1
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Uryu H, Mishima Y, Ishihara Y, Shirouchi Y, Yamauchi N, Hirano M, Hirano K, Teramoto Y, Yoshida K, Maruyama D. Complex karyotype determined using conventional cytogenetic analysis is a poor prognostic factor in patients with multiple myeloma. J Clin Exp Hematop 2024; 64:10-20. [PMID: 38538316 PMCID: PMC11079984 DOI: 10.3960/jslrt.23047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 05/12/2024] Open
Abstract
High-risk cytogenetic abnormalities (HRCAs) influence the prognosis of multiple myeloma (MM). However, additional cytogenetic aberrations can lead to poor outcomes. This study aimed to clarify whether HRCAs and additional chromosomal abnormalities affect MM prognosis. Patients with newly diagnosed MM who were treated with novel agents were retrospectively evaluated. The primary objective was to assess the difference in progression-free survival (PFS) and overall survival (OS) between patients with/without HRCAs and between patients with/without complex karyotype (CK). The secondary objectives were to identify factors affecting PFS/OS and factors related to CK. HRCAs were defined as del(17p), t(4;14), t(14;16), and gain/amplification(1q) assessed using fluorescence in situ hybridization. CK was defined as ≥3 chromosomal abnormalities on G-banding. Among 110 patients, 40 had HRCAs and 15 had CK. In this study, survival durations between patients with/without HRCAs were similar, while the CK group had significantly poorer PFS/OS than the no-CK group (median PFS: 9 vs. 24 months and median OS: 29 vs. 97 months, respectively), and a poor prognostic impact of CK was maintained in patients with HRCAs. In multivariate analysis, CK was correlated with poor PFS/OS (hazard ratio [HR]: 2.39, 95% confidence interval [95% CI]: 1.22-4.66 and HR: 2.66, 95% CI: 1.10-6.45, respectively). Bone marrow plasma cell (BMPC) ≥60% (odds ratio [OR] = 6.40, 95% CI: 1.50-27.2) and Revised International Staging System III (OR = 7.53, 95% CI: 2.09-27.1) were associated with CK. Our study suggests that CK may contribute to the poor prognosis of MM. Aggressive disease status including high BMPC proliferation could be relevant to CK.
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Affiliation(s)
- Hideki Uryu
- Department of Hematology
Oncology, Cancer Institute Hospital, Japanese Foundation for
Cancer Research, Tokyo, Japan
| | - Yuko Mishima
- Department of Hematology
Oncology, Cancer Institute Hospital, Japanese Foundation for
Cancer Research, Tokyo, Japan
| | - Yuko Ishihara
- Department of Hematology
Oncology, Cancer Institute Hospital, Japanese Foundation for
Cancer Research, Tokyo, Japan
| | - Yuko Shirouchi
- Department of Hematology
Oncology, Cancer Institute Hospital, Japanese Foundation for
Cancer Research, Tokyo, Japan
| | - Nobuhiko Yamauchi
- Department of Hematology
Oncology, Cancer Institute Hospital, Japanese Foundation for
Cancer Research, Tokyo, Japan
| | - Mitsuhito Hirano
- Department of Hematology
Oncology, Cancer Institute Hospital, Japanese Foundation for
Cancer Research, Tokyo, Japan
| | - Kei Hirano
- Department of Hematology
Oncology, Cancer Institute Hospital, Japanese Foundation for
Cancer Research, Tokyo, Japan
| | - Yukako Teramoto
- Department of Hematology
Oncology, Cancer Institute Hospital, Japanese Foundation for
Cancer Research, Tokyo, Japan
| | - Kikuaki Yoshida
- Department of Hematology
Oncology, Cancer Institute Hospital, Japanese Foundation for
Cancer Research, Tokyo, Japan
| | - Dai Maruyama
- Department of Hematology
Oncology, Cancer Institute Hospital, Japanese Foundation for
Cancer Research, Tokyo, Japan
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2
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Kanaan BA, Al-Ouqaili MT, Murshid RM. Cytogenetic screening of chromosomal abnormalities and genetic analysis of FSH receptor Ala307Thr and Ser680Asn genes in amenorrheic patients. PeerJ 2023; 11:e15267. [PMID: 37255590 PMCID: PMC10226477 DOI: 10.7717/peerj.15267] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/29/2023] [Indexed: 06/01/2023] Open
Abstract
Objective Amenorrhea is a rare reproductive medical condition defined by the absence of menstruation during puberty or later life. This study aims to establish the frequency and pattern of chromosomal abnormalities (CA) in both primary amenorrhea (PA) and secondary amenorrhea (SA), and further to detect the genetic changes in exon 10 at nucleotide positions 919 and 2039 of the genotypes Thr307Ala, and Asn680Ser, respectively. Design settings and patients This cross-sectional study was conducted on a sample of seventy amenorrhoeic women according to the Helsinki declaration rules of medical ethics, as divided into 40 (57.14%) with PA and 30 (42.86%) with SA, and 30 healthy women with normal menstruation as the control. The chromosomal karyotyping was performed according to the ISCN, 2020. PCR products were submitted to RFLP and Sanger sequencing for women with normal karyotype and high FSH serum levels. Results The classical Turner Syndrome was the most common CA in PA, followed by isochromosome X [46, Xi(X)(q10)], mosaicism of Turner and isochromosome X [45, X /46, Xi(X)(q10)], sex reversal (46, XY) and (46, XX,-3,+der3,-19,del 19 p). Abnormal SA cases were characterized by mosaicism Turner syndrome (45,X/46,XX) and (46,XX,-3,+der3,X,+derX). The homozygous genotypes AA and GG of Ala307Thr (rs6165) in the FSHR gene are most common in PA, while the homozygous genotype AA is more common in SA. GG and AG genotypes of Ser680Asn (rs6166) are more frequent in Iraqi patients with PA and SA compared to the healthy control women. Both PCR-RFLP and Sanger sequencing indicated a marked matching between genotypes. Conclusions The study emphasizes the need for cytogenetic analysis to determine the genetic basis of PA and SA. Further, genotyping for women with normal karyotype and high FSH serum concentrations via PCR-RFLP should be considered for the precise diagnosis and development of appropriate management of and counselling for these patients.
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Affiliation(s)
- Bushra A. Kanaan
- Department of Microbiology, University of Anbar, College of Medicine, Ramadi, Al-Anbar Province, Iraq
| | - Mushtak T.S. Al-Ouqaili
- Department of Microbiology, University of Anbar, College of Medicine, Ramadi, Al-Anbar Province, Iraq
| | - Rafal M. Murshid
- Department of Gynecology and Obstetrics, University of Anbar, College of Medicine, Ramadi, Al-Anbar Province, Iraq
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3
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Nguyen PC, Muirhead J, Tan J, Kalff A, Bergin K, Walker P, Spencer A. Upfront tandem autologous non-myeloablative allogeneic stem cell transplant in high-risk multiple myeloma: a long-term single-centre experience. Intern Med J 2022; 52:1263-1267. [PMID: 35808923 PMCID: PMC9543527 DOI: 10.1111/imj.15842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 05/29/2022] [Indexed: 12/01/2022]
Abstract
The role of upfront non‐myeloablative allogeneic stem cell transplantation (NMA alloSCT) in high‐risk multiple myeloma (HR‐MM) is unclear. We evaluated outcomes of NMA alloSCT following autologous stem cell transplant (ASCT) compared with ASCT alone for newly diagnosed HR‐MM. Two‐year progression‐free survival was improved in the ASCT‐NMA alloSCT group (44% vs 16%; P = 0.035), with a trend for improved overall survival (P = 0.118). These results suggest that ASCT‐NMA alloSCT can be considered as upfront therapy in HR‐MM.
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Affiliation(s)
- Phillip C Nguyen
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - Jenny Muirhead
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - Joanne Tan
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - Anna Kalff
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - Krystal Bergin
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - Patricia Walker
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew Spencer
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
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4
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Hagen P, Sellin M, Berg S, Zhang J. Increasing genomic discovery in newly diagnosed multiple myeloma: defining disease biology and its correlation to risk. Ann Hematol 2022; 101:1407-1420. [PMID: 35585246 PMCID: PMC9756633 DOI: 10.1007/s00277-022-04856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/25/2022] [Indexed: 01/03/2023]
Abstract
Our understanding of MM genomics has expanded rapidly in the past 5-10 years as a consequence of cytogenetic analyses obtained in routine clinical practice as well as the ability to perform whole-exome/genome sequencing and gene expression profiling on large patient data sets. This knowledge has offered new insights into disease biology and is increasingly defining high-risk genomic patterns. In this manuscript, we present a thorough review of our current knowledge of MM genomics. The epidemiology and biology of chromosomal abnormalities including both copy number abnormalities and chromosomal translocation are described in full with a focus on those most clinically impactful such as 1q amplification and del(17p) as well as certain chromosome 14 translocations. A review of our ever-expanding knowledge of genetic mutations derived from recent whole-genome/exome data sets is then reviewed including those that drive disease pathogenesis from precursor states as well as those that may impact clinical outcomes. We then transition and attempt to elucidate how both chromosomal abnormalities and gene mutations are evolving our understanding of disease risk. We conclude by offering our perspectives moving forward as to how we might apply whole-genome/exome-level data in addition to routine cytogenetic analyses to improve patient outcomes as well as further knowledge gaps that must be addressed.
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Affiliation(s)
- Patrick Hagen
- Department of Hematology/Oncology, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Mark Sellin
- Department of Hematology/Oncology, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Stephanie Berg
- Department of Cancer Biology, Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Jiwang Zhang
- Department of Cancer Biology, Oncology Institute, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, 60153, USA,Department of Pathology and Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, 60153, USA
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5
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Abdallah NH, Binder M, Rajkumar SV, Greipp PT, Kapoor P, Dispenzieri A, Gertz MA, Baughn LB, Lacy MQ, Hayman SR, Buadi FK, Dingli D, Go RS, Hwa YL, Fonder AL, Hobbs MA, Lin Y, Leung N, Kourelis T, Warsame R, Siddiqui MA, Kyle RA, Bergsagel PL, Fonseca R, Ketterling RP, Kumar SK. A simple additive staging system for newly diagnosed multiple myeloma. Blood Cancer J 2022; 12:21. [PMID: 35102148 PMCID: PMC8803917 DOI: 10.1038/s41408-022-00611-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/07/2021] [Accepted: 01/12/2022] [Indexed: 11/21/2022] Open
Abstract
Risk stratification in multiple myeloma is important for prognostication, patient selection for clinical trials, and comparison of treatment approaches. We developed and validated a staging system that incorporates additional FISH abnormalities not included in the R-ISS and reflects the additive effects of co-occurring high-risk disease features. We first evaluated the prognostic value of predefined cytogenetic and laboratory abnormalities in 2556 Mayo Clinic patients diagnosed between February 2004 and June 2019. We then used data from 1327 patients to develop a risk stratification model and validated this in 502 patients enrolled in the MMRF CoMMpass study. On multivariate analysis, high-risk IgH translocations [risk ratio (RR): 1.7], 1q gain/amplification (RR: 1.4), chromosome17 abnormalities (RR: 1.6), ISS III (RR: 1.7), and elevated LDH (RR: 1.3) were independently associated with decreased overall survival (OS). Among 1327 evaluable patients, OS was 11.0 (95% CI: 9.2–12.6), 7.0 (95% CI: 6.3–9.2), and 4.5 (95% CI: 3.7–5.2) years in patients with 0 (stage I), 1 (stage II), and ≥2 (stage III) high-risk factors, respectively. In the MMRF cohort, median OS was 7.8 (95% CI: NR-NR), 6.0 (95% CI: 5.7-NR), and 4.3 (95% CI: 2.7-NR) years in the 3 groups, respectively (P < 0.001). This 5-factor, 3-tier system is easy to implement in practice and improves upon the current R-ISS.
