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Buckstein R.,Odette Cancer and Sunnybrook Health science Center | Kerbel R.,Sunnybrook Research Institute | Cheung M.,Odette Cancer and Sunnybrook Health science Center | Shaked Y.,Technion - Israel Institute of Technology | And 11 more authors.
Leukemia Research | Year: 2014

Metronomic, low dose chemotherapy may have anti-angiogenic effects and augment the effects of lenalidomide in MDS and CMML. We evaluated the clinical efficacy, tolerability and anti-angiogenic effects of melphalan 2. mg and lenalidomide 10. mg for 21 days/28 in CMML (n= 12) and higher risk MDS (n= 8) patients in a prospective phase II study. The primary endpoint was overall response and secondary endpoints included survival, progression-free survival, toxicity and biomarkers of angiogenesis. The median age was 73 years, 55% were pretreated and transfusion dependent. The overall response rate was 3(15%) of 19 evaluable patients but 25% in CMML and 33% in pCMML. Dose reductions and/or delays were common due to myelosuppression. Transient spikes in circulating endothelial cells that declined below baseline were seen in responders and patients with CMML, suggesting anti-angiogenic activity. In conclusion, lenalidomide and metronomic low dose melphalan demonstrate signals of clinical and possible anti-angiogenic activity in patients with pCMML that require future validation. This trial was registered at clinicaltrial.gov under # NCT00744536. © 2014 The Authors.

Abel G.A.,Dana-Farber Cancer Institute | Efficace F.,Italian Group for Adult Hematologic Diseases GIMEMA | Buckstein R.J.,Odette Cancer and Sunnybrook Health science Center | Tinsley S.,H. Lee Moffitt Cancer Center and Research Institute | And 8 more authors.
Haematologica | Year: 2016

Disease-specific measures of quality of life can improve assessment of disease-related symptoms and psychosocial sequelae. We report on the development and validation of the Quality of Life in Myelodysplasia Scale (QUALMS), a 38-item assessment tool for patients with myelodysplastic syndromes (MDS). In 2014-2015, a multicenter cohort of patients with myelodysplasia completed the QUALMS, as well as the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) and the Functional Assessment of Cancer Therapy Anemia Scale (FACT-An); a second administration was undertaken three to six months later. A total of 255 patients from the United States, Canada and Italy participated. Median age was 72 years, 56.1% were men, and the International Prognostic Scoring System distribution was 40.4% low, 42.0% intermediate-1, 13.3% intermediate-2 and 2.3% high. QUALMS scores ranged from 24 to 99 (higher scores are better), with a mean of 67.2 [standard deviation (SD)=15.2]. The measure was internally consistent (α=0.92), and moderately correlated with the multi-item QLQ-C30 scales and the FACT-An (r=-0.65 to 0.79; all P<0.001). Patients with hemoglobin of 8 g/dL or under scored lower than those with hemoglobin over 10 g/dL (61.8 vs. 71.1; P<0.001), and transfusion-dependent patients scored lower than transfusion-independent patients (62.4 vs. 69.7; P<0.01). Principal components analysis revealed “physical burden”, “benefit-finding”, and “emotional burden” subscales. There was good overall test-retest reliability among those with stable hemoglobin (r=0.81), and significant changes for patients hospitalized or with infections between administrations (both P<0.01). These data suggest the QUALMS is a valuable tool for assessing MDS-specific quality of life in the modern treatment era. © 2016 Ferrata Storti Foundation.

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