51
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Muchtar E, Gertz MA, Lacy MQ, Go RS, Buadi FK, Dingli D, Grogan M, AbouEzzeddine OF, Hayman SR, Kapoor P, Leung N, Fonder A, Hobbs M, Hwa YL, Gonsalves W, Warsame R, Kourelis TV, Russell S, Lust JA, Lin Y, Zeldenrust S, Kyle RA, Rajkumar SV, Kumar SK, Dispenzieri A. Ten-year survivors in AL amyloidosis: characteristics and treatment pattern. Br J Haematol 2019; 187:588-594. [PMID: 31298751 DOI: 10.1111/bjh.16096] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022]
Abstract
Improvement in survival in Light chain (AL) amyloidosis has been seen over recent decades, enabling more patients to achieve long-term survival. Patients with AL amyloidosis who survived ≥10 years from time of diagnosis (n = 186) were the subject of this study. Ten-year survivors represented 22% of the total population. These patients were characterized by favourable patient, organ and plasma cell features. Of note, trisomies were less common among 10-year survivors compared to those who did not survive to 10 years. All-time best haematological response was complete response in 67%, very good partial response in 30%, partial response in 2% and no response in 1%, with 11% having received a consolidative strategy for inadequate response to first line therapy. The overall organ response rate to first-line therapy was 76%, which increased to 86% when considering subsequent line(s) of therapy. Forty-seven percent of the 10-year survivors did not require a second-line therapy. The median treatment-free survival (TFS) among the 10-year survivors was 10·5 years (interquartile range 7·4-12·2). On multivariate analysis independent predictors for TFS were the achievement of complete haematological response and lack of cardiac involvement. Long-term survivors are increasingly seen in AL amyloidosis and present distinct patient, organ and clonal disease features.
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Affiliation(s)
- Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - John A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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52
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Sidiqi M, Saleh AA, Kumar S, Morie G, Dispenzieri A, Buadi F, Lacy M, Leung N, Muchtar E, Kyle R, Go R, Hobbs M, Gonsalves W, Kourelis T, Warsame R, Dingli D, Lust J, Hayman S, Rajkumar V, Kapoor P. PS1422 VENETOCLAX FOR THE TREATMENT OF MULTIPLE MYELOMA: OUTCOMES OUTSIDE OF CLINICAL TRIALS. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000563964.92802.c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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53
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Vijayvargiya P, Gonsalves W, Burton D, Hogan WJ, Miceli T, Rossini W, Taylor A, Lueke A, Donato L, Camilleri M. Increased fecal primary bile acids in multiple myeloma with engraftment syndrome diarrhea after stem cell transplant. Bone Marrow Transplant 2019; 54:1898-1907. [PMID: 31148601 DOI: 10.1038/s41409-019-0581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/05/2019] [Accepted: 05/10/2019] [Indexed: 11/10/2022]
Abstract
Autologous stem cell transplant (ASCT) for multiple myeloma (MM) is associated with diarrhea during the peri-transplant period. We aimed to appraise mechanisms of peri-ASCT diarrhea in a prospective, longitudinal study of patients with MM. We compared by repeated measures (RM)-ANOVA daily bowel movements (BMs) and consistency [7-point Bristol Stool Form Scale (BSFS)], fecal calprotectin (intestinal inflammation), 13C-mannitol excretion in urine 0-2 h (small intestinal permeability), fasting serum C4 (bile acid synthesis) and total and primary bile acid in stool samples during baseline, peri-transplant period (Days 5-7 after stem cell infusion), and after hematological recovery post-ASCT. The 12 (5F, 7M) patients' median age was 61 y (IQR 54.8-63.3). All participants reported increased BMs (increase of 2 and 1 per day with and without engraftment syndrome, respectively). There were no significant increases in serum C4, total fecal bile acids, or intestinal permeability. Relative to patients without engraftment syndrome, four participants with engraftment syndrome had looser stool consistency (mean 2.6 points higher BSFS compared to without engraftment syndrome), increased primary fecal bile acids relative to baseline (>33 µmol/L vs. 6 µmol/L without engraftment syndrome), and increased fecal calprotectin compared to baseline (313 μg/mL vs. 35.6 μg/mL without engraftment syndrome; p = 0.06). Engraftment syndrome post-ASCT is associated with increased fecal primary bile acids.
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Affiliation(s)
- Priya Vijayvargiya
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, MN, USA
| | | | - Duane Burton
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, MN, USA
| | | | - Teresa Miceli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - William Rossini
- Division of Medicine Clinical Trials Unit, Mayo Clinic, Rochester, MN, USA
| | - Ann Taylor
- Division of Medicine Clinical Trials Unit, Mayo Clinic, Rochester, MN, USA
| | - Alan Lueke
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Leslie Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, MN, USA.
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Grieb B, Abeykoon J, Zanwar S, Rajkumar S, Lacy M, Dispenzieri A, Gertz M, Gonsalves W, Go R, Buadi F, Dingli D, Hayman S, Warsame R, Kourelis T, Muchtar E, Kyle R, Kumar S, Kapoor P. PS1397 OUTCOMES OF LONG-TERM SURVIVORS WITH ACTIVE MULTIPLE MYELOMA. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000563864.43294.ef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sidana S, Tandon N, Gertz MA, Dispenzieri A, Ramirez‐Alvarado M, Murray DL, Kourelis TV, Buadi FK, Kapoor P, Gonsalves W, Warsame R, Lacy MQ, Kyle RA, Rajkumar SV, Kumar SK, Leung N. Clinical features, laboratory characteristics and outcomes of patients with renal
versus
cardiac light chain amyloidosis. Br J Haematol 2019; 185:701-707. [DOI: 10.1111/bjh.15832] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/02/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Surbhi Sidana
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
| | - Nidhi Tandon
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
| | - Morie A. Gertz
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
| | - Angela Dispenzieri
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
| | - Marina Ramirez‐Alvarado
- Department of Biochemistry and Molecular Biology Mayo Clinic Rochester MNUSA
- Department of Immunology Mayo Clinic Rochester MNUSA
| | - David L. Murray
- Department of Laboratory and Pathology Medicine Mayo Clinic Rochester MNUSA
| | | | - Francis K. Buadi
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
| | - Prashant Kapoor
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
| | - Wilson Gonsalves
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
| | - Rahma Warsame
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
| | - Martha Q. Lacy
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
| | - Robert A. Kyle
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
| | - S. Vincent Rajkumar
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
| | - Shaji K. Kumar
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
| | - Nelson Leung
- Division of Hematology Department of Internal Medicine Mayo Clinic Rochester MNUSA
- Division of Nephrology Department of Internal Medicine Mayo Clinic Rochester MN USA
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56
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Muchtar E, Gertz MA, Kyle RA, Lacy MQ, Dingli D, Leung N, Buadi FK, Hayman SR, Kapoor P, Hwa YL, Fonder A, Hobbs M, Gonsalves W, Kourelis TV, Warsame R, Russell S, Lust JA, Lin Y, Go RS, Zeldenrust S, Rajkumar SV, Kumar SK, Dispenzieri A. A Modern Primer on Light Chain Amyloidosis in 592 Patients With Mass Spectrometry-Verified Typing. Mayo Clin Proc 2019; 94:472-483. [PMID: 30770096 DOI: 10.1016/j.mayocp.2018.08.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/30/2018] [Accepted: 08/09/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe the clinical and laboratory characteristics of patients with meticulously typed light chain (AL) amyloidosis. PATIENTS AND METHODS Patients (N=592) with biopsy-proven, mass spectrometry-confirmed AL amyloidosis diagnosed from January 1, 2008, through August 31, 2015, were included. RESULTS The median patient age at diagnosis was 63 years. Thirty-four percent of patients (n=204) had isolated organ involvement, mostly heart (19% [n=115]) followed by kidney (9% [n=53]). In contrast, 25% (n=146) had more than 2 involved organs. Patients with isolated cardiac involvement had similar cardiac dysfunction compared with those with nonisolated cardiac amyloidosis. In contrast, isolated renal involvement was associated with increased proteinuria and higher estimated glomerular filtration rate compared with nonisolated renal amyloidosis. Serum and urine immunofixation electrophoresis results were positive in 80% and 88% of patients, respectively, with 94% of patients having at least 1 positive immunofixation electrophoresis result (serum or urine). The serum free light chain ratio was abnormal in 91% of patients. When all monoclonal protein studies were combined, only 1 patient (0.2%) had normal results. The 1- and 5-year survival rates were 65% and 46%, respectively. Survival of patients with cardiac amyloidosis was not influenced by the number of involved organs (1 vs >1 organ), emphasizing the prognostic significance of cardiac involvement. CONCLUSION When mass spectrometry is used to definitively type amyloid, only a fraction of a percent of patients with AL have negative monoclonal protein studies, unlike historical reports. Patient characteristics and outcomes of accurately typed patients are described.