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Affiliation(s)
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Linda B Baughn
- Department of Laboratory Medicine and Pathology, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi L Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Amie L Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Yi Lin
- 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
| | | | - Rahma Warsame
- 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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6
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Seyhanlı A, Yavuz B, Akşit Z, Yüce Z, Özkal S, Altungöz O, Demirkan F, Alacacıoğlu İ, Özsan GH. Assessment of Bone Marrow Biopsy and Cytogenetic Findings in Patients with Multiple Myeloma. Turk J Haematol 2021; 39:109-116. [PMID: 34823323 PMCID: PMC9160703 DOI: 10.4274/tjh.galenos.2021.2021.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective Multiple myeloma (MM) is a malignant condition that is characterized by the accumulation of malignant plasma cells. Although MM remains incurable, the survival of MM patients has improved considerably due to applied autologous stem cell transplantation (ASCT), novel agents, and treatment strategies. This study aimed to determine the cytogenetic characterization and bone marrow features of Turkish patients with MM. Materials and Methods Eighty-five MM patients were admitted to the 9 Eylul University Hospital in Turkey. Bone marrow (BM) samples MM patients were subject to cytogenetic analyses on diagnosis and during therapy as part of therapeutical and clinical evaluation. A complete cytogenetic study was performed using the G-banding technique. The Fluorescent in situ hybridization (FISH) analysis was performed using cytoplasmic immunoglobulin (cIg)-FISH. The degree of bone marrow fibrosis was determined using the histochemical stain of reticulin. We determined the percentage of bone marrow plasma cells based on the extent of CD38 staining. Results Eighty-five MM patients were retrospectively identified between 2015 and 2021. The median age was 63 (38-90) years. Of the 85 patients, 60 (70.6%) were male, and 25 (29.4%) were female. Seventy-two (84.7%) cases had bone marrow fibrosis at the time of diagnosis. The most common was grade-2 fibrosis, recorded in 35 patients (41.2%). About 72.9% of the patients showed more than 50% plasma cells. The FISH analysis indicated the presence of abnormal chromosomes in 37% (32/85) of the patients. The most frequent abnormality was IGH translocation (21.3%). Conclusion Subgroup analysis of IGH mutations is crucial in the identification of high-risk MM patients. We believe that our study will contribute to the determination of bone marrow biopsy and cytogenetic features of MM patients in our country.
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Affiliation(s)
- Ahmet Seyhanlı
- Sivas Numune Hospital, Department of Hematology, Sivas, Turkey
| | - Boran Yavuz
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Zehra Akşit
- Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine, İzmir, Turkey
| | - Zeynep Yüce
- Dokuz Eylül University Faculty of Medicine, Department of Medical Biology, İzmir, Turkey
| | - Sermin Özkal
- Dokuz Eylül University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Oğuz Altungöz
- Dokuz Eylül University Faculty of Medicine, Department of Medical Biology, İzmir, Turkey
| | - Fatih Demirkan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - İnci Alacacıoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Güner Hayri Özsan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
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7
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Bhardwaj MK, Mishra SK, Sharma S, Salona B, Mohanty SK. Potential Prognostic Significance of Patterns of Deletion (13q) in Plasma Cell Myelomas—Reappraisal of a Perennial Bone of Contention. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1732852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractDeletion 13q is recommended in the initial cytogenetic workup of myeloma patients. The patterns of this abnormality have been shown to have differential prognostic value. The presence of monosomy 13 is associated with a significantly poor progression-free survival, while interstitial deletion 13q is associated with significant improvement in the overall survival. We analyzed the patterns of 13q abnormalities on fluorescent in situ hybridization (FISH) assay results in myeloma patients. Deletion 13q abnormalities were observed in 38% (55 of 138) of the myeloma patients. Ten (18%) and 44 (80%) patients showed interstitial deletion and terminal deletion, respectively. One had a mosaic of both the patterns. Nine of the ten patients with interstitial deletions were males. For terminal deletion 13q, there appeared to be a slight female predilection, with a male to female ratio of 0.83:1. Half of the patients with deletion 13q had coexistent cytogenetic abnormalities. We suggest a baseline FISH for deletion 13q and specification of the type of abnormality (terminal vs. interstitial) in patients with myeloma. Based on our observation in conjunction with the available literature, further studies in a large cohort of patients with survival data are warranted to clearly delineate the role of deletion 13q in myeloma.
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Affiliation(s)
- Mohit Kumar Bhardwaj
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, Haryana, India
| | - Sourav Kumar Mishra
- Department of Medical Oncology, Advanced Medical Research Institute, Bhubaneswar, Odisha, India
| | - Shivani Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, Haryana, India
| | - Beklashwar Salona
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, Haryana, India
| | - Sambit Kumar Mohanty
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, Haryana, India
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, Odisha, India
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8
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Co-evolution of tumor and immune cells during progression of multiple myeloma. Nat Commun 2021; 12:2559. [PMID: 33963182 PMCID: PMC8105337 DOI: 10.1038/s41467-021-22804-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/10/2021] [Indexed: 12/17/2022] Open
Abstract
Multiple myeloma (MM) is characterized by the uncontrolled proliferation of plasma cells. Despite recent treatment advances, it is still incurable as disease progression is not fully understood. To investigate MM and its immune environment, we apply single cell RNA and linked-read whole genome sequencing to profile 29 longitudinal samples at different disease stages from 14 patients. Here, we collect 17,267 plasma cells and 57,719 immune cells, discovering patient-specific plasma cell profiles and immune cell expression changes. Patients with the same genetic alterations tend to have both plasma cells and immune cells clustered together. By integrating bulk genomics and single cell mapping, we track plasma cell subpopulations across disease stages and find three patterns: stability (from precancer to diagnosis), and gain or loss (from diagnosis to relapse). In multiple patients, we detect “B cell-featured” plasma cell subpopulations that cluster closely with B cells, implicating their cell of origin. We validate AP-1 complex differential expression (JUN and FOS) in plasma cell subpopulations using CyTOF-based protein assays, and integrated analysis of single-cell RNA and CyTOF data reveals AP-1 downstream targets (IL6 and IL1B) potentially leading to inflammation regulation. Our work represents a longitudinal investigation for tumor and microenvironment during MM progression and paves the way for expanding treatment options. Clonal evolution in multiple myeloma (MM) needs to be understood in both the tumor and its microenvironment. Here the authors perform single-cell multi-omics profiling of samples from MM patients at different stages, finding transitions in the immune cell composition throughout progression.
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9
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Chen C, Lim AST, Lau LC, Lim TH, Heng EYH, Tien SL. Implementation of cytogenomic microarray with plasma cell enrichment enables better abnormality detection and risk stratification in patients with plasma cell neoplasia than conventional cytogenetics and fluorescence in situ hybridization. Cancer Genet 2020; 252-253:25-36. [PMID: 33341677 DOI: 10.1016/j.cancergen.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/21/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
The detection of chromosomal abnormalities is important in the diagnosis, prognosis and disease monitoring in plasma cell neoplasia (PCN). However, the gold standard diagnostic techniques of conventional cytogenetics (CC) and fluorescence in situ hybridization (FISH) are hampered by culture difficulties and probe availability. Cytogenomic microarray (CMA), however, is able to surmount such limitations and generate a comprehensive genomic profile with the implementation of plasma cell (PC) enrichment. In this study, we examined 89 bone marrow specimens with CC and FISH without PC enrichment, 35 of which were examined with CMA after PC enrichment. Results revealed that after PC enrichment, CMA was able to detect chromosomal abnormalities in 34 of 35 specimens tested (97.1%), compared to 21 and 32 specimens (60% and 91.4%, respectively) achieved by CC and FISH, respectively, which were similar to the abnormality detection rates among all 89 specimens (59.5% by CC and 92.1% by FISH). In addition, as the only technique capable of detecting copy neutral loss of heterozygosity (CN-LOH) and chromothripsis, CMA appears to be the most powerful tool in risk stratification as it successfully re-stratified 9 (25.7%) and 12 (34.3%) specimens from standard risk (determined by CC and FISH, respectively) to high risk. Based on the encouraging data presented by our study and others, we conclude that implementation of CMA with PC enrichment is of great value in routine clinical workup in achieving a more complete genetic profile of patients with PCN.
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Affiliation(s)
- Chuanfei Chen
- Cytogenetics Laboratory, Department of Molecular Pathology, Singapore General Hospital, Singapore.
| | - Alvin Soon Tiong Lim
- Cytogenetics Laboratory, Department of Molecular Pathology, Singapore General Hospital, Singapore
| | - Lai Ching Lau
- Cytogenetics Laboratory, Department of Molecular Pathology, Singapore General Hospital, Singapore
| | - Tse Hui Lim
- Cytogenetics Laboratory, Department of Molecular Pathology, Singapore General Hospital, Singapore
| | - Evelyn Yee Hsieh Heng
- Cytogenetics Laboratory, Department of Molecular Pathology, Singapore General Hospital, Singapore
| | - Sim Leng Tien
- Cytogenetics Laboratory, Department of Molecular Pathology, Singapore General Hospital, Singapore; Department of Haematology, Singapore General Hospital, Singapore
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10
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Barilà G, Bonaldi L, Grassi A, Martines A, Liço A, Macrì N, Nalio S, Pavan L, Berno T, Branca A, Calabretto G, Carrino M, Teramo A, Manni S, Piazza F, Semenzato G, Zambello R. Identification of the true hyperdiploid multiple myeloma subset by combining conventional karyotyping and FISH analysis. Blood Cancer J 2020; 10:18. [PMID: 32066724 PMCID: PMC7026173 DOI: 10.1038/s41408-020-0285-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
- Gregorio Barilà
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padua University School of Medicine, Padua, Italy
| | - Laura Bonaldi
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Angela Grassi
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Annalisa Martines
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Albana Liço
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padua University School of Medicine, Padua, Italy
| | - Nadia Macrì
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Silvia Nalio
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Laura Pavan
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padua University School of Medicine, Padua, Italy
| | - Tamara Berno
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padua University School of Medicine, Padua, Italy
| | - Antonio Branca
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padua University School of Medicine, Padua, Italy
| | - Giulia Calabretto
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padua University School of Medicine, Padua, Italy
| | - Marilena Carrino
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padua University School of Medicine, Padua, Italy
| | - Antonella Teramo
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padua University School of Medicine, Padua, Italy
| | - Sabrina Manni
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padua University School of Medicine, Padua, Italy
| | - Francesco Piazza
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padua University School of Medicine, Padua, Italy
| | - Gianpietro Semenzato
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padua University School of Medicine, Padua, Italy
| | - Renato Zambello
- Department of Medicine (DIMED), Hematology and Clinical Immunology section, Padua University School of Medicine, Padua, Italy.
