Epidemiology of multiple myeloma in city Moscow

2019 ◽  
Vol 91 (7) ◽  
pp. 83-92
Author(s):  
O Yu Vinogradova ◽  
V V Ptushkin ◽  
M V Chernikov ◽  
Yu B Kochkareva ◽  
V A Zherebtsova
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Life Expectancy ◽  
Maximum Increase ◽  
The Past ◽  
Gender And Age ◽  
Moscow City ◽  
International Data ◽  
Age Range ◽  
The City

Aim. To study the epidemiology of multiple myeloma in the city of Moscow and compare the results obtained with data from similar studies in other countries. Materials and methods. The study is based on information from a database of case histories of 3942 patients suffering from symptomatic MM, residents of the city of Moscow, which is maintained at the Hematologic Moscow City Center of S.P. Botkin Municipal Clinical Hospital. The control of the completeness of inclusion was carried out by cross - comparison with the data of the Moscow Cancer Register and the Register of Program 7 (beginning in 2019 - 12) of Highly Expensive Nosologies. The assessment was made according to data as of January 1, 2019. The calculations were carried out taking into account the data of Rosstat at the beginning of 2019 on the population of Moscow in different gender and age categories. Results. Among the 3942 patients with active MM 1707 men - 43% and 2241 women - 57%, the median of the current age was 68 (28-94) years. The median time of observation of patients since the diagnosis of the disease 34 (1-423) months. The peak incidence was in the age range of more than 60 years. There were no significant differences in gender ratio in different age strata with a breakdown of 10 years. The number of cases of newly diagnosed MM per year for the period from 2009 (n=219) to 2018 (n=385) increased by 75.8%. At the same time, the demonstrated increase in the incidence rate for the described period turned out to be fair only for groups of patients over 50 years old, with the maximum increase in this indicator over the described period in the age range of 60-69 years. This is mainly due to the increase in life expectancy in Moscow in recent years. The study demonstrated that over the past 10 years, the average annual mortality rate from MM has decreased in Moscow, and as a result, its prevalence has increased. The rate of 2-year overall survival of patients with MM was 76%, 5-year - old - 49%, 10-year - old - 27%. The median overall survival of patients under the age of 65 when diagnosing the disease was 79 months, and 48 months. The distribution of patients within international classifications was consistent with international data. Conclusions. The study revealed a significant dynamic of the epidemiological situation concerning MM in Moscow. Over the past 10 years there has been an increase in the incidence of MM, as a result of an increase in the life expectancy of the population. The use of modern diagnostics and therapy of MM in real clinical practice has led to a significant reduction in mortality. Due to these factors, an increase in the prevalence of MM in Moscow has taken place, and this process will no doubt progress in the future.

scholarly journals Quantifying the Burden of Multiple Myeloma Across Europe

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5960-5960 ◽  
Author(s):  
Stephen A Schey ◽  
James Morris ◽  
Áine Maguire ◽  
Sujith Dhanasiri
Keyword(s):  
Multiple Myeloma ◽  
European Union ◽  
Overall Survival ◽  
Life Expectancy ◽  
Research Funding ◽  
Disease Burden ◽  
The European Union ◽  
Hypothetical Scenario ◽  
New Treatments ◽  
The Eu