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Affiliation(s)
- Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | | | | | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - John A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN
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57
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Muchtar E, Dispenzieri A, Leung N, Lacy MQ, Buadi FK, Dingli D, Grogan M, Hayman SR, Kapoor P, Hwa YL, Fonder A, Hobbs M, Chakraborty R, Gonsalves W, Kourelis TV, Warsame R, Russell S, Lust JA, Lin Y, Go RS, Zeldenrust S, Kyle RA, Rajkumar SV, Kumar SK, Gertz MA. Depth of organ response in AL amyloidosis is associated with improved survival: new proposed organ response criteria. Amyloid 2019; 26:101-102. [PMID: 31343331 DOI: 10.1080/13506129.2019.1582486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Eli Muchtar
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | | | - Nelson Leung
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA.,b Division of Nephrology and Hypertension, Mayo Clinic , Rochester , MN , USA
| | - Martha Q Lacy
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - Francis K Buadi
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - David Dingli
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - Martha Grogan
- c Department of Cardiovascular Diseases, Mayo Clinic , Rochester , MN , USA
| | | | - Prashant Kapoor
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - Yi Lisa Hwa
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - Amie Fonder
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - Miriam Hobbs
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - Rajshekhar Chakraborty
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA.,d Essentia Health St. Joseph's Hospital, Hospitalist Services , Brainerd , MN , USA
| | | | | | - Rahma Warsame
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - Stephen Russell
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - John A Lust
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - Yi Lin
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - Ronald S Go
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | | | - Robert A Kyle
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | | | - Shaji K Kumar
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - Morie A Gertz
- a Division of Hematology, Mayo Clinic , Rochester , MN , USA
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58
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Tschautscher M, Rajkumar V, Dispenzieri A, Lacy M, Gertz M, Buadi F, Dingli D, Hwa L, Fonder A, Hobbs M, Hayman S, Zeldenrust S, Lust J, Russell S, Leung N, Kapoor P, Go R, Lin Y, Gonsalves W, Kourelis T, Warsame R, Kyle R, Kumar S. Serum free light chain measurements to reduce 24-h urine monitoring in patients with multiple myeloma with measurable urine monoclonal protein. Am J Hematol 2018; 93:1207-1210. [PMID: 30016549 DOI: 10.1002/ajh.25215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/10/2018] [Indexed: 11/10/2022]
Abstract
Detection of myeloma progression (PD) relies on serial 24-h urinary M protein measurements in patients without measurable serum M spike. We examined whether serial difference free light chain (dFLC) levels could be used as a surrogate for serial 24-h urine M protein measurements in monitoring for PD in patients with baseline measurable urine M protein. We studied 122 patients who had serial measurement of urine M protein and serum FLC and had demonstrated PD. The median increase in dFLC with progression as defined by urine M spike was 110% (IQR: 55-312) and median absolute increase was 74 mg/dL; while 89% of patients had dFLC increase ≥ 25%, 94% had absolute increase in dFLC > 10 mg/dL, and 98% met at least 1 of these 2 criteria at PD. In patients with baseline measurable serum FLC (n = 118), 89% had increase in dFLC ≥ 25%, 97% had dFLC increase of > 10 mg/dL, and 98% had 1 of the 2. We conclude that serial dFLC assessments can be used in place of serial 24-h urine protein assessments during myeloma surveillance to monitor for PD. Once patients have an absolute increase in dFLC of >10 mg/dL from the nadir, a 24-h urine collection can then be assessed to document PD as per the International Myeloma Working Group criteria.
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Affiliation(s)
| | | | | | - Martha Lacy
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Morie Gertz
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Francis Buadi
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - David Dingli
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Lisa Hwa
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Amie Fonder
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Miriam Hobbs
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Suzanne Hayman
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - John Lust
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Stephen Russell
- Division of Hematology and Molecular Medicine; Mayo Clinic; Rochester Minnesota
| | - Nelson Leung
- Division of Nephrology and Hypertension, Department of Internal Medicine; Mayo Clinic; Rochester Minnesota
| | | | - Ronald Go
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Yi Lin
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | - Rahma Warsame
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Robert Kyle
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Shaji Kumar
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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59
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Abeykoon JP, Zanwar S, Dispenzieri A, Gertz MA, Leung N, Kourelis T, Gonsalves W, Muchtar E, Dingli D, Lacy MQ, Hayman SR, Buadi F, Warsame R, Kyle RA, Rajkumar V, Kumar S, Kapoor P. Daratumumab-based therapy in patients with heavily-pretreated AL amyloidosis. Leukemia 2018; 33:531-536. [DOI: 10.1038/s41375-018-0262-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/15/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022]
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Kumar SK, Buadi FK, LaPlant B, Halvorson A, Leung N, Kapoor P, Dingli D, Gertz MA, Go RS, Bergsagel PL, Lin Y, Dispenzieri A, Hwa YL, Fonder A, Hobbs M, Fonseca R, Hayman SR, Stewart AK, Lust JA, Mikhael J, Gonsalves W, Reeder C, Skacel T, Rajkumar SV, Lacy MQ. Phase 1/2 trial of ixazomib, cyclophosphamide and dexamethasone in patients with previously untreated symptomatic multiple myeloma. Blood Cancer J 2018; 8:70. [PMID: 30061664 PMCID: PMC6066484 DOI: 10.1038/s41408-018-0106-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/16/2018] [Accepted: 05/30/2018] [Indexed: 12/31/2022] Open
Abstract
Ixazomib is the first oral proteasome inhibitor to enter the clinic. Given the efficacy of bortezomib in combination with cyclophosphamide and dexamethasone, we studied the combination of ixazomib, cyclophosphamide and dexamethasone (ICd) in newly diagnosed multiple myeloma (NDMM) and patients with measurable disease, irrespective of transplant eligibility, were enrolled. The phase 1 was to determine the maximum tolerated dose (MTD) of cyclophosphamide in the combination. Patients received ixazomib 4 mg (days 1, 8, 15), dexamethasone 40 mg (days 1, 8, 15, 22), and cyclophosphamide 300 or 400 mg/m2 days 1, 8, 15, 22; cycles were 28 days. We enrolled 51 patients, 10 in phase 1 and 41 patients in phase 2. The median age was 64.5 years (range: 41–88); 29% had high or intermediate risk FISH. The MTD was 400 mg/m2 of cyclophosphamide weekly. The best confirmed response in all 48 patients included ≥ partial response in 77%, including ≥ VGPR in 35%; 3 patients had a sCR. The response rate for all 48 evaluable patients at 4-cycles was 71%; the median time to response was 1.9 months. Common adverse events included cytopenias, fatigue and GI intolerance. ICd is a convenient, all oral combination that is well tolerated and effective in NDMM.
