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Triphenylphosphane 1, its oxide 2 and sulfide 3 undergo one-electron reduction at a mercury cathode in DMF to yield the corresponding radical anions. ESE analysis of the paramagnetic species is facilitated by deuteration and suggests a pyramidal geometry of the radicals. Reduction with potassium metal in DME at low temperature yields also radical anions for 2 and 3. The phosphane 1, however, reacts under phenyl cleavage and potassiumphenyl-assisted ring closure to the dianion of 5H-dibenzophosphole 4. This radical 4· ⊖⊖ is also obtainod by alkali metal reduction of P-phenyldibenzophosphole o, and its spin distribution is compared to iso-.-π-electronic radicals containing CH, N, O, S, or Se links instead of the phosphorus atom.
Lenalidomide (LEN) maintenance (MT) post autologous stem cell transplantation (ASCT) is standard of care in newly diagnosed multiple myeloma (MM) but has not been compared to other agents in clinical trials. We retrospectively compared bortezomib (BTZ; n = 138) or LEN (n = 183) MT from two subsequent GMMG phase III trials. All patients received three cycles of BTZ-based triplet induction and post-ASCT MT. BTZ MT (1.3 mg/m2 i.v.) was administered every 2 weeks for 2 years. LEN MT included two consolidation cycles (25 mg p.o., days 1–21 of 28 day cycles) followed by 10–15 mg/day for 2 years. The BTZ cohort more frequently received tandem ASCT (91% vs. 33%) due to different tandem ASCT strategies. In the LEN and BTZ cohort, 43% and 46% of patients completed 2 years of MT as intended (p = 0.57). Progression-free survival (PFS; HR = 0.83, p = 0.18) and overall survival (OS; HR = 0.70, p = 0.15) did not differ significantly with LEN vs. BTZ MT. Patients with <nCR after first ASCT were assigned tandem ASCT in both trials. In patients with <nCR and tandem ASCT (LEN: n = 54 vs. BTZ: n = 84), LEN MT significantly improved PFS (HR = 0.61, p = 0.04) but not OS (HR = 0.46, p = 0.09). In conclusion, the significant PFS benefit after eliminating the impact of different tandem ASCT rates supports the current standard of LEN MT after ASCT.
Background: Despite novel therapeutic agents, most multiple myeloma (MM) patients eventually relapse. Two large phase III trials have shown significantly improved response rates (RR) of lenalidomide/dexamethasone compared with placebo/dexamethasone in relapsed MM (RMM) patients. These results have led to the approval of lenalidomide for RMM patients and lenalidomide/dexamethasone has since become a widely accepted second-line treatment. Furthermore, in RMM patients consolidation with high-dose chemotherapy plus autologous stem cell transplantation has been shown to significantly increase progression free survival (PFS) as compared to cyclophosphamide in a phase III trial. The randomized prospective ReLApsE trial is designed to evaluate PFS after lenalidomide/dexamethasone induction, high-dose chemotherapy consolidation plus autologous stem cell transplantation and lenalidomide maintenance compared with the well-established lenalidomide/dexamethasone regimen in RMM patients.
Methods/Design: ReLApsE is a randomized, open, multicenter phase III trial in a planned study population of 282 RMM patients. All patients receive three lenalidomide/dexamethasone cycles and - in absence of available stem cells from earlier harvesting - undergo peripheral blood stem cell mobilization and harvesting. Subsequently, patients in arm A continue on consecutive lenalidomide/dexamethasone cycles, patients in arm B undergo high dose chemotherapy plus autologous stem cell transplantation followed by lenalidomide maintenance until discontinuation criteria are met. Therapeutic response is evaluated after the 3rd (arm A + B) and the 5th lenalidomide/dexamethasone cycle (arm A) or 2 months after autologous stem cell transplantation (arm B) and every 3 months thereafter (arm A + B). After finishing the study treatment, patients are followed up for survival and subsequent myeloma therapies. The expected trial duration is 6.25 years from first patient in to last patient out. The primary endpoint is PFS, secondary endpoints include overall survival (OS), RR, time to best response and the influence of early versus late salvage high dose chemotherapy plus autologous stem cell transplantation on OS.
Discussion: This phase III trial is designed to evaluate whether high dose chemotherapy plus autologous stem cell transplantation and lenalidomide maintenance after lenalidomide/dexamethasone induction improves PFS compared with the well-established continued lenalidomide/dexamethasone regimen in RMM patients. Trial registration: ISRCTN16345835 (date of registration 2010-08-24).
