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Musto P, Anderson KC, Attal M, Richardson PG, Badros A, Hou J, Comenzo R, Du J, Durie BGM, San Miguel J, Einsele H, Chen WM, Garderet L, Pietrantuono G, Hillengass J, Kyle RA, Moreau P, Lahuerta JJ, Landgren O, Ludwig H, Larocca A, Mahindra A, Cavo M, Mazumder A, McCarthy PL, Nouel A, Rajkumar SV, Reiman A, Riva E, Sezer O, Terpos E, Turesson I, Usmani S, Weiss BM, Palumbo A. Second primary malignancies in multiple myeloma: an overview and IMWG consensus. Ann Oncol 2018; 29:1074. [PMID: 28541409 DOI: 10.1093/annonc/mdx160] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aaltonen P, Brahme A, Lax I, Levernes S, Näslund I, Reitan JB, Turesson I. Specification of Dose Delivery in Radiation Therapy. Recommendations by the Nordic Association of Clinical Physics (NACP). Acta Oncol 2017; 36:1-32. [PMID: 28173715 DOI: 10.1080/0284186x.1997.11835454] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Musto P, Anderson K, Attal M, Richardson P, Badros A, Hou J, Comenzo R, Du J, Durie B, San Miguel J, Einsele H, Chen W, Garderet L, Pietrantuono G, Hillengass J, Kyle R, Moreau P, Lahuerta J, Landgren O, Ludwig H, Larocca A, Mahindra A, Cavo M, Mazumder A, McCarthy P, Nouel A, Rajkumar S, Reiman A, Riva E, Sezer O, Terpos E, Turesson I, Usmani S, Weiss B, Palumbo A. Second primary malignancies in multiple myeloma: an overview and IMWG consensus. Ann Oncol 2017; 28:228-245. [DOI: 10.1093/annonc/mdw606] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Laubach J, Garderet L, Mahindra A, Gahrton G, Caers J, Sezer O, Voorhees P, Leleu X, Johnsen HE, Streetly M, Jurczyszyn A, Ludwig H, Mellqvist UH, Chng WJ, Pilarski L, Einsele H, Hou J, Turesson I, Zamagni E, Chim CS, Mazumder A, Westin J, Lu J, Reiman T, Kristinsson S, Joshua D, Roussel M, O'Gorman P, Terpos E, McCarthy P, Dimopoulos M, Moreau P, Orlowski RZ, Miguel JS, Anderson KC, Palumbo A, Kumar S, Rajkumar V, Durie B, Richardson PG. Management of relapsed multiple myeloma: recommendations of the International Myeloma Working Group. Leukemia 2015; 30:1005-17. [DOI: 10.1038/leu.2015.356] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/11/2015] [Accepted: 09/24/2015] [Indexed: 11/09/2022]
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Hultcrantz M, Pfeiffer RM, Björkholm M, Goldin LR, Turesson I, Schulman S, Landgren O, Kristinsson SY. Elevated risk of venous but not arterial thrombosis in Waldenström macroglobulinemia/lymphoplasmacytic lymphoma. J Thromb Haemost 2014; 12:1816-21. [PMID: 25196979 DOI: 10.1111/jth.12724] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/01/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many malignancies, including multiple myeloma and its precursor, monoclonal gammopathy of unknown significant, are associated with an elevated risk of thromboembolism. There is limited information on the risk of thrombosis in patients with Waldenström macroglobulinemia (WM) and lymphoplasmacytic lymphoma (LPL). OBJECTIVES To assess the risk of venous and arterial thrombosis in WM/LPL patients in a large population-based cohort study in Sweden. PATIENTS/METHODS A total of 2190 patients with WM/LPL and 8086 matched controls were identified through Swedish registers between 1987 and 2005. Information on occurrence of venous and arterial thrombosis after the diagnosis of WM/LPL was obtained through the centralized Swedish Patient Register, with follow-up to 2006. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Patients with WM/LPL had a significantly increased risk of venous thrombosis and the highest risk was observed during the first year following diagnosis (HR = 4.0, 95% CI 2.5-6.4). The risk was significantly elevated 5 (HR = 2.3, 95% CI 1.7-3.0) and 10 years after diagnosis (HR = 2.0, 95% CI 1.6-2.5). There was no increased risk of arterial thrombosis during any period of follow-up time (10-year HR = 1.0, 95% CI 0.9-1.1). CONCLUSIONS Venous thrombosis is a significant cause of morbidity in patients with WM/LPL. The potential role of thromboprophylaxis in WM/LPL, especially during the first year after diagnosis and in patients treated with thrombogenic agents, needs to be assessed to further improve outcome in WM/LPL patients.