Abstract Background: In recent years there has been an increasing focus on the costs of managing patients with Multiple Myeloma (MM). Novel agents such as immunomodulators and proteasome inhibitors have been added into the treatment pathway alongside conventional management options including intensive chemotherapy, stem cell transplantation, and supportive care. Commissioners of healthcare have evaluated these additional costs in the context of clinical outcomes such as response rates, progression free survival and overall survival. However, relatively little attention has been paid to disease burden which we argue is an important dimension alongside costs and outcomes. Objective:To estimate the burden of disease associated with MM in the European Union. Methods: A literature review was undertaken to identify assessments of disease burden in MM. A de novo analysis was undertaken to quantify disease burden across the European Union, using Disability Adjusted Life Years (DALYs). DALYs represent the sum of Years of Life Lost (YLL) due to premature mortality and the Years Lost due to Disability (YLD) for a condition. We use long-term projections for incidence, mortality, and life expectancy to estimate DALYs in 5 year intervals out to 2030. Finally, we ran a hypothetical scenario to explore the impact of potential improvements in treatment outcomes. Results: Across the European Union we estimate a total of over 175,000 DALYs for 2015 attributable to MM; which is equivalent to more than 34.5 DALYs per 100,000 population. Disease burden appears to vary considerably by country, partly as a function of incidence rates. For the EU as a whole, MM incidence is projected to increase from approximately 35k new cases to over 43k by 2030. Over the same time period, deaths due to MM are projected to increase from 21.5k to over 27k. Using data from Eurostat and Globocan, we estimate that DALYs for MM in the EU will increase from 175k to approaching 290k by 2030. In terms of DALYs per 100,000 population, this represents a more than 60% projected increase from 34.4 to 55.6 DALYs per 100,000. In our hypothetical scenario, a 1-year increase in overall survival reduced the number of DALYs in the EU by 16,000 for 2020 and by 19,000 for 2030. Discussion: Incorporation of new treatments in the management of myeloma in the last decade has helped improve the median survival of patients. However, as population life expectancy increases, incidence of MM and associated disability is expected to increase substantially. New treatments represent a significant opportunity to reduce this burden. We estimate that a 1-year increase in life expectancy for MM patients would be associated with a 7% reduction in DALYs. Further research is required to confirm DALY estimates in MM but we argue that DALYs provide a useful metric for healthcare commissioners. Disclosures Schey: Celgene, Takeda: Honoraria; Celgene, Johnson & Johnson: Speakers Bureau; Celgene: Consultancy. Morris:Cogentia UK: Research Funding. Maguire:Cogentia UK: Research Funding. Dhanasiri:Celgene: Employment, Equity Ownership.

Experience of air medical teams of the Scientific and Practical Center for Emergency Medical Care of the Moscow City Health Department for 2015—2019

2020 ◽  
pp. 60-68
Author(s):  
S. A. Gumenyuk ◽  
S. A. Fedotov ◽  
V. I. Potapov ◽  
A. Yu. Sysoev
Keyword(s):  
Medical Care ◽  
Health Department ◽  
Disaster Medicine ◽  
Emergency Medical Care ◽  
Emergency Situations ◽  
The Past ◽  
Emergency Medical ◽  
Moscow City ◽  
Medical Teams ◽  
The City

Relevance. Due to busy roads of large cities and the resulting slow movement of ambulances with severely affected patients in need of specialized emergency care, new organizational technologies for medical evacuation support as well as modern means of transporting patients to qualified hospitals are required.Intention is to analyze activities of the aviation medical teams of the Scientific and Practical Center for Emergency Medical Care in Moscow in 2015-2019.Methodology. Using the automated information-analytical system “Disaster Medicine of the Moscow City”, activities of aviation medical teams over the last 5 years (2015-2019) were analyzed retrospectively in the Scientific and Practical Center of Emergency Medical Care. Ambulance helicopters are fully equipped to provide comprehensive intensive care for severely affected patients without noticeable deterioration of their condition, and utilization of this equipment was also assessed.Results and Discussion. Main stages of air ambulance formation in Moscow are described. Experience of aviation medical teams over the past 5 years in providing emergency medical care at the pre-hospital stage to those affected in emergency situations and severely ill patients is presented. The description of medical equipment of ambulance helicopters intended for providing emergency medical care to adults and children, including newborns, is given. The number of calls for aviation medical teams over the past five years is provided along with basic reasons and amount of night flights.Most often helicopters were used for transporting patients with severe concomitant and multiple injuries as a result of road accidents. Medical team composition of ambulance helicopters and the number of helipads on the territory of medical organizations of the city and the territories attached to Moscow are given.Conclusion. Based on the analysis of aviation medical teams activities, further ways to improve and develop the aviation medical service of the city of Moscow can be outlined to expand its use.