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11
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Prognostic Value of 1q21 Gain in Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e159-e164. [DOI: 10.1016/j.clml.2018.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 06/29/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022]
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12
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Saxe D, Seo EJ, Bergeron MB, Han JY. Recent advances in cytogenetic characterization of multiple myeloma. Int J Lab Hematol 2018; 41:5-14. [PMID: 29971938 DOI: 10.1111/ijlh.12882] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/08/2018] [Indexed: 12/21/2022]
Abstract
The detection of cytogenetic abnormalities in multiple myeloma (MM) has received more importance over last years for risk stratification and the new risk-adapted treatment strategies. Conventional G-banding analysis should be included in a routine procedure for the initial diagnostic workup for patients suspected of MM. However, the detection of chromosomal abnormalities in MM by conventional cytogenetics is limited owing to the low proliferative activity of malignant plasma cells as well as the low number of plasma cells in bone marrow specimens. Fluorescence in situ hybridization (FISH) or microarray-based technologies can overcome some of those drawbacks and detect specific target arrangements as well as chromosomal copy number changes. In this review, we will discuss different cytogenetic approaches and compare their strength and weakness to provide genetic information for risk stratification and prediction of outcome in MM patients.
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Affiliation(s)
- Debra Saxe
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Eul-Ju Seo
- Department of Laboratory Medicine, College of Medicine and Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Melanie Beaulieu Bergeron
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Jin-Yeong Han
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
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13
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Walker BA. Whole Exome Sequencing in Multiple Myeloma to Identify Somatic Single Nucleotide Variants and Key Translocations Involving Immunoglobulin Loci and MYC. Methods Mol Biol 2018; 1792:71-95. [PMID: 29797253 DOI: 10.1007/978-1-4939-7865-6_6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Multiple myeloma is a malignancy of terminally differentiated plasma cells in the bone marrow. These plasma cells produce high levels of immunoglobulin which cause end-organ damage. Rearrangements within the immunoglobulin loci are a physiological part of B cell development, but these DNA level double-strand breaks may result in interchromosomal translocations. There are five main translocations involving the Ig loci: t(4;14) 12%, t(6;14) 1%, t(11;14) 15%, t(14;16) 3%, and t(14;20) 2%. These are primary events, found in all cells within the tumor clone and are associated with different prognosis. The t(4;14), t(14;16), and t(14;20) are associated with a poor prognosis, whereas the others are associated with a more favorable prognosis. Rearrangements at the MYC locus are also associated with a poor prognosis and increased expression of MYC. MYC rearrangements are frequent (25%) and involve interchromosomal translocations involving Ig loci or other partners, but also include intrachromosomal inversions, duplications and deletions. As such, the Ig and MYC loci are key players in the myeloma genome and including these in any genomic studies is key to understanding the relationship with other abnormalities. We have designed a custom capture of the Ig and MYC loci which can be added to exome or targeted captures to inform on these key events. This saves on performing additional tests to determine these events, which are generally mandatory for any genetic investigations in myeloma. This custom capture is also relevant to other B cell malignancies where MYC and Ig translocations occur.
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Affiliation(s)
- Brian A Walker
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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14
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Automatic digital quantification of bone marrow myeloma volume in appendicular skeletons - clinical implications and prognostic significance. Sci Rep 2017; 7:12885. [PMID: 29018236 PMCID: PMC5635114 DOI: 10.1038/s41598-017-13255-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/22/2017] [Indexed: 12/26/2022] Open
Abstract
Multiple myeloma (MM) is a clonal plasma cell disorder originating in bone marrow. Whole body low-dose multidetector CT (MDCT) can depict bone marrow infiltration by myeloma cells into the adipose-rich fatty marrow of the appendicular skeleton. However, automated and objective volume measurement of bone marrow infiltration has not been established, and its clinical relevance remains unclear. We therefore developed novel CT post-processing software (MABLE software) and measured the total sum of CT values (cumulative CT value, cCTv) representing bone marrow infiltration, by combining volume and voxel-based CT values. The cCTv was greater in patients with symptomatic MM than in those with smouldering MM or monoclonal gammopathy of unknown significance. Patients with revised International Staging System (R-ISS) III had a higher cCTv than those with R-ISS I or II. Age, albumin, and M-protein levels independently predicted cCTv. Mixed graphical model analysis revealed direct relationships between cCTv and age or R-ISS. Tree-structured survival analysis and multivariate Cox analysis revealed that a cCTv greater than or equal to 4.4 was independently prognostic for overall survival. Anti-myeloma therapy reduced cCTv after treatment. These findings suggest that the automatically calculated cCTv reflects disease aggressiveness and is useful for accurate prognostic prediction in MM patients.
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15
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Granzow M, Hegenbart U, Hinderhofer K, Hose D, Seckinger A, Bochtler T, Hemminki K, Goldschmidt H, Schönland SO, Jauch A. Novel recurrent chromosomal aberrations detected in clonal plasma cells of light chain amyloidosis patients show potential adverse prognostic effect: first results from a genome-wide copy number array analysis. Haematologica 2017; 102:1281-1290. [PMID: 28341732 PMCID: PMC5566044 DOI: 10.3324/haematol.2016.160721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/15/2017] [Indexed: 01/12/2023] Open
Abstract
Immunoglobulin light chain (AL) amyloidosis is a rare plasma cell dyscrasia characterized by the deposition of abnormal amyloid fibrils in multiple organs, thus impairing their function. In the largest cohort studied up to now of 118 CD138-purified plasma cell samples from previously untreated immunoglobulin light chain amyloidosis patients, we assessed in parallel copy number alterations using high-density copy number arrays and interphase fluorescence in situ hybridization (iFISH). We used fluorescence in situ hybridization probes for the IgH translocations t(11;14), t(4;14), and t(14;16) or any other IgH rearrangement as well as numerical aberrations of the chromosome loci 1q21, 8p21, 5p15/5q35, 11q22.3 or 11q23, 13q14, 15q22, 17p13, and 19q13. Recurrent gains included chromosomes 1q (36%), 9 (24%), 11q (24%), as well as 19 (15%). Recurrent losses affected chromosome 13 (29% monosomy) and partial losses of 14q (19%), 16q (14%) and 13q (12%), respectively. In 88% of patients with translocation t(11;14), the hallmark chromosomal aberration in AL amyloidosis, a concomitant gain of 11q22.3/11q23 detected by iFISH was part of the unbalanced translocation der(14)t(11;14)(q13;q32) with the breakpoint in the CCND1/MYEOV gene region. Partial loss of chromosome regions 14q and 16q were significantly associated to gain 1q. Gain 1q21 detected by iFISH almost always resulted from a gain of the long arm of chromosome 1 and not from trisomy 1, whereas deletions on chromosome 1p were rarely found. Overall and event-free survival analysis found a potential adverse prognostic effect of concomitant gain 1q and deletion 14q as well as of deletion 1p. In conclusion, in the first whole genome report of clonal plasma cells in AL amyloidosis, novel aberrations and hitherto unknown potential adverse prognostic effects were uncovered.
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Affiliation(s)
- Martin Granzow
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - Ute Hegenbart
- Department of Internal Medicine V, Hematology/Oncology, Amyloidosis Center, University of Heidelberg, Heidelberg, Germany
| | - Katrin Hinderhofer
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - Dirk Hose
- Department of Internal Medicine V, Hematology/Oncology, Amyloidosis Center, University of Heidelberg, Heidelberg, Germany
| | - Anja Seckinger
- Department of Internal Medicine V, Hematology/Oncology, Amyloidosis Center, University of Heidelberg, Heidelberg, Germany
| | - Tilmann Bochtler
- Department of Internal Medicine V, Hematology/Oncology, Amyloidosis Center, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, Hematology/Oncology, Amyloidosis Center, University of Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany
| | - Stefan O Schönland
- Department of Internal Medicine V, Hematology/Oncology, Amyloidosis Center, University of Heidelberg, Heidelberg, Germany
| | - Anna Jauch
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
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16
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Grzasko N, Hajek R, Hus M, Chocholska S, Morawska M, Giannopoulos K, Czarnocki K, Druzd-Sitek A, Pienkowska-Grela B, Rygier J, Usnarska-Zubkiewicz L, Dytfeld D, Kubicki T, Jurczyszyn A, Korpysz M, Dmoszynska A. Chromosome 1 amplification has similar prognostic value to del(17p13) and t(4;14)(p16;q32) in multiple myeloma patients: analysis of real-life data from the Polish Myeloma Study Group. Leuk Lymphoma 2017; 58:1-15. [DOI: 10.1080/10428194.2016.1272684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Norbert Grzasko
- Department of Hematology, St. John’s Cancer Center, Lublin, Poland
- Department of Experimental Hematooncology, Medical University of Lublin, Lublin, Poland
| | - Roman Hajek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Marek Hus
- Department of Experimental Hematooncology, Medical University of Lublin, Lublin, Poland
| | - Sylwia Chocholska
- Department of Experimental Hematooncology, Medical University of Lublin, Lublin, Poland
| | - Marta Morawska
- Department of Hematology, St. John’s Cancer Center, Lublin, Poland
| | - Krzysztof Giannopoulos
- Department of Hematology, St. John’s Cancer Center, Lublin, Poland
- Department of Experimental Hematooncology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Czarnocki
- Department of Hematology, St. John’s Cancer Center, Lublin, Poland
- Department of Ergonomics, Faculty of Management, Lublin University of Technology, Lublin, Poland
| | - Agnieszka Druzd-Sitek
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | - Barbara Pienkowska-Grela
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | - Jolanta Rygier
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | - Lidia Usnarska-Zubkiewicz
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Dominik Dytfeld
- Department of Hematology and Bone Marrow Transplantation Poznan, Poznan University of Medical Sciences, Poland
| | - Tadeusz Kubicki
- Department of Hematology and Bone Marrow Transplantation Poznan, Poznan University of Medical Sciences, Poland
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
| | - Maciej Korpysz
- Department of Biochemical Diagnostics, Medical University of Lublin, Lublin, Poland
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17
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Abstract
Multiple myeloma is a heterogeneous disease. Its chromosomal abnormalities have been extensively studied with a view to accurate prognostication and personalized therapy. Here, we describe the techniques commonly employed for elucidating chromosomal aberrations, prognostic impact of recurrent chromosomal abnormalities, and recently updated risk stratification systems.