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Affiliation(s)
- Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
| | | | - Betsy LaPlant
- Department of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Alese Halvorson
- Department of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Leif Bergsagel
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Rafael Fonseca
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - A Keith Stewart
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - John A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Joseph Mikhael
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Craig Reeder
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Tomas Skacel
- Takeda Pharmaceutical Company Limited, Osaka, Japan.,31st Medical Department Clinical Department of Haematology of the First Faculty of Medicine and General, Teaching Hospital Charles University, Praha, Czech Republic.,Clinical Department of Haematology of the First Faculty of Medicine and General Teaching Hospital, Charles University, Praha, Czech Republic
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Miller KC, Haug J, Kimlinger T, Kumar S, Gonsalves W, Rajkumar SV, Kumar SK, Ramakrishnan V. Abstract 3909: HDAC inhibition in combination with MEK or BCL-2 inhibition as novel therapeutic strategies in multiple myeloma. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Multiple myeloma (MM) is an incurable malignancy of plasma cells. It is the second most common hematologic cancer, affecting nearly 30,000 people in the United States annually. Substantial progress has been made in the past fifteen years in the treatment of MM due to the approval of several new classes of drugs. However, patients inevitably relapse and become refractory to existing therapies. Hence, there is an immediate unmet need to develop novel therapies for MM based on a better understanding of the disease biology. Mutations in RAS have been found to occur in about 40% of newly diagnosed MM patients, with the frequency increasing to around 70% in relapsed/refractory patients. Such mutations are absent in patients with the premalignant conditions monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). Clearly, RAS mutations contribute to both disease progression and relapse. However, targeting the MEK/ERK pathway has been unsuccessful in MM patients to date. Given the high frequency of RAS mutations in MM, we hypothesized that targeting this pathway could still be a promising strategy when combined with existing agents that have multifaceted mechanisms to promote tumor cell death, such as the recently approved histone deacetylase (HDAC) inhibitor LBH589 (panobinostat). Our results clearly demonstrate that low doses of LBH589 in combination with the MEK inhibitor AZD6244 induce BIM-dependent synergistic cell death in several MM cell lines and patient cells. Our studies also suggest that mutations in RAS/RAF could serve as a predictive biomarker for sensitivity to AZD6244/LBH589. RAS/RAF mutations appear to confer Mcl-1 dependence in MM cells, in part by driving up the phosphorylation of Mcl-1. The AZD6244/LBH589 combination is able to decrease the phosphorylation of Mcl-1 at several sites, which dissociates BIM-Mcl-1 complexes, ultimately leading to activation of the intrinsic apoptosis pathway. Additionally, we identified that wild-type RAS/RAF cells have relatively lower levels of phospho-Mcl-1, as well as higher levels of Bcl-2 and phospho-Bcl-2 when compared to mutated RAS/RAF cells. This seems to confer functional Bcl-2 dependence. Consequently, we found that wild-type RAS/RAF cells are sensitive to the BH3-mimetic ABT199 (venetoclax) when combined with LBH589. Through ongoing experiments, we hope to further confirm the mechanism of action of both these combinations, identify the particular HDAC that is required to be inhibited for the observed synergy, and validate RAS/RAF mutational status as a biomarker for predicting sensitivity to either combination. Our findings have broad therapeutic potential given the prevalence of RAS mutations in MM. Moreover, the ABT199/LBH589 combination could emerge as a targeted therapy for wild-type RAS patients, perhaps broadening the scope and capacity of Bcl-2 inhibition in MM.
Citation Format: Kevin C. Miller, Jessica Haug, Teresa Kimlinger, Sanjay Kumar, Wilson Gonsalves, S. Vincent Rajkumar, Shaji K. Kumar, Vijay Ramakrishnan. HDAC inhibition in combination with MEK or BCL-2 inhibition as novel therapeutic strategies in multiple myeloma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3909.
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Chakraborty R, Muchtar E, Kumar SK, Buadi FK, Dingli D, Dispenzieri A, Hayman SR, Hogan WJ, Kapoor P, Lacy MQ, Leung N, Warsame R, Kourelis T, Gonsalves W, Gertz MA. Impact of duration of induction therapy on survival in newly diagnosed multiple myeloma patients undergoing upfront autologous stem cell transplantation. Br J Haematol 2018; 182:71-77. [DOI: 10.1111/bjh.15244] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/16/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Rajshekhar Chakraborty
- Division of Hematology; Mayo Clinic; Rochester MN USA
- Department of Hematology and Oncology; Cleveland Clinic; Taussig Cancer Institute; Cleveland OH USA
| | - Eli Muchtar
- Division of Hematology; Mayo Clinic; Rochester MN USA
| | | | | | - David Dingli
- Division of Hematology; Mayo Clinic; Rochester MN USA
| | | | | | | | | | | | - Nelson Leung
- Division of Hematology; Mayo Clinic; Rochester MN USA
| | - Rahma Warsame
- Division of Hematology; Mayo Clinic; Rochester MN USA
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Muchtar E, Dispenzieri A, Lacy MQ, Buadi FK, Kapoor P, Hayman SR, Gonsalves W, Warsame R, Kourelis TV, Chakraborty R, Russell S, Lust JA, Lin Y, Go RS, Zeldenrust S, Rajkumar SV, Dingli D, Leung N, Kyle RA, Kumar SK, Gertz MA. Overuse of organ biopsies in immunoglobulin light chain amyloidosis (AL): the consequence of failure of early recognition. Ann Med 2017; 49:545-551. [PMID: 28271734 DOI: 10.1080/07853890.2017.1304649] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The diagnosis of amyloidosis requires histological confirmation of Congo-red (CR) deposits. The tissue source is preferably fat aspiration and/or bone marrow (BM) biopsy, but at times organ biopsy is required. METHODS We studied 612 patients with systemic immunoglobulin light chain amyloidosis to characterise the tissues used to establish the diagnosis. RESULTS The median number of tissue samples was 3. About 95% of BM biopsies were stained for CR, while 79% of patients had fat aspiration CR-stained. CR stain sensitivity was 69% in BM, 75% in fat aspiration and 89% for both sources combined. In comparison, CR sensitivity was 97-100% for heart, renal and liver biopsies. About 42% of patients with renal involvement, 21% of patients with liver involvement and 13% of patients with heart involvement underwent organ biopsy, when a less invasive biopsy would have established the diagnosis. Predictors for the requirement for organ biopsy were male sex, limited organ involvement and lack of fat aspiration. DISCUSSION Fat aspiration is underutilised for histologic confirmation of amyloidosis. A high rate of organ biopsies represents a failure to recognise the disease. Early awareness of amyloidosis in patients with organ dysfunction may lead to more judicious use of organ biopsies in this disease. Key messages Fat pad aspiration is underutilised to establish the diagnosis of amyloidosis. Bone marrow and fat pad aspiration obviates the need for invasive biopsies. The excessive use of organ biopsy in AL amyloidosis reflects failure to recognise the disease early in its course.
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Affiliation(s)
- Eli Muchtar
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
| | | | - Martha Q Lacy
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
| | - Francis K Buadi
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
| | - Prashant Kapoor
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
| | | | | | - Rahma Warsame
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
| | | | - Rajshekhar Chakraborty
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA.,b Internal Medicine Department , Essentia Health St. Joseph's Hospital , Brainerd , MN , USA
| | - Stephen Russell
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
| | - John A Lust
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
| | - Yi Lin
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
| | - Ronald S Go
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
| | | | | | - David Dingli
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
| | - Nelson Leung
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA.,c Division of Nephrology and Hypertension , Mayo Clinic , Rochester , MN , USA
| | - Robert A Kyle
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
| | - Shaji K Kumar
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
| | - Morie A Gertz
- a Division of Haematology , Mayo Clinic , Rochester , MN , USA
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64
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Chakraborty R, Muchtar E, Kumar SK, Buadi FK, Dingli D, Dispenzieri A, Hayman SR, Hogan WJ, Kapoor P, Lacy MQ, Leung N, Warsame R, Kourelis T, Gonsalves W, Gertz MA. Outcomes of maintenance therapy with lenalidomide or bortezomib in multiple myeloma in the setting of early autologous stem cell transplantation. Leukemia 2017; 32:712-718. [PMID: 28848227 DOI: 10.1038/leu.2017.256] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/20/2017] [Accepted: 08/02/2017] [Indexed: 01/04/2023]
Abstract
Post-transplant maintenance is widely used in multiple myeloma (MM); however, there is a lack of data on real-world outcomes. We have analyzed 577 patients with newly diagnosed MM undergoing early auto-transplantation between 2010 and 2015. A total of 341, 132 and 104 patients received no, lenalidomide (Len) or bortezomib (Bort) maintenance, respectively. Patients receiving Len or Bort maintenance had a higher incidence of high-risk cytogenetics by fluorescence in situ hybridization (31% (Len) vs 58% (Bort) vs 8% (No); P<0.001). Len maintenance led to a superior progression-free survival (PFS) compared with no maintenance (median, 37 vs 28 months, respectively; P=0.002; adjusted hazard ratio 0.48 (95% CI, 0.35-0.66)), including in subgroups with ISS stage III disease (median, 40 vs 24 months; P=0.008) and high-risk cytogenetics (median, 27 vs 16 months; P=0.032). Bort maintenance did not confer PFS benefit for the entire cohort, but improved PFS in the high-risk cytogenetic subgroup (median, 28 vs 16 months; P=0.035). Discontinuation due to toxicity was seen in 17 and 7% of patients receiving Len or Bort maintenance, respectively. Our results indicate that post-transplant maintenance with Len or Bort is well tolerated in clinical practice and improves PFS in high-risk subgroups of MM patients.
