kemeny ◽

Galo Alava ◽

Jorge M. Oliver

Keyword(s):

Hepatic Artery ◽

Objective Response Rate ◽

Response Rate ◽

Objective Response ◽

Hepatic Metastases ◽

Colon Adenocarcinoma ◽

Constant Infusion ◽

Hepatic Artery Infusion ◽

Antitumor Effects ◽

Colorectal Hepatic Metastases

Although continuous hepatic artery infusions (CHAI) of (FUDR) Floxuridine have been effective in reducing the size of colorectal hepatic metastases the toxicity of the infusions have been high with almost a quarter of the patients developing biliary sclerosis. Techniques to lower toxicity, yet continue the beneficial antitumor effects, are being investigated. One suggested strategy is to change the flow pattern of the continuous infusion from a constant rate to a day cycled pattern. In this infusion a continuous rate is given over a 24 hour period with 60% of the infusion delivered between 3 PM and 9 PM and the least amount of infusion delivered between 3 AM and 9 PM. Previous research has suggested that this day cycle pattern will lower the toxicity of the infusion. This experiment is a test of “day cycled” continuous hepatic artery infusions in rats bearing hepatic metastases from a colon adenocarcinoma. Previous research from our laboratory has shown a lowered toxicity when the constant infusion was replaced with the day cycled pattern.In the present study 10 rats with hepatic adenocarcinoma metastases were placed on constant CHAI of FUDR at 10mg/kg/day for 14 days. There was an 80% mortality from chemotherapy toxicity and a 90% objective response rate. Nine other rats were treated with “day cycled” CHAI of FUDR at 15mg/kg/d. There was no mortality in this group and the objective response rate was 90% as in the previous group. This study demonstrated that “day cycled” CHAI of FUDR was substantially less toxic and that the antitumor effect was identical to the constant infusion.

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Hepatic artery infusion pump for nasopharyngeal carcinoma with liver metastasis

Clinical & Experimental Metastasis ◽

10.1007/s10585-019-10015-0 ◽

2019 ◽

Vol 37 (2) ◽

pp. 333-339

Author(s):

Changli Peng ◽

Chunhui Zhou ◽

Gang Li ◽

Haiping Li ◽

Liangrong Shi

Keyword(s):

Nasopharyngeal Carcinoma ◽

Liver Metastases ◽

Hepatic Artery ◽

Infusion Pump ◽

Objective Response ◽

Complete Response ◽

Hepatic Artery Infusion ◽

Significant Difference ◽

Extrahepatic Metastases ◽

Grade 3

AbstractTo evaluate the benefits and risks of hepatic artery infusion (HAI) gemcitabine and floxuridine (FUDR) in patients with nasopharyngeal carcinoma liver metastases. HAI catheter systems were implanted under the guide of digital subtract angiography (DSA) in 16 patients with unresectable nasopharyngeal carcinoma liver metastases. HAI gemcitabine and FUDR in combination with radiotherapy and systemic chemotherapy were delivered. Disease control rate (DCR) of intrahepatic lesions is 100%, objective response rate (ORR) of intrahepatic lesions is 87.5%, including 4 patients (25%) with complete response (CR), 10 patients (62.5%) with partial response (PR) and 2 patients (12.5%) with stable disease (SD). The median overall survival (mOS) was 30 months. There was no significant difference between patients with < 9 intrahepatic lesions and patients with ≥ 9 intrahepatic lesions (31 months vs. 24 months, P = 0.562). Patients without extrahepatic metastases has longer survival than patients with extrahepatic metastases (31 months vs. 17 months, P = 0.005). In all 72 cycles of HAI, the main grade 3/4 toxicities related to HAI include: leukopenia occur in 8 cycles (11.1%), thrombocytopenia in 5 cycles (6.9%), AST/ALT elevation in 12 cycles (16.7). Catheter related complications occurred in 2 patients (12.5%). HAI gemcitabine and FUDR is effective to improve DCR of intrahepatic lesions and prolong mOS for patients with nasopharyngeal carcinoma liver metastases, and is associated with a relative low rate of toxicity.