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Affiliation(s)
- Nelson Chun Ngai Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong.
| | - Natalie Pui Ha Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong
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18
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Manier S, Salem KZ, Park J, Landau DA, Getz G, Ghobrial IM. Genomic complexity of multiple myeloma and its clinical implications. Nat Rev Clin Oncol 2016; 14:100-113. [DOI: 10.1038/nrclinonc.2016.122] [Citation(s) in RCA: 293] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Harbhajanka A, Brickman A, Park JW, Reddy VB, Bitterman P, Gattuso P. Cytomorphology, clinicopathologic, and cytogenetics correlation of myelomatous effusion of serous cavities: A retrospective review. Diagn Cytopathol 2016; 44:742-7. [DOI: 10.1002/dc.23523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Aparna Harbhajanka
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Arlen Brickman
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Ji-Weon Park
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Vijaya B Reddy
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Pincas Bitterman
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Paolo Gattuso
- Department of Pathology; Rush University Medical Center; Chicago Illinois
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20
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Mitchell JS, Li N, Weinhold N, Försti A, Ali M, van Duin M, Thorleifsson G, Johnson DC, Chen B, Halvarsson BM, Gudbjartsson DF, Kuiper R, Stephens OW, Bertsch U, Broderick P, Campo C, Einsele H, Gregory WA, Gullberg U, Henrion M, Hillengass J, Hoffmann P, Jackson GH, Johnsson E, Jöud M, Kristinsson SY, Lenhoff S, Lenive O, Mellqvist UH, Migliorini G, Nahi H, Nelander S, Nickel J, Nöthen MM, Rafnar T, Ross FM, da Silva Filho MI, Swaminathan B, Thomsen H, Turesson I, Vangsted A, Vogel U, Waage A, Walker BA, Wihlborg AK, Broyl A, Davies FE, Thorsteinsdottir U, Langer C, Hansson M, Kaiser M, Sonneveld P, Stefansson K, Morgan GJ, Goldschmidt H, Hemminki K, Nilsson B, Houlston RS. Genome-wide association study identifies multiple susceptibility loci for multiple myeloma. Nat Commun 2016; 7:12050. [PMID: 27363682 PMCID: PMC4932178 DOI: 10.1038/ncomms12050] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/24/2016] [Indexed: 02/08/2023] Open
Abstract
Multiple myeloma (MM) is a plasma cell malignancy with a significant heritable basis. Genome-wide association studies have transformed our understanding of MM predisposition, but individual studies have had limited power to discover risk loci. Here we perform a meta-analysis of these GWAS, add a new GWAS and perform replication analyses resulting in 9,866 cases and 239,188 controls. We confirm all nine known risk loci and discover eight new loci at 6p22.3 (rs34229995, P=1.31 × 10(-8)), 6q21 (rs9372120, P=9.09 × 10(-15)), 7q36.1 (rs7781265, P=9.71 × 10(-9)), 8q24.21 (rs1948915, P=4.20 × 10(-11)), 9p21.3 (rs2811710, P=1.72 × 10(-13)), 10p12.1 (rs2790457, P=1.77 × 10(-8)), 16q23.1 (rs7193541, P=5.00 × 10(-12)) and 20q13.13 (rs6066835, P=1.36 × 10(-13)), which localize in or near to JARID2, ATG5, SMARCD3, CCAT1, CDKN2A, WAC, RFWD3 and PREX1. These findings provide additional support for a polygenic model of MM and insight into the biological basis of tumour development.
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Affiliation(s)
- Jonathan S. Mitchell
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Ni Li
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Niels Weinhold
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
- Department of Internal Medicine V, University of Heidelberg, 69117 Heidelberg, Germany
| | - Asta Försti
- German Cancer Research Center, 69120 Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, SE-205 02 Malmo, Sweden
| | - Mina Ali
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84 Lund, Sweden
| | - Mark van Duin
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA Rotterdam, The Netherlands
| | | | - David C. Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, Surrey SM2 5NG, UK
| | - Bowang Chen
- German Cancer Research Center, 69120 Heidelberg, Germany
| | - Britt-Marie Halvarsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84 Lund, Sweden
| | - Daniel F. Gudbjartsson
- deCODE Genetics, Sturlugata 8, IS-101 Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, IS-101 Reykjavik, Iceland
| | - Rowan Kuiper
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA Rotterdam, The Netherlands
| | - Owen W. Stephens
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
| | - Uta Bertsch
- Department of Internal Medicine V, University of Heidelberg, 69117 Heidelberg, Germany
- National Centre of Tumor Diseases, 69120 Heidelberg, Germany
| | - Peter Broderick
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Chiara Campo
- German Cancer Research Center, 69120 Heidelberg, Germany
| | | | - Walter A. Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds LS2 9PH, UK
| | - Urban Gullberg
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84 Lund, Sweden
| | - Marc Henrion
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Jens Hillengass
- Department of Internal Medicine V, University of Heidelberg, 69117 Heidelberg, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, D-53127 Bonn, Germany
- Division of Medical Genetics, Department of Biomedicine, University of Basel, 4003 Basel, Switzerland
| | | | - Ellinor Johnsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84 Lund, Sweden
| | - Magnus Jöud
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84 Lund, Sweden
- Clinical Immunology and Transfusion Medicine, Laboratory Medicine, Office of Medical Services, SE-221 85 Lund, Sweden
| | - Sigurður Y. Kristinsson
- Department of Hematology, Landspitali, National University Hospital of Iceland, IS-101 Reykjavik, Iceland
| | - Stig Lenhoff
- Hematology Clinic, Skåne University Hospital, SE-221 85 Lund, Sweden
| | - Oleg Lenive
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Ulf-Henrik Mellqvist
- Section of Hematology, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - Gabriele Migliorini
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Hareth Nahi
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Sven Nelander
- Rudbeck Laboratory, Department of Immunology, Pathology and Genetics, Uppsala University, SE-751 05 Uppsala, Sweden
| | - Jolanta Nickel
- Department of Internal Medicine V, University of Heidelberg, 69117 Heidelberg, Germany
| | - Markus M. Nöthen
- Institute of Human Genetics, University of Bonn, D-53127 Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, D-53127 Bonn, Germany
| | - Thorunn Rafnar
- deCODE Genetics, Sturlugata 8, IS-101 Reykjavik, Iceland
| | - Fiona M. Ross
- Wessex Regional Genetics Laboratory, University of Southampton, Salisbury SP2 8BJ, UK
| | | | - Bhairavi Swaminathan
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84 Lund, Sweden
| | - Hauke Thomsen
- German Cancer Research Center, 69120 Heidelberg, Germany
| | - Ingemar Turesson
- Hematology Clinic, Skåne University Hospital, SE-221 85 Lund, Sweden
| | - Annette Vangsted
- Department of Haematology, University Hospital of Copenhagen at Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Ulla Vogel
- National Research Centre for the Working Environment, DK-2100 Copenhagen, Denmark
| | - Anders Waage
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Box 8905, N-7491 Trondheim, Norway
| | - Brian A. Walker
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
| | - Anna-Karin Wihlborg
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84 Lund, Sweden
| | - Annemiek Broyl
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA Rotterdam, The Netherlands
| | - Faith E. Davies
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
| | - Unnur Thorsteinsdottir
- deCODE Genetics, Sturlugata 8, IS-101 Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, IS-101 Reykjavik, Iceland
| | - Christian Langer
- Department of Internal Medicine III, University of Ulm, D-89081 Ulm, Germany
| | - Markus Hansson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84 Lund, Sweden
- Hematology Clinic, Skåne University Hospital, SE-221 85 Lund, Sweden
| | - Martin Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, Surrey SM2 5NG, UK
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, 3075 EA Rotterdam, The Netherlands
| | | | - Gareth J. Morgan
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, 69117 Heidelberg, Germany
- National Centre of Tumor Diseases, 69120 Heidelberg, Germany
| | - Kari Hemminki
- German Cancer Research Center, 69120 Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, SE-205 02 Malmo, Sweden
| | - Björn Nilsson
- Hematology and Transfusion Medicine, Department of Laboratory Medicine, BMC B13, SE-221 84 Lund, Sweden
- Clinical Immunology and Transfusion Medicine, Laboratory Medicine, Office of Medical Services, SE-221 85 Lund, Sweden
- Broad Institute, 7 Cambridge Center, Cambridge, Massachusetts 02142, USA
| | - Richard S. Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
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21
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Lehners N, Hayden PJ, Goldschmidt H, Raab MS. Management of high-risk Myeloma: an evidence-based review of treatment strategies. Expert Rev Hematol 2016; 9:753-65. [PMID: 27337562 DOI: 10.1080/17474086.2016.1204908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Despite the progress made in the treatment of patients with multiple myeloma over recent decades, a significant cohort with high-risk disease as defined by specific clinical and genetic criteria continue to respond poorly to standard treatment. These patients represent a particular challenge to the treating physician and require early identification as well as personalized treatment strategies. AREAS COVERED In this review, we discuss the prognostic impact of adverse clinical, radiological and genetic factors, evaluate available scoring systems and highlight key aspects of the therapeutic management of high-risk myeloma. MEDLINE and recent scientific meetings' databases were searched for the keywords 'high-risk' and 'multiple myeloma' and relevant studies relating to both diagnostic and therapeutic approaches were identified. Expert commentary: A case is made for intensive induction using combinations of novel agents, early high-dose therapy supported by autologous stem cell transplantation and the widespread use of maintenance therapies. Novel therapeutic options, especially in the field of immunotherapy, are currently explored in clinical trials and have the potential to further improve outcomes for patients with high-risk multiple myeloma.
