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Shang Y, Wang W, Liang Y, Kaweme NM, Wang Q, Liu M, Chen X, Xia Z, Zhou F. Development of a Risk Assessment Model for Early Grade ≥ 3 Infection During the First 3 Months in Patients Newly Diagnosed With Multiple Myeloma Based on a Multicenter, Real-World Analysis in China. Front Oncol 2022; 12:772015. [PMID: 35372017 PMCID: PMC8967980 DOI: 10.3389/fonc.2022.772015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The study aimed to assess factors associated with early infection and identify patients at high risk of developing infection in multiple myeloma. Methods The study retrospectively analyzed patients with MM seen at two medical centers between January 2013 and June 2019. One medical center reported 745 cases, of which 540 of the cases were available for analysis and were further subdivided into training cohort and internal validation cohort. 169 cases from the other medical center served as an external validation cohort. The least absolute shrinkage and selection operator (Lasso) regression model was used for data dimension reduction, feature selection, and model building. Results Bacteria and the respiratory tract were the most common pathogen and localization of infection, respectively. In the training cohort, PS≥2, HGB<35g/L of the lower limit of normal range, β2MG≥6.0mg/L, and GLB≥2.1 times the upper limit of normal range were identified as factors associated with early grade ≥ 3 infections by Lasso regression. An infection risk model of MM (IRMM) was established to define high-, moderate- and low-risk groups, which showed significantly different rates of infection in the training cohort (46.5% vs. 22.1% vs. 8.8%, p<0.0001), internal validation cohort (37.9% vs. 24.1% vs. 13.0%, p=0.009) and external validation cohort (40.0% vs. 29.2% vs. 8.5%, p=0.0003). IRMM displayed good calibration (p<0.05) and discrimination with AUC values of 0.76, 0.67 and 0.71 in the three cohorts, respectively. Furthermore, IRMM still showed good classification ability in immunomodulatory (IMiD) based regimens, proteasome-inhibitors (PI) based regimens and combined IMiD and PI regimens. Conclusion In this study, we determined risk factors for early grade ≥ 3 infection and established a predictive model to help clinicians identify MM patients with high-risk infection.
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Affiliation(s)
- Yufeng Shang
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Weida Wang
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Hematologic Oncology, State Key Laboratory of Oncology in South China/Cancer Center, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Yuxing Liang
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | | | - Qian Wang
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Minghui Liu
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaoqin Chen
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhongjun Xia
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Hematologic Oncology, State Key Laboratory of Oncology in South China/Cancer Center, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Dimopoulos MA, Mikhael J, Terpos E, Leleu X, Moreau P, Bladé J, Kim JS, Stockerl-Goldstein K, Richardson PG. An overview of treatment options for patients with relapsed/refractory multiple myeloma and renal impairment. Ther Adv Hematol 2022; 13:20406207221088458. [PMID: 35392438 PMCID: PMC8980434 DOI: 10.1177/20406207221088458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Renal impairment (RI) is a relatively common complication of multiple myeloma, which increases in frequency as disease becomes more advanced and recovery of renal function becomes less likely as patients progress through lines of therapy. Clinical trials in the relapsed/refractory multiple myeloma (RRMM) setting have not uniformly included patients with RI or robustly reported their outcomes. Here, we review existing data among patients with RI and RRMM across drug classes (including immunomodulatory agents, proteasome inhibitors, monoclonal antibodies, antibody-drug conjugates, chimeric antigen receptor T-cell therapies, and exportin-1 inhibitor) to provide an improved understanding of available treatment options for this important population. We highlight data from pivotal clinical trials, including data relating to renal response (as defined by the International Myeloma Working Group) and discuss real-world experiences in patients with RI, where applicable. Despite substantial advances in RRMM treatment, the presence of RI remains associated with reduced overall survival. Consistent inclusion of patients with RI, and uniform reporting of their outcomes, should be encouraged in future prospective trials of treatments for RRMM.
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Affiliation(s)
- Meletios A. Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Joseph Mikhael
- Applied Cancer Research and Drug Discovery Division at the Translational Genomics Research Institute (TGen), City of Hope Cancer Center, Phoenix, AZ, USA
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Xavier Leleu
- Service d’Hématologie et Thérapie Cellulaire, CHU and CIC Inserm 1402, Poitiers Cedex, France
| | | | - Joan Bladé
- Hospital Clínic de Barcelona/IDIBAPS, Barcelona, Spain
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Keith Stockerl-Goldstein
- Division of Oncology, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Paul G. Richardson
- Dana Farber Cancer Institute, 450 Brookline Avenue, 44 Binney St., Boston, MA 02115, USA
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53
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Caro J, Cairns D, Menzies T, Boyle E, Pawlyn C, Cook G, Kaiser M, Walker BA, Owen R, Jackson GH, Morgan GJ, Heaney J, Drayson MT, Davies FE. Impact of Etiological Cytogenetic Abnormalities on the Depth of Immunoparesis and Survival in Newly Diagnosed Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e279-e284. [PMID: 34876373 DOI: 10.1016/j.clml.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION/BACKGROUND Immunoparesis, or low polyclonal immunoglobulin levels, is commonly seen in multiple myeloma (MM), and is associated with poor clinical outcomes. MM can be divided into subgroups with distinct biology and outcomes based on etiologic cytogenetic abnormalities. These include hyperdiploidy and translocations of t(11;14), t(4;14), t(14;16), and t(14;20), with the latter 3 associated with high-risk disease. We hypothesized that the different etiologic cytogenetic abnormalities drive bone marrow microenvironmental changes, resulting in different degrees of immunoparesis, and subgroup-dependent effects on clinical outcomes. MATERIALS AND METHODS We performed a retrospective review of 985 newly diagnosed patients enrolled in the Myeloma IX and XI trials. Immunoglobulin levels, survival outcomes, and infection rates were evaluated for each cytogenetic subgroup. RESULTS A significant proportion of patients with high-risk t(4;14), t(14;16), or t(14;20) had suppressed polyclonal immunoglobulins compared to standard-risk patients with hyperdiploidy or t(11;14). The clinical impact of immunoparesis depended on the cytogenetic subgroup, with the degree of IgM suppression effecting progression-free and overall survival only in the hyperdiploid subgroup. There was no significant difference in infection rates amongst the etiologic subgroups. CONCLUSION These findings demonstrate that the etiologic cytogenetic subgroup influences the degree and clinical impact of immunoparesis. This suggests that the underlying cytogenetic abnormality affects remodeling of the bone marrow plasma cell niche, resulting in suppressed normal plasma cell function, and low immunoglobulin levels.
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Affiliation(s)
- Jessica Caro
- Perlmutter Cancer Center, NYU Langone Health, New York, NY.
| | - David Cairns
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Tom Menzies
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Eileen Boyle
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | | | - Gordon Cook
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Martin Kaiser
- The Institute of Cancer Research, London, United Kingdom
| | | | - Roger Owen
- St James's University Hospital, Leeds, United Kingdom
| | - Graham H Jackson
- Department of Hematology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Jennifer Heaney
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Faith E Davies
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
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54
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Rubinstein SM, Bhutani D, Lynch RC, Hsu CY, Shyr Y, Advani S, Mesa RA, Mishra S, Mundt DP, Shah DP, Sica RA, Stockerl-Goldstein KE, Stratton C, Weiss M, Beeghly-Fadiel A, Accordino M, Assouline SE, Awosika J, Bakouny Z, Bashir B, Berg S, Bilen MA, Castellano CA, Cogan JC, Kc D, Friese CR, Gupta S, Hausrath D, Hwang C, Johnson NA, Joshi M, Kasi A, Klein EJ, Koshkin VS, Kuderer NM, Kwon DH, Labaki C, Latif T, Lau E, Li X, Lyman GH, McKay RR, Nagaraj G, Nizam A, Nonato TK, Olszewski AJ, Polimera HV, Portuguese AJ, Puc MM, Razavi P, Rosovski R, Schmidt A, Shah SA, Shastri A, Su C, Torka P, Wise-Draper TM, Zubiri L, Warner JL, Thompson MA. Patients recently treated for B-lymphoid malignancies show increased risk of severe COVID-19: a CCC19 registry analysis. Blood Cancer Discov 2022; 3:181-193. [PMID: 35262738 DOI: 10.1158/2643-3230.bcd-22-0013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/07/2022] [Accepted: 03/05/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with B-lymphoid malignancies have been consistently identified as a population at high risk of severe COVID-19. Whether this is exclusively due to cancer-related deficits in humoral and cellular immunity, or whether risk of severe COVID-19 is increased by anti-cancer therapy, is uncertain. Using data derived from the COVID-19 and Cancer Consortium (CCC19), we show that patients treated for B-lymphoid malignancies have an increased risk of severe COVID-19 compared to control populations of patients with non-B-lymphoid hematologic malignancies. Among patients with B-lymphoid malignancies, those who received anti-cancer therapy within 12 months of COVID-19 diagnosis experienced increased COVID-19 severity compared to patients with B-lymphoid malignancies off therapy, after adjustment for cancer status and several other prognostic factors. Our findings suggest that patients recently treated for a B-lymphoid malignancy are at uniquely high risk for severe COVID-19.