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Phase II Results of Bendamustine in Combination with Rituximab in Relapsed Indolent and Mantle-Cell Non-Hodgkin’s Lymphoma.

Blood ◽

10.1182/blood.v108.11.2710.2710 ◽

2006 ◽

Vol 108 (11) ◽

pp. 2710-2710 ◽

Cited By ~ 6

Author(s):

Richard H. Van der Jagt ◽

Philip Cohen ◽

Bruce D. Cheson ◽

Anil Tulpule ◽

Jordan A. Herst ◽

...

Keyword(s):

Phase Ii ◽

Objective Response Rate ◽

Response Rate ◽

Objective Response ◽

Complete Response ◽

Hodgkin's Lymphoma ◽

Prior Chemotherapy ◽

Non Hodgkin's Lymphoma ◽

Mantle Cell ◽

Grade 3

Abstract Objective: The objective of this study was to evaluate the efficacy and safety of bendamustine HCl (TREANDA®) in combination with rituximab in patients with relapsed non-Hodgkin’s lymphoma (NHL). Background: Bendamustine is a novel hybrid, alkylating agent with single-agent activity in multiple hematologic and solid tumors. It induces cell death via both apoptosis and the apoptosis-independent pathway of mitotic catastrophe. The combination of bendamustine and rituximab has been shown to exhibit a synergistic antitumor effect on NHL cells. Methods: This Phase II, multicenter study enrolled adult patients with relapsed, indolent B-cell or mantle-cell NHL who were not refractory to rituximab (defined as progression ≤6 months of last rituximab dose). Patients received rituximab 375 mg/m2 intravenously (IV) on day 1 and bendamustine 90 mg/m2 IV on days 2 and 3 of a 28-day cycle for 4 to 6 cycles. An additional dose of rituximab 375 mg/m2 IV was given 1 week before the first cycle of bendamustine and 4 weeks after the last cycle. Results: The intent-to-treat (ITT) population included 66 patients (59% men) with a median age of 60 years (range, 40–84). Indolent histologic phenotype was seen in 54 patients with the following histologic subtypes: follicular center cell (61%), small lymphocytic (15%), lymphoplasmacytic (3%), and marginal zone (3%); 18% had mantle-cell lymphoma (MCL). A total of 85% of patients had stage III/IV disease. These patients relapsed from a median of 1 prior chemotherapy (range: 0–5), with 56% having had prior treatment with rituximab. Patients with no prior chemotherapy relapsed following biologic therapy. In the ITT population, the overall objective response rate (ORR) was 94% (complete response [CR]/complete response unconfirmed [CRu], 41%; partial response [PR], 53%); 6% had stable disease. The ORR for the 12 MCL patients was 92% (CR/CRu, 42%; PR 50%). For all patients, the median duration of response and progression-free survival has not been reached after a median follow-up of 8.3 months (range, 0.14–31 months). Grade 3/4 neutropenia was seen in 41% of patients (7%, febrile neutropenia). Common nonhematologic toxicities (grade 1/2, grade 3, grade 4) were nausea (68%, 0%, 0%) and fatigue (53%, 5%, 0%); one patient had grade 3 sepsis. No alopecia was observed. Conclusions: Bendamustine administered in combination with rituximab produced a high objective response rate and was generally well tolerated in patients with relapsed indolent and mantle-cell NHL who were not refractory to rituximab. These results suggest that the combination of bendamustine and rituximab may be comparable in activity to R-CHOP, and further studies of this combination are warranted.

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Evaluation of Hepatic Artery Infusion Chemotherapy after Hepatectomy for Colorectal Hepatic Metastases.