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Affiliation(s)
- Nicola Lehners
- a Department of Hematology , University Hospital of Heidelberg , Heidelberg , Germany
| | - Patrick J Hayden
- b Academic Department of Haematology , St. James's Hospital, Trinity College Dublin, College Green , Dublin 2 , Ireland
| | - Hartmut Goldschmidt
- a Department of Hematology , University Hospital of Heidelberg , Heidelberg , Germany
| | - Marc-Steffen Raab
- a Department of Hematology , University Hospital of Heidelberg , Heidelberg , Germany
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22
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Franssen LE, Raymakers RAP, Buijs A, Schmitz MF, van Dorp S, Mutis T, Lokhorst HM, van de Donk NWCJ. Outcome of allogeneic transplantation in newly diagnosed and relapsed/refractory multiple myeloma: long-term follow-up in a single institution. Eur J Haematol 2016; 97:479-488. [DOI: 10.1111/ejh.12758] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Laurens E. Franssen
- Department of Hematology; University Medical Center Utrecht; Utrecht the Netherlands
- Department of Hematology; VU University Medical Center; Amsterdam the Netherlands
| | | | - Arjan Buijs
- Department of Genetics; University Medical Center Utrecht; Utrecht the Netherlands
| | - Marian F. Schmitz
- Department of Hematology; University Medical Center Utrecht; Utrecht the Netherlands
| | - Suzanne van Dorp
- Department of Hematology; Radboud University Medical Center; Nijmegen the Netherlands
| | - Tuna Mutis
- Department of Hematology; VU University Medical Center; Amsterdam the Netherlands
| | - Henk M. Lokhorst
- Department of Hematology; University Medical Center Utrecht; Utrecht the Netherlands
- Department of Hematology; VU University Medical Center; Amsterdam the Netherlands
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23
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Johnson DC, Weinhold N, Mitchell J, Chen B, Stephens OW, Försti A, Nickel J, Kaiser M, Gregory WA, Cairns D, Jackson GH, Hoffmann P, Noethen MM, Hillengass J, Bertsch U, Barlogie B, Davis FE, Hemminki K, Goldschmidt H, Houlston RS, Morgan GJ. Genetic factors influencing the risk of multiple myeloma bone disease. Leukemia 2016; 30:883-8. [PMID: 26669972 PMCID: PMC4832071 DOI: 10.1038/leu.2015.342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/25/2015] [Accepted: 11/30/2015] [Indexed: 01/18/2023]
Abstract
A major complication of multiple myeloma (MM) is the development of osteolytic lesions, fractures and bone pain. To identify genetic variants influencing the development of MM bone disease (MBD), we analyzed MM patients of European ancestry (totaling 3774), which had been radiologically surveyed for MBD. Each patient had been genotyped for ~6 00 000 single-nucleotide polymorphisms with genotypes for six million common variants imputed using 1000 Genomes Project and UK10K as reference. We identified a locus at 8q24.12 for MBD (rs4407910, OPG/TNFRSF11B, odds ratio=1.38, P=4.09 × 10(-9)) and a promising association at 19q13.43 (rs74676832, odds ratio=1.97, P=9.33 × 10(-7)). Our findings demonstrate that germline variation influences MBD and highlights the importance of RANK/RANKL/OPG pathway in MBD development. These findings will contribute to the development of future strategies for prevention of MBD in the early precancerous phases of MM.
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Affiliation(s)
- D C Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - N Weinhold
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - J Mitchell
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - B Chen
- German Cancer Research Center, Heidelberg, Germany
| | - O W Stephens
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - A Försti
- German Cancer Research Center, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - J Nickel
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - M Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - W A Gregory
- Leeds Institute of Molecular Medicine, Section of Clinical Trials Research, University of Leeds, Leeds, UK
| | - D Cairns
- Leeds Institute of Molecular Medicine, Section of Clinical Trials Research, University of Leeds, Leeds, UK
| | - G H Jackson
- Department of Haematology, Newcastle University, Newcastle-Upon-Tyne, UK
| | - P Hoffmann
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Division of Medical Genetics, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - M M Noethen
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - J Hillengass
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - U Bertsch
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - B Barlogie
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - F E Davis
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K Hemminki
- German Cancer Research Center, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - H Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
- National Center of Tumor Diseases, Heidelberg, Germany
| | - R S Houlston
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - G J Morgan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group. Blood 2016; 127:2955-62. [PMID: 27002115 DOI: 10.1182/blood-2016-01-631200] [Citation(s) in RCA: 615] [Impact Index Per Article: 76.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/08/2016] [Indexed: 02/07/2023] Open
Abstract
The International Myeloma Working Group consensus updates the definition for high-risk (HR) multiple myeloma based on cytogenetics Several cytogenetic abnormalities such as t(4;14), del(17/17p), t(14;16), t(14;20), nonhyperdiploidy, and gain(1q) were identified that confer poor prognosis. The prognosis of patients showing these abnormalities may vary with the choice of therapy. Treatment strategies have shown promise for HR cytogenetic diseases, such as proteasome inhibition in combination with lenalidomide/pomalidomide, double autologous stem cell transplant plus bortezomib, or combination of immunotherapy with lenalidomide or pomalidomide. Careful analysis of cytogenetic subgroups in trials comparing different treatments remains an important goal. Cross-trial comparisons may provide insight into the effect of new drugs in patients with cytogenetic abnormalities. However, to achieve this, consensus on definitions of analytical techniques, proportion of abnormal cells, and treatment regimens is needed. Based on data available today, bortezomib and carfilzomib treatment appear to improve complete response, progression-free survival, and overall survival in t(4;14) and del(17/17p), whereas lenalidomide may be associated with improved progression-free survival in t(4;14) and del(17/17p). Patients with multiple adverse cytogenetic abnormalities do not benefit from these agents. FISH data are implemented in the revised International Staging System for risk stratification.
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26
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Johnson DC, Weinhold N, Mitchell JS, Chen B, Kaiser M, Begum DB, Hillengass J, Bertsch U, Gregory WA, Cairns D, Jackson GH, Försti A, Nickel J, Hoffmann P, Nöethen MM, Stephens OW, Barlogie B, Davis FE, Hemminki K, Goldschmidt H, Houlston RS, Morgan GJ. Genome-wide association study identifies variation at 6q25.1 associated with survival in multiple myeloma. Nat Commun 2016; 7:10290. [PMID: 26743840 PMCID: PMC4729868 DOI: 10.1038/ncomms10290] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/25/2015] [Indexed: 01/08/2023] Open
Abstract
Survival following a diagnosis of multiple myeloma (MM) varies between patients and some of these differences may be a consequence of inherited genetic variation. In this study, to identify genetic markers associated with MM overall survival (MM-OS), we conduct a meta-analysis of four patient series of European ancestry, totalling 3,256 patients with 1,200 MM-associated deaths. Each series is genotyped for ∼600,000 single nucleotide polymorphisms across the genome; genotypes for six million common variants are imputed using 1000 Genomes Project and UK10K as the reference. The association between genotype and OS is assessed by Cox proportional hazards model adjusting for age, sex, International staging system and treatment. We identify a locus at 6q25.1 marked by rs12374648 associated with MM-OS (hazard ratio=1.34, 95% confidence interval=1.22-1.48, P=4.69 × 10(-9)). Our findings have potential clinical implications since they demonstrate that inherited genotypes can provide prognostic information in addition to conventional tumor acquired prognostic factors.
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Affiliation(s)
- David C. Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, London SW7 3RP, UK
| | - Niels Weinhold
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
- Department of Internal Medicine V, University of Heidelberg, 69120 Heidelberg, Germany
| | - Jonathan S. Mitchell
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SW7 3RP, UK
| | - Bowang Chen
- German Cancer Research Center, 69121 Heidelberg, Germany
| | - Martin Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London SW7 3RP, UK
| | - Dil B. Begum
- Division of Molecular Pathology, The Institute of Cancer Research, London SW7 3RP, UK
| | - Jens Hillengass
- Department of Internal Medicine V, University of Heidelberg, 69120 Heidelberg, Germany
| | - Uta Bertsch
- Department of Internal Medicine V, University of Heidelberg, 69120 Heidelberg, Germany
| | - Walter A. Gregory
- Leeds Institute of Molecular Medicine, Section of Clinical Trials Research, University of Leeds, Leeds LS2 9PH, UK
| | - David Cairns
- Leeds Institute of Molecular Medicine, Section of Clinical Trials Research, University of Leeds, Leeds LS2 9PH, UK
| | - Graham H. Jackson
- Department of Haematology, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK
| | - Asta Försti
- German Cancer Research Center, 69121 Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, 221 00 Malmö, Sweden
| | - Jolanta Nickel
- Department of Internal Medicine V, University of Heidelberg, 69120 Heidelberg, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, D-53127 Bonn, Germany
- Division of Medical Genetics, Department of Biomedicine, University of Basel, 4031 Basel, Switzerland
| | - Markus M. Nöethen
- Institute of Human Genetics, University of Bonn, D-53127 Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, D-53127 Bonn, Germany
| | - Owen W. Stephens
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
| | - Bart Barlogie
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
| | - Faith E. Davis
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
| | - Kari Hemminki
- German Cancer Research Center, 69121 Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, 221 00 Malmö, Sweden
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, 69120 Heidelberg, Germany
- National Center of Tumor Diseases, 69120 Heidelberg, Germany
| | - Richard S. Houlston
- Division of Molecular Pathology, The Institute of Cancer Research, London SW7 3RP, UK
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SW7 3RP, UK
| | - Gareth J. Morgan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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27
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Abstract
Multiple myeloma (MM) is a genetically complex disease. The past few years have seen an evolution in cancer research with the emergence of next-generation sequencing (NGS), enabling high throughput sequencing of tumors-including whole exome, whole genome, RNA, and single-cell sequencing as well as genome-wide association study (GWAS). A few inherited variants have been described, counting for some cases of familial disease. Hierarchically, primary events in MM can be divided into hyperdiploid (HDR) and nonhyperdiploid subtypes. HRD tumors are characterized by trisomy of chromosomes 3, 5, 7, 9, 11, 15, 19, and/or 21. Non-HRD tumors harbor IGH translocations, mainly t(4;14), t(6;14), t(11;14), t(14;16), and t(14;20). Secondary events participate to the tumor progression and consist in secondary translocation involving MYC, copy number variations (CNV) and somatic mutations (such as mutations in KRAS, NRAS, BRAF, P53). Moreover, the dissection of clonal heterogeneity helps to understand the evolution of the disease. The following review provides a comprehensive review of the genomic landscape in MM.
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Affiliation(s)
- Salomon Manier
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
- Department of Hematology, Lille Hospital University, Lille, France
| | - Karma Salem
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Siobhan V Glavey
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Aldo M Roccaro
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
- Department of Hematology, CREA Laboratory, ASST-Spedali Civili di Brescia, Brescia, BS, Italy
| | - Irene M Ghobrial
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
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28
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Stella F, Pedrazzini E, Agazzoni M, Ballester O, Slavutsky I. Cytogenetic Alterations in Multiple Myeloma: Prognostic Significance and the Choice of Frontline Therapy. Cancer Invest 2015; 33:496-504. [DOI: 10.3109/07357907.2015.1080833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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29
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Molecular Classification and Pharmacogenetics of Primary Plasma Cell Leukemia: An Initial Approach toward Precision Medicine. Int J Mol Sci 2015; 16:17514-34. [PMID: 26263974 PMCID: PMC4581206 DOI: 10.3390/ijms160817514] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive variant of multiple myeloma (MM) which may represent a valid model for high-risk MM. This disease is associated with a very poor prognosis, and unfortunately, it has not significantly improved during the last three decades. New high-throughput technologies have allowed a better understanding of the molecular basis of this disease and moved toward risk stratification, providing insights for targeted therapy studies. This knowledge, added to the pharmacogenetic profile of new and old agents in the analysis of efficacy and safety, could contribute to help clinical decisions move toward a precision medicine and a better clinical outcome for these patients. In this review, we describe the available literature concerning the genomic characterization and pharmacogenetics of plasma cell leukemia (PCL).