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Affiliation(s)
| | - Divaya Bhutani
- Herbert Irving Comprehensive Cancer Center, United States
| | - Ryan C Lynch
- University of Washington, Seattle, WA, United States
| | - Chih-Yuan Hsu
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Yu Shyr
- Vanderbilt University Medical Center, Nashville,, TN, United States
| | - Shailesh Advani
- Georgetown University Medical Center, Washington DC, MD, United States
| | - Ruben A Mesa
- Mays Cancer Center at UT Health San Antonio, San Antonio, TX, United States
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | | | - Dimpy P Shah
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | | | | | | | | | | | | | - Sarit E Assouline
- Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | - Joy Awosika
- University of Cincinnati Cancer Center, Cincinnati, OH, United States
| | - Ziad Bakouny
- Brigham and Women's Hospital, Boston, MA, United States
| | - Babar Bashir
- Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Stephanie Berg
- Loyola University Medical Center, Maywood, IL, United States
| | - Mehmet Asim Bilen
- Winship Cancer Institute of Emory Univesity, Atlanta, GA, United States
| | | | | | - Devendra Kc
- Hartford HealthCare Cancer Institute, Hartford, CT, United States
| | | | - Shilpa Gupta
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel Hausrath
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Clara Hwang
- Henry Ford Cancer Institute, Detroit, MI, United States
| | - Nathalie A Johnson
- Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | - Monika Joshi
- Penn State Hershey Cancer Institute, Hershey, PA, United States
| | - Anup Kasi
- University of Kansas Medical Center, Kansas City, KS, United States
| | | | - Vadim S Koshkin
- University of California, San Francisco, San Francisco, CA, United States
| | | | - Daniel H Kwon
- University of California, San Francisco, San Francisco, United States
| | - Chris Labaki
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Tahir Latif
- University of Cincinnati Cancer Center, United States
| | - Eric Lau
- Loma Linda University, Loma Linda, California, United States
| | - Xuanyi Li
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Rana R McKay
- University of California, San Diego, La Jolla, CA, United States
| | | | - Amanda Nizam
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Taylor K Nonato
- Franciscan Health Mooresvilles Comprehensive Cancer Center, United States
| | - Adam J Olszewski
- Brown University/Rhode Island Hospital, Providence, RI, United States
| | | | | | | | - Pedram Razavi
- Moores Comprehensive Cancer Center, La Jolla, United States
| | - Rachel Rosovski
- Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Andrew Schmidt
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Sumit A Shah
- Stanford University, Stanford, CA, United States
| | - Aditi Shastri
- Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, United States
| | - Christopher Su
- University of Michigan Medical Center, Ann Arbor, MI, United States
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | | | - Leyre Zubiri
- Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Jeremy L Warner
- Vanderbilt University Medical Center, Nashville, TN, United States
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55
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Huang W, Wei X, Wei Q, Wei Y, Feng R. Partial immunoparesis contributes to risk of early infections in patients with multiple myeloma. Transl Cancer Res 2022; 10:5258-5266. [PMID: 35116375 PMCID: PMC8797456 DOI: 10.21037/tcr-21-1627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/22/2021] [Indexed: 12/15/2022]
Abstract
Background Partial immunoparesis, which means at least two suppressed uninvolved immunoglobulins (Igs), had been reported to be associated with poor prognosis in patients with multiple myeloma (MM), but the impact on early infections remains unknown. The purpose of our study was to determine the prognostic implications of partial immunoparesis on early grade ≥3 infections in patients with MM. Methods Herein we retrospectively analyzed the clinical data of 123 MM patients between 2012 and 2020 at Nanfang Hospital. All patients received bortezomib-based regimens. The relationship between early grade ≥3 infections and partial immunoparesis was investigated using Cox regression analysis. Results Our data showed partial immunoapresis was found in 63% MM patients. Partial immunoparesis was significantly related to elevated beta-2-microglobulin (B2M), decreased estimated glomerular filtration rate (eGFR) and progressive international staging system (ISS) stage (P<0.05). Especially, univariate Cox regression analysis showed partial immunoparesis was significantly correlated with early grade ≥3 infections (P=0.003). Moreover, multivariate Cox regression analysis showed partial immunoparesis was an independent significant prognostic factor for early grade ≥3 infections [odds ratio (OR) =3.048; 95% confidence interval (CI): 1.429–6.504; P=0.004]. Furthermore, partial immunoapresis could improve the infection risk model built by Dumontet et al. Conclusions Our study showed that partial immunoparesis could predict early infections in patients with MM, which may be used to identify the high risk patients for infections and guide strategies for infection prevention.
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Affiliation(s)
- Weimin Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaolei Wei
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qi Wei
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yongqiang Wei
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ru Feng
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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56
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Sidana S, Kumar S, Fraser R, Estrada-Merly N, Giralt S, Agrawal V, Anderson LD, Aljurf M, Banerjee R, Bashey A, Battiwalla M, Beitinjaneh A, Chakraborty R, Chhabra S, Dhakal B, Dholaria B, Hashmi S, Janakiram M, Lee C, Lekakis L, Murthy HS, Parrondo R, Wangjam T, Usmani S, Shah N, Qazilbash M, D’Souza A. Impact of Induction Therapy with VRD versus VCD on Outcomes in Patients with Multiple Myeloma in Partial Response or Better Undergoing Upfront Autologous Stem Cell Transplantation. Transplant Cell Ther 2022; 28:83.e1-83.e9. [PMID: 34781066 PMCID: PMC8900987 DOI: 10.1016/j.jtct.2021.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 02/03/2023]
Abstract
Bortezomib-based triplet regimens-specifically bortezomib, lenalidomide, and dexamethasone (VRD) and bortezomib, cyclophosphamide, and dexamethasone (VCD)-are the 2 most common induction regimens used in transplantation-eligible patients with newly diagnosed multiple myeloma (NDMM), with conflicting data on comparative efficacy and outcomes in this population. We compared long-term outcomes of patients with NDMM receiving VRD induction and those receiving VCD induction prior to autologous stem cell transplantation (ASCT). Patients registered with the Center for International Blood and Marrow Transplant Registry were included if they had undergone ASCT for MM within 6 months of diagnosis between January 2013 and December 2018, received VRD or VCD induction, and achieved a pretransplantation partial or better response. Of 1135 patients, 914 received VRD and 221 received VCD. The patients receiving VCD were more likely to have renal impairment and International Staging System (ISS) stage III disease and less likely to receive full-dose melphalan (200 mg/m2) conditioning (69% versus 80%; P < .001). Very good partial response rates pretransplantation, post-transplantation, and at best response were not significantly different in the 2 groups. Maintenance use was more common after VRD induction (88% versus 76%; P < .001), with lenalidomide the most common agent (80% versus 63%). Patients in the VRD group had a higher rate of renal recovery (74% versus 43%; P < .001), possibly due to a rapid reduction of light chains in the VRD group or improvement in renal function with VCD, which allowed a switch over to VRD, as patients who switched were classified in the VRD group. Patients receiving VRD had better survival on univariate analysis, with a median progression-free survival (PFS) from transplantation of 44.6 months versus 34.1 months (P = .004) and median 5-year overall survival (OS) of 79% versus 60% (P < .001). Multivariate analysis showed no significant survival difference, with a hazard ratio for VCD versus VRD induction of 1.22 (95% CI, 0.96 to 1.55; P = .10) for PFS and 1.33 (95% CI, 0.93 to 1.92, P = .12) for OS. Maintenance use was independently associated with superior PFS and OS, along with ISS stage, cytogenetics, and pretransplantation response (PFS only). In patients with MM undergoing upfront ASCT after VRD or VCD induction, no independent survival difference was seen based on the induction therapy received after adjusting for other prognostic factors. The use of maintenance treatment was uniformly associated with superior outcomes. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
