Summary
With increasing number of therapies available for the treatment of multiple myeloma, it is timely to examine the course of patients' journeys. We investigated patient characteristics, ...treatment durations and outcomes, and symptom burden across the treatment pathway in Belgium, France, Germany, Italy, Spain, Switzerland and the UK. In total, 435 physicians retrospectively reviewed 4997 patient charts. Profiles of patients diagnosed with multiple myeloma during the last 12 months were similar across countries; bone pain was the most common presentation. Median duration of first‐line therapy was 6 months, followed by a median treatment‐free interval of 10 months; both these decreased with increasing lines of therapy, as did time to progression. Depth of response, as assessed by the treating physician, also decreased with each additional line of therapy: 74% of patients achieved at least a very good partial response at first line, compared with only 11% at fifth line. Deeper responses were associated with longer time to progression, although these were physician‐judged. Toxicities and co‐morbidities increased with later treatment lines, and were more likely to have led to discontinuation of treatment. These real‐world data provide an insight into patient outcomes and treatment decisions being made in clinical practice.
Summary
Real‐world data describing management of patients with multiple myeloma are limited. A European (Belgium, France, Germany, Italy, Spain, Switzerland, UK) observational chart review was ...conducted to address this. Physicians completed questionnaires for every patient seen during a 2–4‐week observation period, regardless of treatment status. A total of 435 physicians completed 7635 cross‐sectional chart reviews. Overall, 47% of patients were undergoing anti‐tumour drug treatment, 42% had previously received ≥1 line of treatment and 12% had never received anti‐tumour drug treatment. Of the patients treated by oncologists, onco‐haematologists or internists, 95% received, or were expected to receive, at least one line of anti‐tumour drug treatment, 61% received ≥2 lines of therapy and 38% received ≥3 lines. Except in the UK, the most commonly used induction therapies contained bortezomib (48%); lenalidomide was the most commonly used first‐line maintenance therapy (45%) and second‐ and third‐line agent overall (60% and 52% of patients at those lines, respectively). Bortezomib retreatment was used in 47% of patients who received it first line. Treatment patterns became more diverse with subsequent treatment lines. This study provides insight into real‐world treatment patterns in Europe. While treatment practices are broadly similar across countries, some notable differences in the agents used exist.
Objectives
This study aimed to provide real‐world data on the characteristics and treatment of patients with multiple myeloma (MM) at the time of death.
Methods
The study was a retrospective patient ...chart review across France, Germany, Italy, Spain and the UK during 2016, and included patients who had died in the 3 months before the index date.
Results
Data from 786 patients were reviewed. At the time of death, 37% of patients were receiving active treatment, 12% were in a treatment‐free interval and 51% were receiving only supportive care. Death before and during active first‐line treatment was not uncommon (6% and 24% of patients, respectively) but these deaths were often not solely due to disease progression; factors such as renal failure and infection frequently played a role (in 30% and 20% of patients at first‐line, respectively). Most deaths at later lines were due to progressive disease. Cox model results suggested that early deaths were associated with advanced disease stage, high‐risk cytogenetics and poor response and relapse profiles.
Conclusions
These real‐world data could be used to help develop strategies for improving survival in patients with MM and to support management tailored to the stage of disease.
The surfaces of silica particles were molecularly imprinted with an α-chymotrypsin transition-state analogue (TSA) by utilizing the technique of template-directed synthesis of mineralized materials. ...The resulting catalytic particles hydrolyzed amides in an enantioselective manner. A mixture of a nonionic surfactant and the acylated chymotrypsin TSA, with the TSA acting as the headgroup at the surfactant−water interface, was used to form a microemulsion for silica particle formation. Incorporation of amine-, dihydroimidazole-, and carboxylate-terminated trialkoxysilanes into the particles during imprinting resulted in enhancement of the rates of amide hydrolysis. Acylated imprint molecules formed more effective imprints in the presence of the functionalized silanes than nonacylated imprint molecules. Particles surface-imprinted with the chymotrypsin TSA were selective for the trypsin substrate, and particles surface-imprinted with the l-isomer of the enzyme TSA were enantioselective for the d-isomer of the substrate.
The intense coloration of butterflies, snakes, hummingbirds and arthropods is due to reflective interference by stacked thin film layers of alternating high and low index of refraction materials. By ...controlling film thickness, it is also possible to create a single layer film of similar materials with well-defined color. Cross-linked chitosan and poly(allyl amine) hydrochloride thin films were assembled by dropping a dilute solution onto a spinning silicon substrate. Film quality and reproducibility were investigated, as well as the effects of cross-linking. Control of thickness could be used to determine film color. When dipped into a variety of metal ion solutions, the cross-linked films changed in thickness and color.
Nature creates selectively refractive materials in butterfly wings and crab shells by alternating layers of chitin with different refractive indices. To mimic this construction, control of both ...thickness and refractive index of chitosan films is required. Methods were developed for adhering the chitosan layer to glass and silicon, polymerizing the chitosan, stabilizing the chitosan films against environmental changes in temperature and humidity, and depositing a uniform chitosan layer with defined thickness. First, commercial chitosan was hydrolyzed to obtain lower molecular weight polymers and further purified. Then chitosan layers were prepared on clean silicon chips pretreated with polyvinyl butyral resin for adhesion. The chitosan solution with a polymerizing component and a plasticizer consisted of 2.5% purified chitosan/2.5% Resimene/0.25% tetraethylene glycol. Spin-coating at varying speeds after an incubation period of 1 h at room temperature produced chitosan layer thicknesses in the ideal range of 1200−2000 Å. The different thicknesses were reproducible, with a standard deviation across the film between 3 and 5%. The experimental index of refraction calculated for these layers was 1.59.
We describe a new electroless iron bath capable of depositing a ferromagnetic FeB coating onto Pd/Sn-catalyzed substrates at room temperature without the need for an accompanying galvanic couple and ...illustrate its use for the fabrication of magnetic cellulose microfibers. The new electroless iron bath contains Fe2+ as the metal source, citrate as the metal chelator, boric acid buffer as the pH controller, and borohydride as the reductant. Surface analysis following plating confirms the deposition of an amorphous FeB coating of composition ∼Fe10B onto the microfiber surface. Through the use of two-level factorial design statistical methods, we characterize the effects of plating variables (i.e., bath pH and concentrations of each bath component) on bath behavior, identifying pH as the sole factor influencing the mass of plated Fe and establishing optimal, reproducible conditions for electroless Fe deposition.
This paper describes the investigation of chitosan and poly(allylamine) (PAH) for the creation of a multi-film, color-based dipstick for the detection of metal ions in solution. Thin, colored films ...of chitosan and PAH cross-linked with hexamethylene 1,6-di(aminocarboxysulfonate) (HDACS) are created where color is due to film thickness and optical interference effects. The films are investigated for their ability to selectively detect aqueous metal ions via changes in thickness and/or color. Chitosan-HDACS films were selective for Cr(VI) over all other metal ions tested including Cr(acac)3 and Cr(NO3)3·9H2O, and PAH-HDACS films were selective for Cu(II) and Cu(I) salts over all other metal ions tested. The irreversible, selective changes due to metal ion solutions were not caused by varying the pH. Potomac River water was also tested using the two films, with results indicating the presence of Cu(II) in the aqueous sample.
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