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Affiliation(s)
- R Chakraborty
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - E Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S R Hayman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W J Hogan
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T Kourelis
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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65
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Muchtar E, Dispenzieri A, Lacy MQ, Buadi FK, Kapoor P, Hayman SR, Gonsalves W, Warsame R, Kourelis TV, Chakraborty R, Russell S, Lust JA, Lin Y, Go RS, Zeldenrust S, Dingli D, Leung N, Rajkumar SV, Kyle RA, Kumar SK, Gertz MA. Elevation of serum lactate dehydrogenase in AL amyloidosis reflects tissue damage and is an adverse prognostic marker in patients not eligible for stem cell transplantation. Br J Haematol 2017; 178:888-895. [PMID: 28699650 DOI: 10.1111/bjh.14830] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/05/2017] [Indexed: 11/27/2022]
Abstract
The significance of serum lactate dehydrogenase (LDH) in light chain (AL) amyloidosis has not been previously explored. We studied 1019 newly diagnosed patients and correlated the elevation of LDH above the upper limit of normal (ULN) with disease characteristics and outcome. Four hundred and nine patients had an LDH above ULN, representing 40% of the study population. Patients with an elevated LDH were older, were less likely to be male and had more extensive organ involvement compared to patients with a normal LDH. Patients with high LDH had greater cardiac and renal dysfunction. Elevated LDH was an independent prognostic marker for overall survival and for death within 6 months of diagnosis, but this was restricted to patients not eligible for stem cell transplant. Serum LDH may act as a marker for organ damage and should be explored as a potential marker for tissue healing and organ recovery.
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Affiliation(s)
- Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rajshekhar Chakraborty
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Hospitalist Services, Essentia Health St. Joseph's Hospital, Brainerd, MN, USA
| | | | - John A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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66
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Ravi P, Kumar S, Gonsalves W, Buadi F, Lacy MQ, Go RS, Dispenzieri A, Kapoor P, Lust JA, Dingli D, Lin Y, Russell SJ, Leung N, Gertz MA, Kyle RA, Bergsagel PL, Rajkumar SV. Changes in uninvolved immunoglobulins during induction therapy for newly diagnosed multiple myeloma. Blood Cancer J 2017. [PMID: 28622306 PMCID: PMC5584483 DOI: 10.1038/bcj.2017.46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Little is known about the impact of multiple myeloma (MM) treatment on uninvolved immunoglobulins (Ig). We identified 448 patients who received high-dose dexamethasone (HD-DEX), lenalidomide and dexamethasone (RD), bortezomib and dexamethasone (VD), bortezomib, cyclophosphamide and dexamethasone (VCD) or bortezomib, lenalidomide and dexamethasone (VRD) for newly diagnosed MM at our institution between 2000 and 2013, and who had available data on absolute lymphocyte count (ALC) and quantitative uninvolved Ig at baseline and at the end of four cycles of therapy. Changes in ALC and uninvolved Ig were significantly different across treatments, with VCD and HD-DEX producing reductions in uninvolved Ig, and RD, VD and VRD leading to increases in uninvolved Ig. In addition, treatment with RD, VD and VRD was independently associated with higher odds of achieving a ⩾25% increase in or normalization of the primary uninvolved Ig on multivariate analysis. Although achievement of a humoral response in the primary uninvolved Ig was associated with a higher odds of achieving VGPR or better after four cycles of therapy, it was not associated with improved overall survival. These data highlight the different mechanisms of action of MM drugs and point toward a possible role for the use of VCD in treating antibody-mediated autoimmune disease.
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Affiliation(s)
- P Ravi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S J Russell
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P L Bergsagel
- Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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67
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Muchtar E, Dean DS, Dispenzieri A, Dingli D, Buadi FK, Lacy MQ, Hayman SR, Kapoor P, Leung N, Russell S, Lust JA, Lin Y, Warsame R, Gonsalves W, Kourelis TV, Go RS, Chakraborty R, Zeldenrust S, Kyle RA, Rajkumar SV, Kumar SK, Gertz MA. Prevalence and predictors of thyroid functional abnormalities in newly diagnosed AL amyloidosis. J Intern Med 2017; 281:611-619. [PMID: 28439924 DOI: 10.1111/joim.12617] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data on the effect of systemic immunoglobulin light chain amyloidosis (AL amyloidosis) on thyroid function are limited. OBJECTIVE To assess the prevalence of hypothyroidism in AL amyloidosis patients and determine its predictors. METHODS 1142 newly diagnosed AL amyloidosis patients were grouped based on the thyroid-stimulating hormone (TSH) measurement at diagnosis: hypothyroid group (TSH above upper normal reference; >5 mIU L-1 ; n = 217, 19% of study participants) and euthyroid group (n = 925, 81%). Predictors for hypothyroidism were assessed in a binary multivariate model. Survival between groups was compared using the log-rank test and a multivariate analysis. RESULTS Patients with hypothyroidism were older, more likely to present with renal and hepatic involvement and had a higher light chain burden compared to patients in the euthyroid group. Higher proteinuria in patients with renal involvement and lower albumin in patients with hepatic involvement were associated with hypothyroidism. In a binary logistic regression model, age ≥65 years, female sex, renal involvement, hepatic involvement, kappa light chain restriction and amiodarone use were independently associated with hypothyroidism. Ninety-three per cent of patients in the hypothyroid group with free thyroxine measurement had normal values, consistent with subclinical hypothyroidism. Patients in the hypothyroid group had a shorter survival compared to patients in the euthyroid group (4-year survival 36% vs 43%; P = 0.008), a difference that was maintained in a multivariate analysis. CONCLUSION A significant proportion of patients with AL amyloidosis present with hypothyroidism, predominantly subclinical, which carries a survival disadvantage. Routine assessment of TSH in these patients is warranted.