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30
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Coexistent hyperdiploidy does not abrogate poor prognosis in myeloma with adverse cytogenetics and may precede IGH translocations. Blood 2014; 125:831-40. [PMID: 25428216 DOI: 10.1182/blood-2014-07-584268] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The acquisition of the cytogenetic abnormalities hyperdiploidy or translocations into the immunoglobulin gene loci are considered as initiating events in the pathogenesis of myeloma and were often assumed to be mutually exclusive. These lesions have clinical significance; hyperdiploidy or the presence of the t(11;14) translocation is associated with a favorable outcome, whereas t(4;14), t(14;16), and t(14;20) are unfavorable. Poor outcomes are magnified when lesions occur in association with other high-risk features, del17p and +1q. Some patients have coexistence of both good and poor prognostic lesions, and there has been no consensus on their risk status. To address this, we have investigated their clinical impact using cases in the Myeloma IX study (ISRCTN68454111) and shown that the coexistence of hyperdiploidy or t(11;14) does not abrogate the poor prognosis associated with adverse molecular lesions, including translocations. We have also used single-cell analysis to study cases with coexistent translocations and hyperdiploidy to determine how these lesions cosegregate within the clonal substructure, and we have demonstrated that hyperdiploidy may precede IGH translocation in a proportion of patients. These findings have important clinical and biological implications, as we conclude patients with coexistence of adverse lesions and hyperdiploidy should be considered high risk and treated accordingly.
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31
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van de Donk NWCJ, Sonneveld P. Diagnosis and risk stratification in multiple myeloma. Hematol Oncol Clin North Am 2014; 28:791-813. [PMID: 25212883 DOI: 10.1016/j.hoc.2014.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Multiple myeloma (MM) is a tumor of monoclonal plasma cells, which produce a monoclonal antibody and expand predominantly in the bone marrow. Patients present with hypercalcemia, renal impairment, anemia, and/or bone disease. Only patients with symptomatic MM require therapy, whereas asymptomatic patients receive regular follow-up. Survival of patients with MM is very heterogeneous. The variety in outcome is explained by host factors as well as tumor-related characteristics reflecting biology of the MM clone and tumor burden. The identification of cytogenetic abnormalities by fluorescence in situ hybridization is currently the most important and widely available prognostic factor in MM.
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Affiliation(s)
- Niels W C J van de Donk
- Department of Hematology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, 's Gravendijkwal 230, Rotterdam 3015CE, The Netherlands.
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32
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The genetic architecture of multiple myeloma. Adv Hematol 2014; 2014:864058. [PMID: 24803933 PMCID: PMC3996928 DOI: 10.1155/2014/864058] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/16/2014] [Indexed: 11/18/2022] Open
Abstract
Multiple myeloma is a malignant proliferation of monoclonal plasma cells leading to clinical features that include hypercalcaemia, renal dysfunction, anaemia, and bone disease (frequently referred to by the acronym CRAB) which represent evidence of end organ failure. Recent evidence has revealed myeloma to be a highly heterogeneous disease composed of multiple molecularly-defined subtypes each with varying clinicopathological features and disease outcomes. The major division within myeloma is between hyperdiploid and nonhyperdiploid subtypes. In this division, hyperdiploid myeloma is characterised by trisomies of certain odd numbered chromosomes, namely, 3, 5, 7, 9, 11, 15, 19, and 21 whereas nonhyperdiploid myeloma is characterised by translocations of the immunoglobulin heavy chain alleles at chromosome 14q32 with various partner chromosomes, the most important of which being 4, 6, 11, 16, and 20. Hyperdiploid and nonhyperdiploid changes appear to represent early or even initiating mutagenic events that are subsequently followed by secondary aberrations including copy number abnormalities, additional translocations, mutations, and epigenetic modifications which lead to plasma cell immortalisation and disease progression. The following review provides a comprehensive coverage of the genetic and epigenetic events contributing to the initiation and progression of multiple myeloma and where possible these abnormalities have been linked to disease prognosis.
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33
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Walker BA, Wardell CP, Brioli A, Boyle E, Kaiser MF, Begum DB, Dahir NB, Johnson DC, Ross FM, Davies FE, Morgan GJ. Translocations at 8q24 juxtapose MYC with genes that harbor superenhancers resulting in overexpression and poor prognosis in myeloma patients. Blood Cancer J 2014; 4:e191. [PMID: 24632883 PMCID: PMC3972699 DOI: 10.1038/bcj.2014.13] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/06/2014] [Indexed: 02/06/2023] Open
Abstract
Secondary MYC translocations in myeloma have been shown to be important in the pathogenesis and progression of disease. Here, we have used a DNA capture and massively parallel sequencing approach to identify the partner chromosomes in 104 presentation myeloma samples. 8q24 breakpoints were identified in 21 (20%) samples with partner loci including IGH, IGK and IGL, which juxtapose the immunoglobulin (Ig) enhancers next to MYC in 8/23 samples. The remaining samples had partner loci including XBP1, FAM46C, CCND1 and KRAS, which are important in B-cell maturation or myeloma pathogenesis. Analysis of the region surrounding the breakpoints indicated the presence of superenhancers on the partner chromosomes and gene expression analysis showed increased expression of MYC in these samples. Patients with MYC translocations had a decreased progression-free and overall survival. We postulate that translocation breakpoints near MYC result in colocalization of the gene with superenhancers from loci, which are important in the development of the cell type in which they occur. In the case of myeloma these are the Ig loci and those important for plasma cell development and myeloma pathogenesis, resulting in increased expression of MYC and an aggressive disease phenotype.
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Affiliation(s)
- B A Walker
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - C P Wardell
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - A Brioli
- 1] Division of Molecular Pathology, The Institute of Cancer Research, London, UK [2] Istituto di Ematologia Seràgnoli, Università degli Studi di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - E Boyle
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - M F Kaiser
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - D B Begum
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - N B Dahir
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - D C Johnson
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - F M Ross
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury, UK
| | - F E Davies
- Divisions of Molecular Pathology, Cancer Therapeutics and Clinical Sciences, The Institute of Cancer Research, London, UK
| | - G J Morgan
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
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34
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Kim GY, Gabrea A, Demchenko YN, Bergsagel L, Roschke AV, Kuehl WM. Complex IGH rearrangements in multiple myeloma: Frequent detection discrepancies among three different probe sets. Genes Chromosomes Cancer 2014; 53:467-74. [PMID: 24585545 DOI: 10.1002/gcc.22158] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 01/29/2014] [Accepted: 02/03/2014] [Indexed: 11/07/2022] Open
Abstract
Primary IGH translocations involving seven recurrent partner loci and oncogenes are present in about 40% of multiple myeloma tumors. Secondary IGH rearrangements, which occur in a smaller fraction of tumors, usually are complex structures, including insertions or translocations that can involve three chromosomes, and often with involvement of MYC. The main approach to detect IGH rearrangements is interphase-but sometimes metaphase-FISH strategies that use a telomeric variable region probe and a centromeric constant region/ Eα enhancer or 3' flanking probe to detect a separation of these two probes, or a fusion of these probes with probes located at nonrandom partner sites in the genome. We analyzed 18 myeloma cell lines for detection discrepancies among Vysis, Cytocell, and in-house IGH probe sets that hybridize with differing sequences in the IGH locus. There were no detection discrepancies for the three telomeric IGH probes, or for unrearranged IGH loci or primary IGH translocations using the centromeric IGH probes. However, the majority of complex IGH rearrangements had detection discrepancies among the three centromeric IGH probes.
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Affiliation(s)
- Gina Y Kim
- Genetics Branch, National Cancer Institute, Bethesda, MD
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35
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Brioli A, Tacchetti P, Zamagni E, Cavo M. Maintenance therapy in newly diagnosed multiple myeloma: current recommendations. Expert Rev Anticancer Ther 2014; 14:581-94. [PMID: 24579569 DOI: 10.1586/14737140.2014.884930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The recent availability of novel agents has substantially improved the outcomes of patients with Multiple Myeloma (MM). Achieving the deepest level of complete response and maintaining a sustained remission are important steps towards MM cure. To achieve this goal, consolidation and maintenance therapies are currently incorporated into the modern therapeutic paradigm. The excellent activity shown by new drugs has led to their investigational use as maintenance therapy. However, despite promising results of continuous treatment with the novel agents, consensus regarding maintenance therapy still lacks. This review will focus on maintenance therapy, offering an overview of the different strategies available in MM. The issue of continuous treatment in the light of new biological discoveries, including intra-clonal heterogeneity, will also be addressed.
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Affiliation(s)
- Annamaria Brioli
- "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
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36
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Melchor L, Brioli A, Wardell CP, Murison A, Potter NE, Kaiser MF, Fryer RA, Johnson DC, Begum DB, Hulkki Wilson S, Vijayaraghavan G, Titley I, Cavo M, Davies FE, Walker BA, Morgan GJ. Single-cell genetic analysis reveals the composition of initiating clones and phylogenetic patterns of branching and parallel evolution in myeloma. Leukemia 2014; 28:1705-15. [DOI: 10.1038/leu.2014.13] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/26/2013] [Accepted: 12/11/2013] [Indexed: 02/07/2023]
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37
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Chubb D, Weinhold N, Broderick P, Chen B, Johnson DC, Försti A, Vijayakrishnan J, Migliorini G, Dobbins SE, Holroyd A, Hose D, Walker BA, Davies FE, Gregory WA, Jackson GH, Irving JA, Pratt G, Fegan C, Fenton JA, Neben K, Hoffmann P, Nöthen MM, Mühleisen TW, Eisele L, Ross FM, Straka C, Einsele H, Langer C, Dörner E, Allan JM, Jauch A, Morgan GJ, Hemminki K, Houlston RS, Goldschmidt H. Common variation at 3q26.2, 6p21.33, 17p11.2 and 22q13.1 influences multiple myeloma risk. Nat Genet 2013; 45:1221-1225. [PMID: 23955597 PMCID: PMC5053356 DOI: 10.1038/ng.2733] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 07/26/2013] [Indexed: 02/07/2023]
Abstract
To identify variants for multiple myeloma risk, we conducted a genome-wide association study with validation in additional series totaling 4,692 individuals with multiple myeloma (cases) and 10,990 controls. We identified four risk loci at 3q26.2 (rs10936599, P = 8.70 × 10(-14)), 6p21.33 (rs2285803, PSORS1C2, P = 9.67 × 10(-11)), 17p11.2 (rs4273077, TNFRSF13B, P = 7.67 × 10(-9)) and 22q13.1 (rs877529, CBX7, P = 7.63 × 10(-16)). These data provide further evidence for genetic susceptibility to this B-cell hematological malignancy, as well as insight into the biological basis of predisposition.