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Olsen OE, Wader KF, Misund K, Våtsveen TK, Rø TB, Mylin AK, Turesson I, Størdal BF, Moen SH, Standal T, Waage A, Sundan A, Holien T. Bone morphogenetic protein-9 suppresses growth of myeloma cells by signaling through ALK2 but is inhibited by endoglin. Blood Cancer J 2014; 4:e196. [PMID: 24658374 PMCID: PMC3972702 DOI: 10.1038/bcj.2014.16] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 12/28/2022] Open
Abstract
Multiple myeloma is a malignancy of plasma cells predominantly located in the bone marrow. A number of bone morphogenetic proteins (BMPs) induce apoptosis in myeloma cells in vitro, and with this study we add BMP-9 to the list. BMP-9 has been found in human serum at concentrations that inhibit cancer cell growth in vitro. We here show that the level of BMP-9 in serum was elevated in myeloma patients (median 176 pg/ml, range 8–809) compared with healthy controls (median 110 pg/ml, range 8–359). BMP-9 was also present in the bone marrow and was able to induce apoptosis in 4 out of 11 primary myeloma cell samples by signaling through ALK2. BMP-9-induced apoptosis in myeloma cells was associated with c-MYC downregulation. The effects of BMP-9 were counteracted by membrane-bound (CD105) or soluble endoglin present in the bone marrow microenvironment, suggesting a mechanism for how myeloma cells can evade the tumor suppressing activity of BMP-9 in multiple myeloma.
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Ocio EM, Richardson PG, Rajkumar SV, Palumbo A, Mateos MV, Orlowski R, Kumar S, Usmani S, Roodman D, Niesvizky R, Einsele H, Anderson KC, Dimopoulos MA, Avet-Loiseau H, Mellqvist UH, Turesson I, Merlini G, Schots R, McCarthy P, Bergsagel L, Chim CS, Lahuerta JJ, Shah J, Reiman A, Mikhael J, Zweegman S, Lonial S, Comenzo R, Chng WJ, Moreau P, Sonneveld P, Ludwig H, Durie BGM, Miguel JFS. New drugs and novel mechanisms of action in multiple myeloma in 2013: a report from the International Myeloma Working Group (IMWG). Leukemia 2014; 28:525-42. [PMID: 24253022 PMCID: PMC4143389 DOI: 10.1038/leu.2013.350] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/23/2013] [Accepted: 11/07/2013] [Indexed: 01/08/2023]
Abstract
Treatment in medical oncology is gradually shifting from the use of nonspecific chemotherapeutic agents toward an era of novel targeted therapy in which drugs and their combinations target specific aspects of the biology of tumor cells. Multiple myeloma (MM) has become one of the best examples in this regard, reflected in the identification of new pathogenic mechanisms, together with the development of novel drugs that are being explored from the preclinical setting to the early phases of clinical development. We review the biological rationale for the use of the most important new agents for treating MM and summarize their clinical activity in an increasingly busy field. First, we discuss data from already approved and active agents (including second- and third-generation proteasome inhibitors (PIs), immunomodulatory agents and alkylators). Next, we focus on agents with novel mechanisms of action, such as monoclonal antibodies (MoAbs), cell cycle-specific drugs, deacetylase inhibitors, agents acting on the unfolded protein response, signaling transduction pathway inhibitors and kinase inhibitors. Among this plethora of new agents or mechanisms, some are specially promising: anti-CD38 MoAb, such as daratumumab, are the first antibodies with clinical activity as single agents in MM. Moreover, the kinesin spindle protein inhibitor Arry-520 is effective in monotherapy as well as in combination with dexamethasone in heavily pretreated patients. Immunotherapy against MM is also being explored, and probably the most attractive example of this approach is the combination of the anti-CS1 MoAb elotuzumab with lenalidomide and dexamethasone, which has produced exciting results in the relapsed/refractory setting.