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Affiliation(s)
- E Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D S Dean
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S R Hayman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - S Russell
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - T V Kourelis
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Chakraborty
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Hospitalist Services, Essentia Health St. Joseph's Hospital, Brainerd, MN, USA
| | - S Zeldenrust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - S K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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68
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Warsame R, Kumar SK, Gertz MA, Lacy MQ, Buadi FK, Hayman SR, Leung N, Dingli D, Lust JA, Lin Y, Russell S, Kapoor P, Go RS, Kourelis T, Gonsalves W, Zeldenrust SR, Kyle RA, Vincent Rajkumar S, Zemla T, Sloan J, Dispenzieri A. Hematology patient reported symptom screen to assess quality of life for AL amyloidosis. Am J Hematol 2017; 92:435-440. [PMID: 28181278 DOI: 10.1002/ajh.24676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/27/2017] [Accepted: 02/03/2017] [Indexed: 11/07/2022]
Abstract
Patients with light chain amyloidosis (AL) often have delayed diagnosis and present with significant symptomatology; this may result in decreased quality of life (QOL). We prospectively employ a "Hematology Patient Reported Symptom Screen" (HPRSS), which is three questions about fatigue, pain, and QOL, scored 0-10. The aim of this study is to better understand QOL and determine if HPRSS parameters predict for clinical outcomes. From 2009 to 2014, 302 newly diagnosed AL patients were included. Baseline median scores [interquartile range] for fatigue, pain, and QOL were 6 [3,7], 2 [0,5], 5 [3,8], respectively. Median overall survival was 53 months, with 102 (34%) deaths in the first year. There were significant differences in baseline HPRSS between those that lived longer than one year and early death patients in the domains of fatigue (5 [IQR 3, 7] vs. 7 [IQR 5, 8], P < 0.0001) and QOL (6 [IQR 4, 8] vs. 5 [IQR 3, 7], P = 0.006). On univariate analysis fatigue, QOL, physician-reported performance status, autologous stem cell transplant (ASCT), and Mayo stage were prognostic for survival. On multivariate analysis Mayo stage, ASCT, and baseline fatigue remained independently prognostic. When analyses were restricted to the 125 patients with HPRSS measurements at 12 months, we found that over time QOL scores improved significantly 6 [IQR 3.5, 8] → 7 [IQR 5, 8] (P = 0.01). Asking AL patients to rate their fatigue and QOL has predictive value. Baseline patient reported fatigue is an independent prognostic factor for survival. Survival at one year was associated with significant improvement in QOL.
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Affiliation(s)
- Rahma Warsame
- Division of HematologyMayo ClinicRochester Minnesota USA
| | - Shaji K. Kumar
- Division of HematologyMayo ClinicRochester Minnesota USA
| | - Morie A. Gertz
- Division of HematologyMayo ClinicRochester Minnesota USA
| | - Martha Q. Lacy
- Division of HematologyMayo ClinicRochester Minnesota USA
| | | | | | - Nelson Leung
- Division of HematologyMayo ClinicRochester Minnesota USA
| | - David Dingli
- Division of HematologyMayo ClinicRochester Minnesota USA
| | - John A. Lust
- Division of HematologyMayo ClinicRochester Minnesota USA
| | - Yi Lin
- Division of HematologyMayo ClinicRochester Minnesota USA
| | | | | | - Ronald S. Go
- Division of HematologyMayo ClinicRochester Minnesota USA
| | | | | | | | - Robert A. Kyle
- Division of HematologyMayo ClinicRochester Minnesota USA
| | | | - Tyler Zemla
- Department of BiostatisticsMayo ClinicRochester Minnesota USA
| | - Jeffrey Sloan
- Department of BiostatisticsMayo ClinicRochester Minnesota USA
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69
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Tandon N, Muchtar E, Sidana S, Dispenzieri A, Lacy MQ, Dingli D, Buadi FK, Hayman SR, Chakraborty R, Hogan WJ, Gonsalves W, Warsame R, Kourelis TV, Leung N, Kapoor P, Kumar SK, Gertz MA. Revisiting conditioning dose in newly diagnosed light chain amyloidosis undergoing frontline autologous stem cell transplant: impact on response and survival. Bone Marrow Transplant 2017; 52:1126-1132. [DOI: 10.1038/bmt.2017.68] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/17/2017] [Accepted: 03/01/2017] [Indexed: 11/09/2022]
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70
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Muchtar E, Dispenzieri A, Kumar SK, Buadi FK, Lacy MQ, Zeldenrust S, Hayman SR, Leung N, Kourelis TV, Gonsalves W, Chakraborty R, Russell S, Dingli D, Lust JA, Lin Y, Kapoor P, Go R, Kyle RA, Rajkumar SV, Gertz MA. Immunoparesis in newly diagnosed AL amyloidosis is a marker for response and survival. Amyloid 2017; 24:40-41. [PMID: 28434371 DOI: 10.1080/13506129.2016.1277696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Eli Muchtar
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | | | - Shaji K Kumar
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Francis K Buadi
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Martha Q Lacy
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | | | | | - Nelson Leung
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA.,b Division of Nephrology and hypertension , Mayo Clinic , Rochester , MN , USA , and
| | | | | | - Rajshekhar Chakraborty
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA.,c Hospitalist Services, Essentia Health St. Joseph's Hospital , Brainerd , MN , USA
| | - Steven Russell
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - David Dingli
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - John A Lust
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Yi Lin
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Prashant Kapoor
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Ronald Go
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Robert A Kyle
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | | | - Morie A Gertz
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
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71
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Kourelis TV, Nasr SH, Dispenzieri A, Kumar SK, Gertz MA, Fervenza FC, Buadi FK, Lacy MQ, Erickson SB, Cosio FG, Kapoor P, Lust JA, Hayman SR, Rajkumar V, Zeldenrust SR, Russell SJ, Dingli D, Lin Y, Gonsalves W, Lorenz EC, Zand L, Kyle RA, Leung N. Outcomes of patients with renal monoclonal immunoglobulin deposition disease. Am J Hematol 2016; 91:1123-1128. [PMID: 27501122 DOI: 10.1002/ajh.24528] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 12/20/2022]
Abstract
Recent reports suggest that deep hematologic responses to chemotherapy are associated with improved renal outcomes in monoclonal immunoglobulin deposition disease (MIDD). Here we describe the long term outcomes and identify prognostic factors after first line treatment of the largest reported series of patients with MIDD. Between March 1992 and December 2014, 88 patients with MIDD were seen at Mayo Clinic, MN. Renal responses were defined using criteria used for light chain amyloidosis (AL) or those used by the IMWG. Sixty-one (69%) patients had a GFR < 30 mL/min/1.73 m2 and 16 (18%) were on renal replacement therapy at diagnosis. The interval between albuminuria or elevation in creatinine and MIDD diagnosis was 12 months suggesting a delay in diagnosis. Thirty-seven patients (42%) had at least a hematologic CR/VGPR. Fifty-three (60%) received an autologous stem cell transplant (ASCT) or proteasome inhibitor (PI)-based treatments. Patients receiving ASCT or PI-based therapies were more likely to achieve at least a hematologic CR/VGPR compared to those receiving other therapies: 66% vs 2%, p < 0.0001. Patients that achieved a hematologic CR were more likely to achieve a renal response (53% vs 24%, p = 0.001). Five year overall and renal survival for the entire cohort was 67% and 57%, respectively. In multivariate analyses, a baseline GFR < 20 mL/min/1.73 m2 and a renal response (using AL or IMWG criteria) were independently predictive of progression to dialysis. This study confirms that deep hematologic responses, best achieved with ASCT or PI-based therapies, are a prerequisite to achieving renal responses. Am. J. Hematol. 91:1123-1128, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Samih H. Nasr
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Angela Dispenzieri
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | - Shaji K. Kumar
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | - Morie A. Gertz
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | | | - Francis K. Buadi
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | - Martha Q. Lacy
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | | | - Fernando G. Cosio
- Division of Nephrology and Hypertension; Mayo Clinic; Rochester Minnesota
| | - Prashant Kapoor
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | - John A. Lust
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | - Suzanne R. Hayman
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | - Vincent Rajkumar
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | - Steven R. Zeldenrust
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | - Stephen J. Russell
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | - David Dingli
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | - Yi Lin
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | - Wilson Gonsalves
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | | | - Ladan Zand
- Division of Nephrology and Hypertension; Mayo Clinic; Rochester Minnesota
| | - Robert A. Kyle
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
| | - Nelson Leung
- Division of Hematology; Department of Medicine, Mayo Clinic; Rochester Minnesota
- Division of Nephrology and Hypertension; Mayo Clinic; Rochester Minnesota
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72
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Muchtar E, Derudas D, Mauermann M, Liewluck T, Dispenzieri A, Kumar SK, Dingli D, Lacy MQ, Buadi FK, Hayman SR, Kapoor P, Leung N, Chakraborty R, Gonsalves W, Russell S, Lust JA, Lin Y, Go RS, Zeldenrust S, Kyle RA, Rajkumar SV, Gertz MA. Systemic Immunoglobulin Light Chain Amyloidosis-Associated Myopathy: Presentation, Diagnostic Pitfalls, and Outcome. Mayo Clin Proc 2016; 91:1354-1361. [PMID: 27712634 DOI: 10.1016/j.mayocp.2016.06.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/02/2016] [Accepted: 06/21/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To characterize the natural history of immunoglobulin light chain amyloidosis-associated myopathy and to provide guidelines for recognition. PATIENTS AND METHODS Fifty-one patients with systemic immunoglobulin light chain amyloidosis and biopsy-confirmed muscle amyloid deposition diagnosed between January 1, 1995, and December 31, 2015, were included in this study. RESULTS Common presenting symptoms were muscle weakness in 49 patients (96%), dysphagia in 23 (45%), myalgia in 17 (33%), macroglossia in 17 (33%), jaw claudication in 13 (25%), and hoarseness in 9 (18%). The median time from the onset of symptoms to diagnosis was almost 2 years. Less than two-thirds of the patients with an outside muscle biopsy (16 of 27) had an established pathologic confirmation of amyloidosis due to failure to routinely incorporate Congo red staining. Moreover, 12 patients were incorrectly treated before diagnosis of amyloid myopathy. More than half of the patients had normal creatine kinase levels at diagnosis. Cardiac troponin T levels were elevated above the reference range in 5 of 12 patients who lacked evidence of cardiac involvement. Median overall survival was 32 months. Factors associated with inferior survival were involvement of more than 2 organs (median survival, 13 months), cardiac involvement (median survival, 15 months), and absence of stem cell transplant (median survival, 18 months). With the exclusion of patients treated with stem cell transplant, no improvement in survival was seen over the 1995-2004 and 2005-2015 decades. CONCLUSION Immunoglobulin light chain amyloidosis-associated myopathy is rare. Delay in diagnosis is common, and there is a high rate of pathologic and clinical misdiagnosis. Awareness of elevation of cardiac troponin T levels in the absence of cardiac disease may be a clue to diagnosis.