| | | | - Raphael Fraser
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Noel Estrada-Merly
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vaibhav Agrawal
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Larry D. Anderson
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Rahul Banerjee
- Division of Hematology-Oncology; University of California San Francisco, San Francisco, CA
| | - Asad Bashey
- Blood and Marrow Transplant Program at the Northside Hospital, Atlanta, GA
| | | | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami, Miami, FL
| | - Rajshekhar Chakraborty
- Multiple Myeloma and Amyloidosis Service, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Saurabh Chhabra
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Binod Dhakal
- BMT and Cellular Therapy, Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Shahrukh Hashmi
- 1. Department of Internal Medicine, Mayo Clinic, MN,Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Murali Janakiram
- University of Minnesota, Division of Hematology, Oncology, and Transplantation, Minneapolis, MN
| | - Cindy Lee
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Hemant S. Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | - Ricardo Parrondo
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | | | - Saad Usmani
- Department of Hematologic Oncology & Blood Disorders Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Nina Shah
- Division of Hematology-Oncology; University of California San Francisco, San Francisco, CA
| | | | - Anita D’Souza
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Consensus guidelines and recommendations for infection prevention in multiple myeloma: a report from the International Myeloma Working Group. Lancet Haematol 2022; 9:e143-e161. [DOI: 10.1016/s2352-3026(21)00283-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 12/14/2022]
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58
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Woziwodzka K, Małyszko J, Koc-Żórawska E, Żórawski M, Dumnicka P, Jurczyszyn A, Batko K, Mazur P, Banaszkiewicz M, Krzanowski M, Gołasa P, Małyszko JA, Drożdż R, Krzanowska K. Transgelin-2 in Multiple Myeloma: A New Marker of Renal Impairment? Molecules 2021; 27:molecules27010079. [PMID: 35011306 PMCID: PMC8746652 DOI: 10.3390/molecules27010079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 01/12/2023] Open
Abstract
Transgelin is a 22-kDa protein involved in cytoskeletal organization and expressed in smooth muscle tissue. According to animal studies, it is a potential mediator of kidney injury and fibrosis, and moreover, its role in tumorigenesis is emerging in a variety of cancers. The study included 126 ambulatory patients with multiple myeloma (MM). Serum transgelin-2 concentrations were measured by enzyme-linked immunoassay. We evaluated associations between baseline transgelin and kidney function (serum creatinine, estimated glomerular filtration rate—eGFR, urinary markers of tubular injury: cystatin-C, neutrophil gelatinase associated lipocalin—NGAL monomer, cell cycle arrest biomarkers IGFBP-7 and TIMP-2) and markers of MM burden. Baseline serum transgelin was also evaluated as a predictor of kidney function after a follow-up of 27 months from the start of the study. Significant correlations were detected between serum transgelin-2 and serum creatinine (R = 0.29; p = 0.001) and eGFR (R = −0.25; p = 0.007). Transgelin significantly correlated with serum free light chains lambda (R = 0.18; p = 0.047) and serum periostin (R = −0.22; p = 0.013), after exclusion of smoldering MM patients. Patients with decreasing eGFR had higher transgelin levels (median 106.6 versus 83.9 ng/mL), although the difference was marginally significant (p = 0.05). However, baseline transgelin positively correlated with serum creatinine after the follow-up period (R = 0.37; p < 0.001) and negatively correlated with eGFR after the follow-up period (R = −0.33; p < 0.001). Moreover, higher baseline serum transgelin (beta = −0.11 ± 0.05; p = 0.032) significantly predicted lower eGFR values after the follow-up period, irrespective of baseline eGFR and follow-up duration. Our study shows for the first time that elevated serum transgelin is negatively associated with glomerular filtration in MM and predicts a decline in renal function over long-term follow-up.
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Affiliation(s)
- Karolina Woziwodzka
- Chair and Department of Nephrology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (K.W.); (K.B.); (M.B.); (M.K.); (P.G.)
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Ewa Koc-Żórawska
- Second Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Marcin Żórawski
- Department of Clinical Medicine, Medical University of Bialystok, 15-254 Bialystok, Poland;
| | - Paulina Dumnicka
- Department of Medical Diagnostics, Jagiellonian University Medical College, 30-688 Kraków, Poland; (P.D.); (P.M.); (R.D.)
| | - Artur Jurczyszyn
- Chair and Department of Hematology, Jagiellonian University Medical College, 31-501 Kraków, Poland;
| | - Krzysztof Batko
- Chair and Department of Nephrology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (K.W.); (K.B.); (M.B.); (M.K.); (P.G.)
| | - Paulina Mazur
- Department of Medical Diagnostics, Jagiellonian University Medical College, 30-688 Kraków, Poland; (P.D.); (P.M.); (R.D.)
| | - Małgorzata Banaszkiewicz
- Chair and Department of Nephrology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (K.W.); (K.B.); (M.B.); (M.K.); (P.G.)
| | - Marcin Krzanowski
- Chair and Department of Nephrology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (K.W.); (K.B.); (M.B.); (M.K.); (P.G.)
| | - Paulina Gołasa
- Chair and Department of Nephrology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (K.W.); (K.B.); (M.B.); (M.K.); (P.G.)
| | - Jacek A. Małyszko
- First Department of Nephrology and Transplantology with Dialysis Unit, Medical University of Bialystok, 15-540 Bialystok, Poland;
| | - Ryszard Drożdż
- Department of Medical Diagnostics, Jagiellonian University Medical College, 30-688 Kraków, Poland; (P.D.); (P.M.); (R.D.)
| | - Katarzyna Krzanowska
- Chair and Department of Nephrology, Jagiellonian University Medical College, 30-688 Kraków, Poland; (K.W.); (K.B.); (M.B.); (M.K.); (P.G.)
- Correspondence: ; Tel.: +48-124002850
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Dinh AR, Wong SW, Martin TG, Wolf JL, Webber AB. Outcomes of kidney transplant recipients with ESKD due to plasma cell dyscrasia: A case series. Clin Transplant 2021; 36:e14541. [PMID: 34797567 DOI: 10.1111/ctr.14541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/28/2022]
Abstract
Transplant centers have historically been reluctant to proceed with kidney transplantation in individuals with plasma cell dyscrasias (PCDs) due to concern for high rates of PCD recurrence and PCD-related mortality. As novel therapies for PCDs have improved hematologic outcomes, strategies to optimize kidney transplantation in individuals with PCD-mediated kidney disease are needed. In this single-center case series we discuss our protocol for the transplantation of individuals with ESKD attributed to PCD as well as the hematologic and allograft outcomes of 12 kidney transplant recipients with ESKD attributed to PCD. Median follow-up time after kidney transplantation was 44 months (IQR 36, 84). All patients had a functioning allograft 1 year after kidney transplantation. 9/12 patients were alive and had a functioning allograft 5 years after kidney transplantation. Five patients experienced relapse of PCD (of whom three responded well to subsequent therapies) and four patients developed secondary malignancies, including three patients with urologic malignancies. This case series demonstrates that patients with kidney disease attributed to PCD have favorable outcomes with kidney transplantation. Transplant evaluation in patients with PCDs should involve a multidisciplinary team of transplant nephrologists and oncologists to select appropriate candidates. Providers should consider screening for urologic malignancies pre- and post-transplantation.
