Estudio de costo-efectividad de lenalidomida como terapia de mantenimiento posterior a trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple
ilustraciones, diagramas
- Autores:
-
Sánchez García, Víctor Leonardo
- Tipo de recurso:
- Fecha de publicación:
- 2023
- Institución:
- Universidad Nacional de Colombia
- Repositorio:
- Universidad Nacional de Colombia
- Idioma:
- spa
- OAI Identifier:
- oai:repositorio.unal.edu.co:unal/86657
- Palabra clave:
- 610 - Medicina y salud::616 - Enfermedades
610 - Medicina y salud::615 - Farmacología y terapéutica
Mieloma Múltiple
Plasmacitoma
Lenalidomida
Neoplasias
Multiple Myeloma
Plasmacytoma
Lenalidomide
Neoplasms
Mantenimiento post-trasplante
Costo-efectividad
Cost-effectiveness analisis
Post-transplant maintenance
- Rights
- openAccess
- License
- Atribución-NoComercial 4.0 Internacional
id |
UNACIONAL2_954528f81fc853bd711caf07d47118da |
---|---|
oai_identifier_str |
oai:repositorio.unal.edu.co:unal/86657 |
network_acronym_str |
UNACIONAL2 |
network_name_str |
Universidad Nacional de Colombia |
repository_id_str |
|
dc.title.spa.fl_str_mv |
Estudio de costo-efectividad de lenalidomida como terapia de mantenimiento posterior a trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple |
dc.title.translated.eng.fl_str_mv |
Cost-effectiveness study of lenalidomide as maintenance therapy after autologous hematopoietic stem cell transplantation in patients with multiple myeloma |
title |
Estudio de costo-efectividad de lenalidomida como terapia de mantenimiento posterior a trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple |
spellingShingle |
Estudio de costo-efectividad de lenalidomida como terapia de mantenimiento posterior a trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple 610 - Medicina y salud::616 - Enfermedades 610 - Medicina y salud::615 - Farmacología y terapéutica Mieloma Múltiple Plasmacitoma Lenalidomida Neoplasias Multiple Myeloma Plasmacytoma Lenalidomide Neoplasms Mantenimiento post-trasplante Costo-efectividad Cost-effectiveness analisis Post-transplant maintenance |
title_short |
Estudio de costo-efectividad de lenalidomida como terapia de mantenimiento posterior a trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple |
title_full |
Estudio de costo-efectividad de lenalidomida como terapia de mantenimiento posterior a trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple |
title_fullStr |
Estudio de costo-efectividad de lenalidomida como terapia de mantenimiento posterior a trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple |
title_full_unstemmed |
Estudio de costo-efectividad de lenalidomida como terapia de mantenimiento posterior a trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple |
title_sort |
Estudio de costo-efectividad de lenalidomida como terapia de mantenimiento posterior a trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple |
dc.creator.fl_str_mv |
Sánchez García, Víctor Leonardo |
dc.contributor.advisor.none.fl_str_mv |
Cañón, Oscar Buitrago, Giancarlo |
dc.contributor.author.none.fl_str_mv |
Sánchez García, Víctor Leonardo |
dc.contributor.orcid.spa.fl_str_mv |
Sanchez Garcia, Victor [000000030550530X] |
dc.subject.ddc.spa.fl_str_mv |
610 - Medicina y salud::616 - Enfermedades 610 - Medicina y salud::615 - Farmacología y terapéutica |
topic |
610 - Medicina y salud::616 - Enfermedades 610 - Medicina y salud::615 - Farmacología y terapéutica Mieloma Múltiple Plasmacitoma Lenalidomida Neoplasias Multiple Myeloma Plasmacytoma Lenalidomide Neoplasms Mantenimiento post-trasplante Costo-efectividad Cost-effectiveness analisis Post-transplant maintenance |
dc.subject.decs.spa.fl_str_mv |
Mieloma Múltiple Plasmacitoma Lenalidomida Neoplasias |
dc.subject.decs.eng.fl_str_mv |
Multiple Myeloma Plasmacytoma Lenalidomide Neoplasms |
dc.subject.proposal.spa.fl_str_mv |
Mantenimiento post-trasplante Costo-efectividad |
dc.subject.proposal.eng.fl_str_mv |
Cost-effectiveness analisis Post-transplant maintenance |
description |
ilustraciones, diagramas |
publishDate |
2023 |
dc.date.issued.none.fl_str_mv |
2023-12 |
dc.date.accessioned.none.fl_str_mv |
2024-07-30T20:24:09Z |
dc.date.available.none.fl_str_mv |
2024-07-30T20:24:09Z |
dc.type.spa.fl_str_mv |
Trabajo de grado - Especialidad Médica |
dc.type.driver.spa.fl_str_mv |
info:eu-repo/semantics/masterThesis |
dc.type.version.spa.fl_str_mv |
info:eu-repo/semantics/acceptedVersion |
dc.type.content.spa.fl_str_mv |
Text |
dc.type.redcol.spa.fl_str_mv |
http://purl.org/redcol/resource_type/TM |
status_str |
acceptedVersion |
dc.identifier.uri.none.fl_str_mv |
https://repositorio.unal.edu.co/handle/unal/86657 |
dc.identifier.instname.spa.fl_str_mv |
Universidad Nacional de Colombia |
dc.identifier.reponame.spa.fl_str_mv |
Repositorio Institucional Universidad Nacional de Colombia |
dc.identifier.repourl.spa.fl_str_mv |
https://repositorio.unal.edu.co/ |
url |
https://repositorio.unal.edu.co/handle/unal/86657 https://repositorio.unal.edu.co/ |
identifier_str_mv |
Universidad Nacional de Colombia Repositorio Institucional Universidad Nacional de Colombia |
dc.language.iso.spa.fl_str_mv |
spa |
language |
spa |
dc.relation.references.spa.fl_str_mv |