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.33.169 ◽

2000 ◽

Vol 33 (2) ◽

pp. 169-175

Author(s):

Yasushi Suzuki ◽

Masashi Watanabe ◽

Makoto Kikuchi ◽

Yukitake Hasebe ◽

Haruhiro Nakazaki ◽

...

Keyword(s):

Hepatic Artery ◽

Hepatic Metastases ◽

Hepatic Artery Infusion ◽

Infusion Chemotherapy ◽

Hepatic Artery Infusion Chemotherapy ◽

Colorectal Hepatic Metastases

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Comparative Analysis of Lenvatinib and Hepatic Arterial Infusion Chemotherapy in Unresectable Hepatocellular Carcinoma: A Multi-Center, Propensity Score Study

10.20944/preprints202107.0559.v1 ◽

2021 ◽

Author(s):

Jaejun Lee ◽

Ji Won Han ◽

Pil Soo Sung ◽

Soon Kyu Lee ◽

Hyun Yang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Propensity Score ◽

Cox Regression ◽

Objective Response ◽

Hepatic Artery Infusion ◽

Eligibility Criteria ◽

Historical Cohort ◽

Infusion Chemotherapy ◽

Unresectable Hepatocellular Carcinoma ◽

Hepatic Artery Infusion Chemotherapy

The comparative efficacy and safety between lenvatinib and hepatic artery infusion chemotherapy (HAIC) in patients with unresectable hepatocellular carcinoma (HCC) are still unclear. This multicenter historical cohort study enrolled 244 patients who were treated with HAIC (n = 173) or lenvatinib (n = 71) between 2012 and 2020. Propensity score matching (PSM) was performed, and 52 patients were selected per group. Clinical outcomes and safety were compared. Objective response rate (ORR) was not different between the two groups (26.0% vs. 23.1%, P = 0.736). Before PSM, HAIC group had a higher proportion of Child-Pugh B and portal vein tumor, whereas lenvatinib group had more patients with extrahepatic metastases, which was adjusted after PSM. There were no differences in progression-free survival (PFS) and overall survival (OS) after PSM (HAIC vs. lenvatinib, median PFS, 3.6 vs. 4.0 months, P = 0.706; median OS 10.8 vs. 7.9 months, P = 0.106). Multivariate Cox-regression showed that alpha-fetoprotein ≤ 1000 ng/mL was only associated factor for OS after PSM in all patients (hazard ratio = 0.421, P = 0.011). Subgroup analysis for patients with high tumor burden beyond the REFLECT eligibility criteria revealed that HAIC group (n = 29) had a significantly longer OS than did lenvatinib group (n = 30) (10.0 vs. 5.4 months, P=0.004). More patients in HAIC group achieved better liver function than those in lenvatinib group at the time of best responses. There was no difference in the incidence of grade 3 and 4 adverse events between the two groups. Therefore, lenvatinib is comparable to HAIC in terms of ORR and OS in unresectable HCC meeting REFLECT eligibility criteria.

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Safety and efficacy of chidamide in combination with decitabine plus anti-PD-1 camrelizumab after relapse or progression on decitabine-plus-camrelizumab in classical Hodgkin lymphoma.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e19515 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e19515-e19515

Author(s):

Chunmeng Wang ◽

Jing Nie ◽

Yang Liu ◽

Qingming Yang ◽

Weidong Han

Keyword(s):