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Affiliation(s)
- Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Daniele Derudas
- Department of Haematology, Businco Hospital, Cagliari, Italy
| | | | | | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Rajshekhar Chakraborty
- Division of Hematology, Mayo Clinic, Rochester, MN; Hospitalist Services, Essentia Health-St. Joseph's Medical Center, Brainerd, MN
| | | | | | - John A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN
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73
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Ravi P, Kumar S, Larsen JT, Gonsalves W, Buadi F, Lacy MQ, Go R, Dispenzieri A, Kapoor P, Lust JA, Dingli D, Lin Y, Russell SJ, Leung N, Gertz MA, Kyle RA, Bergsagel PL, Rajkumar SV. Evolving changes in disease biomarkers and risk of early progression in smoldering multiple myeloma. Blood Cancer J 2016; 6:e454. [PMID: 27471870 PMCID: PMC5030386 DOI: 10.1038/bcj.2016.65] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 01/07/2023] Open
Abstract
We studied 190 patients with smoldering multiple myeloma (SMM) at our institution between 1973 and 2014. Evolving change in monoclonal protein level (eMP) was defined as ⩾10% increase in serum monoclonal protein (M) and/or immunoglobulin (Ig) (M/Ig) within the first 6 months of diagnosis (only if M-protein ⩾3 g/dl) and/or ⩾25% increase in M/Ig within the first 12 months, with a minimum required increase of 0.5 g/dl in M-protein and/or 500 mg/dl in Ig. Evolving change in hemoglobin (eHb) was defined as ⩾0.5 g/dl decrease within 12 months of diagnosis. A total of 134 patients (70.5%) progressed to MM over a median follow-up of 10.4 years. On multivariable analysis adjusting for factors known to predict for progression to MM, bone marrow plasma cells ⩾20% (odds ratio (OR)=3.37 (1.30-8.77), P=0.013), eMP (OR=8.20 (3.19-21.05), P<0.001) and eHb (OR=5.86 (2.12-16.21), P=0.001) were independent predictors of progression within 2 years of SMM diagnosis. A risk model comprising these variables was constructed, with median time to progression of 12.3, 5.1, 2.0 and 1.0 years among patients with 0-3 risk factors respectively. The 2-year progression risk was 81.5% in individuals who demonstrated both eMP and eHb, and 90.5% in those with all three risk factors.
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Affiliation(s)
- P Ravi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J T Larsen
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - J A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - D Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Y Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S J Russell
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - N Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - R A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - P L Bergsagel
- Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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74
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Kourelis TV, Buadi FK, Gertz MA, Lacy MQ, Kumar SK, Kapoor P, Go RS, Lust JA, Hayman SR, Rajkumar V, Zeldenrust SR, Russell SJ, Dingli D, Lin Y, Leung N, Hwa YL, Gonsalves W, Kyle RA, Dispenzieri A. Risk factors for and outcomes of patients with POEMS syndrome who experience progression after first-line treatment. Leukemia 2015; 30:1079-85. [DOI: 10.1038/leu.2015.344] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/16/2015] [Accepted: 12/02/2015] [Indexed: 11/09/2022]
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75
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Vu T, Gonsalves W, Kumar S, Dispenzieri A, Lacy MQ, Buadi F, Gertz MA, Rajkumar SV. Characteristics of exceptional responders to lenalidomide-based therapy in multiple myeloma. Blood Cancer J 2015; 5:e363. [PMID: 26495860 PMCID: PMC4635199 DOI: 10.1038/bcj.2015.91] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/18/2015] [Indexed: 01/03/2023] Open
Abstract
We studied all patients at our institution with a diagnosis of multiple myeloma (MM), from 1 January 2004 to 1 July 2009, who received lenalidomide-dexamethasone (Rd) as initial therapy and had a time to progression of 72 months or longer. Of 240 patients, we identified 33 exceptional responders. Twenty-five patients received primary therapy with Rd and eight patients received Rd induction followed by early stem cell transplantation (SCT). Seven of the eight patients who received SCT did not receive maintenance therapy; one patient received 9 months of lenalidomide post transplant. Fifteen (45%) patients had known clonal plasma cell disorder before the diagnosis of MM. The dominant mode of clinical presentation was with lytic lesions in 28 patients. Of those with informative cytogenetics (n=24), trisomies were present in 19 (79%), including one patient with concurrent trisomies and t(11;14). Overall, 21 of 24 patients (88%) had either trisomies or t(11;14). None of these exceptional responders had high-risk cytogenetic features at baseline. Twenty-five patients (76%) had a complete response (CR), whereas eight patients (24%) achieved the exceptional response state without ever achieving a CR. We identify a cohort of exceptional responders to Rd-based therapy, representing ~10-15% newly diagnosed MM patients with normal renal function.