Cowan AJ, Green DJ, Kwok M, Lee S, Coffey DG, Holmberg LA, et al. Diagnosis and Management of Multiple Myeloma: A Review. JAMA. 1 de febrero de 2022;327(5):464-77. Kazandjian D. Multiple myeloma epidemiology and survival, a unique malignancy. Semin Oncol. diciembre de 2016;43(6):676-81 170-colombia-fact-sheets.pdf [Internet]. [citado 26 de noviembre de 2023]. Disponible en: https://gco.iarc.fr/today/data/factsheets/populations/170-colombia-fact-sheets.pdf Rafae A, van Rhee F, Al Hadidi S. Perspectives on the Treatment of Multiple Myeloma. The Oncologist. 23 de noviembre de 2023;oyad306 Chen N, Zhou S, Palmisano M. Clinical Pharmacokinetics and Pharmacodynamics of Lenalidomide. Clin Pharmacokinet. 1 de febrero de 2017;56(2):139-52 McCarthy PL, Owzar K, Hofmeister CC, Hurd DD, Hassoun H, Richardson PG, et al. Lenalidomide after Stem-Cell Transplantation for Multiple Myeloma. N Engl J Med. 10 de mayo de 2012;366(19):1770-81 Palumbo A, Cavallo F, Gay F, Di Raimondo F, Ben Yehuda D, Petrucci MT, et al. Autologous Transplantation and Maintenance Therapy in Multiple Myeloma. N Engl J Med. 4 de septiembre de 2014;371(10):895-905 Attal M, Lauwers-Cances V, Marit G, Caillot D, Moreau P, Facon T, et al. Lenalidomide Maintenance after Stem-Cell Transplantation for Multiple Myeloma. N Engl J Med. 10 de mayo de 2012;366(19):1782-91 Jackson GH, Davies FE, Pawlyn C, Cairns DA, Striha A, Collett C, et al. Lenalidomide maintenance versus observation for patients with newly diagnosed multiple myeloma (Myeloma XI): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 1 de enero de 2019;20(1):57-73 McCarthy PL, Holstein SA, Petrucci MT, Richardson PG, Hulin C, Tosi P, et al. Lenalidomide Maintenance After Autologous Stem-Cell Transplantation in Newly Diagnosed Multiple Myeloma: A Meta-Analysis. J Clin Oncol. 10 de octubre de 2017;35(29):3279-89 Wang Y, Yang F, Shen Y, Zhang W, Wang J, Chang VT, et al. Maintenance Therapy With Immunomodulatory Drugs in Multiple Myeloma: A Meta-Analysis and Systematic Review. JNCI J Natl Cancer Inst. 18 de noviembre de 2015;108(3):djv342 Neumann E by PJ, Sanders GD, Russell LB, Siegel JE, Ganiats and TG, editores. Cost-Effectiveness in Health and Medicine. Second Edition, New to this Edition:, Second Edition, New to this Edition: Oxford, New York: Oxford University Press; 2016. 536 p World Bank Open Data [Internet]. [citado 2 de diciembre de 2023]. World Bank Open Data. Disponible en: https://data.worldbank.org Ley. Ley Estatutaria No 1751. Gac 056 [Internet]. 16 de febrero de 2015; Disponible en: http://www.secretariasenado.gov.co/leyes-de-la-republica Benavidez AP. P44 Multiple Myeloma Total Direct Costs in Colombia: A National Cohort Study Based on Administrative Claims Databases Olry de Labry Lima A, Gimeno-Ballester V, Ríos Tamayo R, Epstein D, Matas Hoces A, Ríos Sánchez E, et al. Cost-effectiveness of lenalidomide maintenance in patients with multiple myeloma who have undergone autologous transplant of hematopoietic progenitor cells. Bone Marrow Transplant. noviembre de 2019;54(11):1908-19 Uyl‐de Groot CA, Ramsden R, Lee D, Boersma J, Zweegman S, Dhanasiri S. Lenalidomide as maintenance treatment for patients with multiple myeloma after autologous stem cell transplantation: A pharmaco‐economic assessment. Eur J Haematol. noviembre de 2020;105(5):635-45 LeBlanc R, Hollmann S, Tay J. Canadian cost analysis comparing maintenance therapy with bortezomib versus lenalidomide for patients with multiple myeloma post autologous stem cell transplant. J Popul Ther Clin Pharmacol [Internet]. 2016 [citado 27 de noviembre de 2023];23(1). Disponible en: https://jptcp.com SH S, E C, NL H, ES J, SA P, H S, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues [Internet]. [citado 30 de noviembre de 2023]. Disponible en: https://publications.iarc.fr/Book-And-Report-Series/Who-Classification-Of-Tumours/WHO-Classification-Of-Tumours-Of-Haematopoietic-And-Lymphoid-Tissues-2017 Short KD, Rajkumar S, Larson D, Buadi F, Hayman S, Dispenzieri A, et al. Incidence of extramedullary disease in patients with multiple myeloma in the era of novel therapy, and the activity of pomalidomide on extramedullary myeloma. Leukemia. junio de 2011;25(6):906-8. Rajkumar SV. Multiple myeloma: 2020 update on diagnosis, risk-stratification and management. Am J Hematol. 2020;95(5):548-67 Curado MP, Oliveira MM, Silva DRM, Souza DLB. Epidemiology of multiple myeloma in 17 Latin American countries: an update. Cancer Med. 1 de mayo de 2018;7(5):2101-8 Kumar SK, Rajkumar V, Kyle RA, van Duin M, Sonneveld P, Mateos MV, et al. Multiple myeloma. Nat Rev Dis Primer. 20 de julio de 2017;3(1):1-20 Palumbo A, Anderson K. Multiple Myeloma. N Engl J Med. 17 de marzo de 2011;364(11):1046-60 Kyle RA, Larson DR, Therneau TM, Dispenzieri A, Kumar S, Cerhan JR, et al. Long-Term Follow-up of Monoclonal Gammopathy of Undetermined Significance. N Engl J Med. 18 de enero de 2018;378(3):241-9 van Nieuwenhuijzen N, Spaan I, Raymakers R, Peperzak V. From MGUS to Multiple Myeloma, a Paradigm for Clonal Evolution of Premalignant Cells. Cancer Res. 14 de mayo de 2018;78(10):2449-56 Rajan AM, Rajkumar SV. Interpretation of cytogenetic results in multiple myeloma for clinical practice. Blood Cancer J. 1 de octubre de 2015;5(10):e365-e365. Hideshima T, Mitsiades C, Tonon G, Richardson PG, Anderson KC. Understanding multiple myeloma pathogenesis in the bone marrow to identify new therapeutic targets. Nat Rev Cancer. 1 de agosto de 2007;7(8):585-98 Ghobrial IM, Detappe A, Anderson KC, Steensma DP. The bone-marrow niche in MDS and MGUS: implications for AML and MM. Nat Rev Clin Oncol. 1 de abril de 2018;15(4):219-33. Bianchi G, Munshi NC. Pathogenesis beyond the cancer clone(s) in multiple myeloma. Blood. 14 de mayo de 2015;125(20):3049-58. Laubach J. Multiple myeloma: Clinical features, laboratory manifestations, and diagnosis - UpToDate [Internet] [Internet]. [citado 13 de agosto de 2020]. Disponible en: https://www.uptodate.com/contents/multiple-myeloma-clinical-features-laboratory-manifestations-and-diagnosis?search=mieloma&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, et al. Review of 1027 Patients With Newly Diagnosed Multiple Myeloma. Mayo Clin Proc. 1 de enero de 2003;78(1):21-33. Hillengass J, Usmani S, Rajkumar SV, Durie BGM, Mateos MV, Lonial S, et al. International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders. Lancet Oncol. 1 de junio de 2019;20(6):e302-12. Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 1 de noviembre de 2014;15(12):e538-48. Walker BA, Mavrommatis K, Wardell CP, Ashby TC, Bauer M, Davies F, et al. A high-risk, Double-Hit, group of newly diagnosed myeloma identified by genomic analysis. Leukemia. 1 de enero de 2019;33(1):159-70. Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L, et al. Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group. J Clin Oncol. 10 de septiembre de 2015;33(26):2863-9. Rafae A, van Rhee F, Al Hadidi S. Perspectives on the Treatment of Multiple Myeloma. The Oncologist. 1 de marzo de 2024;29(3):200-12. Palumbo A, Bringhen S, Mateos MV, Larocca A, Facon T, Kumar SK, et al. Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report. Blood. 26 de marzo de 2015;125(13):2068-74. Attal Michel, Lauwers-Cances Valerie, Hulin Cyrille, Leleu Xavier, Caillot Denis, Escoffre Martine, et al. Lenalidomide, Bortezomib, and Dexamethasone with Transplantation for Myeloma. N Engl J Med. 376(14):1311-20. Stadtmauer EA, Pasquini MC, Blackwell B, Hari P, Bashey A, Devine S, et al. Autologous Transplantation, Consolidation, and Maintenance Therapy in Multiple Myeloma: Results of the BMT CTN 0702 Trial. J Clin Oncol. 1 de marzo de 2019;37(7):589-97 Hari P, Pasquini MC, Stadtmauer EA, Fraser R, Fei M, Devine SM, et al. Long-term follow-up of BMT CTN 0702 (STaMINA) of postautologous hematopoietic cell transplantation (autoHCT) strategies in the upfront treatment of multiple myeloma (MM). J Clin Oncol. 20 de mayo de 2020;38(15_suppl):8506-8506 Cavo M, Gay FM, Patriarca F, Zamagni E, Montefusco V, Dozza L, et al. Double Autologous Stem Cell Transplantation Significantly Prolongs Progression-Free Survival and Overall Survival in Comparison with Single Autotransplantation in Newly Diagnosed Multiple Myeloma: An Analysis of Phase 3 EMN02/HO95 Study. Blood. 8 de diciembre de 2017;130:401. Rajkumar SV, Kumar S. Multiple myeloma current treatment algorithms. Blood Cancer J. 28 de septiembre de 2020;10(9):94 Giralt S, Costa LJ, Maloney D, Krishnan A, Fei M, Antin JH, et al. Tandem Autologous-Autologous versus Autologous-Allogeneic Hematopoietic Stem Cell Transplant for Patients with Multiple Myeloma: Long-Term Follow-Up Results from the Blood and Marrow Transplant Clinical Trials Network 0102 Trial. Biol Blood Marrow Transplant. 1 de abril de 2020;26(4):798-804. Moreau P, Attal M, Hulin C, Arnulf B, Belhadj K, Benboubker L, et al. Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): a randomised, open-label, phase 3 study. The Lancet. 6 de julio de 2019;394(10192):29-38 Moreau P, Hulin C, Perrot A, Arnulf B, Belhadj K, Benboubker L, et al. Maintenance with daratumumab or observation following treatment with bortezomib, thalidomide, and dexamethasone with or without daratumumab and autologous stem-cell transplant in patients with newly diagnosed multiple myeloma (CASSIOPEIA): an open-label, randomised, phase 3 trial. Lancet Oncol. 1 de octubre de 2021;22(10):1378-90 Sonneveld Pieter, Dimopoulos Meletios A., Boccadoro Mario, Quach Hang, Ho P. Joy, Beksac Meral, et al. Daratumumab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple Myeloma. N Engl J Med. 24 de enero de 2024;390(4):301-13 Sengsayadeth S, Malard F, Savani BN, Garderet L, Mohty M. Posttransplant maintenance therapy in multiple myeloma: the changing landscape. Blood Cancer J. marzo de 2017;7(3):e545 Sonneveld P, Dimopoulos MA, Beksac M, van der Holt B, Aquino S, Ludwig H, et al. Consolidation and Maintenance in Newly Diagnosed Multiple Myeloma. J Clin Oncol. 10 de noviembre de 2021;39(32):3613-22. Nooka AK, Joseph NS. Maintenance Strategies for Myeloma: Is Bigger Always Better? Cancer J. mayo de 2021;27(3):231-8 Attal M, Harousseau JL, Leyvraz S, Doyen C, Hulin C, Benboubker L, et al. Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood. 15 de noviembre de 2006;108(10):3289-94 Morgan GJ, Gregory WM, Davies FE, Bell SE, Szubert AJ, Brown JM, et al. The role of maintenance thalidomide therapy in multiple myeloma: MRC Myeloma IX results and meta-analysis. Blood. 5 de enero de 2012;119(1):7-15 Kagoya Y, Nannya Y, Kurokawa M. Thalidomide maintenance therapy for patients with multiple myeloma: Meta-analysis. Leuk Res. 1 de agosto de 2012;36(8):1016-21 Richardson PG, Laubach J, Gandolfi S, Facon T, Weisel K, O’Gorman P. Maintenance and continuous therapy for multiple myeloma. Expert Rev Anticancer Ther. 3 de agosto de 2018;18(8):751-64 Gay F, Jackson G, Rosiñol L, Holstein SA, Moreau P, Spada S, et al. Maintenance Treatment and Survival in Patients With Myeloma. JAMA Oncol. octubre de 2018;4(10):1389-97 Rajkumar SV, Kumar S. Multiple Myeloma: Diagnosis and Treatment. Mayo Clin Proc. 1 de enero de 2016;91(1):101-19 Mikhael J, Ismaila N, Cheung MC, Costello C, Dhodapkar MV, Kumar S, et al. Treatment of Multiple Myeloma: ASCO and CCO Joint Clinical Practice Guideline. J Clin Oncol. 10 de mayo de 2019;37(14):1228-63 Sonneveld P, Schmidt-Wolf IGH, van der Holt B, el Jarari L, Bertsch U, Salwender H, et al. Bortezomib Induction and Maintenance Treatment in Patients With Newly Diagnosed Multiple Myeloma: Results of the Randomized Phase III HOVON-65/ GMMG-HD4 Trial. J Clin Oncol. 20 de agosto de 2012;30(24):2946-55 Rosiñol L, Oriol A, Teruel AI, Hernández D, López-Jiménez J, de la Rubia J, et al. Superiority of bortezomib, thalidomide, and dexamethasone (VTD) as induction pretransplantation therapy in multiple myeloma: a randomized phase 3 PETHEMA/GEM study. Blood. 23 de agosto de 2012;120(8):1589-96 Dimopoulos MA, Gay F, Schjesvold F, Beksac M, Hajek R, Weisel KC, et al. Oral ixazomib maintenance following autologous stem cell transplantation (TOURMALINE-MM3): a double-blind, randomised, placebo-controlled phase 3 trial. The Lancet. 19 de enero de 2019;393(10168):253-64 National Comprehensive Cancer. Multiple Myeloma Version 3.2024 [Internet]. 