scholarly journals Multiple Myeloma :Trends in Consulting Fees and Drug Utilization

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5823-5823
Author(s):  
Daniel Chakos ◽  
Azam Farooqui ◽  
Kimberly McCormick ◽  
Abhishek R Chilkulwar
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Monoclonal Antibodies ◽  
Healthcare System ◽  
Conflicts Of Interest ◽  
New Drugs ◽  
Pharmaceutical Companies ◽  
The Past ◽  
Approved Drugs ◽  
The Cost

Introduction Per the National Cancer Institute epidemiological data, the incidence of multiple myeloma has not changed significantly over the past decade. Mortality from myeloma has not changed significantly between 2007-2016 with an estimated 5-year survival of 55.2 % between 2009-2015. The treatment of multiple myeloma has improved significantly over the past decade with the approval of several new drugs. In the recent IFM trial, the 4-year overall survival in a select group of myeloma patients was 82% when treated with bortezomib, lenalidomide and dexamethasone followed by autologous stem cell transplant and maintenance therapy. These numbers may further improve with approval of monoclonal antibodies and several new drugs in clinical trials. The cost of healthcare has been growing consistently for the past several years. Per CMS data, healthcare spending grew 3.7% in 2017 reaching $3.5 trillion, or $10,739 per person. National health spending is projected to grow at a rate of 5.5% per year from 2018-2027 reaching nearly $6.0 trillion. Health share of the GDP is expected to rise from 17.9% to 19.4%. Pharmaceutical costs have been rising consistently over the past several years with cancer therapies being some of the costliest. Most new cancer therapy costs more than $100,000 per year with the triplet combinations for myeloma costing upwards of $200,000 per year. Methods Our goal was to evaluate the utilization of the newer drugs approved for myeloma by the Medicare population and assess the economic burden of growing drug prices on the health care system. We queried the national CMS database from 2013-2017 to obtain information on Medicare payments made, number of providers making claims and consulting fees for bortezomib, carfilzomib, daratumumab, elotuzumab, ixazomib, lenalidomide, panobinostat and pomalidomide. Results Between 2013-2017 there has been a significant increase in the annual Medicare payments made for myeloma drugs. The amount of payments has tripled between 2013-2017. The number of claims made and providers making those claims have increased. There has also been an exponential increase in consulting fees paid by various pharmaceutical companies to promote prescription of the aforementioned drugs. The amount of money paid in consultation has nearly quadrupled since 2013. Results are consolidated in Table 1 and Figure 1. Discussion This past decade has been an exciting period in cancer research and drug approvals, with myeloma being one of the many malignancies benefitting from this progress. This was made possible by the collaboration between pharmaceutical companies and academic institutions. With the need for continuous combination therapy in multiple myeloma along with increasing prices of existing drugs and high upfront market prices for newly approved drugs, there is significant financial burden placed on the healthcare system. Based on the published literature substitution of carfilzomib for bortezomib or addition of monoclonal antibodies in induction would double cost. Some of these drug approvals are based solely on surrogate endpoints of overall response rates and progression free survival benefit of few months. This is without proven overall survival data while harboring significant toxicity. Conclusion: With pharmaceutical companies spending millions of dollars for drug development there has been a trend towards higher drug pricing. These companies also pay large amounts of consulting fees to physicians dedicated to aggressively market these newly approved drugs which are priced higher than existing therapy. Some of the current cancer guidelines include authors who have financial conflicts of interest and receive consulting fees from pharmaceutical companies. It would be interesting to investigate the correlation between the consulting fees and its effect on prescription patterns. Even the cancer care guidelines do not consider the cost effectiveness of equally effective regimens. There has been a push from various pioneers in the field to incorporate value-based recommends into their guidelines. Given the trajectory of rising costs within our healthcare system, it is imperative for all physicians to be mindful of value-based care while seeking therapy options that provide true benefit to their vulnerable patient populations. Disclosures No relevant conflicts of interest to declare.

