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Change in ploidy status from hyperdiploid to near-tetraploid in multiple myeloma associated with bortezomib/lenalidomide resistance. Cancer Genet 2014; 207:326-31. [DOI: 10.1016/j.cancergen.2014.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/21/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
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Kiba T, Ito T, Nakashima T, Okikawa Y, Kido M, Kimura A, Kameda K, Miyamae F, Tanaka S, Atsumi M, Sumitani Y, Shitakubo Y, Niimi H. Bortezomib and dexamethasone for multiple myeloma: higher AST and LDH levels associated with a worse prognosis on overall survival. BMC Cancer 2014; 14:462. [PMID: 24952705 PMCID: PMC4078016 DOI: 10.1186/1471-2407-14-462] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/18/2014] [Indexed: 12/27/2022] Open
Abstract
Background Bortezomib offers a novel approach to the treatment of multiple myeloma producing rapid control. The aim of this study was to investigate the outcomes of bortezomib and dexamethasone-treated patients with multiple myeloma. Methods We conducted a retrospective study of 44 consecutively-treated multiple myeloma patients with bortezomib (1.3 mg/m2 on days 1, 4, 8, and 11 of a 21-day cycle or 1.3 mg/m2 intravenously 1, 8, 15, and 22 of every 35-day cycle) and dexamethasone. Results The median time to progression, progression free survival time, and overall survival time in the treatment groups was 14.9, 14.9, and 38.3 months, respectively. The present study also suggests the possibility that the prognosis of patients with high levels of AST and LDH might be worse. Conclusions Our results indicate that the treatment of multiple myeloma with bortezomib and dexamethasone is feasible.
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Affiliation(s)
- Takayoshi Kiba
- Division of Modern Medical Technology, Institute for Clinical Research, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1, Aoyama-cho, Kure-shi, Hiroshima 737-0023, Japan.
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Tete SM, Bijl M, Sahota SS, Bos NA. Immune defects in the risk of infection and response to vaccination in monoclonal gammopathy of undetermined significance and multiple myeloma. Front Immunol 2014; 5:257. [PMID: 24917865 PMCID: PMC4042361 DOI: 10.3389/fimmu.2014.00257] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/18/2014] [Indexed: 12/13/2022] Open
Abstract
The plasma cell proliferative disorders monoclonal gammopathy of undetermined significance (MGUS) and malignant multiple myeloma (MM) are characterized by an accumulation of transformed clonal plasma cells in the bone marrow and production of monoclonal immunoglobulin. They typically affect an older population, with median age of diagnosis of approximately 70 years. In both disorders, there is an increased risk of infection due to the immunosuppressive effects of disease and conjointly of therapy in MM, and response to vaccination to counter infection is compromised. The underlying factors in a weakened immune response in MGUS and MM are as yet not fully understood. A confounding factor is the onset of normal aging, which quantitatively and qualitatively hampers humoral immunity to affect response to infection and vaccination. In this review, we examine the status of immune alterations in MGUS and MM and set these against normal aging immune responses. We focus primarily on quantitative and functional aspects of B-cell immunity. Furthermore, we review the current knowledge relating to susceptibility to infectious disease in MGUS and MM, and how efficacy of conventional vaccination is affected by proliferative disease-related and therapy-related factors.
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Affiliation(s)
- Sarah M Tete
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen , Groningen , Netherlands ; Cancer Sciences Unit, Faculty of Medicine, University of Southampton , Southampton , UK
| | - Marc Bijl
- Department of Internal Medicine and Rheumatology, Martini Hospital , Groningen , Netherlands
| | - Surinder S Sahota
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton , Southampton , UK
| | - Nicolaas A Bos
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen , Groningen , Netherlands
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Hope C, Ollar SJ, Heninger E, Hebron E, Jensen JL, Kim J, Maroulakou I, Miyamoto S, Leith C, Yang DT, Callander N, Hematti P, Chesi M, Bergsagel PL, Asimakopoulos F. TPL2 kinase regulates the inflammatory milieu of the myeloma niche. Blood 2014; 123:3305-15. [PMID: 24723682 PMCID: PMC4046426 DOI: 10.1182/blood-2014-02-554071] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/07/2014] [Indexed: 02/06/2023] Open
Abstract
Targeted modulation of microenvironmental regulatory pathways may be essential to control myeloma and other genetically/clonally heterogeneous cancers. Here we report that human myeloma-associated monocytes/macrophages (MAM), but not myeloma plasma cells, constitute the predominant source of interleukin-1β (IL-1β), IL-10, and tumor necrosis factor-α at diagnosis, whereas IL-6 originates from stromal cells and macrophages. To dissect MAM activation/cytokine pathways, we analyzed Toll-like receptor (TLR) expression in human myeloma CD14(+) cells. We observed coregulation of TLR2 and TLR6 expression correlating with local processing of versican, a proteoglycan TLR2/6 agonist linked to carcinoma progression. Versican has not been mechanistically implicated in myeloma pathogenesis. We hypothesized that the most readily accessible target in the versican-TLR2/6 pathway would be the mitogen-activated protein 3 (MAP3) kinase, TPL2 (Cot/MAP3K8). Ablation of Tpl2 in the genetically engineered in vivo myeloma model, Vκ*MYC, led to prolonged disease latency associated with plasma cell growth defect. Tpl2 loss abrogated the "inflammatory switch" in MAM within nascent myeloma lesions and licensed macrophage repolarization in established tumors. MYC activation/expression in plasma cells was independent of Tpl2 activity. Pharmacologic TPL2 inhibition in human monocytes led to dose-dependent attenuation of IL-1β induction/secretion in response to TLR2 stimulation. Our results highlight a TLR2/6-dependent TPL2 pathway as novel therapeutic target acting nonautonomously through macrophages to control myeloma progression.
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Affiliation(s)
- Chelsea Hope
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Samuel J Ollar
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Erika Heninger
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Ellen Hebron
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Jeffrey L Jensen
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Jaehyup Kim
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Ioanna Maroulakou
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Shigeki Miyamoto
- University of Wisconsin Carbone Cancer Center, Madison, WI; Department of Oncology, University of Wisconsin-Madison, Madison, WI
| | - Catherine Leith
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; and
| | - David T Yang
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; and
| | - Natalie Callander
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Peiman Hematti
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | | | - Fotis Asimakopoulos
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; University of Wisconsin Carbone Cancer Center, Madison, WI
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He L, Ji JN, Liu SQ, Xue E, Liang Q, Ma Z. Expression of cancer-testis antigen in multiple myeloma. ACTA ACUST UNITED AC 2014; 34:181-185. [PMID: 24710929 DOI: 10.1007/s11596-014-1255-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 02/25/2014] [Indexed: 11/25/2022]
Abstract
Recently, the immunotherapy has been highlighted among cancer treatments. Cancer-testis antigen (CTA) has been studied in a variety of solid tumors because of its specific expression in tumors, and testis, ovary and placenta tissues, but not in other normal tissues. In order to provide a new approach for multiple myeloma (MM) immunotherapy, we examined the CTA expression in MM cell lines, and primary myeloma cells in patients with MM. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect the mRNA expression of MAGE-C1/CT7, SSX1, SSX2 and SSX4 in MM cell lines of RPMI-8226 and U266, and bone marrow (BM) cells of 25 MM patients and 18 healthy volunteers. The results showed that the 4 CTAs were expressed in RPMI-8226 and U266 cell lines. The positive expression rate of MAGE-C1/CT7, SSX1, SSX2 and SSX4 in the BM cells of 25 MM patients was 28% (7/25), 80% (20/25), 40% (10/25) and 68% (17/25), respectively. In contrast, the expression of any member of the CTAs was not detected in BM cells of 18 healthy volunteers. The expression of two or more CTAs was detected in 80% (20/25) MM patients, and that of at least one CTA in 88% (22/25). The mRNA expression levels of SSX1 and SSX4 were significantly higher in patients with MM at stage III than in those at stage I and II (P<0.05). No statistically significant differences were observed in the mRNA expression levels of MAGE-C1/CT7 and SSX2 in further stratified analyses by age, gender, MM types and percentage of MM cells in BM (P>0.05). In conclusion, our present study showed that MAGE-C1/CT7, SSX1, SSX2 and SSX4 were co-expressed in MM cell lines and the primary myeloma cells in MM patients, but not expressed in BM cells of healthy subjects. The mRNA levels of SSX1 and SSX4 are associated with MM clinical stage. This work may provide a new insight into MM immunotherapy in the future.