2024. Disponible en: NCCN.org Dimopoulos MA, Moreau P, Terpos E, Mateos MV, Zweegman S, Cook G, et al. Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 1 de marzo de 2021;32(3):309-22 Facon T, Kumar SK, Plesner T, Orlowski RZ, Moreau P, Bahlis N, et al. Daratumumab, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone alone in newly diagnosed multiple myeloma (MAIA): overall survival results from a randomised, open-label, phase 3 trial. Lancet Oncol. 1 de noviembre de 2021;22(11):1582-96 Facon Thierry, Kumar Shaji, Plesner Torben, Orlowski Robert Z., Moreau Philippe, Bahlis Nizar, et al. Daratumumab plus Lenalidomide and Dexamethasone for Untreated Myeloma. N Engl J Med. 30 de mayo de 2019;380(22):2104-15 Durie BGM, Hoering A, Abidi MH, Rajkumar SV, Epstein J, Kahanic SP, et al. Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trial. The Lancet. 4 de febrero de 2017;389(10068):519-27 Durie BGM, Hoering A, Sexton R, Abidi MH, Epstein J, Rajkumar SV, et al. Longer term follow-up of the randomized phase III trial SWOG S0777: bortezomib, lenalidomide and dexamethasone vs. lenalidomide and dexamethasone in patients (Pts) with previously untreated multiple myeloma without an intent for immediate autologous stem cell transplant (ASCT). Blood Cancer J. 11 de mayo de 2020;10(5):53 Mateos María-Victoria, Dimopoulos Meletios A., Cavo Michele, Suzuki Kenshi, Jakubowiak Andrzej, Knop Stefan, et al. Daratumumab plus Bortezomib, Melphalan, and Prednisone for Untreated Myeloma. N Engl J Med. 8 de febrero de 2018;378(6):518-28 Mateos MV, Cavo M, Blade J, Dimopoulos MA, Suzuki K, Jakubowiak A, et al. Overall survival with daratumumab, bortezomib, melphalan, and prednisone in newly diagnosed multiple myeloma (ALCYONE): a randomised, open-label, phase 3 trial. The Lancet. 11 de enero de 2020;395(10218):132-41 Kumar S, Paiva B, Anderson KC, Durie B, Landgren O, Moreau P, et al. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 1 de agosto de 2016;17(8):e328-46 Goel U, Charalampous C, Kapoor P, Binder M, Buadi FK, Dingli D, et al. Outcomes of patients with multiple myeloma refractory to standard dose vs low dose lenalidomide. Blood Cancer J. 26 de marzo de 2024;14(1):55. Anderson KC, Kyle RA, Rajkumar SV, Stewart AK, Weber D, Richardson P, et al. Clinically relevant end points and new drug approvals for myeloma. Leukemia. 1 de febrero de 2008;22(2):231-9 Kumar S, Baizer L, Callander NS, Giralt SA, Hillengass J, Freidlin B, et al. Gaps and opportunities in the treatment of relapsed-refractory multiple myeloma: Consensus recommendations of the NCI Multiple Myeloma Steering Committee. Blood Cancer J. 29 de junio de 2022;12(6):98 Kastritis E, Roussou M, Gavriatopoulou M, Kanellias N, Migkou M, Eleutherakis-Papaiakovou E, et al. Impact of last lenalidomide dose, duration, and IMiD-free interval in patients with myeloma treated with pomalidomide/dexamethasone. Blood Adv. 10 de diciembre de 2019;3(23):4095-103 Rajkumar SV. Multiple Myeloma: 2022 update on Diagnosis, Risk-stratification and Management. Am J Hematol. agosto de 2022;97(8):1086-107 Morgan GJ, Child JA, Gregory WM, Szubert AJ, Cocks K, Bell SE, et al. Effects of zoledronic acid versus clodronic acid on skeletal morbidity in patients with newly diagnosed multiple myeloma (MRC Myeloma IX): secondary outcomes from a randomised controlled trial. Lancet Oncol. 1 de agosto de 2011;12(8):743-52 Raje N, Terpos E, Willenbacher W, Shimizu K, García-Sanz R, Durie B, et al. Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, double-dummy, randomised, controlled, phase 3 study. Lancet Oncol. 1 de marzo de 2018;19(3):370-81 Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance and GW. Methods for the Economic Evaluation of Health Care Programmes. Fourth Edition, Fourth Edition. Oxford, New York: Oxford University Press; 2015. 464 p Briggs A, Claxton K, Sculpher and M. Decision Modelling for Health Economic Evaluation. Oxford, New York: Oxford University Press; 2006. 256 p. (Handbooks in Health Economic Evaluation) Zhou ZY, Parikh K, Chai X, Rokito A, Udeze C, Xie J, et al. Cost-Effectiveness Analysis of Lenalidomide for Maintenance Therapy after Autologous Stem Cell Transplant (ASCT) in Newly Diagnosed Multiple Myeloma (NDMM) Patients: A United States Payer Perspective. Blood. 29 de noviembre de 2018;132:3535 Proskorovsky I, Lewis P, Williams CD, Jordan K, Kyriakou C, Ishak J, et al. Mapping EORTC QLQ-C30 and QLQ-MY20 to EQ-5D in patients with multiple myeloma. Health Qual Life Outcomes. 11 de marzo de 2014;12(1):35 Iino H, Hashiguchi M, Hori S. Estimating the range of incremental cost-effectiveness thresholds for healthcare based on willingness to pay and GDP per capita: A systematic review. PLOS ONE. 14 de abril de 2022;17(4):e0266934. Naunheim KS, Platz JJ. Integrating Advocacy into Your Practice. Thorac Surg Clin. 1 de febrero de 2024;34(1):77-84 Smeele NVR, Chorus CG, Schermer MHN, de Bekker-Grob EW. Towards machine learning for moral choice analysis in health economics: A literature review and research agenda. Soc Sci Med. 1 de junio de 2023;326:115910 |
dc.rights.coar.fl_str_mv |
http://purl.org/coar/access_right/c_abf2 |
dc.rights.license.spa.fl_str_mv |
Atribución-NoComercial 4.0 Internacional |
dc.rights.uri.spa.fl_str_mv |
http://creativecommons.org/licenses/by-nc/4.0/ |
dc.rights.accessrights.spa.fl_str_mv |
info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Atribución-NoComercial 4.0 Internacional http://creativecommons.org/licenses/by-nc/4.0/ http://purl.org/coar/access_right/c_abf2 |
eu_rights_str_mv |
openAccess |
dc.format.extent.spa.fl_str_mv |
94 páginas |
dc.format.mimetype.spa.fl_str_mv |
application/pdf |
dc.publisher.spa.fl_str_mv |
Universidad Nacional de Colombia |
dc.publisher.program.spa.fl_str_mv |
Bogotá - Medicina - Especialidad en Hematología |