scholarly journals Early Intervention in Multiple Myeloma—Exploring New Frontiers

2018 ◽  
Vol 14 (1) ◽  
pp. 12
Author(s):  
Shaji K Kumar
Keyword(s):  
Multiple Myeloma ◽  
Early Intervention ◽  
Life Expectancy ◽  
Supportive Care ◽  
Duration Of Therapy ◽  
The Past ◽  
Disease Biology ◽  
Drug Classes ◽  
Extended Duration ◽  
Made In

The progress that has been made in myeloma during the past decade has been remarkable, and paralleled by few other cancers, if any. This has come through a combination of better understanding of the disease biology, introduction of new drug classes, development of rational and highly effective combinations, extended duration of therapy, and better supportive care. However, we are still far from being able to label myeloma as a curable disease given the inability to predict who, if any, will be able to have a normal life expectancy after a diagnosis of myeloma. We clearly need a different approach to achieve this elusive goal. What might that be?

scholarly journals Advantages and Drawbacks of Carfilzomib vs. Bortezomib

2020 ◽  
Vol 70 (12) ◽  
pp. 4499-4503
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Adverse Events ◽  
Biological Parameters ◽  
Disease Evolution ◽  
Clinical Hospital ◽  
The City

In myeloma therapy, various biological parameters are considered to have an effect on disease evolution and guiding the course of treatment. In the present study we have enrolled 105 patients with Multiple Myeloma admitted in the Hematology Department within the City Emergency Clinical Hospital Timisoara over a 4-year period. This study aims to assess the adverse events, response and overall survival after administration of bortezomib and dexamethasone vs. carfilzomib and dexamethasone regimens. Keywords: Carfilzomib, Bortezomib, Multiple myeloma

IL-10-592 Polymorphism Predicts the Clinical Outcome of Japanese Patients with Multiple Myeloma and MGUS.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4759-4759
Author(s):  
Tetsuhiro Kasamatsu ◽  
Takayuki Saitoh ◽  
Hiroshi Handa ◽  
Takafumi Matsushima ◽  
Norifumi Tsukamoto ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Cell Proliferation ◽  
Overall Survival ◽  
Stem Cell ◽  
Clinical Outcome ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Healthy Controls ◽  
Genotype Frequencies ◽  
Age Range

Abstract Introduction: Interleukin 10 (IL-10) has been reported as an anti-inflammatory cytokine and B-cell proliferation factor, and has been implicated in autoimmunity, tunorigenesis and stem cell transplantation tolerance. IL-10 is also reported to be involved in multiple myeloma (MM) cell proliferation and survival. The polymorphism of position-592, -819, and -1082 in the promoter of IL-10 gene is a strong determinant of IL-10 expression. However, it is unclear whether IL-10 polymorphisms alter the incidence and clinical outcome of MM. We examined the single nucleotide polymorphism (SNPs) located within the promoter region of IL-10 genes in patients with MM, monoclonal gammopathy of undetermined significance (MGUS) and healthy controls in Japan. Methods: Seventy nine patients with MM [age range, 40–83 years; stage I (n=9), stage II (n=20), stage III (n=50); IgG(n=47), IgA(n=12), IgD(n=1), non-secretory (n=3), Bence Jones(n=16)], 46 patients with MGUS (age range, 44–86 years), and 200 healthy controls were included. Fifteen patients with transformation of MGUS to MM were included in MM group. Genotyping in IL-10 -1082G/A, -819C/T, -592A/C was determined by the polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) technique. Genotype and allele frequencies were compared between the study groups using χ2-test. The characteristics and laboratory features of MM patients with each IL-10 promoter polymorphism were compared using χ2-tests and student t-tests. Probability values <0.05 were considered statistically significant. The Kaplan-Meier method was used in the calculation of overall survival. Overall survival curves were compared with the log-rank test. Results: IL-10-592 A/A, A/C and C/C genotype frequencies were not significantly different between MM patients (51%, 34%, and 15%) and controls (42%, 43%, and 15%). Higher frequency of −592A/A genotype was seen in our Asian control compared with Caucasian. The frequency of IL-10 -1082 and -819 were also not significantly different between MM patients and healthy controls. The IL-10-592A/C genotype was detected in 10 of 16 patients (63%) with transformation of MGUS to MM and 20 of 46 patients (43%) with MGUS who did not progress to MM (odds ratio [OR], 2.2; 95% confidence interval [95% CI], 0.7–7.0; p=0.15). In MM patients who received autologous stem cell transplantation (ASCT), the overall survival was similar among 3 genotype groups. However, in patients who did not received ASCT, patients with IL-10-592A/C and C/C genotype had shorter overall survival compared with patients with IL-10-592A/A genotype (median survival, 32 months vs. not reached). Conclusion: It is reported that IL-10-592 A/C and C/C genotype are high producer of IL-10. Our results suggested that the IL-10-592 A/C and C/C genotype was not associated with the susceptibility to MM, however associated with poor prognosis in MM patients who did not receive ASCT. In addition, IL-10-592 A/C and C/C genotype may contribute to transformation of MGUS to MM. According these data, IL-10 may be implicated in the progression of MM and MGUS, and SNPs of IL-10 is one of prognostic factors in patients with MGUS and MM.