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Affiliation(s)
- Alex R Dinh
- Department of Medicine, Division of Nephrology, University of California, San Francisco, California, USA.,Department of Medicine, Kidney Transplant Service, University of California, San Francisco, California, USA
| | - Sandy W Wong
- Department of Medicine, Division of Hematology/Oncology/Blood and Marrow Transplant, University of California, San Francisco, California, USA
| | - Thomas G Martin
- Department of Medicine, Division of Hematology/Oncology/Blood and Marrow Transplant, University of California, San Francisco, California, USA
| | - Jeffrey L Wolf
- Department of Medicine, Division of Hematology/Oncology/Blood and Marrow Transplant, University of California, San Francisco, California, USA
| | - Allison B Webber
- Department of Medicine, Division of Nephrology, University of California, San Francisco, California, USA.,Department of Medicine, Kidney Transplant Service, University of California, San Francisco, California, USA
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60
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Decrease in early mortality for newly diagnosed multiple myeloma patients in the Netherlands: a population-based study. Blood Cancer J 2021; 11:178. [PMID: 34764237 PMCID: PMC8586330 DOI: 10.1038/s41408-021-00571-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 11/14/2022] Open
Abstract
Identification of risk factors for early mortality (EM) in multiple myeloma (MM) patients may contribute to different therapeutic approaches in patients at risk for EM. This population-based study aimed to assess trends in EM and risk factors for EM among MM patients diagnosed in the Netherlands. All MM patients, newly diagnosed between 1989 and 2018, were identified in the Netherlands Cancer Registry. Patients were categorized into three calendar periods (1989–1998, 1999–2008, 2009–2018) and into five age groups (≤65, 66–70, 71–75, 76–80, >80 years). EM was defined as death by any cause ≤180 days post-diagnosis. We included 28,328 MM patients (median age 70 years; 55% males). EM decreased from 22% for patients diagnosed in 1989–1998 to 13% for patients diagnosed in 2009–2018 (P < 0.01) and this decrease was observed among all age groups. Exact causes of death could not be elucidated. Besides patient’s age, we found that features related to a more aggressive disease presentation, and patient characteristics reflecting patients’ physical condition were predictive of EM. In summary, EM decreased from 1999 onwards. Nevertheless, EM remains high, especially for patients aged >70 years. Therefore, novel strategies should be explored to improve the outcome of patients at risk for EM.
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61
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Takakuwa T, Ohta K, Sogabe N, Nishimoto M, Kuno M, Makuuchi Y, Okamura H, Nakashima Y, Koh H, Nakamae H, Hino M. Isatuximab plus Pomalidomide and Dexamethasone in a Patient with Dialysis-Dependent Multiple Myeloma. Chemotherapy 2021; 66:192-195. [PMID: 34710867 DOI: 10.1159/000519783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022]
Abstract
The phase 3 ICARIA-MM trial showed that the addition of isatuximab improved the progression-free survival compared with pomalidomide/dexamethasone. However, the safety and efficacy of isatuximab for end-stage renal failure remains unclear. A 67-year-old man who started hemodialysis 5 years ago for diabetic nephropathy was diagnosed with International Staging System stage III multiple myeloma (MM) of IgD-λ type 3 years ago. After receiving a total of 7 treatment regimens, his free light chain (FLC) λ level increased from 419 to 2,070 mg/L, indicating progressive disease. Twelve days after starting isatuximab plus pomalidomide (3 mg daily) and dexamethasone (IsaPd), his FLC λ level rapidly decreased to 412 mg/L. The patient has now completed 7 courses of IsaPd with no adverse events, including infusion reactions and neutropenia. Isatuximab requires a lower dilution volume than daratumumab and can be safely and effectively administered to hemodialysis-dependent MM patients.
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Affiliation(s)
- Teruhito Takakuwa
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | | | - Nobuhiro Sogabe
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Mitsutaka Nishimoto
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masatomo Kuno
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yosuke Makuuchi
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiroshi Okamura
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yasuhiro Nakashima
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hideo Koh
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hirohisa Nakamae
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masayuki Hino
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Miceli TS, Gonsalves WI, Buadi FK. Supportive care in multiple myeloma: Current practices and advances. Cancer Treat Res Commun 2021; 29:100476. [PMID: 34653748 DOI: 10.1016/j.ctarc.2021.100476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/02/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
Supportive care in multiple myeloma (MM) can have a major impact on quality of life and the survival outcomes of MM patients. In this review, we will focus on disease and treatment related toxicities experienced by MM patients and what are the best approaches to date to help mitigate the effects. We will specifically focus on a practical approach to managing bone disease, thrombosis, infection risk, peripheral neuropathy, dermatologic complications, gastrointestinal and ocular toxicities, and fatigue in MM.
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Affiliation(s)
- Teresa S Miceli
- Division of Hematology, Mayo Clinic Rochester, United States
| | | | - Francis K Buadi
- Division of Hematology, Mayo Clinic Rochester, United States.
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Rodríguez-Lobato LG, Pereira A, Fernández de Larrea C, Cibeira MT, Tovar N, Jiménez-Segura R, Moreno DF, Oliver-Caldés A, Rosiñol L, Bladé J. Real-world data on survival improvement in patients with multiple myeloma treated at a single institution over a 45-year period. Br J Haematol 2021; 196:649-659. [PMID: 34622447 DOI: 10.1111/bjh.17888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 12/17/2022]
Abstract
The prognostic landscape of multiple myeloma (MM) has evolved significantly over the last few decades. There are, however, few data measuring such improvement in real-world patients. This study aimed to investigate trends in survival improvement over 45 years, and the associated clinical factors, in an unselected population of patients with MM. Between 1970 and 2015, 1 161 MM patients were included. Patients were classified into three calendar periods (1970-1984, 1985-1999, and 2000-2015), according to the treatment received; polychemotherapy, autologous stem cell transplantation, and novel drugs respectively. We analysed relative survival (RS) to accurately evaluate MM-related death rates after excluding the mortality expected in the general population. RS at five years increased from 27% in 1970-1984 to 38% and 56% in the next two calendar periods respectively. The improvement to survival was greater in the younger population, but it was also observed in elderly patients and those with poor performance status and more advanced disease. Although myeloma is still a non-curable disease, encouraging results have been observed in the last decades. Progress is expected to continue with the use of new generations of anti-myeloma drugs, and will, hopefully, be documented in real-world patients by the appropriate population-based studies.
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Affiliation(s)
- Luis Gerardo Rodríguez-Lobato
- Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Arturo Pereira
- Transfusion Medicine Department, Hospital Clínic, Barcelona, Spain
| | - Carlos Fernández de Larrea
- Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Teresa Cibeira
- Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Natalia Tovar
- Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Raquel Jiménez-Segura
- Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David F Moreno
- Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Aina Oliver-Caldés
- Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Rosiñol
- Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Bladé
- Amyloidosis and Multiple Myeloma Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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64
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Strategies to Overcome High-Risk Multiple Myeloma. ACTA ACUST UNITED AC 2021; 27:201-204. [PMID: 34549908 DOI: 10.1097/ppo.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Multiple myeloma (MM) patients with high-risk cytogenetics continue to have inferior outcomes despite recent advances in the treatment of MM. As defined by the International Myeloma Working Group, the presence of t(4;14), t(14;16), del(17p), t(14;20) and amplification of 1q are considered to be high-risk chromosomal abnormalities associated with poor survival. Despite the use of immunomodulatory agents, proteasome inhibitors, autologous stem cell transplantation, and anti-CD38 monoclonal antibodies, clinical trials of current therapies have not shown strong statistical evidence of being able to overcome the poor prognosis of high-risk disease. Novel treatment approaches are urgently needed to improve survival in this subset of MM patients.