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Affiliation(s)
- Li He
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Jing-Na Ji
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Shang-Qin Liu
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Er Xue
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Qing Liang
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zi Ma
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
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Hosing C, Saliba RM, Hamerschlak N, Kutner JM, Sakashita AM, Kondo AT, Rodrigues M, Fernande JF, Chiattone A, Chiattone VC, Barros JC, Chiattone CS, Chiattone R, Popat U, Qazilbash M, Tang XW, Wu D, Majilis A, de Lima M, Anguita T. Peripheral blood stem cell yield calculated using preapheresis absolute CD34+ cell count, peripheral blood volume processed, and donor body weight accurately predicts actual yield at multiple centers. Transfusion 2014; 54:1081-7. [PMID: 24118027 DOI: 10.1111/trf.12435] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/18/2013] [Accepted: 07/22/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Accurate prediction of stem cell yield is important for planning leukapheresis procedures. A formula has been published (Pierelli et al., Vox Sang 2006;91:126-34) to estimate the CD34+ dose collected on the first day of leukapheresis that was based on the preapheresis peripheral blood (PB) CD34+ counts, the blood volume processed, and the donor's weight. The aim of this study was to assess the predictive value of this formula. STUDY DESIGN AND METHODS Data were retrospectively collected on 1126 consecutive PB stem cell harvests conducted at five institutions. Information on age, sex, diagnosis, weight, preapheresis absolute peripheral CD34+ count, total blood volume processed, and CD34+ cells harvested per kilogram of body weight on the first day of apheresis was collected. RESULTS Among donors at least 18 years old, Pearson's correlation coefficient (r) between actual yield (AY) and predicted yield (PY) was 0.76. To characterize this correlation, AY and PY were classified as being within the conventionally acceptable CD34+ doses (>2 × 10(6) -5 × 10(6) cells/kg), below this range (≤2 × 10(6) cells/kg), or above it (>5 × 10(6) cells/kg). The positive predictive value (PPV) of PY was estimated considering the distribution of AY as the "gold standard." PPV was relatively high for PY of more than 5 × 10(6) cells/kg (85%), moderate for PY of not more than 2 × 10(6) cells/kg (72%), and low for PY more than 2 × 10(6) to 5 × 10(6) cells/kg (56%). A consistent pattern was observed within institutions. CONCLUSION The formula of Pierelli et al. is associated with a PPV that is high, moderate, and relatively low for the corresponding predicted CD34+ doses.
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Affiliation(s)
- Chitra Hosing
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Zaroulis CK, Chairopoulos K, Sachanas SP, Maltezas D, Tzenou T, Pessach I, Koulieris E, Koutra E, Kilindireas K, Pangalis GA, Kyrtsonis MC. Assessment of bortezomib induced peripheral neuropathy in multiple myeloma by the reduced Total Neuropathy Score. Leuk Lymphoma 2014; 55:2277-83. [DOI: 10.3109/10428194.2013.873535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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58
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Vinayachandran D, Sankarapandian S. Multiple osteolytic lesions. J Clin Imaging Sci 2014; 3:6. [PMID: 24516769 PMCID: PMC3906660 DOI: 10.4103/2156-7514.117460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 07/29/2013] [Indexed: 12/22/2022] Open
Abstract
Several systemic diseases initially present with various oral manifestations. Investigation of these oral symptoms may at times lead to the diagnosis of grave underlying life-threatening conditions. We present one such case, where the patient manifested with gross enlargement of the mandible, along with lesions in the lower limbs. These lesions were the initial manifestation and on further investigations the patient was diagnosed with multiple myeloma.
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Affiliation(s)
- Divya Vinayachandran
- Department of Oral Medicine and Radiology, Sri Ramaswamy Memorial Kattankulathur Dental College and Hospitals, Chennai, Tamil Nadu, India
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59
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Cytogenetic and clinical risk factors for assessment of ultra high-risk multiple myeloma. Leuk Res 2014; 38:188-93. [DOI: 10.1016/j.leukres.2013.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/31/2013] [Accepted: 11/08/2013] [Indexed: 11/17/2022]
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60
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Greenberg AJ, Rajkumar SV, Therneau TM, Singh PP, Dispenzieri A, Kumar SK. Relationship between initial clinical presentation and the molecular cytogenetic classification of myeloma. Leukemia 2014; 28:398-403. [PMID: 24005246 PMCID: PMC3924716 DOI: 10.1038/leu.2013.258] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/19/2013] [Accepted: 08/02/2013] [Indexed: 11/09/2022]
Abstract
Multiple myeloma (MM) consists of several distinct cytogenetic subtypes, and we hypothesized that each subtype may have a unique mode of initial presentation and end-organ damage. We studied 484 patients with newly diagnosed MM to determine the relationship between specific myeloma-defining event (MDE) and the cytogenetic subtype. Patients were divided into four non-overlapping groups based on the MDE at diagnosis: isolated renal failure, isolated anemia, isolated lytic bone disease or a combination (mixed). MM with translocations without trisomies accounted for 30% of all patients, but accounted for 50% of patients with renal failure. Specifically, the t(14;16) translocation accounted for only 5% of all MM patients, but was present in 13.5% of patients with renal failure as MDE. Among patients with t(14;16), 25% presented with renal failure only as MDE. Patients with isolated renal failure as MDE had significantly poorer survival compared with all other groups, whereas patients with bone disease as MDE had the best outcome (P<0.001). Our findings support the hypothesis that in addition to prognostic differences, there is significant heterogeneity in clinical presentation associated with the cytogenetic subtype, suggesting that MM encompasses a group of cytogenetically and phenotypically distinct disorders rather than a single entity.
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Affiliation(s)
- A J Greenberg
- 1] Center for Translational Science Activities, Rochester, MN, USA [2] Division of Epidemiology, Department of Health Sciences Research, Rochester, MN, USA
| | - S V Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - T M Therneau
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN, USA
| | - P P Singh
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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61
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Palumbo A, Rajkumar SV, San Miguel JF, Larocca A, Niesvizky R, Morgan G, Landgren O, Hajek R, Einsele H, Anderson KC, Dimopoulos MA, Richardson PG, Cavo M, Spencer A, Stewart AK, Shimizu K, Lonial S, Sonneveld P, Durie BGM, Moreau P, Orlowski RZ. International Myeloma Working Group consensus statement for the management, treatment, and supportive care of patients with myeloma not eligible for standard autologous stem-cell transplantation. J Clin Oncol 2014; 32:587-600. [PMID: 24419113 DOI: 10.1200/jco.2013.48.7934] [Citation(s) in RCA: 273] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To provide an update on recent advances in the management of patients with multiple myeloma who are not eligible for autologous stem-cell transplantation. METHODS A comprehensive review of the literature on diagnostic criteria is provided, and treatment options and management of adverse events are summarized. RESULTS Patients with symptomatic disease and organ damage (ie, hypercalcemia, renal failure, anemia, or bone lesions) require immediate treatment. The International Staging System and chromosomal abnormalities identify high- and standard-risk patients. Proteasome inhibitors, immunomodulatory drugs, corticosteroids, and alkylating agents are the most active agents. The presence of concomitant diseases, frailty, or disability should be assessed and, if present, treated with reduced-dose approaches. Bone disease, renal damage, hematologic toxicities, infections, thromboembolism, and peripheral neuropathy are the most frequent disabling events requiring prompt and active supportive care. CONCLUSION These recommendations will help clinicians ensure the most appropriate care for patients with myeloma in everyday clinical practice.