scholarly journals The Clinical Course and Life Expectancy of Patients with Multiple Myeloma Who Discontinue Their First Daratumumab-Containing Line of Therapy

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3779-3779
Author(s):  
Agoston Gyula Szabo ◽  
Jonathan Thorsen ◽  
Katrine Fladeland Iversen ◽  
Mette Bøegh Levring ◽  
Birgitte Preiss ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
High Risk ◽  
Life Expectancy ◽  
Median Time ◽  
Drug Class ◽  
Entire Cohort ◽  
One Year ◽  
Multi Center Study ◽  
Line Of Therapy

Abstract Daratumumab is an integral part of the treatment of multiple myeloma (MM) but its real-world efficacy has only been described in small cohorts. MAMMOTH is the only large multi-center study that reported the outcomes of CD38-refractory MM. The present study includes a complete, Danish, nation-wide cohort of 635 MM patients who initiated treatment a daratumumab-containing index regimen (IR) prior to 1.1.2019, and describes the outcomes of 472 patients who discontinued their IR until 1.1.2021. Patients received a median of 3 lines of therapy (LOT) prior to the IR. The median time from diagnosis to discontinuation of the IR (T 0) was 4 years. At T 0, 73% of patients were quadruple drug class exposed (CE). The median overall survival (mOS) after T 0 was 12.2 months in the entire cohort, 15.3 months in double CE, 22.5 months in triple CE, 12.6 months in quadruple CE and 8.3 months in alkylator-bortezomib-carfilzomib-daratumumab-lenalidomide-pomalidomide-exposed patients. After T 0, 79%, 48%, 29%, 17%, 10% and 6% of patients received 1, 2, 3, 4, 5, 6 additional LOT, respectively, achieving overall response rates ranging from 44% to 11% and median time to next treatment (TNT) from 138 to 54 days. In the first subsequent LOT after T 0, 51% of patients were retreated with daratumumab. Despite the lack of benefit in terms response and TNT, daratumumab retreatment was associated with superior OS on multivariate analysis adjusting for age, previous transplantation, IR, drug class exposure at T 0, treating site, time from diagnosis to T 0 and presence of cytogenetic high-risk markers. Median OS was 24.6 months in patients retreated with and 11.3 months in patients treated without daratumumab (p&lt;0.0001). In conclusion, patients with MM who discontinue their first daratumumab-containing regimen have a life expectancy of approximately one year. Our results support a rationale behind daratumumab retreatment. Legends to Figure: A: Overall survival after T 0; B: Overall survival after T 0 by cytogenetic risk; C: Overall survival after T 0 by IR; D: Overall survival after T 0 by prior exposure. Abbreviations: T 0=time of discontinuation of the first daratumumab-containing line of therapy; IR=index regimen; high-risk=t(4;14), t(14;16) or del17p by FISH; D-mono=daratumumab monotherapy; D-bor=daratumumab-bortezomib-dexamethasone; D-len=daratumumab-lenalidomide-dexamethasone; D-other=daratumumab in other combinations; Double_CE=exposed to daratumumab and another class of drugs; Triple_CE=exposed to daratumumab and two other classes of drugs; Quadruple_CE=exposed to daratumumab and three other classes of drugs; ABCDLP-exposed=exposed to daratumumab, bortezomib, carfilzomib, lenalidomide and pomalidomide Figure 1 Figure 1. Disclosures Szabo: Takeda: Consultancy; Sanofi: Consultancy; Janssen: Consultancy.