dc.publisher.faculty.spa.fl_str_mv |
Facultad de Medicina |
dc.publisher.place.spa.fl_str_mv |
Bogotá, Colombia |
dc.publisher.branch.spa.fl_str_mv |
Universidad Nacional de Colombia - Sede Bogotá |
institution |
Universidad Nacional de Colombia |
bitstream.url.fl_str_mv |
https://repositorio.unal.edu.co/bitstream/unal/86657/1/license.txt https://repositorio.unal.edu.co/bitstream/unal/86657/2/7187450.2024.pdf https://repositorio.unal.edu.co/bitstream/unal/86657/3/7187450.2024.pdf.jpg |
bitstream.checksum.fl_str_mv |
eb34b1cf90b7e1103fc9dfd26be24b4a a933c0b4a107ec2c6d8119320a61f7f0 46bac5c269774ceb286742c3e20da7f6 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 MD5 |
repository.name.fl_str_mv |
Repositorio Institucional Universidad Nacional de Colombia |
repository.mail.fl_str_mv |
repositorio_nal@unal.edu.co |
_version_ |
1814090134856925184 |
spelling |
Atribución-NoComercial 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Cañón, Oscar84dea157e7609d1e2c476573919a4149Buitrago, Giancarlo19a82f19b8c97c639a7055263d101c08Sánchez García, Víctor Leonardo7c664c00f67f23d36466c55e340e2ab0Sanchez Garcia, Victor [000000030550530X]2024-07-30T20:24:09Z2024-07-30T20:24:09Z2023-12https://repositorio.unal.edu.co/handle/unal/86657Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, diagramasEl mieloma múltiple es una neoplasia de células plasmáticas que se origina principalmente en la médula ósea, es la segunda neoplasia hematológica más común, en rasgos generales el tratamiento tiene una fase inducción, una de consolidación y una de mantenimiento, esta última se utiliza generalmente hasta la progresión, la lenalidomida es el medicamento estándar en el escenario post-trasplante sin embargo tiene un alto costo, el objetivo de este trabajo es evaluar la costo-efectividad del mantenimiento post-trasplante con lenalidomida en pacientes con mieloma múltiple. En este estudio se realizó una busqueda sistemática para obtener los datos de efectividad de las intervenciones, posteriormente se realizo el calculo de los costos asociados a la adquisición y administración de los medicamentos y los efectos adversos más frecuentes, para finalmente calcular la razon incremental de costo-efectividad para cada alternativa. La lenalidomida fue la terapia mas efectiva sin embargo fue tambien más costosa con un razon incremental de costo efectividad de $319´622.212 por año de vida ganado y $333’155.871 por años de vida ajustado por calidad (QALY). Con el precio de adquisición actual la lenalidomida no es costo-efectiva para el sistema de salud colombiano si se utiliza el umbral recomendado por la OMS (Texto tomado de la fuente).Multiple myeloma is a plasma cell neoplasm that originates mainly in the bone marrow, it is the second most common hematological neoplasm, in general terms the treatment has an induction phase, a consolidation phase and a maintenance phase, the latter is generally used until progression, lenalidomide is the standard drug in the post-transplant scenario, however it has a high cost, the objective of this work is to evaluate the cost-effectiveness of post-transplant maintenance with lenalidomide in patients with multiple myeloma. In this study, a systematic search was carried out to obtain data on the effectiveness of the interventions, then the costs associated with the acquisition and administration of the drugs and the most frequent adverse effects were calculated, to finally calculate the incremental cost-effectiveness ratio for each alternative. Lenalidomide was the most effective therapy; however, it was also the most expensive with an incremental cost-effectiveness ratio of $319'622,212 per life-year gained and $333'155,871 per quality-adjusted life-year (QALY). 8 At the current acquisition price, lenalidomide is not cost-effective for the Colombian health system if the threshold recommended by the WHO is used.Especialidades MédicasEspecialista en HematologíaLa información de efectividad y efectos adversos se obtendrá de los ensayos clínicos aleatorizados. Los costos de los medicamentos se obtendrán a partir de las circulares de la comisión Nacional de precios de medicamentos y dispositivos médicos y del Sistema de Información de Precios de medicamentos (SISMED). Los costos de los dispositivos, procedimientos e insumos se obtendrán del manual tarifario ISS 2001 ajustados por inflación, se incluirán únicamente los servicios cuya frecuencia de uso cambie según el comparador.94 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Especialidad en HematologíaFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::616 - Enfermedades610 - Medicina y salud::615 - Farmacología y terapéuticaMieloma MúltiplePlasmacitomaLenalidomidaNeoplasiasMultiple MyelomaPlasmacytomaLenalidomideNeoplasmsMantenimiento post-trasplanteCosto-efectividadCost-effectiveness analisisPost-transplant maintenanceEstudio de costo-efectividad de lenalidomida como terapia de mantenimiento posterior a trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltipleCost-effectiveness study of lenalidomide as maintenance therapy after autologous hematopoietic stem cell transplantation in patients with multiple myelomaTrabajo de grado - Especialidad Médicainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMCowan AJ, Green DJ, Kwok M, Lee S, Coffey DG, Holmberg LA, et al. Diagnosis and Management of Multiple Myeloma: A Review. JAMA. 1 de febrero de 2022;327(5):464-77.Kazandjian D. Multiple myeloma epidemiology and survival, a unique malignancy. Semin Oncol. diciembre de 2016;43(6):676-81170-colombia-fact-sheets.pdf [Internet]. [citado 26 de noviembre de 2023]. Disponible en: https://gco.iarc.fr/today/data/factsheets/populations/170-colombia-fact-sheets.pdfRafae A, van Rhee F, Al Hadidi S. Perspectives on the Treatment of Multiple Myeloma. The Oncologist. 