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Affiliation(s)
- Antonio Palumbo
- Antonio Palumbo and Alessandra Larocca, University of Torino, Torino; Michele Cavo, Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; S. Vincent Rajkumar, Mayo Clinic, Rochester, MN; Jesus F. San Miguel, University Hospital of Salamanca, Salamanca, Spain; Ruben Niesvizky, Weill Cornell Medical College, New York, NY; Gareth Morgan, Royal Marsden Hospital, London, United Kingdom; Ola Landgren, National Cancer Institute, Bethesda, MD; Roman Hajek, University of Ostrava School of Medicine and University Hospital Ostrava, Ostrava, Czech Republic; Hermann Einsele, University of Wurzburg, Wurzburg, Germany; Kenneth C. Anderson and Paul G. Richardson, Dana-Farber Cancer Institute, Boston, MA; Meletios A. Dimopoulos, University of Athens School of Medicine, Athens, Greece; Andrew Spencer, Alfred Hospital, Melbourne, Victoria, Australia; A. Keith Stewart, Mayo Clinic, Scottsdale, AZ; Kazuyuki Shimizu, Aichi Gakuin Hospital, Nagoya, Japan; Sagar Lonial, Emory University, Atlanta, GA; Pieter Sonneveld, Erasmus Medical Centre, Rotterdam, the Netherlands; Brian G.M. Durie, Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA; Philippe Moreau, University Hospital, Nantes, France; and Robert Z. Orlowski, MD Anderson Cancer Center, Houston, TX
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Toprak SK. Is there an optimal timing of autologous stem-cell transplantation for multiple myeloma in the era of novel agents? Turk J Haematol 2014; 30:338-9. [PMID: 24385820 PMCID: PMC3878532 DOI: 10.4274/tjh.2013.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/15/2013] [Indexed: 12/03/2022] Open
Affiliation(s)
- Selami Koçak Toprak
- Başkent University School of Medicine, Department of Hematology, Ankara, Turkey
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Gomez-Bougie P, Amiot M. Apoptotic machinery diversity in multiple myeloma molecular subtypes. Front Immunol 2013; 4:467. [PMID: 24391642 PMCID: PMC3870331 DOI: 10.3389/fimmu.2013.00467] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/04/2013] [Indexed: 12/29/2022] Open
Abstract
Multiple myeloma (MM) is a plasma-cell (PC) malignancy that is heterogeneous in its clinical presentation and prognosis. Monoclonal gammopathy of undetermined significance (MGUS) consistently preceded development of MM. The presence of primary IgH translocations and the universal overexpression of cyclin D genes led to a molecular classification of MM patients into different disease subtypes. Since Bcl-2 family proteins determine cell fate, we analyzed a publicly available Affymetrix gene expression of 44 MGUS and 414 newly diagnosed MM patients to investigate (1) the global change of Bcl-2 family members in MM versus MGUS (2) whether the four major subtypes defined as hyperdiploid, CyclinD1, MAF, and MMSET, display specific apoptotic machineries. We showed that among the main anti-apoptotic members (Bcl-2, Bcl-xL, and Mcl-1), Mcl-1 up-regulation discriminated MM from MGUS, in agreement with the prominent role of Mcl-1 in PC differentiation. Surprisingly, the expression of multi-domain pro-apoptotic Bak and Bax were increased during the progression of MGUS to MM. The combined profile of Bcl-2, Bcl-xL, and Mcl-1 was sufficient to distinguish MM molecular groups. While specific pro-apoptotic members expression was observed for each MM subtypes, CyclinD1 subgroup, was identified as a particular entity characterized by a low expression of BH3-only (Puma, Bik, and Bad) and multi-domain pro-apoptotic members (Bax and Bak). Our analysis supports the notion that MM heterogeneity is extended to the differential expression of the Bcl-2 family content in each MM subgroup. The influence of Bcl-2 family profile in the survival of the different patient groups will be further discussed to establish the potential consequences for therapeutic interventions. Finally, the use of distinct pro-survival members in the different steps of immune responses to antigen raises also the question of whether the different Bcl-2 anti-apoptotic profile could reflect a different origin of MM cells.
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Affiliation(s)
- Patricia Gomez-Bougie
- INSERM, U892 , Nantes , France ; Université de Nantes , Nantes , France ; CNRS, UMR 6299 , Nantes , France ; Service d'Hématologie CHU de Nantes , Nantes , France
| | - Martine Amiot
- INSERM, U892 , Nantes , France ; Université de Nantes , Nantes , France ; CNRS, UMR 6299 , Nantes , France
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Cerrato C, Mina R, Palumbo A. Optimal management of elderly patients with myeloma. Expert Rev Anticancer Ther 2013; 14:217-28. [PMID: 24308685 DOI: 10.1586/14737140.2014.856269] [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
Many advances have been made in the treatment of patients with multiple myeloma including elderly subjects. The introduction of novel agents, such as thalidomide, lenalidomide, bortezomib, have revolutionized the treatment paradigm of this neoplasm, and second-generation molecules are currently being tested to offer patients a wider variety of treatment options and to improve outcome. The efficacy of a regimen should be carefully balanced against its toxicity profile. Elderly patients are particularly susceptible to adverse events that may lead to early treatment discontinuation. Thus, a more accurate distinction within the elderly population and a more appropriate treatment allocation is necessary. Here we describe the major and more recent treatment options available today for elderly patients with multiple myeloma.
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Affiliation(s)
- Chiara Cerrato
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
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Greenberg AJ, Walters DK, Kumar SK, Rajkumar SV, Jelinek DF. Responsiveness of cytogenetically discrete human myeloma cell lines to lenalidomide: lack of correlation with cereblon and interferon regulatory factor 4 expression levels. Eur J Haematol 2013; 91:504-13. [PMID: 23992230 PMCID: PMC3834223 DOI: 10.1111/ejh.12192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2013] [Indexed: 11/29/2022]
Abstract
The introduction of novel immunomodulatory drugs (IMiDs) has dramatically improved the survival of patients with multiple myeloma (MM). While it has been shown that patients with specific cytogenetic subtypes, namely t(4;14), have the best outcomes when treated with bortezomib-based regimens, the relationship between cytogenetic subtypes and response to IMiDs remains unclear. Using DNA synthesis assays, we investigated the relationship between cytogenetic subtype and lenalidomide response in a representative panel of human myeloma cell lines (HMCLs). We examined HMCL protein expression levels of the lenalidomide target cereblon (CRBN) and its downstream target interferon regulatory factor-4 (IRF4), which have previously been shown to be predictive of lenalidomide response in HMCLs. Our results reveal that lenalidomide response did not correlate with specific cytogenetic translocations. There were distinct groups of lenalidomide-responsive and non-responsive HMCLs, as defined by inhibition of cellular proliferation; notably, all of the hyperdiploid HMCLs fell into the latter category. Repeated dosing of lenalidomide significantly lowered the IC50 of the responsive HMCL ALMC-1 (IC50 = 2.6 μm vs. 0.005 μm, P < 0.0001), but did not have an effect on the IC50 of the non-responsive DP-6 HMCL (P > 0.05). Moreover, no association was found between lenalidomide responsiveness and CRBN and IRF4 expression. Our data indicate that lenalidomide sensitivity is independent of cytogenetic subtype in HMCLs. While CRBN and IRF4 have been shown to be associated with response to lenalidomide in patients, these findings do not translate back to HMCLs, which could be attributable to factors present in the bone marrow microenvironment.
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Affiliation(s)
- Alexandra J Greenberg
- Center for Translational Science Activities, Mayo Clinic, Rochester, MN, USA
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Shaji K Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Diane F Jelinek
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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67
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Park S, Lee SJ, Chang WJ, Maeng CH, Hong JY, Choi MK, Kim YS, Jung CW, Jang JH, Kim SJ, Kim WS, Choi JY, Kim K. Positive correlation between baseline PET or PET/CT findings and clinical parameters in multiple myeloma patients. Acta Haematol 2013; 131:193-9. [PMID: 24296366 DOI: 10.1159/000354839] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 07/07/2013] [Indexed: 11/19/2022]
Abstract
Recently, positron emission tomography (PET) has been incorporated into a series of prospective studies as a predictor of outcomes in multiple myeloma (MM), and the number of (18)F-fluorodeoxuglucose (FDG)-avid focal lesions (FLs) and the intensity of tumor metabolism have been designated as important surrogate markers for predicting prognosis. Here, we compared initial clinical characteristics of MM patients with baseline PET parameters: the number of FLs and the maximum standardized uptake value (SUVmax). A total of 59 patients diagnosed with MM between August 2004 and February 2012 were reviewed. At diagnosis, 23 patients (40.0%) had ≤3 FLs, 11 patients (18.6%) 4-9 FLs, and 25 patients (42.4%) ≥10 FLs. The median SUVmax was 5.3 (range 0-24.3), and 40 patients (67.8%) showed a SUVmax >4. No clinical characteristics were significantly different between groups with a SUVmax ≤4 and a SUVmax >4. However, there were significant differences in several clinical indices between the FLs ≤3 and FLs >3 groups; elevated β2-microglobulin, elevated lactate dehydrogenase, anemia and more advanced disease by the Durie-Salmon stage corresponded to FLs >3 at baseline PET. Adverse baseline PET findings are positively correlated with prognostically relevant clinical parameters. Regarding PET parameters, FLs are more likely to be well correlated with disease aggressiveness and pathophysiology compared to SUVmax.
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Affiliation(s)
- Silvia Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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68
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Rasche L, Knop S. Multiple myeloma – current status and future directions. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.841577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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69
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The impact of the type of hospital on survival of multiple myeloma patients: The MICORE study. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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70
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Romano A, Conticello C, Di Raimondo F. Bortezomib for the treatment of previously untreated multiple myeloma. Immunotherapy 2013; 5:327-52. [PMID: 23557417 DOI: 10.2217/imt.13.14] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Management of multiple myeloma (MM) has been drastically changed in the last 10 years thanks to the introduction of novel agents, which, combined with the backbone of classical chemotherapy, have led to a significant improvement in disease control. Bortezomib is the first reversible proteasome inhibitor approved for the treatment of MM, with wide synergism in vitro and in vivo with a plethora of drugs active for MM. In patients eligible for autologous stem cell transplantation (ASCT), the achievement of complete response or very good partial response before ASCT is associated with prolonged progression-free and overall survival. Thus, the goal of induction regimens should include, at least for younger patients, a continued improvement of the quality and depth of the achieved response. This article is focused on reviewing the major efforts in frontline therapy for MM, including bortezomib-containing induction regimens in patients either eligible or ineligible for ASCT.