Adverse Events ◽

Hodgkin Lymphoma ◽

Objective Response Rate ◽

Response Rate ◽

Objective Response ◽

Complete Response ◽

Classical Hodgkin Lymphoma ◽

Primary Resistance ◽

Safety And Efficacy ◽

Treatment Regimens

e19515 Background: The anti-PD-1 combination therapy significantly improves clinical outcomes in patients with relapsed/refractory classical Hodgkin lymphoma (cHL), and up to 71% of patients who receive decitabine-plus-anti-PD-1 camrelizumab could achieve a complete response. However, a subset of patients is recalcitrant to decitabine-plus-camrelizumab and half of patients might experience disease progression within three years. Effective treatment regimens for those with relapsed or progressive cHL who failed decitabine-plus-camrelizumab are needed. This Phase II study was designed to assess the safety and efficacy of the combination of decitabine-plus-camrelizumab and chidamide, a histone deacetylase inhibitor, in decitabine-plus-camrelizumab resistant cHL patients. Methods: Patients with relapsed/refractory cHL who had primary resistance or progressed/relapsed on decitabine-plus-camrelizumab were enrolled and administrated with chidamide at 10 mg (days 1 to 4) and 20 mg (days 8, 11,15 and 18); plus decitabine at 10 mg (days 1 to 5); and camrelizumab at 200 mg (day 6), every 3 weeks. Safety was assessed by CTCAEv5.0, and antitumor response by PET-CT according to the revised Lugano classification. The primary endpoint was objective response rate. Recruitment is ongoing. This trial is registered with ClinicalTrial.gov number, NCT04233294. Results: Between January 19, 2020, and January 31, 2021, nineteen patients with relapsed/refractory cHL after relapse or progression on decitabine-plus-camrelizumab were enrolled. A median of 20 cycles of prior decitabine-plus-camrelizumab was given (range, 4-28). Fourteen patients completed response evaluation with a median follow-up of 5.7 months. All eligible patients received this triplet-agent regimen with a median of 8 cycles (range, 3 to 12). Thirteen of the fourteen evaluated patients (93%) had an objective response, including six acquiring a complete remission (43%) and seven reaching a partial response (50%). The most common adverse events were leukocytopenia (58%; grade 3: 16%), nausea (53%) and hypertriglyceridemia (26%). No immune-related adverse events were observed. Conclusions: The preliminary result shows a high objective response rate with the combination of chidamide, decitabine and camrelizumab in patients with resistance to decitabine-plus-camrelizumab therapy. The addition of chidamide to decitabine-plus-camrelizumab has an acceptable safety profile, and does not trigger immune-related adverse events. Clinical trial information: NCT04233294.

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Pembrolizumab in Relapsed or Refractory Primary Mediastinal Large B-Cell Lymphoma

Journal of Clinical Oncology ◽

10.1200/jco.19.01389 ◽

2019 ◽

Vol 37 (34) ◽

pp. 3291-3299 ◽

Cited By ~ 35

Author(s):

Philippe Armand ◽

Scott Rodig ◽

Vladimir Melnichenko ◽

Catherine Thieblemont ◽

Kamal Bouabdallah ◽

...

Keyword(s):

Objective Response Rate ◽

Response Rate ◽

Objective Response ◽

Progression Free Survival ◽

B Cell Lymphoma ◽

Complete Response ◽

End Points ◽

Free Survival ◽

Large B Cell Lymphoma ◽

Duration Of Response

PURPOSE Patients with relapsed or refractory primary mediastinal large B-cell lymphoma (rrPMBCL) have a poor prognosis, and their treatment represents an urgent and unmet need. Because PMBCL is associated with genetic aberrations at 9p24 and overexpression of programmed cell death-1 (PD-1) ligands (PD-L1), it is hypothesized to be susceptible to PD-1 blockade. METHODS In the phase IB KEYNOTE-013 (ClinicalTrials.gov identifier: NCT01953692 ) and phase II KEYNOTE-170 (ClinicalTrials.gov identifier: NCT02576990 ) studies, adults with rrPMBCL received pembrolizumab for up to 2 years or until disease progression or unacceptable toxicity. The primary end points were safety and objective response rate in KEYNOTE-013 and objective response rate in KEYNOTE-170. Secondary end points included duration of response, progression-free survival, overall survival, and safety. Exploratory end points included association between biomarkers and pembrolizumab activity. RESULTS The objective response rate was 48% (7 complete responses; 33%) among 21 patients in KEYNOTE-013 and 45% (7 complete responses; 13%) among 53 patients in KEYNOTE-170. After a median follow-up time of 29.1 months in KEYNOTE-013 and 12.5 months in KEYNOTE-170, the median duration of response was not reached in either study. No patient with complete response experienced progression, including 2 patients with complete response for at least 1 year off therapy. Treatment-related adverse events occurred in 24% of patients in KEYNOTE-013 and 23% of patients in KEYNOTE-170. There were no treatment-related deaths. Among 42 evaluable patients, the magnitude of the 9p24 gene abnormality was associated with PD-L1 expression, which was itself significantly associated with progression-free survival. CONCLUSION Pembrolizumab is associated with high response rate, durable activity, and a manageable safety profile in patients with rrPMBCL.