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Affiliation(s)
- Daniel Chubb
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Niels Weinhold
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Peter Broderick
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Bowang Chen
- German Cancer Research Center, Heidelberg, Germany
| | - David C Johnson
- Haemato-Oncology, Division of Pathology, Institute of Cancer Research, Surrey, UK
| | - Asta Försti
- German Cancer Research Center, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmo, Sweden
| | | | - Gabriele Migliorini
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Sara E Dobbins
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Amy Holroyd
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Dirk Hose
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
- National Centre of Tumour Diseases, Heidelberg, Germany
| | - Brian A Walker
- Haemato-Oncology, Division of Pathology, Institute of Cancer Research, Surrey, UK
| | - Faith E Davies
- Haemato-Oncology, Division of Pathology, Institute of Cancer Research, Surrey, UK
| | | | | | - Julie A Irving
- Newcastle Cancer Centre, Northern Institute for Cancer Research, Medical School, Newcastle University, Newcastle-upon-Tyne, UK
| | - Guy Pratt
- Department of Haematology, Birmingham Heartlands Hospital, Birmingham, UK
| | - Chris Fegan
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Kai Neben
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, University of Bonn, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, University of Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Thomas W Mühleisen
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, University of Bonn, Germany
| | - Lewin Eisele
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Germany
| | - Fiona M Ross
- Cytogenetics Group, Wessex Regional Cytogenetic Laboratory, Salisbury, UK
| | | | | | - Christian Langer
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Elisabeth Dörner
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - James M Allan
- Newcastle Cancer Centre, Northern Institute for Cancer Research, Medical School, Newcastle University, Newcastle-upon-Tyne, UK
| | - Anna Jauch
- Institute of Human Genetics, University of Heidelberg, Germany
| | - Gareth J Morgan
- Haemato-Oncology, Division of Pathology, Institute of Cancer Research, Surrey, UK
| | - Kari Hemminki
- German Cancer Research Center, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmo, Sweden
| | - Richard S Houlston
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
- National Centre of Tumour Diseases, Heidelberg, Germany
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38
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Walker BA, Wardell CP, Ross FM, Morgan GJ. Identification of a novel t(7;14) translocation in multiple myeloma resulting in overexpression ofEGFR. Genes Chromosomes Cancer 2013; 52:817-22. [DOI: 10.1002/gcc.22077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 04/25/2013] [Indexed: 01/08/2023] Open
Affiliation(s)
- Brian A. Walker
- Molecular Haematology, Haemato-Oncology Research Unit, Division of Molecular Pathology; The Institute of Cancer Research; London UK
| | - Christopher P. Wardell
- Molecular Haematology, Haemato-Oncology Research Unit, Division of Molecular Pathology; The Institute of Cancer Research; London UK
| | - Fiona M. Ross
- Wessex Regional Genetics Laboratory; Salisbury District Hospital; Salisbury UK
| | - Gareth J. Morgan
- Molecular Haematology, Haemato-Oncology Research Unit, Division of Molecular Pathology; The Institute of Cancer Research; London UK
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Treatment outcomes in patients with relapsed and refractory multiple myeloma and high-risk cytogenetics receiving single-agent carfilzomib in the PX-171-003-A1 study. Leukemia 2013; 27:2351-6. [PMID: 23670297 PMCID: PMC3865533 DOI: 10.1038/leu.2013.152] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/12/2013] [Accepted: 04/24/2013] [Indexed: 12/28/2022]
Abstract
Several cytogenetic abnormalities are associated with poor outcomes in multiple myeloma (MM). We prospectively analyzed the impact of cytogenetic abnormalities on outcomes during the phase 2 PX-171-003-A1 study of single-agent carfilzomib for relapsed and refractory MM. In the response-evaluable population (257/266), fluorescence in situ hybridization (FISH)/conventional cytogenetic profiles were available for 229 patients; 62 (27.1%) had high-risk cytogenetics—del 17p13, t(4;14) or t(14;16) by interphase FISH or deletion 13 or hypodiploidy by metaphase cytogenetics—and 167 (72.9%) had standard-risk profiles. Generally, baseline characteristics were similar between the subgroups, but International Staging System stage III disease was more common in high- vs standard-risk patients (41.9% vs 27.5%) as was Eastern Cooperative Oncology Group performance status 1/2 (85.5% vs 68.3%). Overall response was comparable between the subgroups (25.8% vs 24.6%, respectively; P=0.85), while time-to-event end points showed a trend of shorter duration in high-risk patients, including median duration of response (5.6 months (95% confidence interval (CI) 3.7–7.8) vs 8.3 months (95% CI 5.6–12.3)) and overall survival (9.3 (95% CI 6.5–13.0) vs 19.0 months (95% CI 15.4–NE); P=0.0003). Taken together, these findings demonstrate that single-agent carfilzomib is efficacious and has the potential to at least partially overcome the impact of high-risk cytogenetics in heavily pre-treated patients with MM.
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40
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Boyd KD, Pawlyn C, Morgan GJ, Davies FE. Understanding the molecular biology of myeloma and its therapeutic implications. Expert Rev Hematol 2013; 5:603-17. [PMID: 23216592 DOI: 10.1586/ehm.12.51] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Myeloma develops due to the accumulation of multiple pathological genetic events, many of which have been defined. Hyperdiploidy and reciprocal translocations centered on the immunoglobulin heavy chain variable region constitute primary genetic lesions. These primary lesions co-operate with secondary genetic events including chromosomal deletions and gains, gene mutations and epigenetic modifiers such as DNA methylation to produce the malignant phenotype of myeloma. Some of these events have been linked with distinct clinical outcome and can be used to define patient groups. This review explores the molecular biology of myeloma and identifies how genetic lesions can be used to define high- and low-risk patient groups, and also defines potential targets for therapy. The authors also explore how this information can be used to guide therapeutic decision-making and the design and interpretation of clinical trials, both now and in the future.
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Affiliation(s)
- Kevin D Boyd
- The Institute of Cancer Research, Brookes Lawley Building, 15 Cotswold Road, Sutton, Surrey, UK
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41
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Weinhold N, Johnson DC, Chubb D, Chen B, Försti A, Hosking FJ, Broderick P, Ma YP, Dobbins SE, Hose D, Walker BA, Davies FE, Kaiser MF, Li NL, Gregory WA, Jackson GH, Witzens-Harig M, Neben K, Hoffmann P, Nöthen MM, Mühleisen TW, Eisele L, Ross FM, Jauch A, Goldschmidt H, Houlston RS, Morgan GJ, Hemminki K. The CCND1 c.870G>A polymorphism is a risk factor for t(11;14)(q13;q32) multiple myeloma. Nat Genet 2013; 45:522-525. [PMID: 23502783 PMCID: PMC5056630 DOI: 10.1038/ng.2583] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 02/21/2013] [Indexed: 12/15/2022]
Abstract
A number of specific chromosomal abnormalities define the subgroups of multiple myeloma. In a meta-analysis of two genome-wide association studies of multiple myeloma including a total of 1,661 affected individuals, we investigated risk for developing a specific tumor karyotype. The t(11;14)(q13;q32) translocation in which CCND1 is placed under the control of the immunoglobulin heavy chain enhancer was strongly associated with the CCND1 c.870G>A polymorphism (P = 7.96 × 10(-11)). These results provide a model in which a constitutive genetic factor is associated with risk of a specific chromosomal translocation.
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Affiliation(s)
- Niels Weinhold
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - David C Johnson
- Haemato-Oncology Research Unit, Division of Molecular Pathology, Institute of Cancer Research, Surrey, UK
| | - Daniel Chubb
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Bowang Chen
- German Cancer Research Center, Heidelberg, Germany
| | - Asta Försti
- German Cancer Research Center, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmo, Sweden
| | - Fay J Hosking
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Peter Broderick
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Yussanne P Ma
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Sara E Dobbins
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Dirk Hose
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
- National Centre for Tumour Diseases, Heidelberg, Germany
| | - Brian A Walker
- Haemato-Oncology Research Unit, Division of Molecular Pathology, Institute of Cancer Research, Surrey, UK
| | - Faith E Davies
- Haemato-Oncology Research Unit, Division of Molecular Pathology, Institute of Cancer Research, Surrey, UK
| | - Martin F Kaiser
- Haemato-Oncology Research Unit, Division of Molecular Pathology, Institute of Cancer Research, Surrey, UK
| | - Ni L Li
- Haemato-Oncology Research Unit, Division of Molecular Pathology, Institute of Cancer Research, Surrey, UK
| | | | | | | | - Kai Neben
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Lewin Eisele
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
| | - Fiona M Ross
- Cytogenetics Group, Wessex Regional Cytogenetic Laboratory, Salisbury, UK
| | - Anna Jauch
- Institute of Human Genetics, University of Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
- National Centre for Tumour Diseases, Heidelberg, Germany
| | - Richard S Houlston
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Gareth J Morgan
- Haemato-Oncology Research Unit, Division of Molecular Pathology, Institute of Cancer Research, Surrey, UK
| | - Kari Hemminki
- German Cancer Research Center, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmo, Sweden
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42
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Characterization of IGH locus breakpoints in multiple myeloma indicates a subset of translocations appear to occur in pregerminal center B cells. Blood 2013; 121:3413-9. [DOI: 10.1182/blood-2012-12-471888] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Key Points
IGH translocations in myeloma can occur through at least 5 mechanisms. t(11;14) and t(14;20) DH-JH rearrangement-mediated translocations occur indicating these appear to occur in a pregerminal center cell.
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43
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Mikhael JR, Dingli D, Roy V, Reeder CB, Buadi FK, Hayman SR, Dispenzieri A, Fonseca R, Sher T, Kyle RA, Lin Y, Russell SJ, Kumar S, Bergsagel PL, Zeldenrust SR, Leung N, Drake MT, Kapoor P, Ansell SM, Witzig TE, Lust JA, Dalton RJ, Gertz MA, Stewart AK, Rajkumar SV, Chanan-Khan A, Lacy MQ. Management of newly diagnosed symptomatic multiple myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines 2013. Mayo Clin Proc 2013; 88:360-76. [PMID: 23541011 DOI: 10.1016/j.mayocp.2013.01.019] [Citation(s) in RCA: 369] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/29/2013] [Accepted: 01/31/2013] [Indexed: 12/28/2022]
Abstract
Multiple myeloma remains an incurable neoplasm of plasma cells that affects more than 20,000 people annually in the United States. There has been a veritable revolution in this disease during the past decade, with dramatic improvements in our understanding of its pathogenesis, the development of several novel agents, and a concomitant doubling in overall survival. Because multiple myeloma is a complex and wide-ranging disorder, its management must be guided by disease- and patient-related factors; emerging as one of the most influential factors is risk stratification, primarily based on cytogenetic features. A risk-adapted approach provides optimal therapy to patients, ensuring intense therapy for aggressive disease and minimizing toxic effects, providing sufficient but less intense therapy for low-risk disease. This consensus statement reflects recommendations from more than 20 Mayo Clinic myeloma physicians, providing a practical approach for newly diagnosed patients with myeloma who are not enrolled in a clinical trial.