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Affiliation(s)
- T Vu
- Mayo Medical School, Mayo Clinic, Rochester, MN, USA
| | - W Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - F Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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76
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Gupta V, Gonsalves W, Patnaik M, Gangat N. Central nervous system relapse in acute promyelocytic leukemia: a single institution experience. Leuk Lymphoma 2013; 54:2728-30. [PMID: 23469963 DOI: 10.3109/10428194.2013.782609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Vinay Gupta
- Department of Hematology, Mayo Clinic Rochester , Rochester, MN , USA
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77
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Aldoss IT, Tashi T, Gonsalves W, Kalaiah RK, Fang X, Silberstein P, Ganti AK, Subbiah S. Role of chemotherapy in the very elderly patients with metastatic pancreatic cancer — A Veterans Affairs Cancer Registry analysis. J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2011.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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78
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Gonsalves W, Ganti AK. Targeted anti-cancer therapy in the elderly. Crit Rev Oncol Hematol 2011; 78:227-42. [DOI: 10.1016/j.critrevonc.2010.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 01/15/2010] [Accepted: 06/08/2010] [Indexed: 11/25/2022] Open
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79
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Tiwana J, Ortman S, Davies T, Gonsalves W, Tashi T, Krishnamurthy J, Thota R, Abu Hazeem M, Ganta A, Sama AR, Aldoss IT, Ganti AK, Silberstein PT, Subbiah S. Long-standing diabetes and its effects on outcomes in colon cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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80
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Krishnamurthy J, Tashi T, Gonsalves W, Thota R, Silberstein PT, Subbiah S. Hodgkin lymphoma of the elderly veterans: Veterans Affairs Cancer Registry analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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81
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Subbiah S, Tashi T, Thota R, Sama AR, Silberstein PT, Gonsalves W. Malignant pleural mesothelioma (MPM): Retrospective analysis of clinicopathologic and survival data of the Veterans Affairs Cancer Registry (VACCR). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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82
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Thota R, Birdsong S, Tashi T, Gonsalves W, Tiwana J, Sama AR, Krishnamurthy J, Fang X, Townley PM, Silberstein PT, Subbiah S. Clinicopathologic features and survival outcomes of primary signet ring cell carcinoma of colon: Retrospective analysis of VACCR database. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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83
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Tashi T, Aldoss IT, Gonsalves W, Ganti AK, Silberstein PT, Townley P, Subbiah S. Surgical resection in early limited-stage small cell lung cancer: Time to rethink? A retrospective analysis of the VA Central Cancer Registry. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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84
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Wilkes A, Tashi T, Wolpert J, Goshgarian A, Gonsalves W, Thota R, Krishnamurthy J, Aldoss IT, Sama AR, Townley P, Didwaniya N, Ganti AK, Silberstein PT, Subbiah S. Primary non-Hodgkin lymphoma of the colon: A Veterans Affairs Central Cancer Registry analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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85
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Gonsalves W, Tashi T, Davies T, Ortman S, Thota R, Krishnamurthy J, Aldoss IT, Kalaiah M, Ganta A, Didwaniya N, Eberle C, Ganti AK, Subbiah S, Silberstein PT. Aggressiveness of end-of-life care before and after the utilization of a palliative care service. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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86
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Birdsong S, Thota R, Tashi T, Gonsalves W, Silberstein PT, Subbiah S. Surgical outcomes of colorectal cancer in octogenarians: Survival analysis of the Veteran's Affairs population. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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87
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Abu Hazeem M, Wolpert J, Tashi T, Gonsalves W, Krishnamurthy J, Thota R, Sama AR, Aldoss IT, AL-Howaidi I, Townley P, Silberstein PT, Subbiah S. The impact of lymph node ratio (LNR) on survival in patients with stage IV colon cancer: A Veteran’s Affairs Central Cancer Registry analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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88
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Alla VM, Reddy YM, Kanuri S, Gonsalves W, Tashi T, Subbaiah SP, Hunter C, Mooss A. Impact of preoperative total leucocyte count on mortality and cardiovascular complications in patients undergoing nonemergent thoracic aortic surgery. Cardiovascular Revascularization Medicine 2011. [DOI: 10.1016/j.carrev.2011.04.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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89
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Al-Howaidi I, Shatat L, Tashi T, Gonsalves W, Silberstein PT, Subbiah S. Racial disparities in stage IV prostate cancer outcomes in the Veterans Affairs hospital system. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
199 Background: Epidemiological studies have demonstrated that African-American (AA) men with prostate cancer have lower overall survival and cancer-specific survival rates than Caucasian (CA) men with prostate cancer. We aim to assess whether racial disparities exist for prostate cancer within an equal access health care system like the Veterans Affairs (VA) hospitals. Methods: A retrospective analysis of AA and CA with metastatic prostate adenocarcinoma diagnosed between 1995 to 2007 via the Veterans Affairs Central Cancer Registry was conducted. Age, Race and type of treatment received were studied with respect to overall survival by using log-rank and Kaplan-Meier analysis. Results: A total of 8,195 patients with advanced prostate cancer were analyzed, majority of them where CA (66.32%), 30.8% were AA and 2.8% belonged to other races. The median survival for AA was 2.71 years, 2.88 years in CA and 4.02 years in other races (P value <0.0001). Subgroup analysis based on treatment modality used showed the following median survival rates in years: No treatment (CA: 1.73, AA: 1.39, other races: 3.79, P<0.816), Hormonal therapy alone (CA: 2.51,AA: 2.45, Others:3.72, P<0.022), Radiation therapy alone (CA: 2.2, AA: 2.7, Others: 2.26, P<0.832), combined hormone and radiation therapy (CA: 2.71, AA: 2.31, Others: 6.64, P<0.029). However when CA and AA survival were compared excluding other races there was no statistically significant difference in survival irrespective of type of therapy received. Conclusions: In advanced prostate cancer, AA and CA have uniformly poor prognosis. Type of therapy received did not influence the survival of both races. The numbers for other races is too small to make a definitive conclusion regarding their prognosis. No significant financial relationships to disclose.
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Affiliation(s)
- I. Al-Howaidi
- Creighton University Medical Center, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University, Omaha, NE
| | - L. Shatat
- Creighton University Medical Center, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University, Omaha, NE
| | - T. Tashi
- Creighton University Medical Center, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University, Omaha, NE
| | - W. Gonsalves
- Creighton University Medical Center, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University, Omaha, NE
| | - P. T. Silberstein
- Creighton University Medical Center, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University, Omaha, NE
| | - S. Subbiah
- Creighton University Medical Center, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University, Omaha, NE
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90
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Thota R, Tashi T, Gonsalves W, Murukesan V, Townley P, Ganti A, Silberstein PT, Subbiah S. Primary signet ring cell carcinoma of colon: Retrospective analysis of VACCR database. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
58 Background: Signet ring cell carcinoma accounts for less than 1% of all colon cancers. We examined the clinical pathological features and prognosis of signet ring cell carcinoma of colon and compare it with mucinous and non-mucinous adenocarcinoma of colon. Methods: A total of 206 patients diagnosed with signet ring cell carcinoma from 1995 to 2009 were identified from the VA Central Cancer Registry (VACCR) database. Age, race, histology, grade, lymph node status, stage and type of treatment received data were collected. Results: Out of 206 patients, 173 (83.9%) were white, 31 (15%) were black, and 2 patients were listed as unknown. Median age of diagnosis was 67 years as compared to 70 years for both mucinous and non-mucinous adenocarcinoma of colon. Pathological T-stages were as follows: T1 = 2.9%, T2=5.3%, T3=33.9%, T4= 25.7%, and unknown 32%. Of the total, 22.3% were located in caecum, 21.8% in ascending colon, 15.5% in sigmoid colon, 7.7% in appendix and hepatic flexure of colon, 11.1% in transverse colon, 2.9% in splenic flexure and 4.4% in descending colon. 33.5% were lymph node positive, 34.6% were lymph node negative, and 31.8% were unknown. Histologically grade 3 (55.4%) was most commonly reported followed by grade 2 (7.3%), grade 1 (2.5%), grade 4 (1.9%)and in 33% grade was unknown. 41.3% patients received only surgery while 34% received surgery with adjuvant chemotherapy, 7.3% received chemotherapy alone and 7.8% patients received either chemotherapy, radiation or hormonal therapy alone, 9% did not receive any therapy. 1 year, 3 year and 5 year survivals for signet ring cell cancer compared to adeno carcinoma was 60% vs 80%, 33% vs 60%, and 24% vs 47% respectively. Median survival of signet ring cell carcinoma compared to mucinous and non mucinous adenocarcinoma was 19 months, 48 months and 62 months respectively. Conclusions: Signet ring cell carcinoma of colon has poor survival rates than the other histological subtypes. Signet ring cell carcinoma presents at an earlier age, higher tumor grade and advanced stage at diagnosis when compared to mucinous and non-mucinous adenocarcinoma of colon. Due to rarity of this disease further multi-institute studies are required for in-depth understanding and analysis of this disease. No significant financial relationships to disclose.