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65
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Blimark CH, Vangsted AJ, Klausen TW, Gregersen H, Szabo AG, Hermansen E, Wålinder G, Knut-Bojanowska D, Zang C, Turesson I. Outcome data from >10 000 multiple myeloma patients in the Danish and Swedish national registries. Eur J Haematol 2021; 108:99-108. [PMID: 34514635 DOI: 10.1111/ejh.13707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We describe real-world evidence (RWE) from the nationwide Swedish and Danish registries that provide important information on incidence and outcome in multiple myeloma (MM). METHOD First line treatment data on more than 10.000 MM patients from Denmark and Sweden between 2005-2018 are presented. Key results from research conducted within the Swedish and Danish myeloma registries are summarized, describing subgroups of patients with comorbidity, myeloma complications, and early relapse. RESULTS We show that national guidelines, generated on results from randomized clinical trials (RCTs) are rapidly implemented and improve overall survival (OS). We find that both the incidence of MM and the median age at diagnosis is higher in national registries compared to results from referral centres, indicating a more complete coverage. This highlights the need of validation of prognostic scoring systems and indices in e.g., SMM and high-risk MM in a real- world-population. We show that these subgroups are unlikely to be captured in RCTs with narrow inclusion and exclusion criteria, that they have worse survival, and are in need of new treatment approaches. CONCLUSION National registries that include all MM patients are an important source of knowledge on epidemiology, treatment and outcome with implications for the planning of MM care. Despite the introduction of new and better treatments, rapidly implemented in our countries, our registries uncover subgroups of patients that still have inferior outcome. Our RWE can help to identify important research questions to be studied in further clinical trials also in patients currently not included in RCTs.
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Affiliation(s)
- Cecilie Hveding Blimark
- Department of Haematology, Sahlgrenska University Hospital and Institution of Internal Medicine, Sahlgrenska Academy at the University of Gothenburg, Goteborg, Sweden
| | | | | | - Henrik Gregersen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Emil Hermansen
- Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | - Göran Wålinder
- Department of medicine and Department of hematology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | | | - Chenyang Zang
- Regional Cancer Centre, Sahlgrenska University Hospital and Institution of Internal Medicine, Sahlgrenska Academy at the University of Gothenburg, Goteborg, Sweden
| | - Ingemar Turesson
- Department of Hematology, Skåne University Hospital Malmö, Lund, Sweden
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66
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Sánchez-Ramón S, Chapel H, Cunningham-Rundles C. On the relevance of immunodeficiency evaluation in haematological cancer. Hematol Oncol 2021; 39:721-723. [PMID: 34477234 DOI: 10.1002/hon.2921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Silvia Sánchez-Ramón
- Department of Clinical Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain.,Department of Immunology, ENT and Ophthalmology, Complutense University School of Medicine, Madrid, Spain
| | - Helen Chapel
- Primary Immunodeficiency Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Charlotte Cunningham-Rundles
- Departments of Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Allergy and Clinical Immunology, New York, New York, USA
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67
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Hemminki K, Försti A, Hansson M. Incidence, mortality and survival in multiple myeloma compared to other hematopoietic neoplasms in Sweden up to year 2016. Sci Rep 2021; 11:17272. [PMID: 34446811 PMCID: PMC8390646 DOI: 10.1038/s41598-021-96804-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/31/2021] [Indexed: 12/13/2022] Open
Abstract
Survival in multiple myeloma (MM) has developed favorably over the past decades for reasons that have been ascribed to new medications and treatment. However, development of survival over a long period and comparison to other hematopoietic neoplasms (HN) is less well known. Here we used Swedish cancer data from the Nordcan database, spanning a 50-year period from 1967 to 2016, and analyzed 1- and 5-year survival data. As a novel type of analysis we calculate the difference in survival between year 1 and 5 which indicates how well survival was maintained in the 4-year period following year 1 after diagnosis. The relative 1- and 5- year survival increased constantly; the 5-year survival graph for women was almost linear. The difference between 1- and 5-year survival revealed that the 5-year survival gain was entirely due to the improvement in 1-year survival, except for the last period. Survival improvement in all HNs exceeded that in MM. The linear 5-year survival increase for female MM patients suggests a contribution by many small improvements in the first year care rather than single major events. The future challenges are to push the gains past year 1 and to extend them to old patients.
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Affiliation(s)
- Kari Hemminki
- Faculty of Medicine and Biomedical Center in Pilsen, Biomedical Center, Charles University in Prague, 30605, Pilsen, Czech Republic. .,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120, Heidelberg, Germany.
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Markus Hansson
- Sahlgrenska Academy, 413 25, Göteborg, Sweden.,Sahlgrenska University Hospital, 413 25, Göteborg, Sweden
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68
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Hemminki K, Försti A, Houlston R, Sud A. Epidemiology, genetics and treatment of multiple myeloma and precursor diseases. Int J Cancer 2021; 149:1980-1996. [PMID: 34398972 DOI: 10.1002/ijc.33762] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022]
Abstract
Multiple myeloma (MM) is a hematological malignancy caused by the clonal expansion of plasma cells. The incidence of MM worldwide is increasing with greater than 140 000 people being diagnosed with MM per year. Whereas 5-year survival after a diagnosis of MM has improved from 28% in 1975 to 56% in 2012, the disease remains essentially incurable. In this review, we summarize our current understanding of MM including its epidemiology, genetics and biology. We will also provide an overview of MM management that has led to improvements in survival, including recent changes to diagnosis and therapies. Areas of unmet need include the management of patients with high-risk MM, those with reduced performance status and those refractory to standard therapies. Ongoing research into the biology and early detection of MM as well as the development of novel therapies, such as immunotherapies, has the potential to influence MM practice in the future.
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Affiliation(s)
- Kari Hemminki
- Biomedical Center, Faculty of Medicine, Charles University in Pilsen, Pilsen, Czech Republic.,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Richard Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Amit Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.,The Department of Haemato-Oncology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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69
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Tian MR, Yang PY, Yue TT, Li MY, Zhang YJ, Zhang MX, Zhang LM, Yan YR, Hu ZL, Du YZ, Li YY, Jin FY. [A predictive model based on risk factors for early mortality in patients with newly diagnosed multiple myeloma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:666-672. [PMID: 34547873 PMCID: PMC8501273 DOI: 10.3760/cma.j.issn.0253-2727.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
目的 分析影响初治多发性骨髓瘤(NDMM)患者早期死亡(EM)的因素,建立其预测模型,以期识别EM风险。 方法 回顾性分析2009年5月至2017年1月吉林大学白求恩第一医院收治的275例NDMM患者,对6个月(EM6)、12个月(EM12)及24个月(EM24)内死亡患者初诊时基线特征进行单因素分析,并根据多因素分析结果建立EM的预测模型。 结果 本研究中EM6、EM12及EM24的发生率分别是5.5%、12.7%和30.2%;最常见的死亡原因为疾病复发/进展,在EM6、EM12及EM24中分别占60.0%、77.1%及84.3%。影响EM6的因素包括经白蛋白校正的血清钙(校正钙)>2.75 mmol/L和PLT<100×109/L;影响EM12的因素包括年龄>75岁、国际分期系统(ISS) Ⅲ期、修订版国际分期系统(R-ISS) Ⅲ期、校正钙>2.75 mmol/L、血清肌酐>177 µmol/L、PLT<100×109/L及骨髓浆细胞比例≥60%;影响EM24的因素中,除上述影响EM12的因素外,还包括男性和染色体核型1q+。多因素分析尚未发现EM6和EM12的独立预后因素。在EM24的多因素分析中,年龄>75岁、PLT<100×109/L和染色体核型1q+是EM24的独立预后因素。根据Logistic回归系数赋分:年龄>75岁:1分;PLT<100×109/L:2分;染色体核型1q+:1分,建立EM24预测模型,ROC曲线下面积为0.709(95%CI 0.626~0.793)。积分≥3分的患者24个月内死亡风险是0~2分患者的26倍,积分0~4分的NDMM患者中位总生存期分别为59、41、22、17.5及16个月(P<0.001)。 结论 年龄>75岁、PLT<100×109/L和染色体核型1q+为EM24的独立预后因素,依据上述变量构建的EM24预测模型有助于识别EM风险和预测生存,具有较好标准度与区分度。
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Affiliation(s)
- M R Tian
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - P Y Yang
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - T T Yue
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - M Y Li
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Y J Zhang
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - M X Zhang
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - L M Zhang
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Y R Yan
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Z L Hu
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Y Z Du
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - Y Y Li
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
| | - F Y Jin
- Department of Hematology, the First Hospital of Jilin University, Changchun 130021, China
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LeBlanc R, Bergstrom DJ, Côté J, Kotb R, Louzada ML, Sutherland HJ. Management of Myeloma Manifestations and Complications: The Cornerstone of Supportive Care: Recommendation of the Canadian Myeloma Research Group (formerly Myeloma Canada Research Network) Consensus Guideline Consortium. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:e41-e56. [PMID: 34456159 DOI: 10.1016/j.clml.2021.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 11/18/2022]
Abstract
Multiple myeloma (MM) is a hematological cancer associated with significant symptomatic burden. Bone disease, renal insufficiency, cytopenias, infection, and peripheral neuropathy, among other disease manifestations and complications, impair patients' quality of life. The Canadian Myeloma Research Group Consensus Guideline Consortium, formerly Myeloma Canada Research Network Consensus Guideline Consortium, proposes national consensus recommendations for the management of MM-related manifestations and complications. To address the needs of Canadian physicians and people living with MM across the country, this document focuses on the improvement and maintenance of patient care by clarifying best-practice approaches for the prevention, detection and management of disease manifestations and complications. The Canadian Myeloma Research Group Consensus Guideline Consortium will periodically review the recommendations herein and update as necessary.