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Affiliation(s)
- Joseph R Mikhael
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA.
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44
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López de Frutos L, Álvarez Y, Armengol G, Caballín MR. New mitogens in cultures for multiple myeloma cytogenetic analysis. Leuk Lymphoma 2013; 54:2548-50. [PMID: 23418873 DOI: 10.3109/10428194.2013.777066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Laura López de Frutos
- Department of Cytogenetics, Balagué Center Special Techniques Laboratory, Hospitalet de Llobregat , Barcelona , Spain
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45
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Brioli A, Boyd KD, Kaiser MF, Pawlyn C, Wu P, Gregory WM, Owen R, Ross FM, Jackson GH, Cavo M, Davies FE, Morgan GJ. Response and biological subtype of myeloma are independent prognostic factors and combine to define outcome after high-dose therapy. Br J Haematol 2013; 161:291-4. [DOI: 10.1111/bjh.12218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Kevin D. Boyd
- Division of Molecular Pathology, Haemato-Oncology Research Unit; The Institute of Cancer Research; London; UK
| | - Martin F. Kaiser
- Division of Molecular Pathology, Haemato-Oncology Research Unit; The Institute of Cancer Research; London; UK
| | - Charlotte Pawlyn
- Division of Molecular Pathology, Haemato-Oncology Research Unit; The Institute of Cancer Research; London; UK
| | - Ping Wu
- Division of Molecular Pathology, Haemato-Oncology Research Unit; The Institute of Cancer Research; London; UK
| | | | - Roger Owen
- St James's University Hospital; Leeds; UK
| | - Fiona M. Ross
- Wessex Regional Genetics Laboratory; University of Southampton; Salisbury; UK
| | - Graham H. Jackson
- Department of Haematology; University of Newcastle; Newcastle-upon-Tyne; UK
| | - Michele Cavo
- Istituto di Ematologia Seràgnoli; Università degli Studi di Bologna; Policlinico S. Orsola-Malpighi; Bologna; Italy
| | - Faith E. Davies
- Division of Molecular Pathology, Haemato-Oncology Research Unit; The Institute of Cancer Research; London; UK
| | - Gareth J. Morgan
- Division of Molecular Pathology, Haemato-Oncology Research Unit; The Institute of Cancer Research; London; UK
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46
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Brioli A, Kaiser MF, Pawlyn C, Wu P, Gregory WM, Owen R, Ross FM, Jackson GH, Cavo M, Davies FE, Morgan GJ. Biologically defined risk groups can be used to define the impact of thalidomide maintenance therapy in newly diagnosed multiple myeloma. Leuk Lymphoma 2013; 54:1975-81. [PMID: 23270579 DOI: 10.3109/10428194.2012.760736] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Maintenance therapy is an attractive strategy for patients with multiple myeloma. However, the impact of maintenance thalidomide according to the underlying biology of the disease is still a matter of debate, with some studies suggesting that thalidomide is more beneficial in high risk disease, whilst others show the opposite. Biological risk groups defined by interphase fluorescence in situ hybridization (FISH) are powerful predictors of outcome. In this report we investigated the effect of maintenance thalidomide in different biological risk groups defined by different FISH categories. Our data show that maintenance thalidomide improves outcome in patients with biologically low risk disease, defined by the absence of adverse cytogenetic lesion or by the presence of hyperdiploidy alone. Conversely, thalidomide maintenance is detrimental for the overall survival of patients with biological high risk. We conclude that it is important to identify biologically low risk patients who will benefit from a maintenance strategy with thalidomide.
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Affiliation(s)
- Annamaria Brioli
- Haemato-Oncology Research Unit, Division of Molecular Pathology, The Institute of Cancer Research, London, UK
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47
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Petrini I, Meltzer PS, Zucali PA, Luo J, Lee C, Santoro A, Lee HS, Killian KJ, Wang Y, Tsokos M, Roncalli M, Steinberg SM, Wang Y, Giaccone G. Copy number aberrations of BCL2 and CDKN2A/B identified by array-CGH in thymic epithelial tumors. Cell Death Dis 2012; 3:e351. [PMID: 22825469 PMCID: PMC3406591 DOI: 10.1038/cddis.2012.92] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The molecular pathology of thymic epithelial tumors (TETs) is largely unknown. Using array comparative genomic hybridization (CGH), we evaluated 59 TETs and identified recurrent patterns of copy number (CN) aberrations in different histotypes. GISTIC algorithm revealed the presence of 126 significant peaks of CN aberration, which included 13 cancer-related genes. Among these peaks, CN gain of BCL2 and CN loss of CDKN2A/B were the only genes in the respective regions of CN aberration and were associated with poor outcome. TET cell lines were sensitive to siRNA knockdown of the anti-apoptotic molecules BCL2 and MCL1. Gx15-070, a pan-BCL2 inhibitor, induced autophagy-dependent necroptosis in TET cells via a mechanism involving mTOR pathways, and inhibited TET xenograft growth. ABT263, an inhibitor of BCL2/BCL-XL/BCL-W, reduced proliferation in TET cells when administered in combination with sorafenib, a tyrosine kinase inhibitor able to downregulate MCL1. Immunohistochemistry on 132 TETs demonstrated that CN loss of CDKN2A correlated with lack of expression of its related protein p16INK4 and identified tumors with poor prognosis. The molecular markers BCL2 and CDKN2A may be of potential value in diagnosis and prognosis of TETs. Our study provides the first preclinical evidence that deregulated anti-apoptotic BCL2 family proteins may represent suitable targets for TET treatment.
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Affiliation(s)
- I Petrini
- Medical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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48
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Huang JJ, Yu J, Li JY, Liu YT, Zhong RQ. Circulating microRNA expression is associated with genetic subtype and survival of multiple myeloma. Med Oncol 2012; 29:2402-8. [PMID: 22447484 DOI: 10.1007/s12032-012-0210-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 03/05/2012] [Indexed: 12/17/2022]
Abstract
Circulating microRNAs (miRNAs) have shown potential as non-invasive prognostic biomarkers in cancer. Here, we investigated whether miRNAs present in the plasma of multiple myeloma (MM) patients have prognostic utility. We evaluated global miRNA expression profiles in the plasma of 12 multiple myeloma patients and 8 healthy controls using TaqMan Low-Density Arrays. Six miRNAs (miR-148a, miR-181a, miR-20a, miR-221, miR-625, and miR-99b) that were significantly upregulated in MM were selected and further quantified independently by quantitative reverse transcription PCR in plasma from 28 MM patients and 12 healthy controls. Moreover, within the patient group, the expression levels of miR-99b and miR-221 were associated with chromosomal abnormalities t(4; 14) and del(13q), respectively. High levels of miR-20a and miR-148a were related to shorter relapse-free survival. In summary, we have identified aberrant expression of particular circulating miRNAs that are associated with the genetic subtype and survival of MM. These plasma miRNAs have potential as clinical biomarkers in MM.
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Affiliation(s)
- Jing-jing Huang
- Department of Laboratory Medicine, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
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49
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Kiyota M, Kobayashi T, Fuchida S, Yamamoto-Sugitani M, Ohshiro M, Shimura Y, Mizutani S, Nagoshi H, Sasaki N, Nakayama R, Chinen Y, Sakamoto N, Uchiyama H, Matsumoto Y, Horiike S, Shimazaki C, Kuroda J, Taniwaki M. Monosomy 13 in metaphase spreads is a predictor of poor long-term outcome after bortezomib plus dexamethasone treatment for relapsed/refractory multiple myeloma. Int J Hematol 2012; 95:516-26. [PMID: 22426624 DOI: 10.1007/s12185-012-1035-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/18/2012] [Accepted: 02/23/2012] [Indexed: 12/01/2022]
Abstract
We retrospectively investigated the prognostic impact of high-risk cytogenetic abnormalities (CAs) on the outcome of treatment with bortezomib plus dexamethasone (BD) in 43 relapsed/refractory (Rel/Ref) multiple myeloma patients. Fluorescence in situ hybridization (FISH) analysis identified del(13q) in 25 patients, t(4;14) in 14, t(14;16) in 4, 1q21 abnormality in 12 and del(17p) in 2, while G-banding also detected chromosome 13 monosomy (-13) in metaphase spreads from 7 patients. Eighteen of 25 patients with FISH-detected chromosome 13 abnormalities also exhibited other abnormalities. Median observation period was 510 days, and median overall survival (OS) and progression-free survival (PFS) were 912 days and 162 days, respectively. Detection of del(13q), t(4;14), t(14;16) or 1q21 abnormalities by FISH and co-occurrence of chromosome 13 abnormality with other abnormalities were not associated with poorer outcomes. In contrast, detection of -13 by G-banding in metaphase spreads showed significant association with shorter OS, although the overall response rate and PFS were not inferior to those for patients without -13 detected by G-banding. BD therapy may be a potent weapon for overcoming most classical high-risk CAs, while the detection of -13 in metaphase spreads may serve as a predictor of highly progressive disease, even when treated with BD.
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Affiliation(s)
- Miki Kiyota
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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50
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Shetty S, Siady M, Mallempati KC, Wilson A, Poarch J, Chandler B, Gray J, Salama ME. Utility of a column-free cell sorting system for separation of plasma cells in multiple myeloma FISH testing in clinical laboratories. Int J Hematol 2012; 95:274-81. [PMID: 22328174 DOI: 10.1007/s12185-012-1021-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 01/22/2012] [Accepted: 01/24/2012] [Indexed: 12/15/2022]
Abstract
Targeted FISH analysis is an essential component of the management of plasma cell myeloma for identification of cytogenetic abnormalities. The purpose of this study was to evaluate the column-free method, RoboSep® (RS), for sorting CD138-expressing cells in bone marrow aspirates. Comparative analysis of column-based and RS methodologies was carried out on 54 paired bone marrow aspirate validation samples from patients undergoing work-up for plasma cell dyscrasia. Abnormalities detected by FISH analysis using an IGH@/CCND1 probe set were seen in 54% with RS, and 44% with column-based. We found a statistically significant difference between the yield of abnormalities detected in paired positive cases (p = 0.0001). An additional 183 consecutive post-validation samples sorted by RS showed recurrent genetic abnormalities in 85/120 (71%) of successfully sorted samples with ≥ 1% plasma cells but in none of 63 samples in which FISH analysis was completed on samples that could not be sorted due to insufficient plasma cells upon cell sorting. The column-free method successfully sorted PC, when present in ≥ 1% of cells, for detection of abnormalities by FISH. Furthermore, our data suggest that FISH analysis should not be performed on samples with an inadequate yield at the cell selection step.
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Affiliation(s)
- Shashirekha Shetty
- Cleveland Clinic, 9500 Euclid Avenue, Mail Code LL2-2, Cleveland, OH 44195, USA.
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