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Johansson S, Åström L, Sandin F, Isacsson U, Montelius A, Turesson I. PO-0704: Hypofractionated transperineal proton-boost combined with external beam radiotherapy for prostate cancer. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Turesson I, Johansson S, Laurell A, Åström L, Nilsson K, Isaksson U, Sörensen J. EP-1076: Individualized radiotherapy of very high risk prostate cancer with PET and Protons at hands: Learning from two cases. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kristinsson SY, Goldin L, Turesson I, Hultcrantz M, Björkholm M, Landgren O. Family history of venous thromboembolism is associated with increased risk for thrombosis in multiple myeloma: a population-based study. J Thromb Haemost 2012; 10:962-4. [PMID: 22372994 PMCID: PMC7241862 DOI: 10.1111/j.1538-7836.2012.04676.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Nilsson K, Johansson A, Turesson I, Isacsson U, Ljung G. EP-1119 DECREASED DOSE TO THE RECTUM DURING PHOTON THERAPY OF THE PROSTATE – A COMPARATIVE STUDY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71452-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lavtraqoon-Lewin N, Castro J, Elmberger G, Rutqvist L, Lewin F, Turesson I, Lundgren J. 8505 ORAL DNA Methylation in Tumour and Normal Mucosal Tissue of Head and Neck Squamous Cell Carcinoma (HNSCC) Patients – New Diagnostic Approaches and Treatment. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72147-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cederblad L, Ekberg T, Turesson I, Johansson S. 8600 POSTER Head and Neck Mucosal Malignant Melanoma Expressing C-kit Might Benefit From New Treatment Option. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72242-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Johansson S, Åström L, Isacsson U, Vallhagen-Dahlgren C, Montelius A, Turesson I. 7024 POSTER Dose Escalated Radiotherapy for Prostate Cancer With Proton Boost. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71975-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Turesson I, Qvarnström F, Simonsson M, Thunberg U, Hermansson I, Book M, Johansson K, Nyman J. 1125 POSTER DNA Damage Response of Epithelial and Mesenchymal Cell Lineages in the Clinical Setting of Radiotherapy. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70768-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Valianti C, Mavroidis P, Isacsson U, Montelius A, Johansson S, Papanikolaou N, Sakellaropoulos G, Nikiforidis G, Turesson I, Lind B. SU-GG-T-494: Clinically Derived Dose-Response Relations for Rectum and Penile Bulb from Combined Photon and Proton Prostate Cancer Radiotherapy. Med Phys 2010. [DOI: 10.1118/1.3468891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Boumpoutsi I, Mavroidis P, Isacsson U, Johansson S, Montelius A, Papanikolaou N, Sakellaropoulos G, Nikiforidis G, Turesson I, Lind B. SU-GG-T-497: Dose-Response Parameters for Urinary Bladder from Combined Photon and Proton Irradiations in Prostate Cancer Radiotherapy. Med Phys 2010. [DOI: 10.1118/1.3468894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Mavroidis P, Valianti C, Boumpoutsi I, Isacsson U, Johansson S, Montelius A, Papanikolaou N, Sakellaropoulos G, Nikiforidis G, Turesson I, Lind B. SU-GG-T-507: Clinically Derived Dose-Response Relations for Prostate from Combined Photon and Proton Prostate Cancer Radiotherapy. Med Phys 2010. [DOI: 10.1118/1.3468903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Eriksson T, Höglund P, Turesson I, Waage A, Don BR, Vu J, Scheffler M, Kaysen GA. Pharmacokinetics of thalidomide in patients with impaired renal function and while on and off dialysis. J Pharm Pharmacol 2010; 55:1701-6. [PMID: 14738599 DOI: 10.1211/0022357022241] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
There is a renewed interest in thalidomide for use in malignancies and systemic inflammatory diseases. Reduced renal function is not uncommon among patients with these disease states but the pharmacokinetics has not been fully investigated. The aim of this study was to investigate the pharmacokinetics of thalidomide in haemodialysis patients while on and off dialysis and in myeloma patients with varying degrees of renal function.