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Affiliation(s)
- Alessandra Romano
- Department of Clinical & Molecular Biomedicine, Section of Hematology, University of Catania, Catania, Italy
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71
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Yu J, Qiu X, Shen X, Shi W, Wu X, Gu G, Zhu B, Ju S. miR-202 expression concentration and its clinical significance in the serum of multiple myeloma patients. Ann Clin Biochem 2013; 51:543-9. [PMID: 24048721 DOI: 10.1177/0004563213501155] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To explore microRNA-202 (miR-202) expression in serum of patients with multiple myeloma (MM), and investigate correlations between serum miR-202 expression and the development and prognosis of MM. DESIGN AND METHODS RNA was extracted from serum by QIAGEN miRNeasy Mini kit. Reverse transcription was performed with specific stem-loop primers. SYBR Green I QF-PCR was applied to detect the relative expression of miR-202 in 40 MM patients and 30 healthy controls. The linearity, specificity and reproducibility were evaluated. In addition, correlations between the relative expression of serum miR-202 and the concentrations of lactic acid dehydrogenase (LDH), β2M, λ light chain and κ light chain were assessed. RESULTS The relative expression of miR-202 in MM patients 1.503 (0.161-9.831) was significantly higher than that in healthy controls 1.000 (0.105-3.046) (P < 0.01) and was significantly correlated with serum β2M and κ light chain concentrations (r = 0.366, P = 0.0305; r = 0.358, P = 0.0348). CONCLUSIONS The relative expression of serum miR-202 in MM patients was significantly higher than that in healthy controls, and therefore it may prove to be useful in the auxiliary diagnosis of MM.
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Affiliation(s)
- Jiajia Yu
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong Jiangsu, China
| | - Xiaojun Qiu
- Department of Radiation Oncology, Affiliated Hospital of Nantong University, Nantong Jiangsu, China
| | - Xianjuan Shen
- Surgical Comprehensive Laboratory, Affiliated Hospital of Nantong University, Nantong Jiangsu, China
| | - Wei Shi
- Surgical Comprehensive Laboratory, Affiliated Hospital of Nantong University, Nantong Jiangsu, China
| | - Xinhua Wu
- Surgical Comprehensive Laboratory, Affiliated Hospital of Nantong University, Nantong Jiangsu, China
| | - Guohao Gu
- The First Hospital Affiliated to Soochow University, Suzhou Jiangsu, China
| | - Baoli Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, People's Republic of China
| | - Shaoqing Ju
- Laboratory Medicine Center, Affiliated Hospital of Nantong University, Nantong Jiangsu, China Department of Radiation Oncology, Affiliated Hospital of Nantong University, Nantong Jiangsu, China Surgical Comprehensive Laboratory, Affiliated Hospital of Nantong University, Nantong Jiangsu, China Public Health School of Nantong University, Nantong Jiangsu, China
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Greenberg AJ, Cousin M, Kumar S, Ketterling RP, Knudson RA, Larson D, Colby C, Scott C, Vachon CM, Rajkumar SV. Differences in the distribution of cytogenetic subtypes between multiple myeloma patients with and without a family history of monoclonal gammopathy and multiple myeloma. Eur J Haematol 2013; 91:193-195. [PMID: 23647020 PMCID: PMC3762589 DOI: 10.1111/ejh.12133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 11/28/2022]
Abstract
We previously reported an increased risk of monoclonal gammopathy of undetermined significance (MGUS) in first-degree relatives of MGUS and multiple myeloma patients. Here, we examine whether primary cytogenetic categories of myeloma differ between patients with and without a family history of MGUS or myeloma. We studied 201 myeloma patients with available data on family history and molecular cytogenetic classification. Myeloma with trisomies was more common in probands who had an affected first-degree relative with MGUS or myeloma compared with those without a family history (46.9% vs. 33.5%, P = 0.125); however, the difference was not statistically significant. Additional studies on the cytogenetic types of myeloma associated with familial tendency are needed.
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Affiliation(s)
- Alexandra J. Greenberg
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
- Mayo Clinic Center for Translational Science Activities, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Margot Cousin
- Mayo Clinic Center for Translational Science Activities, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Shaji Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Rhett P. Ketterling
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Ryan A. Knudson
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Dirk Larson
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Colin Colby
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Christopher Scott
- Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Celine M. Vachon
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - S. Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
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Favaloro J, Brown R, Aklilu E, Yang S, Suen H, Hart D, Fromm P, Gibson J, Khoo L, Ho PJ, Joshua D. Myeloma skews regulatory T and pro-inflammatory T helper 17 cell balance in favor of a suppressive state. Leuk Lymphoma 2013; 55:1090-8. [PMID: 23865833 DOI: 10.3109/10428194.2013.825905] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Discrepancies in the literature between regulatory T cell (Treg) and pro-inflammatory T helper 17 (Th17) numbers in multiple myeloma (MM) can be largely explained by technical differences in methodology and patient selection. In this study, Treg cells were defined as CD3(+)CD4(+)CD25(++)CD127(lo) cells. Patients with MM (n = 20) had a significant imbalance in Treg/Th17 ratio when compared with either aged-matched controls (n = 28) or other monoclonal gammopathies, and this was associated with a significantly worse survival. The percent Treg in bone marrow of patients with MM was higher than that in matched peripheral blood samples (p = 0.02), although FOXP3 expression within bone marrow T cells was lower (p = 0.02). We observed increased Treg function, both in vivo and in vitro, due at least partially to an increase in CTLA-4 expression by concurrent treatment with dexamethasone and immune modulatory compounds (iMiDs). We suggest that immunoregulatory balance is important during active chemotherapy and that conclusions related to the immunostimulatory effect of iMiDs based on in vitro testing must be considered with caution.
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Affiliation(s)
- James Favaloro
- Institute of Haematology, Royal Prince Alfred Hospital , Sydney, NSW , Australia
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74
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Association of response endpoints with survival outcomes in multiple myeloma. Leukemia 2013; 28:258-68. [PMID: 23868105 PMCID: PMC3918869 DOI: 10.1038/leu.2013.220] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 06/26/2013] [Accepted: 07/01/2013] [Indexed: 12/23/2022]
Abstract
Since the introduction of the proteasome inhibitor bortezomib and the immunomodulatory drugs (IMiDs) thalidomide and lenalidomide, more patients with multiple myeloma are achieving deep, durable responses and disease control, and are living longer. These improvements have afforded more robust analyses of the relationship between response and survival. Generally, these studies have demonstrated that improvements in the quality of response across all stages of treatment are associated with better disease control and longer survival. Thus, achievement of maximal response should be strongly considered, particularly in the frontline setting, but must also be balanced with tolerability, quality of life and patient preferences. In select patients, achievement of a lesser response may be adequate to prolong survival, and attempts to treat these patients to a deeper response may place them at unnecessary risk without significant benefit. Maintenance therapy has been shown to improve the quality of response and disease control and, in some studies, survival. Studies support maintenance therapy for high-risk patients as a standard of care, and there are emerging data supporting maintenance therapy in standard-risk patients to improve progression-free and possibly overall survival. Multidrug regimens combining a proteasome inhibitor and an IMiD have shown exceptional response outcomes with acceptable increases in toxicity in both the frontline and salvage settings, and are becoming a standard treatment approach. Moving forward, the use of immunophenotypic and molecular response criteria will be essential in better understanding the impact of highly active and continuous treatment regimens across myeloma patient populations. Future translational studies will help to develop antimyeloma agents to their fullest potential. The introduction of novel targeted therapies, including the IMiD pomalidomide and the proteasome inhibitors carfilzomib and ixazomib (MLN9708), will provide greater options to individualize treatment and help patients achieve a clinically meaningful response.
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75
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The impact of upfront versus sequential use of bortezomib among patients with newly diagnosed multiple myeloma (MM): a joint analysis of the Singapore MM Study Group and the Korean MM Working Party for the Asian myeloma network. Leuk Res 2013; 37:1070-6. [PMID: 23816344 DOI: 10.1016/j.leukres.2013.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/29/2013] [Accepted: 06/05/2013] [Indexed: 11/22/2022]
Abstract
From the comprehensive MM registries of the Singapore (SG) and South Korea (SK) MM study groups, we study the survival data of 432 unselected and previously untreated MM patients diagnosed from 2006 to 2009. Although novel agents were introduced to both countries which have compatible healthcare standards at the same time, MM patients with high-risk features in SG could receive frontline bortezomib while bortezomib could only be approved for salvage setting in SK. After a median follow-up of 19 months, despite 26% of patients in SG versus none in SK having received frontline bortezomib, the overall bortezomib-exposure rate was higher in SK (60% versus 47%, p<0.001). Significantly more patients had no response to induction in SK. Although the median overall survival (OS) of patients in SG and SK was not significantly different (not reached versus 4.83 years respectively, p=0.2), corresponding 2-year OS for high-risk ISS patients treated in SG and SK was 81% and 67% respectively (p=0.01). On multivariate analysis stratified by country, the attainment of ≥ VGPR was the only significant prognostic factor in SG while the presence of high-risk ISS has significant early prognostic impact in SK. Frontline use of bortezomib compared to its sequential may avert early mortality especially among patients with high-risk MM.