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Affiliation(s)
- R. Thota
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - T. Tashi
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - W. Gonsalves
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - V. Murukesan
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - P. Townley
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - A. Ganti
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - P. T. Silberstein
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - S. Subbiah
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
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91
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Thota R, Tashi T, Gonsalves W, Sama AR, Silberstein PT, Townley P, Subbiah S. Prognostic significance of positive lymph node ratio in resected esophageal cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
100 Background: Nodal involvement in esophageal cancer is associated with poor survival. We aim to determine whether the ratio of metastatic to examined lymph nodes (the lymph node ratio [LNR]) is a better predictor of survival as compared to the number of positive lymph nodes in resected esophageal cancer. Methods: 1,149 patients with resected esophageal cancer from 1995 to 2009 were identified from the VA Central Cancer Registry (VACCR) database. The patients were further characterized to 3 lymph node quartiles based on LNR and their median survivals were calculated using the Kaplan-Meier method. Results: Out of 1149 patients 26.4% patients (303) had squamous cell carcinoma and 73.6% (846) were of adenocarcinoma histology. Median age of diagnosis is 63 years. 353 (31%) are stage 1, 384 (33%) are stage 2, and 412 (36%) are stage 3. Majority of them 71% arise in lower third of esophagus followed by 13% in middle third, 4% in upper third and 12 % had unknown site of origin. The group was subdivided into 3 quartiles with 62.7% in LNR1 (0.0-0.1), 25.6% in LNR2 (0.1-0.5) and 11.7% in LNR3 (0.5-1.0). 13.7% had less than 2 nodes removed, 29.3% had 3-6 nodes and 57% had >7 nodes examined. 28% of them had tumor invading sub mucosa, 23.5% had tumor invading muscularis mucosa, 43.2% had involvement of adventitia and 5.3% had penetrating tumor at the time of diagnosis The 5 year survivals based on number of lymph nodes examined, number of positive lymph nodes and positive lymph node ratio are listed in the table. The median overall survival for resected esophageal cancer based on LNR quartiles was 37 vs 14 vs 11.5 months (p<0.0001). Conclusions: Number of positive lymph nodes and positive lymph node ratio correlated with survival outcomes but number of lymph nodes retrieved did not predict any survival differences. However LNR was a better predictor of survival when compared to number of positive nodes. Further validation of this observation needs to done in large multicenter studies. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- R. Thota
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
| | - T. Tashi
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
| | - W. Gonsalves
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
| | - A. R. Sama
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
| | - P. T. Silberstein
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
| | - P. Townley
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
| | - S. Subbiah
- Creighton University, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE
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92
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Tashi T, Thota R, Krishnamurthy J, Sama AR, Aldoss IT, Gonsalves W, Ganti A, Townley P, Silberstein PT, Subbiah S. Primary non-Hodgkin lymphoma of the colon among patients in the Veterans Affairs Health System. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
554 Background: Primary non-Hodgkin lymphoma (NHL) of the colon is rare. There are no randomized controlled trials describing treatment outcomes for this tumor. We provide the largest descriptive study of this tumor to date. Methods: Retrospective analysis of 109 patients diagnosed with primary non-Hodgkin lymphoma of the colon from 1995 to 2008 was done via the Veteran's Affairs Central Cancer Registry. By definition, all cases presented with a lymphomatous involvement of the colon as the first manifestation of their disease with no previous diagnosis of NHL of any type or site. Demographic, staging, histology, treatment, and outcome data was recorded. Lymphomas were classified as aggressive versus indolent based on their histology. Results: There were 36,260 colon cancers diagnosed in 1995-2008 of which 109 (0.3%) were primary non-Hodgkin colon lymphomas. The median age of diagnosis was 67 years. 55 pts had aggressive disease, 27 pts had indolent disease, and 27 pts had inadequate histological data. Diffuse large B cell lymphoma (73%) was the most common aggressive lymphoma whereas it was marginal zone (56%) in the indolent group. The indolent group had 5- year survival rate of 76.9% compared to 48.6% for the aggressive group. Both groups had received different treatment regimens as seen in the Table with variable mean survival outcomes. Conclusions: Our data suggests addition of postoperative adjuvant chemotherapy appears superior to surgery alone in the treatment of aggressive disease whereas it does not appear to provide any benefit in the treatment of indolent disease. However, patient numbers are too small to draw definite conclusions and warrant future investigation in multinational randomized fashion. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- T. Tashi
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - R. Thota
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - J. Krishnamurthy
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - A. R. Sama
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - I. T. Aldoss
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - W. Gonsalves
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - A. Ganti
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - P. Townley
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - P. T. Silberstein
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
| | - S. Subbiah
- Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE; Creighton University Medical Center, Omaha, NE; University of Nebraska, Omaha, NE
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93
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Didwaniya N, Gonsalves W, Silberstein PT, Subbiah S. Racial disparities in colon cancer: Retrospective analysis of VACCR database. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
528 Background: A racial/ethnic difference in colon cancer survival has been described in literature. However the reasons for this are unclear and access to health care is one of the factors that have been implicated. We plan to examine the clinicopathologic factors of Caucasians (CA) and African Americans (AA) in an equal to access health care system. Methods: 21,992 patients from 1995 to 2009 were identified from the VA Central Cancer Registry database. Age, race, stage, histology, lymph node status, and type of treatment received data were collected. Results: Out of 21,992 patients, 17,924 were CA and 4,068 were AA. 98.07% of CA and 97.83% of all AA were males. Pathological T stages were as follows: T1 = 15.58% vs. 16.13%, T2 = 18.81% vs. 17.56%, T3 = 55.48% vs. 56.03%, T4 = 10.13% vs. 10.28% for CA and AA respectively. Stage-specific incidence, histological grades, and lymph nodal involvement rates were similar in both groups. 77.16% of CA and 77.03% of all AA received chemotherapy. 82.07% of CA and 78.78% of all AA underwent surgery. Median overall survival in CA was 30.73 months and in AA it was 27 months (p < 0.0001). Stage-specific survival (in months) was significantly better for CA in early-stage disease (p < 0.0001) but is similar for both races in metastatic disease (see Table). Median survival in male and female sex irrespective of race was 29.867 months and 35.667 months respectively. Conclusions: Overall survival is better in CA when compared to AA in an equal to access health care system. This survival difference was present only in early-stage disease while in metastatic disease the survival was uniformly poor. Incidence as per stage, lymph node status,and grade were not significantly different among AA and CA. Tumor biology and post-treatment surveillance are potential factors and this needs to be investigated further. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- N. Didwaniya
- Creighton University School of Medicine, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE
| | - W. Gonsalves
- Creighton University School of Medicine, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE
| | - P. T. Silberstein
- Creighton University School of Medicine, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE
| | - S. Subbiah
- Creighton University School of Medicine, Omaha, NE; Hematology/Oncology, Creighton University, Omaha, NE; Creighton University, Omaha, NE
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DePew ZS, Gonsalves W, Schuller D. A 49-Year-Old Woman With Acute Respiratory Failure. Chest 2010; 138:224-7. [DOI: 10.1378/chest.09-2942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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95
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Crockett D, Gonsalves W, Tashi T, Aldoss I, Sama AR, Al-Howaidi I, Fang X, Townley P, Subbiah S, Silberstein PT. Racial disparities in stage II prostate cancer outcomes in the Veterans Affairs hospital system. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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96
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Ganti A, Gonsalves W, Aldoss I, Loberiza FR. Outcomes of patients with stage III (clinical N2) NSCLC: A VACCR analysis. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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97
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Kalaiah M, Gonsalves W, Townley P, Tashi T, Aldoss I, Didwaniya N, Ganta A, Thota R, AL-Howaidi I, Subbiah S. Genitourinary small cell carcinoma: Analysis of clinical and treatment factors associated with survival among patients in the Veterans Affairs Health System. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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98
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Tashi T, Torgersen ZH, Willer B, Gonsalves W, Al-Howaidi I, Silberstein PT, Townley P, Subbiah S, Lee TH, Mittal SK. Survival outcome in resectable esophageal cancer: Single-center experience. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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99
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Sama AR, Gonsalves W, Fang X, Lynch HT, Thome S. Incidence of early-onset multiple myeloma among families with endometrial carcinoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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100
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Gonsalves W, Tashi T, Aldoss I, Kalaiah M, Didwaniya N, Stenoien S, Eberle C, Ganti A, Subbiah S, Silberstein PT. The effect of palliative care consultations on the end-of-life care in the Veteran's cancer population. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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