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Phase II study of sorafenib combined with gemcitabine and 5-fluorouracil in patients with metastatic renal cell carcinoma: Preliminary results

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16093 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16093-e16093

Author(s):

L. Hongyun ◽

C. Zhihong ◽

Y. Xiangqing ◽

S. Lu ◽

C. Chuanliang ◽

...

Keyword(s):

Phase Ii ◽

Objective Response Rate ◽

Kinase Inhibitors ◽

Response Rate ◽

Objective Response ◽

Progression Free Survival ◽

Complete Response ◽

Study Endpoint ◽

Primary Study ◽

Eligibility Criteria

e16093 Background: The tyrosine kinase inhibitors sorafenib and sunitinib have been approved for use in patients with advanced RCC and have supplanted immunotherapy as first-line therapy. Nevertheless, complete responses have been observed only rarely with these agents and only 10% of patients experience PR. The vast majority of responding patients will ultimately progress despite continued therapy. In order to improve the objective response rate and the durability of those responses in patients, we conducted a single-institution, single-arm phase II trial of gemcitabine and 5-fluorouracil (5-FU) combined with sorafenib in patients with RCC. Methods: Eligibility criteria included advanced, histologically confirmed RCC; age >18 years; ECOG PS ≤ 2, adequate bone marrow, renal and hepatic function; measurable/evaluable lesions. Gemcitabine was administered at 1,000 mg/m2 over 30 min i.v. on days 1 and 8, followed by 5-FU 400 mg/m2 i.v. bolus on day 1 and 1,200 mg/m2/day × 2 days continuous infusion (28-day cycle). From day 1 of cycle 1, 400 mg sorafenib was continuously given twice daily. The sample size of 21 patients was sufficient to provide 80% power to detect an objective response rate that was greater than 10% with significance that 0.05 level. Results were expressed as mean±SD or median ± 95% CI. The primary study endpoint was objective response rate and the secondary were toxicity, progression-free survival and overall survival. Results: Patients (n = 21) were enrolled from May 2006 to Dec. 2007. The rate of objective response and disease control (including stable disease, complete responses and partial responses) were 38% (95% CI, 18–62%) and 86% (95% CI, 64–97%), respectively. Among them, there is 1 complete response and 2 pts occurred completely liquefaction deliquesce in metastatic lesions. The median PFS time is longer than 13 months, with 6/21 patients remaining progression free at 2008.12.26 the data were compiled for this report (three are longer than 26 months and there other three longer than 13 months ). The median OS time have not yet been reached, because of the amount of censoring data. Conclusions: The combination of sorafenib with gemcitabine and 5-FU shows promising activity for patients with metastatic RCC. No significant financial relationships to disclose.

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Endoscopic intratumoral injection of OBP-301 (telomelysin) with radiotherapy in esophageal cancer patients unfit for standard treatments.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.130 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 130-130

Author(s):

Shunsuke Tanabe ◽

Hiroshi Tazawa ◽

Nobuhiko Kanaya ◽

Kazuhiro Noma ◽

Shunsuke Kagawa ◽

...