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76
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Jekarl DW, Min CK, Kwon A, Kim H, Chae H, Kim M, Lim J, Kim Y, Han K. Impact of genetic abnormalities on the prognoses and clinical parameters of patients with multiple myeloma. Ann Lab Med 2013; 33:248-54. [PMID: 23826560 PMCID: PMC3698302 DOI: 10.3343/alm.2013.33.4.248] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 03/18/2013] [Accepted: 05/16/2013] [Indexed: 11/19/2022] Open
Abstract
Background We reviewed patients with multiple myeloma (MM) in order to assess the incidence of genetic abnormalities and their associations with clinical parameters, risk groups, and prognosis. Methods A total of 130 patients with MM were enrolled. The incidences of genetic abnormalities were determined in all patients. The relationships of the genetic abnormalities and clinical parameters were investigated. In addition, a survival analysis was performed. Results Abnormal karyotypes were detected in 42.3% (N=55) of the patients, and this was increased to 63.1% (N=82) after including the results determined with interphase FISH. Hypodiploidy was observed in 7.7% (N=10) of the patients, and all were included in the group with complex karyotypes (30.8%, N=40). The 14q32 rearrangements were detected in 29.2% (N=38) of the patients, and these most commonly included t(11;14), which was followed by t(4;14) and t(14;16) (16.2%, 11.5%, and 0.8%, respectively). Abnormal karyotypes and complex karyotypes were associated with disease progression markers, including low hemoglobin levels, low platelet counts, high plasma cell burden, high β2-microglobulin, and high international staging system stages. A high free light chain (FLC) ratio and FLC difference were associated with abnormal karyotypes, complex karyotypes, and higher plasma cell burden. Hypodiploidy and low platelet counts were significant independent prognostic factors and were more important in patient outcome than any single abnormality. Conclusions Genetic abnormalities were associated with disease progression markers and prognosis of MM patients.
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Affiliation(s)
- Dong Wook Jekarl
- Department of Laboratory Medicine, Catholic Genetic Laboratory Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kaufman JL, Fabre C, Lonial S, Richardson PG. Histone deacetylase inhibitors in multiple myeloma: rationale and evidence for their use in combination therapy. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:370-6. [PMID: 23787122 DOI: 10.1016/j.clml.2013.03.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/14/2013] [Accepted: 03/27/2013] [Indexed: 01/07/2023]
Abstract
Multiple myeloma (MM) arises from abnormal proliferation and survival (ie, a high proliferative index and a low apoptotic index) of mature immunoglobulin-producing plasma cells in the bone marrow. Development of novel therapeutic options, such as proteasome inhibitors and immunomodulatory agents (IMiDs), has improved treatment outcomes. However, patients often develop relapsed and refractory MM, thus requiring alternative treatment approaches. Histone acetyltransferases and histone deacetylases (HDACs) control the acetylation status of proteins and affect a broad array of physiologic processes (eg, cell cycle, apoptosis, and protein folding) involved in cell growth and survival. The discovery that HDACs might have a role in various hematologic malignancies, including MM, has led to the development of HDAC inhibitors as potential antitumor agents. Preclinical evidence from studies of HDAC inhibitors in combination with proteasome inhibitors (eg, bortezomib and carfilzomib), other antimyeloma agents, including IMiDs (eg, lenalidomide), and cytotoxic agents (eg, melphalan, pegylated liposomal doxorubicin), provides a strong scientific rationale for the evaluation of these regimens. Results from early stage clinical trials further support the use of HDAC inhibitors as a therapeutic option for MM, in combination with current and emerging antimyeloma agents. In this review, we examine the role of protein acetylation that underlies the antimyeloma effects of HDAC inhibitors, discuss the preclinical rationale for the use of HDAC inhibitors in combination with other antimyeloma agents, and provide an overview of the current clinical evidence supporting the use of HDAC inhibitors as a therapeutic option in MM.
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Affiliation(s)
- Jonathan L Kaufman
- Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.
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78
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Paiva B, Vídriales MB, Rosiñol L, Martínez-López J, Mateos MV, Ocio EM, Montalbán MÁ, Cordón L, Gutiérrez NC, Corchete L, Oriol A, Terol MJ, Echeveste MA, De Paz R, De Arriba F, Palomera L, de la Rubia J, Díaz-Mediavilla J, Granell M, Gorosquieta A, Alegre A, Orfao A, Lahuerta JJ, Bladé J, Miguel JFS. A multiparameter flow cytometry immunophenotypic algorithm for the identification of newly diagnosed symptomatic myeloma with an MGUS-like signature and long-term disease control. Leukemia 2013; 27:2056-61. [DOI: 10.1038/leu.2013.166] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 05/27/2013] [Accepted: 05/30/2013] [Indexed: 12/22/2022]
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79
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Sasaki K, Lu G, Saliba RM, Bashir Q, Hosing C, Popat U, Shah N, Parmar S, Dinh Y, Ahmed S, Shpall EJ, Kebriaei P, Shah JJ, Orlowski RZ, Champlin R, Qazilbash MH. Impact of t(11;14)(q13;q32) on the outcome of autologous hematopoietic cell transplantation in multiple myeloma. Biol Blood Marrow Transplant 2013; 19:1227-32. [PMID: 23733001 DOI: 10.1016/j.bbmt.2013.05.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/22/2013] [Indexed: 11/29/2022]
Abstract
The t(11;14)(q13;q32) translocation is seen in 15%-20% patients with multiple myeloma (MM). It generally is not associated with worse outcomes. We studied the impact of t(11;14)(q13;q32) on outcome in patients with MM who received high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HCT). Eligible patients underwent high-dose chemotherapy followed by auto-HCT at the M.D. Anderson Cancer Center between February 2000 and August 2010, and had conventional cytogenetic (CC) or fluorescence in situ hybridization (FISH) results available before auto-HCT (n = 993). The cohort was divided into 3 groups of patients: (1) normal (diploid by CC and negative by FISH; n = 869); (2) t(11;14)(q13;q32) by CC or FISH (n = 27); and (3) high-risk (HR) abnormalities by CC or FISH (n = 97). Of the 27 patients with t(11;14)(q13;q32), 18 had isolated t(11;14)(q13;q32) and 9 had concurrent HR abnormalities. The primary objective was to compare outcomes in patients with t(11;14)(q13;q32) and patients with diploid or HR markers detected by CC or FISH studies. The median duration of follow-up in surviving patients was 37 months. The 3-year progression-free survival (PFS) was 47% for the normal group, 27% for the t(11;14)(q13;q32) group, and 13% for the HR group (P < .00001). The 3-year OS was 83% for the normal group, 63% for the t(11;14)(q13;q32) group, and 34% for the HR group (P < .00001). On multivariate analysis, t(11;14)(q13;q32) and HR abnormalities by CC or FISH and relapsed disease at auto-HCT were associated with shorter PFS, whereas t(11;14)(q13;q32) and HR abnormalities by CC or FISH, β2 microglobulin of >3.5, and relapsed disease at the time of auto-HCT were associated with shorter OS. In conclusion, patients with t(11;14)(q13;q32) had worse outcomes than patients with normal CC or FISH studies, but better outcomes than patients with HR markers detected by CC or FISH studies.
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Affiliation(s)
- Koji Sasaki
- Department of Medicine, Beth Israel Medical Center, New York, NY 10003, USA.