Two studies were performed. To establish the pharmacokinetics of thalidomide in patients with mild to moderate renal failure, blood samples were taken over 12 weeks from 40 patients with multiple myeloma. A second study was performed in six patients with end-stage renal disease both on a non-dialysis day and before and during a haemodialysis session. Thalidomide concentration was determined by HPLC. A one-compartment open model with first-order absorption and elimination was used to fit total thalidomide concentration to population pharmacokinetics and statistical models using the NONMEM program. Clearance and volumes were slightly below 10 L h−1 and 1 L kg−1, respectively, in both patient groups. The inter- and intra-patient variability was low. Clearance was doubled during dialysis. There was no correlation between thalidomide clearance and renal function. In conclusion, the pharmacokinetics of thalidomide in patients with renal failure are very similar to values reported by others for patients with normal renal function. Although clearance during dialysis is doubled, thalidomide dose need not be changed for patients with decreased kidney function. There is also no need for a supplementary dose due to haemodialysis.
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Berglund M, Enblad G, Turesson I, Edman V, Thunberg U. Folate-metabolizing genes in lymphoma patients from Sweden. Scand J Immunol 2009; 70:408-10. [PMID: 19751277 DOI: 10.1111/j.1365-3083.2009.02287.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fesse P, Nyman J, Book M, Hermansson I, Johansson K, Ahlgren J, Turesson I. 2026 Response of melanocytes to low doses of fractionated radiotherapy. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Qvarnström OF, Simonsson M, Eriksson V, Turesson I, Carlsson J. gammaH2AX and cleaved PARP-1 as apoptotic markers in irradiated breast cancer BT474 cellular spheroids. Int J Oncol 2009; 35:41-7. [PMID: 19513550 DOI: 10.3892/ijo_00000311] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chemo- and radiotherapy induce apoptosis in tumours and surrounding tissues. In a search for robust and reliable apoptosis markers, we have evaluated immunostaining patterns of gammaH2AX and cleaved PARP-1 in paraffin-embedded cellular spheroids. Breast cancer BT474 cells were grown as cell spheroids to diameters of 700-800 microm. The spheroids contained an outer cell layer with proliferative cells, a deeper region with quiescent cells and a central area with necrosis. They were irradiated with 5 Gy and the frequency of apoptotic cells was determined at several time points (0-144 h) and distances (0-150 microm) from the spheroids surface. gammaH2AX and cleaved PARP-1 were quantified independently. Apoptotic frequencies for the two markers agreed both temporally and spatially in the proliferative regions of the spheroids. The gammaH2AX signal was stronger and had lower background compared to cleaved PARP-1. The central necrotic region was intensely stained with cleaved PARP-1, whereas no gammaH2AX could be detected. The apoptotic frequency increased with distance from surface for all time points. However, apoptotic frequencies, above unirradiated control levels, could only be detected for the last time point, 144 h after irradiation. We have shown that the spheroid model is a practical system for evaluation of staining patterns and specificities of apoptosis markers. Also, the radial gradient provides the opportunity to study apoptosis under a range of physiological conditions within the same system. We have further shown that gammaH2AX and cleaved PARP-1 are applicable markers for apoptosis in the proliferative regions of the spheroids. However, the more intense and clear staining patterns of gammaH2AX suggests that this marker is preferable for quantification of apoptosis in spheroids and similar paraffin-embedded materials.