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Affiliation(s)
- Richard LeBlanc
- Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, QC, Canada.
| | | | - Julie Côté
- Centre hospitalier universitaire de Québec, Quebec, QC, Canada
| | - Rami Kotb
- CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Martha L Louzada
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Heather J Sutherland
- Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver General Hospital, BC Cancer, University of British Columbia, Vancouver, BC, Canada
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71
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Desantis V, Solimando AG, Saltarella I, Sacco A, Giustini V, Bento M, Lamanuzzi A, Melaccio A, Frassanito MA, Paradiso A, Montagnani M, Vacca A, Roccaro AM. MicroRNAs as a Potential New Preventive Approach in the Transition from Asymptomatic to Symptomatic Multiple Myeloma Disease. Cancers (Basel) 2021; 13:cancers13153650. [PMID: 34359551 PMCID: PMC8344971 DOI: 10.3390/cancers13153650] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary Multiple myeloma (MM) is the second most common haematologic malignancy, and it remains an incurable disease despite the advances of novel therapies. It is characterised by a multistep process that arises from a pre-malignant asymptomatic status-defined monoclonal gammopathy of undetermined significance (MGUS), evolves to a middle stage named smouldering myeloma phase (SMM), and culminates in the active disease (MM). Identification of early and non-invasive markers of the disease progression is currently an active field of investigation. In this review, we discuss the role and significance of microRNAs (miRNAs) as potential diagnostic biomarkers to predict the clinical transition from MGUS/SMM status to MM. Abstract Multiple myeloma (MM) is a hematological malignancy characterised by proliferation of clonal plasma cells (PCs) within the bone marrow (BM). Myelomagenesis is a multi-step process which goes from an asymptomatic phase, defined as monoclonal gammopathy of undetermined significance (MGUS), to a smouldering myeloma (SMM) stage, to a final active MM disease, characterised by hypercalcemia, renal failure, bone lesions anemia, and higher risk of infections. Overall, microRNAs (miRNAs) have shown to significantly impact on MM tumorigenesis, as a result of miRNA-dependent modulation of genes involved in pathways known to be crucial for MM pathogenesis and disease progression. We aim to revise the literature related to the role of miRNAs as potential diagnostic and prognostic biomarkers, thus highlighting their key role as novel players within the field of MM and related premalignant conditions.
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Affiliation(s)
- Vanessa Desantis
- Unit of Internal Medicine and Clinical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (V.D.); (A.G.S.); (I.S.); (A.L.); (A.M.)
- Department of Biomedical Sciences and Human Oncology, Pharmacology Section, Medical School, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Antonio Giovanni Solimando
- Unit of Internal Medicine and Clinical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (V.D.); (A.G.S.); (I.S.); (A.L.); (A.M.)
- IRCCS Istituto Tumori “Giovanni Paolo II” of Bari, 70124 Bari, Italy;
| | - Ilaria Saltarella
- Unit of Internal Medicine and Clinical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (V.D.); (A.G.S.); (I.S.); (A.L.); (A.M.)
| | - Antonio Sacco
- Clinical Research Development and Phase I Unit, ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.S.); (V.G.)
| | - Viviana Giustini
- Clinical Research Development and Phase I Unit, ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.S.); (V.G.)
| | - Marta Bento
- Centro Hospitalar Lisboa Norte, Department of Hematology and Transplantation, Institute of Molecular Medicine, University of Lisbon, 1649-035 Lisbon, Portugal;
| | - Aurelia Lamanuzzi
- Unit of Internal Medicine and Clinical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (V.D.); (A.G.S.); (I.S.); (A.L.); (A.M.)
| | - Assunta Melaccio
- Unit of Internal Medicine and Clinical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (V.D.); (A.G.S.); (I.S.); (A.L.); (A.M.)
| | - Maria Antonia Frassanito
- Unit of General Pathology, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Angelo Paradiso
- IRCCS Istituto Tumori “Giovanni Paolo II” of Bari, 70124 Bari, Italy;
| | - Monica Montagnani
- Department of Biomedical Sciences and Human Oncology, Pharmacology Section, Medical School, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Angelo Vacca
- Unit of Internal Medicine and Clinical Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (V.D.); (A.G.S.); (I.S.); (A.L.); (A.M.)
- Correspondence: (A.V.); (A.M.R.)
| | - Aldo M. Roccaro
- Clinical Research Development and Phase I Unit, ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.S.); (V.G.)
- Correspondence: (A.V.); (A.M.R.)
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72
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Balmaceda N, Aziz M, Chandrasekar VT, McClune B, Kambhampati S, Shune L, Abdallah AO, Anwer F, Majeed A, Qazilbash M, Ganguly S, McGuirk J, Mohyuddin GR. Infection risks in multiple myeloma: a systematic review and meta-analysis of randomized trials from 2015 to 2019. BMC Cancer 2021; 21:730. [PMID: 34172037 PMCID: PMC8233183 DOI: 10.1186/s12885-021-08451-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/28/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Patients with multiple myeloma (MM) remain at an increased risk of infection due to the disease process, as well as the ensuing treatments. METHODS We performed a systematic review to evaluate the monthly risk of grade III/IV infection, pneumonia, and neutropenia in patients with myeloma enrolled in randomized clinical trials (RCTs). RESULTS The risk of grade III or higher infection, pneumonia, and neutropenia persists among all phases of treatment. There was no statistical difference in grade III or higher infection, pneumonia, and neutropenia between frontline and relapsed/refractory setting. In the maintenance setting, the complications of infection, pneumonia, and neutropenia were low, but not negligible. Three-drug regimens were no more likely than two-drug regimens to have an increased risk of Grade III or higher infection. CONCLUSIONS This is the first study to quantify the monthly risk of grade III or higher infection, pneumonia, and neutropenia across different treatment regimens in the frontline, maintenance, and relapsed/refractory settings. The results of our systematic review demonstrate a significant risk for severe infection, pneumonia, and neutropenia in patients with MM. Further studies are needed to determine the value of antibiotic prophylaxis in a broader myeloma patient population, as well as other approaches that will further mitigate the morbidity and mortality related to infection in this vulnerable patient population.