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80
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Maxwell KN, Porter DL. A classic presentation of an uncommon leukemia. Am J Hematol 2013; 88:431-2. [PMID: 22987274 DOI: 10.1002/ajh.23325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/06/2012] [Accepted: 08/10/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Kara N. Maxwell
- Department of Internal Medicine; Division of Hematology/Oncology; University of Pennsylvania; Philadelphia; PA
| | - David L. Porter
- Blood and Marrow Transplantation; Abramson Cancer Center; University of Pennsylvania; Philadelphia; PA
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81
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Wirk B, Byrne M, Dai Y, Moreb JS. Outcomes of salvage autologous versus allogeneic hematopoietic cell transplantation for relapsed multiple myeloma after initial autologous hematopoietic cell transplantation. J Clin Med Res 2013; 5:174-84. [PMID: 23671543 PMCID: PMC3651068 DOI: 10.4021/jocmr1274w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Standard therapy for multiple myeloma (MM) includes initial autologous hematopoietic cell transplantation (autoHCT1) but this is not curative and most patients will relapse. Role of salvage autoHCT2 or allogeneic HCT (alloHCT2) is undefined. METHODS MM patients who relapsed after autoHCT1 and had salvage autoHCT2 (N = 27) or alloHCT2 (N = 19) between 1995 - 2011 at our institution were studied retrospectively. RESULTS Complete and very good partial remission (CR/VGPR) improved from 7% to 56% after autoHCT2 and from 26% to 37% after alloHCT2. Nonrelapse mortality (NRM) at 3 years was 3.7% for autoHCT2 and 5.3% for alloHCT2 (P = 0.901). Median progression free survival (PFS) and overall survival (OS) for autoHCT2 (19 months, 23 months) and alloHCT2 (6 months, 19 months) were not significantly different. On multivariate analysis, time from autoHCT1 to relapse ≥ 1year (HR 24.81, 95% CI 2.4 - 249.9) and maintenance therapy after autoHCT2 (HR 12.19, 95% CI 2.5 - 249.9) impacted OS after autoHCT2. Time from autoHCT1 to relapse < 1 year vs. ≥ 1 year (HR 18.55, 95% CI 2.28 - 150.57) impacted PFS after autoHCT2. For alloHCT2, no factors impacted NRM, PFS or OS. For those with relapse from autoHCT1 < 1 year vs. ≥ 1 year undergoing autoHCT2, median OS was 15 months (range, 1 - 53) vs. not yet reached at 143 months and median PFS was 5 months (range, 1 - 49) vs. not yet reached at 88 months. CONCLUSIONS Salvage autoHCT2 and alloHCT2 are both feasible for post autoHCT1 MM relapse. Relapse ≥ 1 year from autoHCT1 predicts for better PFS and OS after autoHCT2. Maintenance therapy after autoHCT2 is beneficial.
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Affiliation(s)
- Baldeep Wirk
- Division of Hematology-Oncology, University of Florida, USA
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Dispenzieri A, Seenithamby K, Lacy MQ, Kumar SK, Buadi FK, Hayman SR, Dingli D, Litzow MR, Gastineau DA, Inwards DJ, Micallef IN, Ansell SM, Johnston PB, Porrata LF, Patnaik MM, Hogan WJ, Gertz MAA. Patients with immunoglobulin light chain amyloidosis undergoing autologous stem cell transplantation have superior outcomes compared with patients with multiple myeloma: a retrospective review from a tertiary referral center. Bone Marrow Transplant 2013; 48:1302-7. [DOI: 10.1038/bmt.2013.53] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 03/05/2013] [Accepted: 03/06/2013] [Indexed: 11/09/2022]
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Maes K, Menu E, Van Valckenborgh E, Van Riet I, Vanderkerken K, De Bruyne E. Epigenetic modulating agents as a new therapeutic approach in multiple myeloma. Cancers (Basel) 2013; 5:430-61. [PMID: 24216985 PMCID: PMC3730337 DOI: 10.3390/cancers5020430] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/03/2013] [Accepted: 04/08/2013] [Indexed: 12/31/2022] Open
Abstract
Multiple myeloma (MM) is an incurable B-cell malignancy. Therefore, new targets and drugs are urgently needed to improve patient outcome. Epigenetic aberrations play a crucial role in development and progression in cancer, including MM. To target these aberrations, epigenetic modulating agents, such as DNA methyltransferase inhibitors (DNMTi) and histone deacetylase inhibitors (HDACi), are under intense investigation in solid and hematological cancers. A clinical benefit of the use of these agents as single agents and in combination regimens has been suggested based on numerous studies in pre-clinical tumor models, including MM models. The mechanisms of action are not yet fully understood but appear to involve a combination of true epigenetic changes and cytotoxic actions. In addition, the interactions with the BM niche are also affected by epigenetic modulating agents that will further determine the in vivo efficacy and thus patient outcome. A better understanding of the molecular events underlying the anti-tumor activity of the epigenetic drugs will lead to more rational drug combinations. This review focuses on the involvement of epigenetic changes in MM pathogenesis and how the use of DNMTi and HDACi affect the myeloma tumor itself and its interactions with the microenvironment.
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Affiliation(s)
- Ken Maes
- Department of Hematology and Immunology, Myeloma Center Brussels, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussel, Belgium
| | - Eline Menu
- Department of Hematology and Immunology, Myeloma Center Brussels, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussel, Belgium
| | - Els Van Valckenborgh
- Department of Hematology and Immunology, Myeloma Center Brussels, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussel, Belgium
| | - Ivan Van Riet
- Stem Cell Laboratory, Department Clinical Hematology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussel, Belgium
| | - Karin Vanderkerken
- Department of Hematology and Immunology, Myeloma Center Brussels, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussel, Belgium
| | - Elke De Bruyne
- Department of Hematology and Immunology, Myeloma Center Brussels, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussel, Belgium
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84
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Ríos R, González-Silva M, Molina E, García-Fernández JR, Clavero ME, Durán JM, López-Berenguel F, Romero MM, Jiménez-Moleón JJ, Sánchez MJ, Sáinz J, Jurado M. The impact of the type of hospital on survival of multiple myeloma patients: the MICORE study. Rev Clin Esp 2013; 213:330-5. [PMID: 23562426 DOI: 10.1016/j.rce.2013.02.014] [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] [Received: 11/18/2012] [Revised: 01/17/2013] [Accepted: 02/10/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To analyze the impact of the type of hospital in overall survival of multiple myeloma patients. PATIENTS AND METHOD A survival analysis was performed of all patients (n=431) diagnosed in 5 public hospitals (4 community hospitals and one university hospital) during the period 1993-2006. RESULTS Patients attended to in community hospitals differ significantly from those seen in the university hospital in the following variables: mean age (70 years [31-92] versus 67.9 (35-91), P=.038); percentage of stage iii patients (62.6% versus 69.1%, P=.033), and percentage of patients who had autologous stem cell transplant (8.2% versus 18.2%, P=.026). The variables associated with mortality in the multivariate analysis were age (P<.001), stage (iii versus i; P=.03) and renal failure (P=.04). The type of hospital did not reach statistical significance (hazard ratio of 0.72 (95% confidence interval 0.48-1.07), P=.1]. CONCLUSIONS The type of hospital is not significantly associated with mortality in multiple myeloma patients. These data support our current model of health care, in which the community hospitals are responsible for the primary care of these patients, in a coordinated work with the university hospital.
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Affiliation(s)
- R Ríos
- Servicio de Hematología-Hemoterapia, Hospital Universitario Virgen de las Nieves, Granada, España; Servicio de Hematología-Hemoterapia, Hospital Valle de los Pedroches, Pozoblanco, Córdoba, España.