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Giralt S, Stadtmauer EA, Harousseau JL, Palumbo A, Bensinger W, Comenzo RL, Kumar S, Munshi NC, Dispenzieri A, Kyle R, Merlini G, San Miguel J, Ludwig H, Hajek R, Jagannath S, Blade J, Lonial S, Dimopoulos MA, Einsele H, Barlogie B, Anderson KC, Gertz M, Attal M, Tosi P, Sonneveld P, Boccadoro M, Morgan G, Sezer O, Mateos MV, Cavo M, Joshua D, Turesson I, Chen W, Shimizu K, Powles R, Richardson PG, Niesvizky R, Rajkumar SV, Durie BGM. International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100). Leukemia 2009; 23:1904-12. [PMID: 19554029 DOI: 10.1038/leu.2009.127] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multiple myeloma is the most common indication for high-dose chemotherapy with autologous stem cell support (ASCT) in North America today. Stem cell procurement for ASCT has most commonly been performed with stem cell mobilization using colony-stimulating factors with or without prior chemotherapy. The target CD34+ cell dose to be collected as well as the number of apheresis performed varies throughout the country, but a minimum of 2 million CD34+ cells/kg has been traditionally used for the support of one cycle of high-dose therapy. With the advent of plerixafor (AMD3100) (a novel stem cell mobilization agent), it is pertinent to review the current status of stem cell mobilization for myeloma as well as the role of autologous stem cell transplantation in this disease. On June 1, 2008, a panel of experts was convened by the International Myeloma Foundation to address issues regarding stem cell mobilization and autologous transplantation in myeloma in the context of new therapies. The panel was asked to discuss a variety of issues regarding stem cell collection and transplantation in myeloma especially with the arrival of plerixafor. Herein, is a summary of their deliberations and conclusions.
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Saxne T, Turesson I, Wollheim FA. Preleukemic syndrome simulating SLE. A case report. ACTA MEDICA SCANDINAVICA 2009; 212:421-4. [PMID: 6961756 DOI: 10.1111/j.0954-6820.1982.tb03240.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A 70-year-old man presented with symmetrical arthritis and arthralgias, Raynaud's phenomenon, pleurisy, fever, maculopapular erythema, leuko- and thrombocytopenia, anemia, antinuclear antibodies and hypocomplementemia. His bone marrow morphology was normal. During therapy with corticosteroids he developed pulmonary tuberculosis which responded well to tuberculostatic treatment. Approximately one year after onset of his initial symptoms, myeloblasts were seen in the blood and a few weeks later the bone marrow showed a myeloblastic leukemia. The patient did not respond to cytostatic treatment and died six weeks later. Although this patient presented symptoms suggesting the diagnosis of SLE, in retrospect his condition probably represented an unusual type of preleukemic syndrome.
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Turesson I, Grubb A. Non-secretory or low-secretory myeloma with intracellular kappa chains. Report of six cases and review of the literature. ACTA MEDICA SCANDINAVICA 2009; 204:445-51. [PMID: 104550 DOI: 10.1111/j.0954-6820.1978.tb08472.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This report concerns six cases of multiple myeloma characterized by either no demonstrable monoclonal immunoglobulin in plasma or urine or by trace amounts (less than or equal to 0.1 g/l) of monoclonal kappa chains in the urine. In all cases there was an infiltration of the bone marrow by plasma cells containing kappa chains but no heavy chains. A retrospective analysis was made of 126 consecutive cases of Bence Jones myeloma. The number of kappa and lambda cases was approximately the same. All cases secreting less than or equal to 0.1 g light chains per 1 urine were of kappa type. This contrasts with a kappa/lambda ratio of 1.4-1.9 among reported series of M-components containing both heavy and light chains. A review of reported cases of non-secretory myeloma revealed a preserved capacity for Ig synthesis in the majority of cases and among these a preponderance of kappa chain producing clones. These observations might be explained by a higher tendency for kappa chain producing cells to mutate to low secretors or to cells producing abnormal light chains which are catabolized rapidly. The clinical data from our patients do not indicate a more pessimistic prognosis in non- or low-secretory myeloma, than in other cases of multiple myeloma.
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