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Affiliation(s)
- Nicole Balmaceda
- University of Kansas Cancer Center, 2650 Shawnee Mission Pkwy, Westwood, KS, 66205, USA.
| | - Muhammad Aziz
- University of Toledo, 3000 Arlington Ave, Toledo, OH, 43614, USA
| | | | - Brian McClune
- University of Utah, 50 N Medical Dr., Salt Lake City, UT, 84132, USA
| | - Suman Kambhampati
- U.S. Department of Veterans Affairs, Kansas City Medical Center, 4801 Linwood Blvd., Kansas City, MO, 64128, USA
| | - Leyla Shune
- University of Kansas Cancer Center, 2650 Shawnee Mission Pkwy, Westwood, KS, 66205, USA
| | - Al-Ola Abdallah
- University of Kansas Cancer Center, 2650 Shawnee Mission Pkwy, Westwood, KS, 66205, USA
| | - Faiz Anwer
- Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Aneela Majeed
- Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Muzaffar Qazilbash
- University of Texas MD Anderson Cancer Center, Houston, Texas, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Siddhartha Ganguly
- University of Kansas Cancer Center, 2650 Shawnee Mission Pkwy, Westwood, KS, 66205, USA
| | - Joseph McGuirk
- University of Kansas Cancer Center, 2650 Shawnee Mission Pkwy, Westwood, KS, 66205, USA
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73
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Tsai CK, Yeh CM, Hong YC, Chen PM, Liu JH, Gau JP, Liu CJ. The influence of high-efficiency particulate air filtration on mortality among multiple myeloma patients receiving autologous stem cell transplantation. Sci Rep 2021; 11:11789. [PMID: 34083620 PMCID: PMC8175695 DOI: 10.1038/s41598-021-91135-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/23/2021] [Indexed: 11/09/2022] Open
Abstract
Autologous stem cell transplantation (ASCT) continues to be the standard treatment for transplant-eligible multiple myeloma (MM) patients. A portion of MM patients received ASCT in an isolation room with high-efficiency particulate air (HEPA) filtration. The effectiveness of the HEPA filtration on reducing treatment-related mortality (TRM) is controversial. We enrolled patients with newly diagnosed MM in Taiwan between 2000 and 2017. The primary endpoint of the study was TRM, which was defined as death within 100 days after ASCT. A total of 961 MM patients received ASCT. Of them, 480 patients (49.9%) received ASCT in an isolation room with HEPA filtration (HEPA group). The median overall survival from ASCT was 7.52 years for the HEPA group and 5.88 years for the remaining patients (non-HEPA group) (p = 0.370). The 100-day mortality rate was 1.5% and 1.0% for the HEPA and non-HEPA groups, respectively. In the multivariate analysis, the 100-day mortality had no difference between the HEPA and non-HEPA groups (adjusted hazard ratio 1.65, 95% CI 0.52-5.23). The median cost for ASCT inpatient care was $13,777.6 and $6527.6 for the HEPA and non-HEPA groups, respectively (p < 0.001). Although half of MM patients in Taiwan received ASCT in HEPA room, it didn't affect 100-day mortality.
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Affiliation(s)
- Chun-Kuang Tsai
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan
| | - Chiu-Mei Yeh
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Chung Hong
- Division of Hematology and Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Po-Min Chen
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology and Oncology, Cheng Hsin General Hospital, Taipei, Taiwan.,Chong Hin Loon Cancer and Biotherapy Research Center, and Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan. .,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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74
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Raheem A, Rathish B, Charles D, Wilson A, Warrier A. Pneumococcal Bacteremia and Cryptococcal Meningitis Dual Infection in a Patient With Multiple Myeloma. Cureus 2021; 13:e15089. [PMID: 34155458 PMCID: PMC8210704 DOI: 10.7759/cureus.15089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Infections remain one of the major complications in patients with multiple myeloma, having a significant impact on morbidity and mortality. The increased risk of infection in these patients are a result of various factors contributing to the impairment of immune system caused by the disease and the chemotherapy regimens given during the treatment phases. Here we report a rare case of pneumococcal bacteraemia and cryptococcal meningitis dual infection in a patient with underlying multiple myeloma who had a favourable clinical outcome. This case also serves to highlight the importance of adult vaccinations especially in patients with underlying comorbidities.
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Affiliation(s)
| | | | | | - Arun Wilson
- Infectious Diseases, Aster Medcity, Kochi, IND
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Renal response in real-world carfilzomib- vs bortezomib-treated patients with relapsed or refractory multiple myeloma. Blood Adv 2021; 5:367-376. [PMID: 33496733 DOI: 10.1182/bloodadvances.2019001059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 08/02/2020] [Indexed: 12/15/2022] Open
Abstract
In the phase 3 ENDEAVOR study, carfilzomib-dexamethasone (Kd) improved survival over bortezomib-dexamethasone (Vd) in patients with relapsed or refractory multiple myeloma (RRMM), regardless of baseline renal function. This real-world study compared renal response in patients with RRMM (1-3 prior lines) and renal impairment (estimated glomerular filtration rate ≤50 mL/min) treated with Kd vs Vd. Electronic medical records data from the Oncology Services Comprehensive Electronic Records database were assessed (from January 2012 through February 2018). Time to renal response (defined according to International Myeloma Working Group criteria) was evaluated using the Kaplan-Meier method and log-rank test. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated for renal overall response (ROR) and renal complete response (RCR) using Cox proportional hazard models adjusted for baseline covariates. Included were 543 Kd-treated and 1005 Vd-treated patients. In line 2 (2L), compared with Vd, Kd achieved significantly higher ROR (51.4% vs 39.6%; P < .0001) and RCR (26.6% vs 22.2%; P = .0229). After baseline covariate adjustment, 2L patients receiving Kd vs Vd were 45% more likely to achieve ROR (IRR, 1.45; 95% CI, 1.18-1.78), and 68% were more likely to achieve RCR (IRR, 1.68; 95% CI, 1.24-2.28). The renal response benefit with Kd remained consistent in 2L to line 4 (4L). In a combined analysis of patients receiving Kd and Vd (2L and 2L-4L), renal responders had longer overall survival and time to next treatment than renal nonresponders. These results demonstrate improved real-world effectiveness of Kd over Vd in RRMM renal rescue, and the positive association between renal response and improved survival.
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76
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Abbasi S, Roller J, Abdallah AO, Shune L, McClune B, Sborov D, Mohyuddin GR. Hospitalization at the end of life in patients with multiple myeloma. BMC Cancer 2021; 21:339. [PMID: 33789626 PMCID: PMC8011131 DOI: 10.1186/s12885-021-08079-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite advances in treatment, multiple myeloma (MM) remains incurable and results in significant morbidity and mortality. Further research investigating where MM patients die and characterization of end-of-life hospitalizations is needed. METHODS We utilized the National Inpatient Sample (NIS) to explore the hospitalization burden of MM patients at the end of their lives. RESULTS The percent of patients dying in the hospital as a percent of overall MM deaths ranged from 54% in 2002 to 41.4% in 2017 (p < 0.01). Blood transfusions were received in 32.7% of these hospitalizations and infections were present in 47.8% of patients. Palliative care and/or hospice consultations ranged from 5.3% in 2002 to 31.4% in 2017 (p < 0.01). CONCLUSION Our study demonstrates that patients with MM dying in the hospital have a significant requirement for blood transfusions and have a high infection burden. We also show that palliative care and hospice involvement at the end of life has increased over time but remains low, and that ultimately, inpatient mortality has decreased over time, but MM patients die in the hospital at a higher rate than the general population.
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Affiliation(s)
- Saqib Abbasi
- Department of Hematological Malignancies and Cellular Therapeutics, Kansas University Medical Center, Kansas City, USA
| | - John Roller
- Department of Hematological Malignancies and Cellular Therapeutics, Kansas University Medical Center, Kansas City, USA
| | - Al-Ola Abdallah
- Department of Hematological Malignancies and Cellular Therapeutics, Kansas University Medical Center, Kansas City, USA
| | - Leyla Shune
- Department of Hematological Malignancies and Cellular Therapeutics, Kansas University Medical Center, Kansas City, USA
| | - Brian McClune
- Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, USA
| | - Douglas Sborov
- Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, USA
| | - Ghulam Rehman Mohyuddin
- Department of Hematological Malignancies and Cellular Therapeutics, Kansas University Medical Center, Kansas City, USA.