scholarly journals Survival Trends over 18 Years of Patients with Multiple Myeloma Harboring Del(17p) and/or t(4;14): A Retrospective Real-World Study

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 15-17
Author(s):  
Thomas Chalopin ◽  
Nicolas Vallet ◽  
Marlene Ochmann ◽  
Mourad Tiab ◽  
Pascal Godmer ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Monoclonal Antibodies ◽  
Stem Cell ◽  
In Situ Hybridization ◽  
Research Funding ◽  
Newly Diagnosed ◽  
New Agents ◽  
The Past

Introduction . In multiple myeloma (MM), the presence of translocation t(4;14) and/or 17p deletion, found in around 10 to 15% of the patients, is considered as high-risk feature associated with adverse survival. Despite recent advances in the treatment of MM, t(4;14) and del(17p) are still associated with poor outcome. The aim of this study was to analyze the trends of survival in patients with newly diagnosed MM harboring t(4;14) and or 17p deletion over the past two decades. Methods . Patients from five French centers with newly-diagnosed MM from 2001 to 2019 and displaying del(17p) and/or t(4;14) were retrospectively included. Cytogenetics abnormalities were detected by interphase fluorescence in situ hybridization (FISH) and del(17p) positivity cut-off was 30%. New agents were defined as: pomalidomide, carfilzomib, ixazomib and anti-CD38 monoclonal antibodies. Results . 246 patients carrying either t(4;14) (n=106 patients), del(17p) (n=121 patients) or both (n=19 patients) were included. Median age was 64 years (range, 35-91). ISS and R-ISS score were 3 in 88 patients (36%). Eighty-seven patients (35%) were diagnosed in 2001-2010 period, and 159 (65%) in 2011-2019 period. Front-line autologous stem-cell transplantation (ASCT) was performed in 121 (49%) patients. Among transplant eligible patients, 112 patients (n=93%) received triplet induction, 78 patients (64%) a consolidation regimen and 15 patients (12%) a maintenance therapy. Double-ASCT was decided in 21 patients (17%). Among transplant ineligible patients, 61 patients (49%) received melphalan-based regimen in first line, 36 (29%) a bortezomib-based and 15 patients (14%) a lenalidomide-based regimen. At any line, 92 patients (37%) received at least one of the new agents with only 12 patients (5%) in frontline therapy. Median follow-up was 41 months (IQR: 21-69). Median overall survival (OS) was 58.4 months (IQR: 50.1-66.5) for the entire cohort, 55.5 months (IQR: 46.6-78.3) for del(17p), 62.5 months (IQR: 54.2-76.1) for t(4;14) and 48.6 months (18.1-not reached) for patients with both (p=0.2). Median of first progression-free survival (PFS1) was 25.6 months (IQR: 22.2-29.8), with no difference between del(17p), t(4;14) or both (p=0.57). Importantly, no improvement of median OS was observed in patients diagnosed between 2001-2010 in comparison with patients diagnosed between 2011-2019 (63.7 versus 53.2 months, p=0.32). In univariate and multivariate analysis: age (continuous and cut-off 71 years-old) and ASCT significantly were associated with risk of death (HR: 1.03, 1.09 and 0.45, respectively). Median OS of patients eligible to ASCT was 76.1 months (IQR: 62.5-90.3) vs 42.5 months (IQR: 36.8-54.6) for patients not eligible (HR 0.45, 95%CI 0.28-0.0.71; p&lt;0.001). Double-ASCT did not improve significantly OS (75 vs 81.1 months ; p=0.41) and PFS1 (31.6 vs 47.8, p=0.30) compared with single-ASCT. Conclusion . This large multicenter real-world study confirms that patients with newly diagnosed MM carrying del(17p) and/or t(4;14) remain a therapeutic challenge with no significant overall survival improvement in the past decades despite the use of novel agents. The definition of high-risk MM patients is evolving with incorporation of new markers (i.e chromosome 1 abnormalities, PET-imaging). Minimal-residual disease achievement will also re-defined risk stratification. Nonetheless, the need for innovative approaches such as earlier strategies using new agents or immunotherapy (CAR-T cells, bispecific T-cell engager antibodies) may significantly improve outcomes. Figure captions Table 1. Clinical, biological characteristics, treatment and survival of the 246 included patients based on period of diagnosis. IQR: interquartile range; FISH: fluorescence in situ hybridization; ISS: international score system; LDH: lactate dehydrogenase; ASCT: autologous stem cell transplantation; len: lenalidomide; Poma: pomalidomide; Carfil: carfilzomib; Ixa: ixazomib; mAb: monoclonal antibodies; OS: overall survival Figure 1. Kaplan-Meier curves for overall survival for the 246 included patients based on period of diagnosis. Figure 1 Disclosures Moreau: Amgen: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Celgene/Bristol-Myers Squibb: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Novartis: Honoraria; Takeda: Honoraria. Touzeau:Takeda: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses; Sanofi: Honoraria, Research Funding; Abbvie: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses, Research Funding; Amgen: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses; GlaxoSmithKline: Honoraria, Research Funding.