Reduction of naturally occurring para-and ortho-benzoquinone derivatives M to their respective radical anions M·⊖ can be accomplished under largely aprotic conditions either by cautious low-temperature reaction in THF containing an excess of (2.2.2) cryptand at a potassium mirror or by using the "mild" single electron transfer reagent tetrabutylammonium boranate R4N⊕BH4⊖ in DMF. On addition of soluble alkali tetraphenylborates Me⊕[B(C6H5)4]⊖ , their hitherto unknown radical ion pairs [M·⊖ Me⊕]· and/or triple ion radical cations [Me⊕M·⊖Me⊕]·⊕ form, which might be of biological relevance in molecular carrier and "turn off -turn on" switch processes. On addition of metal perchlorates Me⊕n(ClO4⊖)n with multiply charged counter cations Me⊕n the respective paramagnetic species [M·⊖Me⊕n]·(n-1)⊕ result. Assuming exclusive one-electron transfer reductions without any redox fragmentation reactions, ESR, ENDOR and GENERAL TRIPLE spectra are presented and discussed for the following radical anions and radical ion pairs: mitomycin C (M·⊖ and [M·⊖Mex⊕]·(x-1)⊕ with Me⊕ = Li⊕, Na⊕), streptonigrine (M·⊖ and [M·⊖Lix⊕]·(x-1)⊕), Entobex® (M·⊖ and [M·⊖Me⊕n]·(n-1)⊕ with Me⊕n = Li⊕, Na⊕, Cd⊕⊕, (H5C6)2Tl⊕) as well as brucinequinone ([M·⊖ Me⊕n]·(n-1)⊕ with Me⊕n = Li⊕, Cd⊕⊕, Pb⊕⊕, La⊕⊕⊕).
Ion pairs of 1,10-phenanthrolin-5,6-dione radical anion [M · ⊖Me⊕n] ·⊕(n−1) with Me⊕n = Mg⊕⊕, Ca⊕⊕, Sr⊕⊕, Zn⊕⊕, Cd⊕⊕, Pb⊕⊕ and La⊕⊕⊕ are advantageously prepared in aprotic DMF solution containing appropriate metal salts Me⊕nX⊖ by using the ‘mild’ single-electron reducing agent tetra(n-butyl)ammonium-boranate R4N⊕BH4⊖ . For comparison, the ‘naked’ radical anion with the largely interaction-free [K⊕(2.2.2)-cryptand]⊕ counter cation is chosen, which is formed on reduction with potassium in THF solution of (2.2.2)-cryptand. Addition of excess Na⊕[B(C6H5)4]⊖ to the reduction solution only yields a solvent-separated ion pair (M · ⊖)DMF ··· (Na⊕)DMF, whereas in the presence of multiply charged counter cations Me⊕n the respective contact ion pair radical cations [M · ⊖Me⊕n] · ⊕(n−1) are formed. Their g values decrease with increasing nuclear charge of Me⊕n and their metal-s-spin densities increase with the effective counter cation charge n⊕/rMe⊕n. The ESR /ENDOR data recorded suggest Me⊕n complexation by the δ⊖OC -COδ⊖ chelate tongs and the ion pair stability, which is modified by the dielectric properties of the solvent used, may be rationalized by the Coulombic attraction between the radical anion M · ⊖ and the counter cations Me⊕n.
The radical anion of dimesityltetraketone (ERed, I = -0.40 V) is easily generated in THF by potassium mirror/[2.2.2]-cryptand reduction. Its contact ion pairs with Na⊕, Cs⊕ and Ba⊕⊕ counter cations, prepared in THF solution by single electron transfer from the respective metals, are characterized by their ESR/ENDOR spectra, which exhibit temperature-dependent metal couplings of aNa⊕ = 0.061 mT (190 K), aCs⊕ = 0.021 mT (190 K), and aBa⊕⊕ = 0.145 mT (295 K).
The structurally different radical anions M⊖ of peralkylated 1-sila-2,5-diazacyclopentane-3,4-dithione and of tetrakis(isopropylthio)-p-benzoquinone are generated by reduction with potassium/2.2.2-cryptand under aprotic conditions in THF solution. On addition of Li⊕B(C6H5)4⊖, both form hitherto elusive sulfur-containing contact ion pairs, which are characterized by their ESR/ENDOR spectra.