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Mangiacavalli S, Pochintesta L, Pascutto C, Cocito F, Cazzola M, Corso A, Corso A. Good clinical activity and favorable toxicity profile of once weekly bortezomib, fotemustine, and dexamethasone (B-MuD) for the treatment of relapsed multiple myeloma. Am J Hematol 2013; 88:102-6. [PMID: 23224960 PMCID: PMC3563219 DOI: 10.1002/ajh.23358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 10/24/2012] [Indexed: 11/11/2022]
Abstract
Since multiple myeloma (MM) is still not-curable, the management of relapse remains challenging. Given the known efficacy of alkylating agents in MM, we conducted a phase I/II study to test a new three drug combination in which Fotemustine (Muphoran), an alkylating agent of nitrosurea family, was added to bortezomib + dexamethasone backbone (B-MuD) for the treatment of MM relapsed patients. Fotemustine was administered at two dose levels (80–100 mg/m2 i.v.) on day 1. The original 21-day schedule was early amended for extra-hematological toxicity and a 35-day schedule was adopted (Bortezomib 1.3 mg/m2 i.v. on days 1, 8, 15, and 22, Dexamethasone 20 mg i.v. on days 1, 8, 15, and 22) for a total of six courses. Twenty-four patients were enrolled. The maximum tolerated dose of Fotemustine was 100 mg/m2. The overall response rate was of 62% (CR 8%, VGPR 33%, and PR 21%). The median OS was 28.5 months, the median progression-free survival (PFS) was 19.1 months. B-MuD resulted effective in patients previous exposed to bortezomib without difference of response (P = 0.25) and PFS (P = 0.87) when compared to bortezomib-naive patients. Thrombocytopenia was the most common AE overall. In conclusion, B-MuD is an effective and well tolerated combination in relapsed MM patients even in advanced disease phase. © Am. J. Hematol., 88:102–106, 2013. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Silvia Mangiacavalli
- Division of HematologyFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Lara Pochintesta
- Division of HematologyFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Cristiana Pascutto
- Division of HematologyFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Federica Cocito
- Division of HematologyFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Mario Cazzola
- Division of HematologyFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Alessandro Corso
- Division of HematologyFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
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86
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Detection of t(14;16)(q32;q22) and Monosomy 13 by FISH Analysis in a Patient with Multiple Myeloma Associated with Sjögren's Syndrome: The First Case Report from India. Case Rep Genet 2013; 2013:279801. [PMID: 23401810 PMCID: PMC3562653 DOI: 10.1155/2013/279801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 12/23/2012] [Indexed: 11/17/2022] Open
Abstract
Sjögren's syndrome (SS) is a chronic slowly progressive autoimmune disorder characterized by symptoms of oral and ocular dryness, exocrine dysfunction, and lymphocytic infiltration of exocrine glands. Multiple myeloma (MM) is a bone-marrow-based malignant neoplasm of plasma cells associated with serum/urine monoclonal paraproteins and lytic skeletal lesions. There have been very few reported cases of MM, who had SS as the first presentation. We report a case of a woman diagnosed with Sjögren's syndrome, who was later suspected to have multiple myeloma on serum protein electrophoresis. Fluorescence in situ hybridization (FISH) was carried out to check for deletions of loci 13q14.3, ATM, p53, and IGH (14q32) rearrangements on a bone marrow aspirate. Monosomy 13 was observed in 49% of cells, and a rearrangement at the IGH locus was seen in 42% of cells. To determine the partner chromosome associated with the IGH rearrangement, further FISH tests were set up for t(4;14)(p16;q32) followed by t(14;16)(q32;q22) on fresh slides. The test was negative for t(4;14) but positive for t(14;16) in 27% of cells. This confirmed the diagnosis of MM. We report the first case from India, having an association of Sjögren's syndrome with multiple myeloma, which showed t(14;16) and monosomy 13 by FISH analysis.
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Abstract
PURPOSE OF REVIEW Nearly all patients with multiple myeloma will eventually relapse; and, thus, it is critical to identify new treatments that increase therapeutic options for these patients. This review highlights the newest approaches with already approved drugs for treating this common B-cell malignancy. RECENT FINDINGS Most patients with multiple myeloma in both the frontline and relapsed/refractory settings are now treated with a combination of dexamethasone with the proteasome inhibitor bortezomib and/or an immunomodulatory agent thalidomide or lenalidomide. However, alkylating agents including melphalan, cyclophosphamide and most recently bendamustine as well as anthracyclines, especially the pegylated liposomal doxorubicin, have shown high response rates and prolonged remissions when combined with these agents. There are emerging data showing the importance of maintenance therapy especially with lenalidomide. Because of the marked improvement in survival of multiple myeloma during the past decade, there has been a renewed emphasis on developing therapies that are not only effective but also well tolerated. Alternative dosing, scheduling and routes of administration of already approved drugs have proven effective in accomplishing these goals. SUMMARY The availability of drugs with different mechanisms that produce anti-multiple myeloma effects and also show synergistic effects has paved the way for more effective and safer combinations and led to multiple myeloma patients living longer with improved quality of lives.
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88
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Dmoszyńska A, Walter-Croneck A, Usnarska-Zubkiewicz L, Stella-Hołowiecka B, Walewski J, Charliński G, Jędrzejczak WW, Wiater E, Lech-Marańda E, Mańko J, Dytfeld D, Komarnicki M, Jamroziak K, Robak T, Jurczyszyn A, Skotnicki A, Giannopoulos K. Zalecenia Polskiej Grupy Szpiczakowej dotyczące rozpoznawania i leczenia szpiczaka plazmocytowego oraz innych dyskrazji plazmocytowych na rok 2013. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.achaem.2013.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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de Carvalho F, Alves VLF, Braga WMT, Xavier CV, Colleoni GWB. MAGE-C1/CT7 and MAGE-C2/CT10 are frequently expressed in multiple myeloma and can be explored in combined immunotherapy for this malignancy. Cancer Immunol Immunother 2013; 62:191-5. [PMID: 23180015 PMCID: PMC11028960 DOI: 10.1007/s00262-012-1376-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/07/2012] [Indexed: 12/01/2022]
Abstract
The exact function of MAGE-C1/CT7 and MAGE-C2/CT10 is not yet understood in multiple myeloma (MM). However, the homologs MAGE-C1/CT7 and MAGE-C2/CT10 genes encode highly immunogeneic cancer/testis antigens (CTAs) and can be potential targets for T cell-based immunotherapy. MAGE-C1/CT7 and MAGE-C2/CT10 mRNA expression were investigated in MM patients, solitary plasmacytomas, monoclonal gammopathies of undetermined significance (MGUS) and bone marrow (BM) aspirates from healthy donors by RT-PCR. MAGE-C1/CT7 and MAGE-C1/CT10 were expressed in 67 and 59 % of the 46 MM analyzed patients. At least one of the genes was expressed in 76 % of MM cases. Solitary plasmacytoma also showed MAGE-C1/CT7 and MAGE-C2/CT10 expression. MAGE-C1/CT7 and MAGE-C2/CT10 were not expressed in normal BM samples, showing restricted expression of these CTA genes in MM, solitary plasmacytoma and MGUS. In the present study, we found high expression of the homologs MAGE-C1/CT7 and MAGE-C2/CT10 in monoclonal gammopathies and speculate whether these genes might represent a valuable therapeutic option for myeloma, in particular for combined immunotherapy.
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Affiliation(s)
- Fabricio de Carvalho
- Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo (UNIFESP/EPM), Rua Botucatu, 740, 3o andar, Hematologia, Vila Clementino, CEP 04023-900, São Paulo, Brazil.
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90
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Dowling M, Kelly M, Meenaghan T. Multiple myeloma: treatment- related peripheral neuropathy. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2012; 21:1325. [PMID: 23249799 DOI: 10.12968/bjon.2012.21.22.1325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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Abstract
Abstract
The treatment of multiple myeloma is evolving rapidly. A plethora of doublet, triplet, and quadruplet combinations have been studied for the treatment of newly diagnosed myeloma. Although randomized trials have been conducted comparing older regimens such as melphalan-prednisone with newer regimens containing drugs such as thalidomide, lenalidomide, or bortezomib, there are few if any randomized trials that have compared modern combinations with each other. Even in the few trials that have done so, definitive overall survival or patient-reported quality-of-life differences have not been demonstrated. Therefore, there is marked heterogeneity in how newly diagnosed patients with myeloma are treated around the world. The choice of initial therapy is often dictated by availability of drugs, age and comorbidities of the patient, and assessment of prognosis and disease aggressiveness. This chapter reviews the current data on the most commonly used and tested doublet, triplet, and quadruplet combinations for the treatment of newly diagnosed myeloma and provides guidance on choosing the optimal initial treatment regimen.
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92
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New rising infection: human herpesvirus 6 is frequent in myeloma patients undergoing autologous stem cell transplantation after induction therapy with bortezomib. BONE MARROW RESEARCH 2012; 2012:409765. [PMID: 23243510 PMCID: PMC3517825 DOI: 10.1155/2012/409765] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/01/2012] [Accepted: 11/01/2012] [Indexed: 12/12/2022]
Abstract
Herpesvirus 6 (HHV-6) infection is a common complication during immunosuppression. Its significance for multiple myeloma (MM) patients undergoing autologous stem cell transplantation (ASCT) after treatment with novel agents affecting immune system remains undetermined. Data on 62 consecutive MM patients receiving bortezomib-dexamethasone (VD) (n = 41; 66%) or thalidomide-dexamethasone (TD) (n = 21, 34%) induction, together with melphalan 200 mg/m2 autograft between 01.2005 and 09.2010, were reviewed. HHV-6 reactivation was diagnosed in patients experiencing postengraftment unexplained fever (PEUF) in the presence of any level of HHHV-6 DNA in blood. There were no statistically significant differences in patient characteristics between the groups, excluding dexamethasone dosage, which was significantly higher in patients receiving TD. Eight patients in TD and 18 in VD cohorts underwent viral screening for PEUF. HHV-6 reactivation was diagnosed in 10 patients of the entire series (16%), accounting for 35% of those screened; its incidence was 19.5% (n = 8) in the VD group versus 9.5% (n = 2) in the TD group. All patients recovered without sequelae. In conclusion, HHV-6 reactivation is relatively common after ASCT, accounting for at least a third of PEUF episodes. Further studies are warranted to investigate whether bortezomib has an impact on HHV-6 reactivation development.