Portuguese Sardines - from the ritual to the brand

2017 ◽  
Vol 5 (2) ◽  
pp. 109-120
Author(s):  
Cecília Avelino Barbosa
Keyword(s):  
Social Construction ◽  
Place Branding ◽  
Symbolic Capital ◽  
City Council ◽  
Point Of View ◽  
City Branding ◽  
The Past ◽  
Behavioral Expression ◽  
The City ◽  
City Identity

Place branding is a network of associations in the consumer’s mind, based on the visual, verbal, and behavioral expression of a place. Food can be an important tool to summarize it as it is part of the culture of a city and its symbolic capital. Food is imaginary, a ritual and a social construction. This paper aims to explore a ritual that has turned into one of the brands of Lisbon in the past few years. The fresh sardines barbecued out of doors, during Saint Anthony’s festival, has become a symbol that can be found on t-shirts, magnets and all kinds of souvenirs. Over the year, tourists can buy sardine shaped objects in very cheap stores to luxurious shops. There is even a whole boutique dedicated to the fish: “The Fantastic World of Portuguese Sardines” and an annual competition promoted by the city council to choose the five most emblematic designs of sardines. In order to analyze the Sardine phenomenon from a city branding point of view, the objective of this paper is to comprehend what associations are made by foreigners when they are outside of Lisbon. As a methodological procedure five design sardines, were used of last year to questioning to which city they relate them in interviews carried in Madrid, Lyon, Rome and London. Upon completion of the analysis, the results of the city branding strategy adopted by the city council to promote the sardines as the official symbol of Lisbon is seen as a Folkmarketing action. The effects are positive, but still quite local. On the other hand, significant participation of the Lisbon´s dwellers in the Sardine Contest was observed, which seems to be a good way to promote the city identity and pride in their best ambassador: the citizens.

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