Keyword(s):

Esophageal Cancer ◽

Cancer Patients ◽

Objective Response Rate ◽

Response Rate ◽

Objective Response ◽

Complete Response ◽

Intratumoral Injection ◽

Open Label ◽

Human Telomerase Reverse Transcriptase ◽

Dose Escalation Study

130 Background: OBP-301 (telomelysin) is an attenuated type-5 adenovirus with oncolytic potency that contains the human telomerase reverse transcriptase (hTERT) promoter to regulate viral replication. OBP-301 causes selective replication and lysis of a variety of cancer cells, and also inhibits the repair of radiation-induced DNA double-strand breaks, leading to radiosensitization. We aimed to assess intratumoral injection of OBP-301 with radiotherapy in esophageal cancer patients unfit for standard treatments. Methods: An open-label, phase I dose-escalation study of OBP-301 with radiotherapy was conducted in 13 histologically confirmed esophageal cancer patients who deemed unfit to receive surgery or chemotherapy. Study treatment consisted of intratumoral OBP-301 injections on days 1, 18, and 32 of treatment. Radiation therapy was administered concurrently over 6 weeks, beginning on day 4, to a total of 60 Gy. Virus administration was performed by intratumoral needle injection of the primary tumor through a flexible endoscope. The primary and secondary end points were incidence of dose-limiting toxicities and objective response rate. Results: Of 13 patients, seven, three, and three patients were treated in the cohorts with 1010, 1011, and 1012 virus particles of OBP-301, respectively. The patients comprised 10 males and 3 females, with median age of 79.7 years (range, 53 to 92 years). Common grade 1 and 2 toxicities included fever, esophagitis, pneumonitis, anorexia, constipation, and gastroesophageal reflux. All patients developed a transient, self-limited lymphopenia. Eight patients had local complete response (CR); all of them exhibited pathologically no viable malignant cells in biopsy specimens, and three had partial response. The objective response rate was 84.6%. The clinical CR rate was 80.0% in stage I and 66.7% in stage II/III, respectively. Histopathologic examination in post-treatment specimens showed massive infiltration of CD8+ cells in three partially responded tumors. Conclusions: Multiple courses of endoscopic OBP-301 injection with radiotherapy were feasible and provided definite clinical benefits in patients with esophageal cancer. Clinical trial information: 000010158.

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Salvage therapy for multiple myeloma with thalidomide and CED chemotherapy

Blood ◽

10.1182/blood.v98.13.3846 ◽

2001 ◽

Vol 98 (13) ◽

pp. 3846-3848 ◽

Cited By ~ 84

Author(s):

Thomas M. Moehler ◽

Kai Neben ◽

Axel Benner ◽

Gerlinde Egerer ◽

Fatime Krasniqi ◽

...

Keyword(s):

Multiple Myeloma ◽

Objective Response Rate ◽

Poor Prognosis ◽

Response Rate ◽

Objective Response ◽

Progression Free Survival ◽

Complete Response ◽

World Health ◽

Remission Induction

Abstract The feasibility and efficacy of a combination of thalidomide, cyclophosphamide, etoposide, and dexamethasone were studied in 56 patients with poor-prognosis multiple myeloma. Of 50 patients evaluable for response, 4% achieved complete response (CR), 64% partial response (PR), 18% minimal response (MR), 6% stable disease (SD), and 8% progressive disease (PD), resulting in an objective response rate (≥ MR) of 86.0% (76.7% overall objective response rate in intent-to-treat analysis; n = 56). Subsequent to successful remission induction, 18 patients received autologous or allogeneic stem cell transplantation. The median progression-free survival in all patients was 16 months. The median overall survival time could not be calculated, since the last observed death occurred after 16 months of follow-up (median follow-up of 14 months) with a corresponding estimated survival probability of 55%. Severe adverse effects (World Health Organization III/IV) included infectious complications (35.7%) and cardiovascular events (7.1%). The data suggest that Thal improves antitumor activity of salvage chemotherapy regimens in poor-prognosis multiple myeloma.

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