23 de noviembre de 2023;oyad306Chen N, Zhou S, Palmisano M. Clinical Pharmacokinetics and Pharmacodynamics of Lenalidomide. Clin Pharmacokinet. 1 de febrero de 2017;56(2):139-52McCarthy PL, Owzar K, Hofmeister CC, Hurd DD, Hassoun H, Richardson PG, et al. Lenalidomide after Stem-Cell Transplantation for Multiple Myeloma. N Engl J Med. 10 de mayo de 2012;366(19):1770-81Palumbo A, Cavallo F, Gay F, Di Raimondo F, Ben Yehuda D, Petrucci MT, et al. Autologous Transplantation and Maintenance Therapy in Multiple Myeloma. N Engl J Med. 4 de septiembre de 2014;371(10):895-905Attal M, Lauwers-Cances V, Marit G, Caillot D, Moreau P, Facon T, et al. Lenalidomide Maintenance after Stem-Cell Transplantation for Multiple Myeloma. N Engl J Med. 10 de mayo de 2012;366(19):1782-91Jackson GH, Davies FE, Pawlyn C, Cairns DA, Striha A, Collett C, et al. Lenalidomide maintenance versus observation for patients with newly diagnosed multiple myeloma (Myeloma XI): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 1 de enero de 2019;20(1):57-73McCarthy PL, Holstein SA, Petrucci MT, Richardson PG, Hulin C, Tosi P, et al. Lenalidomide Maintenance After Autologous Stem-Cell Transplantation in Newly Diagnosed Multiple Myeloma: A Meta-Analysis. J Clin Oncol. 10 de octubre de 2017;35(29):3279-89Wang Y, Yang F, Shen Y, Zhang W, Wang J, Chang VT, et al. Maintenance Therapy With Immunomodulatory Drugs in Multiple Myeloma: A Meta-Analysis and Systematic Review. JNCI J Natl Cancer Inst. 18 de noviembre de 2015;108(3):djv342Neumann E by PJ, Sanders GD, Russell LB, Siegel JE, Ganiats and TG, editores. Cost-Effectiveness in Health and Medicine. Second Edition, New to this Edition:, Second Edition, New to this Edition: Oxford, New York: Oxford University Press; 2016. 536 pWorld Bank Open Data [Internet]. [citado 2 de diciembre de 2023]. World Bank Open Data. Disponible en: https://data.worldbank.orgLey. Ley Estatutaria No 1751. Gac 056 [Internet]. 16 de febrero de 2015; Disponible en: http://www.secretariasenado.gov.co/leyes-de-la-republicaBenavidez AP. P44 Multiple Myeloma Total Direct Costs in Colombia: A National Cohort Study Based on Administrative Claims DatabasesOlry de Labry Lima A, Gimeno-Ballester V, Ríos Tamayo R, Epstein D, Matas Hoces A, Ríos Sánchez E, et al. Cost-effectiveness of lenalidomide maintenance in patients with multiple myeloma who have undergone autologous transplant of hematopoietic progenitor cells. Bone Marrow Transplant. noviembre de 2019;54(11):1908-19Uyl‐de Groot CA, Ramsden R, Lee D, Boersma J, Zweegman S, Dhanasiri S. Lenalidomide as maintenance treatment for patients with multiple myeloma after autologous stem cell transplantation: A pharmaco‐economic assessment. Eur J Haematol. noviembre de 2020;105(5):635-45LeBlanc R, Hollmann S, Tay J. Canadian cost analysis comparing maintenance therapy with bortezomib versus lenalidomide for patients with multiple myeloma post autologous stem cell transplant. J Popul Ther Clin Pharmacol [Internet]. 2016 [citado 27 de noviembre de 2023];23(1). Disponible en: https://jptcp.comSH S, E C, NL H, ES J, SA P, H S, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues [Internet]. [citado 30 de noviembre de 2023]. Disponible en: https://publications.iarc.fr/Book-And-Report-Series/Who-Classification-Of-Tumours/WHO-Classification-Of-Tumours-Of-Haematopoietic-And-Lymphoid-Tissues-2017Short KD, Rajkumar S, Larson D, Buadi F, Hayman S, Dispenzieri A, et al. Incidence of extramedullary disease in patients with multiple myeloma in the era of novel therapy, and the activity of pomalidomide on extramedullary myeloma. Leukemia. junio de 2011;25(6):906-8.Rajkumar SV. Multiple myeloma: 2020 update on diagnosis, risk-stratification and management. Am J Hematol. 2020;95(5):548-67Curado MP, Oliveira MM, Silva DRM, Souza DLB. Epidemiology of multiple myeloma in 17 Latin American countries: an update. Cancer Med. 1 de mayo de 2018;7(5):2101-8Kumar SK, Rajkumar V, Kyle RA, van Duin M, Sonneveld P, Mateos MV, et al. Multiple myeloma. Nat Rev Dis Primer. 20 de julio de 2017;3(1):1-20Palumbo A, Anderson K. Multiple Myeloma. N Engl J Med. 17 de marzo de 2011;364(11):1046-60Kyle RA, Larson DR, Therneau TM, Dispenzieri A, Kumar S, Cerhan JR, et al. Long-Term Follow-up of Monoclonal Gammopathy of Undetermined Significance. N Engl J Med. 18 de enero de 2018;378(3):241-9van Nieuwenhuijzen N, Spaan I, Raymakers R, Peperzak V. From MGUS to Multiple Myeloma, a Paradigm for Clonal Evolution of Premalignant Cells. Cancer Res. 14 de mayo de 2018;78(10):2449-56Rajan AM, Rajkumar SV. Interpretation of cytogenetic results in multiple myeloma for clinical practice. Blood Cancer J. 1 de octubre de 2015;5(10):e365-e365.Hideshima T, Mitsiades C, Tonon G, Richardson PG, Anderson KC. Understanding multiple myeloma pathogenesis in the bone marrow to identify new therapeutic targets. Nat Rev Cancer. 1 de agosto de 2007;7(8):585-98Ghobrial IM, Detappe A, Anderson KC, Steensma DP. The bone-marrow niche in MDS and MGUS: implications for AML and MM. Nat Rev Clin Oncol. 1 de abril de 2018;15(4):219-33.Bianchi G, Munshi NC. Pathogenesis beyond the cancer clone(s) in multiple myeloma. Blood. 14 de mayo de 2015;125(20):3049-58.Laubach J. Multiple myeloma: Clinical features, laboratory manifestations, and diagnosis - UpToDate [Internet] [Internet]. [citado 13 de agosto de 2020]. Disponible en: https://www.uptodate.com/contents/multiple-myeloma-clinical-features-laboratory-manifestations-and-diagnosis?search=mieloma&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, et al. Review of 1027 Patients With Newly Diagnosed Multiple Myeloma. Mayo Clin Proc. 1 de enero de 2003;78(1):21-33.Hillengass J, Usmani S, Rajkumar SV, Durie BGM, Mateos MV, Lonial S, et al. International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders. Lancet Oncol. 1 de junio de 2019;20(6):e302-12.Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 1 de noviembre de 2014;15(12):e538-48.Walker BA, Mavrommatis K, Wardell CP, Ashby TC, Bauer M, Davies F, et al. A high-risk, Double-Hit, group of newly diagnosed myeloma identified by genomic analysis. Leukemia. 1 de enero de 2019;33(1):159-70.Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L, et al. Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group. J Clin Oncol. 10 de septiembre de 2015;33(26):2863-9.Rafae A, van Rhee F, Al Hadidi S. Perspectives on the Treatment of Multiple Myeloma. The Oncologist. 1 de marzo de 2024;29(3):200-12.Palumbo A, Bringhen S, Mateos MV, Larocca A, Facon T, Kumar SK, et al. Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report. Blood. 26 de marzo de 2015;125(13):2068-74.Attal Michel, Lauwers-Cances Valerie, Hulin Cyrille, Leleu Xavier, Caillot Denis, Escoffre Martine, et al. Lenalidomide, Bortezomib, and Dexamethasone with Transplantation for Myeloma. N Engl J Med. 376(14):1311-20.Stadtmauer EA, Pasquini MC, Blackwell B, Hari P, Bashey A, Devine S, et al. Autologous Transplantation, Consolidation, and Maintenance Therapy in Multiple Myeloma: Results of the BMT CTN 0702 Trial. J Clin Oncol. 1 de marzo de 2019;37(7):589-97Hari P, Pasquini MC, Stadtmauer EA, Fraser R, Fei M, Devine SM, et al. Long-term follow-up of BMT CTN 0702 (STaMINA) of postautologous hematopoietic cell transplantation (autoHCT) strategies in the upfront treatment of multiple myeloma (MM). J Clin Oncol. 20 de mayo de 2020;38(15_suppl):8506-8506Cavo M, Gay FM, Patriarca F, Zamagni E, Montefusco V, Dozza L, et al. Double Autologous Stem Cell Transplantation Significantly Prolongs Progression-Free Survival and Overall Survival in Comparison with Single Autotransplantation in Newly Diagnosed Multiple Myeloma: An Analysis of Phase 3 EMN02/HO95 Study. Blood. 8 de diciembre de 2017;130:401.Rajkumar SV, Kumar S. Multiple myeloma current treatment algorithms. Blood Cancer J. 28 de septiembre de 2020;10(9):94Giralt S, Costa LJ, Maloney D, Krishnan A, Fei M, Antin JH, et al. Tandem Autologous-Autologous versus Autologous-Allogeneic Hematopoietic Stem Cell Transplant for Patients with Multiple Myeloma: Long-Term Follow-Up Results from the Blood and Marrow Transplant Clinical Trials Network 0102 Trial. Biol Blood Marrow Transplant. 1 de abril de 2020;26(4):798-804.Moreau P, Attal M, Hulin C, Arnulf B, Belhadj K, Benboubker L, et al. Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): a randomised, open-label, phase 3 study. The Lancet. 6 de julio de 2019;394(10192):29-38Moreau P, Hulin C, Perrot A, Arnulf B, Belhadj K, Benboubker L, et al. Maintenance with daratumumab or observation following treatment with bortezomib, thalidomide, and dexamethasone with or without daratumumab and autologous stem-cell transplant in patients with newly diagnosed multiple myeloma (CASSIOPEIA): an open-label, randomised, phase 3 trial. Lancet Oncol. 1 de octubre de 2021;22(10):1378-90Sonneveld Pieter, Dimopoulos Meletios A., Boccadoro Mario, Quach Hang, Ho P. Joy, Beksac Meral, et al. Daratumumab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple Myeloma. N Engl J Med. 24 de enero de 2024;390(4):301-13Sengsayadeth S, Malard F, Savani BN, Garderet L, Mohty M. Posttransplant maintenance therapy in multiple myeloma: the changing landscape. Blood Cancer J. marzo de 2017;7(3):e545Sonneveld P, Dimopoulos MA, Beksac M, van der Holt B, Aquino S, Ludwig H, et al. Consolidation and Maintenance in Newly Diagnosed Multiple Myeloma. J Clin Oncol. 10 de noviembre de 2021;39(32):3613-22.Nooka AK, Joseph NS. Maintenance Strategies for Myeloma: Is Bigger Always Better? Cancer J. mayo de 2021;27(3):231-8Attal M, Harousseau JL, Leyvraz S, Doyen C, Hulin C, Benboubker L, et al. Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood. 15 de noviembre de 2006;108(10):3289-94Morgan GJ, Gregory WM, Davies FE, Bell SE, Szubert AJ, Brown JM, et al. The role of maintenance thalidomide therapy in multiple myeloma: MRC Myeloma IX results and meta-analysis. Blood. 5 de enero de 2012;119(1):7-15Kagoya Y, Nannya Y, Kurokawa M. Thalidomide maintenance therapy for patients with multiple myeloma: Meta-analysis. Leuk Res. 1 de agosto de 2012;36(8):1016-21Richardson PG, Laubach J, Gandolfi S, Facon T, Weisel K, O’Gorman P. Maintenance and continuous therapy for multiple myeloma. Expert Rev Anticancer Ther. 3 de agosto de 2018;18(8):751-64Gay F, Jackson G, Rosiñol L, Holstein SA, Moreau P, Spada S, et al. Maintenance Treatment and Survival in Patients With Myeloma. JAMA Oncol. octubre de 2018;4(10):1389-97Rajkumar SV, Kumar S. Multiple Myeloma: Diagnosis and Treatment. Mayo Clin Proc. 1 de enero de 2016;91(1):101-19Mikhael J, Ismaila N, Cheung MC, Costello C, Dhodapkar MV, Kumar S, et al. Treatment of Multiple Myeloma: ASCO and CCO Joint Clinical Practice Guideline. J Clin Oncol. 10 de mayo de 2019;37(14):1228-63Sonneveld P, Schmidt-Wolf IGH, van der Holt B, el Jarari L, Bertsch U, Salwender H, et al. Bortezomib Induction and Maintenance Treatment in Patients With Newly Diagnosed Multiple Myeloma: Results of the Randomized Phase III HOVON-65/ GMMG-HD4 Trial. J Clin Oncol. 20 de agosto de 2012;30(24):2946-55Rosiñol L, Oriol A, Teruel AI, Hernández D, López-Jiménez J, de la Rubia J, et al. Superiority of bortezomib, thalidomide, and dexamethasone (VTD) as induction pretransplantation therapy in multiple myeloma: a randomized phase 3 PETHEMA/GEM study. Blood. 23 de agosto de 2012;120(8):1589-96Dimopoulos MA, Gay F, Schjesvold F, Beksac M, Hajek R, Weisel KC, et al. Oral ixazomib maintenance following autologous stem cell transplantation (TOURMALINE-MM3): a double-blind, randomised, placebo-controlled phase 3 trial. The Lancet. 19 de enero de 2019;393(10168):253-64National Comprehensive Cancer. Multiple Myeloma Version 3.2024 [Internet]. 