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93
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Gaultney JG, Redekop WK, Sonneveld P, Uyl-de Groot CA. Novel anticancer agents for multiple myeloma: a review of the evidence for their therapeutic and economic value. Expert Rev Anticancer Ther 2012; 12:839-54. [PMID: 22716498 DOI: 10.1586/era.12.42] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Recent advances in oncology treatment have improved patient outcomes at the expense of increasing healthcare costs. The indication multiple myeloma is especially characterized by a recent and continuing flood of expensive novel agents. A review encompassing all elements necessary to perform an economic evaluation of novel agents for multiple myeloma was conducted for thalidomide, bortezomib and lenalidomide. Improvements in efficacy have led to a switch from conventional therapy to novel agents as standard therapy. Incremental cost-effectiveness ratios for novel agents alone or in combination with conventional agents were generally regarded to be within acceptable ranges. Conflicting results were reported for the incremental cost-effectiveness of bortezomib versus lenalidomide, as unresolved questions remain regarding their comparative effectiveness. Future economic evaluations will require an assessment of the cost-effectiveness of these agents in terms of sequence within the treatment paradigm and in combination with one another.
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Affiliation(s)
- Jennifer G Gaultney
- Institute for Medical Technology Assessment/Institute of Health Policy & Management, Erasmus University, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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94
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Current world literature. Curr Opin Oncol 2012; 24:756-68. [PMID: 23079785 DOI: 10.1097/cco.0b013e32835a4c91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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95
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Ram R, Magen-Nativ H, Vidal L, Herscovici C, Peck A, Raanani P, Shpilberg O, Yeshurun M. Toxicity of autologous hematopoietic cell transplantation in patients with multiple myeloma - comparison between two different induction regimens. Clin Transplant 2012; 26:E549-54. [DOI: 10.1111/ctr.12018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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96
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Zehentner BK, Hartmann L, Johnson KR, Stephenson CF, Chapman DB, de Baca ME, Wells DA, Loken MR, Tirtorahardjo B, Gunn SR, Lim L. Array-based karyotyping in plasma cell neoplasia after plasma cell enrichment increases detection of genomic aberrations. Am J Clin Pathol 2012; 138:579-89. [PMID: 23010713 DOI: 10.1309/ajcpkw31baimvgst] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The discovery of genomic abnormalities present in monoclonal plasma cells has diagnostic, prognostic, and disease-monitoring implications in plasma cell neoplasms (PCNs). However, technical and disease-related limitations hamper the detection of these abnormalities using cytogenetic analysis or fluorescence in situ hybridization (FISH). In this study, 28 bone marrow specimens with known PCNs were examined for the presence of genomic abnormalities using microarray analysis after plasma cell enrichment. Cytogenetic analysis was performed on 15 of 28 samples, revealing disease-related genomic aberrations in only 3 (20%) of 15 cases. FISH analysis was performed on enriched plasma cells and detected aberrations in 84.6% of specimens while array comparative genomic hybridization (aCGH) detected abnormalities in 89.3% of cases. Furthermore, aCGH revealed additional abnormalities in 24 cases compared with FISH alone. We conclude that aCGH after plasma cell enrichment, in combination with FISH, is a valuable approach for routine clinical use in achieving a more complete genetic characterization of patients with PCN.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Lony Lim
- Combimatrix Diagnostics, Irvine, CA
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Cutaneous extramedullary plasmacytoma: clinical, prognostic, and interphase cytogenetic analysis. Am J Dermatopathol 2012; 35:357-63. [PMID: 23000906 DOI: 10.1097/dad.0b013e31826d729f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Extramedullary plasmacytoma (EMP) of the skin is a rare indolent neoplasm that shares morphological and immunophenotypic features with plasma cell myeloma (PCM), but the molecular features that distinguish these two entities have not been defined. We reviewed the clinical characteristics, course, and molecular abnormalities in 7 cases of cutaneous EMP (cEMP); 2 patients had primary cEMP and 5 had secondary cEMP. Two patients died of progressive extramedullary plasmacytoma, 1 without PCM; 1 patient who had only a hyperdiploid clone, died within 17 months of the diagnosis of cEMP; and 3 died of PCM. One patient, who had cEMP with a hyperdiploid clone and a 13q deletion, was alive 28 months after diagnosis. Our findings raise questions about the relative prognostic value of molecular aberrations observed in cEMP and PCM. The role of fluorescence in situ hybridization testing in predicting disease progression of cEMP remains to be defined.
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98
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Sottnik JL, Hall CL, Zhang J, Keller ET. Wnt and Wnt inhibitors in bone metastasis. BONEKEY REPORTS 2012; 1:101. [PMID: 23951488 DOI: 10.1038/bonekey.2012.101] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 04/24/2012] [Indexed: 02/06/2023]
Abstract
Bone metastasis is a clinically devastating development of progressive cancers including prostate carcinoma, breast carcinoma and multiple myeloma. Bone metastases are typically painful, lead to adverse skeletal-related events, such as fracture, and are highly resistant to therapy. A major contribution to the ability of cancers to successfully establish bone metastases is their ability to exploit mechanisms of normal bone remodeling. Wnts are a large family of morphogenic proteins that are critical for bone development and contribute to maintaining bone mass in the mature organism. Wnt function is balanced by the presence of a variety of endogenous inhibitors, such as the dickkopf family members, secreted frizzled related proteins and sclerostin. Together, these factors contribute to normal bone homeostasis, allowing for dynamic changes in bone to withstand alterations in physical forces and physiological needs. In this review, we describe the role that Wnts and their inhibitors have in normal bone biology and cancer-related bone pathology. An overview of Wnt signaling pathways is discussed and key bone microenvironment cellular players, as they pertain to Wnt biology, are examined. Finally, we describe clinical trials of several Wnt inhibitor antagonists for patients with tumor-related bone disease. As few options currently exist for the treatment of bone-metastatic disease, Wnt proteins and their inhibitors offer promise for the development of novel therapeutics.
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Affiliation(s)
- Joseph L Sottnik
- Department of Urology, University of Michigan , Ann Arbor, MI, USA
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99
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Naik S, Nace R, Federspiel MJ, Barber GN, Peng KW, Russell SJ. Curative one-shot systemic virotherapy in murine myeloma. Leukemia 2012; 26:1870-8. [PMID: 22425894 PMCID: PMC3411853 DOI: 10.1038/leu.2012.70] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Current therapy for multiple myeloma is complex and prolonged. Antimyeloma drugs are combined in induction, consolidation and/or maintenance protocols to destroy bulky disease, then suppress or eradicate residual disease. Oncolytic viruses have the potential to mediate both tumor debulking and residual disease elimination, but this curative paradigm remains unproven. Here we engineered an oncolytic vesicular stomatitis virus to minimize its neurotoxicity, enhance induction of antimyeloma immunity, and facilitate noninvasive monitoring of its intratumoral spread. Using high resolution imaging, autoradiography and immunohistochemistry, we demonstrate that the intravenously administered virus extravasates from tumor blood vessels in immunocompetent myeloma-bearing mice, nucleating multiple intratumoral infectious centers which expand rapidly and necrose at their centers, ultimately coalescing to cause extensive tumor destruction. This oncolytic tumor debulking phase lasts only for 72 hours after virus administration, and is completed before antiviral antibodies become detectable in the bloodstream. Anti-myeloma T cells, cross-primed as the virus-infected cells provoke an antiviral immune response, then eliminate residual uninfected myeloma cells. The study establishes a curative oncolytic paradigm for multiple myeloma where direct tumor debulking and immune eradication of minimal disease are mediated by a single intravenous dose of a single therapeutic agent. Clinical translation is underway.
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Affiliation(s)
- S Naik
- Department of Molecular Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Krishnan A. Stem cell transplantation for multiple myeloma: who, when, and what type? Am Soc Clin Oncol Educ Book 2012:502-7. [PMID: 24451787 DOI: 10.14694/edbook_am.2012.32.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Early randomized trials of high-dose chemotherapy with autologous stem cell rescue showed improved progression-free survival (PFS) over conventional chemotherapy. However, in the era of novel agents for myeloma in conjunction with the evolution of hematopoietic stem cell transplantation, many new questions arise. First, how can novel agents be incorporated into the transplant paradigm? Given the efficacy of new induction regimens, should transplant be delayed until relapse? Also, in the era of individualized medicine, chronologic age alone should not drive decisions regarding transplantation. Therefore, the feasibility and role of transplantation in older patients with myeloma is being studied. The controversy of transplant type (i.e., autologous compared with reduced intensity allogeneic transplant) remains unresolved. Several large international trials have demonstrated conflicting results in regard to an overall survival (OS) benefit with the allogeneic approach. The role of allogeneic transplant remains under study especially in the high-risk population, which has high relapse rates with traditional autologous approaches. Future directions to reduce relapse include post-transplantation consolidation and maintenance therapy with either approved agents or new agents and immunotherapy, either vaccine based or natural killer (NK) and T-cell based.
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