2024. Disponible en: NCCN.orgDimopoulos MA, Moreau P, Terpos E, Mateos MV, Zweegman S, Cook G, et al. Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 1 de marzo de 2021;32(3):309-22Facon T, Kumar SK, Plesner T, Orlowski RZ, Moreau P, Bahlis N, et al. Daratumumab, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone alone in newly diagnosed multiple myeloma (MAIA): overall survival results from a randomised, open-label, phase 3 trial. Lancet Oncol. 1 de noviembre de 2021;22(11):1582-96Facon Thierry, Kumar Shaji, Plesner Torben, Orlowski Robert Z., Moreau Philippe, Bahlis Nizar, et al. Daratumumab plus Lenalidomide and Dexamethasone for Untreated Myeloma. N Engl J Med. 30 de mayo de 2019;380(22):2104-15Durie BGM, Hoering A, Abidi MH, Rajkumar SV, Epstein J, Kahanic SP, et al. Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trial. The Lancet. 4 de febrero de 2017;389(10068):519-27Durie BGM, Hoering A, Sexton R, Abidi MH, Epstein J, Rajkumar SV, et al. Longer term follow-up of the randomized phase III trial SWOG S0777: bortezomib, lenalidomide and dexamethasone vs. lenalidomide and dexamethasone in patients (Pts) with previously untreated multiple myeloma without an intent for immediate autologous stem cell transplant (ASCT). Blood Cancer J. 11 de mayo de 2020;10(5):53Mateos María-Victoria, Dimopoulos Meletios A., Cavo Michele, Suzuki Kenshi, Jakubowiak Andrzej, Knop Stefan, et al. Daratumumab plus Bortezomib, Melphalan, and Prednisone for Untreated Myeloma. N Engl J Med. 8 de febrero de 2018;378(6):518-28Mateos MV, Cavo M, Blade J, Dimopoulos MA, Suzuki K, Jakubowiak A, et al. Overall survival with daratumumab, bortezomib, melphalan, and prednisone in newly diagnosed multiple myeloma (ALCYONE): a randomised, open-label, phase 3 trial. The Lancet. 11 de enero de 2020;395(10218):132-41Kumar S, Paiva B, Anderson KC, Durie B, Landgren O, Moreau P, et al. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 1 de agosto de 2016;17(8):e328-46Goel U, Charalampous C, Kapoor P, Binder M, Buadi FK, Dingli D, et al. Outcomes of patients with multiple myeloma refractory to standard dose vs low dose lenalidomide. Blood Cancer J. 26 de marzo de 2024;14(1):55.Anderson KC, Kyle RA, Rajkumar SV, Stewart AK, Weber D, Richardson P, et al. Clinically relevant end points and new drug approvals for myeloma. Leukemia. 1 de febrero de 2008;22(2):231-9Kumar S, Baizer L, Callander NS, Giralt SA, Hillengass J, Freidlin B, et al. Gaps and opportunities in the treatment of relapsed-refractory multiple myeloma: Consensus recommendations of the NCI Multiple Myeloma Steering Committee. Blood Cancer J. 29 de junio de 2022;12(6):98Kastritis E, Roussou M, Gavriatopoulou M, Kanellias N, Migkou M, Eleutherakis-Papaiakovou E, et al. Impact of last lenalidomide dose, duration, and IMiD-free interval in patients with myeloma treated with pomalidomide/dexamethasone. Blood Adv. 10 de diciembre de 2019;3(23):4095-103Rajkumar SV. Multiple Myeloma: 2022 update on Diagnosis, Risk-stratification and Management. Am J Hematol. agosto de 2022;97(8):1086-107Morgan GJ, Child JA, Gregory WM, Szubert AJ, Cocks K, Bell SE, et al. Effects of zoledronic acid versus clodronic acid on skeletal morbidity in patients with newly diagnosed multiple myeloma (MRC Myeloma IX): secondary outcomes from a randomised controlled trial. Lancet Oncol. 1 de agosto de 2011;12(8):743-52Raje N, Terpos E, Willenbacher W, Shimizu K, García-Sanz R, Durie B, et al. Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, double-dummy, randomised, controlled, phase 3 study. Lancet Oncol. 1 de marzo de 2018;19(3):370-81Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance and GW. Methods for the Economic Evaluation of Health Care Programmes. Fourth Edition, Fourth Edition. Oxford, New York: Oxford University Press; 2015. 464 pBriggs A, Claxton K, Sculpher and M. Decision Modelling for Health Economic Evaluation. Oxford, New York: Oxford University Press; 2006. 256 p. (Handbooks in Health Economic Evaluation)Zhou ZY, Parikh K, Chai X, Rokito A, Udeze C, Xie J, et al. Cost-Effectiveness Analysis of Lenalidomide for Maintenance Therapy after Autologous Stem Cell Transplant (ASCT) in Newly Diagnosed Multiple Myeloma (NDMM) Patients: A United States Payer Perspective. Blood. 29 de noviembre de 2018;132:3535Proskorovsky I, Lewis P, Williams CD, Jordan K, Kyriakou C, Ishak J, et al. Mapping EORTC QLQ-C30 and QLQ-MY20 to EQ-5D in patients with multiple myeloma. Health Qual Life Outcomes. 11 de marzo de 2014;12(1):35Iino H, Hashiguchi M, Hori S. Estimating the range of incremental cost-effectiveness thresholds for healthcare based on willingness to pay and GDP per capita: A systematic review. PLOS ONE. 14 de abril de 2022;17(4):e0266934.Naunheim KS, Platz JJ. Integrating Advocacy into Your Practice. Thorac Surg Clin. 1 de febrero de 2024;34(1):77-84Smeele NVR, Chorus CG, Schermer MHN, de Bekker-Grob EW. Towards machine learning for moral choice analysis in health economics: A literature review and research agenda. Soc Sci Med. 1 de junio de 2023;326:115910InvestigadoresLICENSElicense.txtlicense.txttext/plain; charset=utf-85879https://repositorio.unal.edu.co/bitstream/unal/86657/1/license.txteb34b1cf90b7e1103fc9dfd26be24b4aMD51ORIGINAL7187450.2024.pdf7187450.2024.pdfTesis de Especialista en Hematologíaapplication/pdf575990https://repositorio.unal.edu.co/bitstream/unal/86657/2/7187450.2024.pdfa933c0b4a107ec2c6d8119320a61f7f0MD52THUMBNAIL7187450.2024.pdf.jpg7187450.2024.pdf.jpgGenerated Thumbnailimage/jpeg4316https://repositorio.unal.edu.co/bitstream/unal/86657/3/7187450.2024.pdf.jpg46bac5c269774ceb286742c3e20da7f6MD53unal/86657oai:repositorio.unal.edu.co:unal/866572024-07-30 23:05:08.88Repositorio Institucional Universidad Nacional de Colombiarepositorio_nal@unal.edu.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 |