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Garcia de Veas Silva JL, Gonzalez Cejudo MT, Garcia Perojil Jimenez A, Garcia Lopez Velez MDS, Garcia Rios Tamayo R, Garcia Bermudo Guitarte C, Garcia De Haro Muñoz T. HLC Pair Suppression as a Risk Factor for Bacterial Bloodstream Infections and Early Mortality in Newly Diagnosed Intact Immunoglobulin Multiple Myeloma Patients. Front Oncol 2021; 11:599532. [PMID: 33767978 PMCID: PMC7985068 DOI: 10.3389/fonc.2021.599532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Despite the outstanding progresses in Multiple Myeloma treatment options in the last decades, it remains an incurable disease nowadays. Infectious events are a complication due to an impaired immune system associated with MM, sometimes a life-threatening one, particularly on the first months after the diagnosis. Both the underlying disease and treatment can contribute to the infection risk, so a biomarker that assess this risk could be highly relevant for a more tailored management of the patient. The measurement of the heavy+light chain (HLC) pairs of immunoglobulins in serum allows the quantification of both the monoclonal component and the non-monoclonal immunoglobulin of the same isotype. This approach has demonstrated high sensitivity for the detection of the clonality and prognostic value for MM. HLC pair suppression itself has prognostic power and it has been proposed to be a reflection of the immune system' attempt to control the tumor. In this study we evaluated the impact of the HLC pair suppression on the rate of bloodstream infections (BSI) and early death in 115 newly diagnosed MM patients. Twenty-one percent of the patients suffered a BSI in the first 6 months after diagnosis, of which 58% died within this period, accounting to 67% of the early deaths in global and highlighting the major impact of infections on MM patients in a "real world" setting. Severe HLC pair suppression identified patients with a higher risk of early BSI (HR: 6,97, p=0,009), and extreme HLC pair suppression together with BSI event and age >65 were independent risk factors for early death (p<0,001). Based on these factors, a stratification model was generated to allow identify patients at a higher risk of early death and poorer OS, with an apparently better performance than the ISS on the early death context. In conclusion, HLC pair suppression associates with both a higher risk of life-threatening early infection and early death in newly diagnosed MM patients. Patients older than 65 with extreme HLC pair suppression and BSI are at a high risk of early death, and thus patients presenting with these criteria have a very adverse prognosis.
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78
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Çiftçiler R, Göker H, Demiroğlu H, Haznedaroğlu İC, Sayınalp N, Aksu S, Özcebe O, Büyükaşık Y. Evaluation of Prognostic Significance of the International Staging System According to Glomerular Filtration Rate in Newly Diagnosed Multiple Myeloma Patients Eligible for Autologous Stem Cell Transplantation. Turk J Haematol 2021; 38:33-40. [PMID: 32539315 PMCID: PMC7927455 DOI: 10.4274/tjh.galenos.2020.2020.0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/14/2020] [Indexed: 12/01/2022] Open
Abstract
Objective The prognosis of multiple myeloma (MM) patients is highly heterogeneous. The aim of this study is to determine the impact of patients’ renal functions on the prognostic performance of the International Staging System (ISS). In addition, we aimed to evaluate the results of survival of patients with ISS stages and normal renal functions and those with ISS stages and abnormal renal functions with this study. Materials and Methods Two hundred and four patients with newly diagnosed MM who received an autologous stem cell transplantation after induction chemotherapy in our tertiary care center between the years of 2001 and 2018 were evaluated. Results There were 153 (75%) MM patients who had a glomerular filtration rate (GFR) of ≥60 mL/min and 51 (25%) MM patients who had GFR of <60 mL/min at the time of diagnosis in this study. There was a strong correlation between ISS stage and GFR. The ISS stages were higher in patients who had GFR of <60 mL/min than patients who had GFR of ≥60 mL/min (p<0.001). Patients with GFR of <60 mL/min were significantly more prevalent in the ISS III group than ISS I and II (p<0.001). Conclusion This study showed that the ISS provides significant prognostic information in MM patients with GFR of ≥60 mL/min at diagnosis. However, in patients with impaired renal function at the time of diagnosis, B2-microglobulin may not be a good prognostic indicator since it may be affected by renal dysfunction as well as tumor burden.
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Affiliation(s)
- Rafiye Çiftçiler
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Hakan Göker
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Haluk Demiroğlu
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | | | - Nilgün Sayınalp
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Salih Aksu
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Osman Özcebe
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey
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Epidemiology and Risks of Infections in Patients With Multiple Myeloma Managed With New Generation Therapies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:444-450.e3. [PMID: 33722538 DOI: 10.1016/j.clml.2021.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Treatment for multiple myeloma (MM) has continued to evolve with second generation immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), and monoclonal antibodies (mAbs). This study aims to evaluate the epidemiology and risks of infection in patients with MM managed with these therapies. PATIENTS AND METHODS Clinical and microbiological records were reviewed to capture patient demographics, disease characteristics, treatment received, episodes of infection, and outcomes. Infections were classified as microbiologically defined (MDI), clinically defined (CDI), and fever of unknown focus (FUF). Univariate and multivariate analyses were performed to determine risk factors for infection, with a P value < .05 considered statistically significant. RESULTS A total of 148 patients with MM with 345 infection episodes were identified. Of these, 29.0% (100/345), 58.0% (200/345), and 13.0% (45/345) were defined as MDI, CDI, and FUF, respectively. Of 100 MDIs, 50.0% were owing to viruses, whereas 45.0% were owing to bacterial infection. The most common infection site was the respiratory tract (56.8%). Hospital admission occurred in 41.7% of infection episodes, and the 30-day all-cause mortality rate was 5.4%. On multivariate regression, receipt of a PI (odds ratio [OR], 16.80; 95% confidence interval [CI], 2.47-114.52), combination of IMiD and PI (OR, 13.44; 95% CI, 2.39-75.76), mAb-combination (OR, 10.44; 95% CI, 1.99-54.51), and lines of therapy (> 4) (OR, 7.72; 95% CI, 1.25-47.81) were associated with increased risk of infection (all P < .05). CONCLUSION Viral infections now constitute the majority of infections in patients with MM treated with newer agents. Receipt of a PI and lines of therapy (> 4) were associated with higher risk for infection.
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80
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Cheng J, Zhang W, Zhao Y, Li X, Lv R, Li H, Chen J. Association of serum calcium levels with renal impairment and all-cause death in Chinese patients with newly diagnosed multiple myeloma: a cross-sectional, longitudinal study. Nutr Metab (Lond) 2021; 18:19. [PMID: 33573678 PMCID: PMC7879693 DOI: 10.1186/s12986-020-00525-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background More studies have shown that serum calcium has a crucial role in many types of cancers. However, few studies have determined the association between serum calcium levels and renal impairment (RI) and all-cause death in Chinese patients with multiple myeloma (MM).
Methods A total of 246 of 565 participants who were followed for > 6 months from a MM cohort at our institution were eligible for the retrospective study. A generalized additive model and smooth curve fitting were performed to investigate the cross-sectional relationship between the serum calcium level and RI at baseline. Multivariate-adjusted Cox regression models were fitted to assess the associations between baseline serum calcium levels and the onset of end-stage renal disease (ESRD) or death in patients with MM. Results A total of 172 of 565 patients (30.4%) with newly diagnosed MM presented with RI. The mean duration of follow-up was 26.64 months. Twenty-one patients (8.54%) died and 28 patients (11.52%) had ESRD. In patients with a serum calcium level > 2.30 mmol/L, the serum calcium level was independently associated with the occurrence of MM-related RI. Cox regression analysis showed that baseline serum calcium levels were consistently associated with a higher risk of all-cause death in the fully adjusted model, but were not associated with the occurrence of ESRD. When patients were categorized into two groups according to baseline mean serum calcium level, deaths occurred in 13 patients (15.1%) with a mean serum calcium level > 2.44 mmol/L compared to eight patients (5.0%) with a mean serum calcium level < 2.44 mmol/L (p < 0.05); Eighteen patients (11.46%) with a mean serum calcium level < 2.44 mmol/L progressed to ESRD compared to 13 patients (11.6%) with a serum calcium level > 2.44 mmol/L (p > 0.05).
Conclusions This observational study showed that there was a nonlinear relationship between the serum calcium level and the presence of RI in patients with MM. An elevated baseline calcium level predicted all-cause death, but did not predict the occurrence of ESRD in patients with MM followed for > 6 months.
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Affiliation(s)
- Jun Cheng
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, 310003, China
| | - Wen Zhang
- Department of Nephrology, The Yuhang District First People's Hospital, Hangzhou, China
| | - Yi Zhao
- Hematology Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, 310003, China
| | - Xiayu Li
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, 310003, China
| | - Rong Lv
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, 310003, China
| | - Heng Li
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, 310003, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, 310003, China.
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81
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Lancman G, Lozada K, Athar N, Jacobs S, Doucette J, Cho HJ, Jagannath S, Madduri D, Parekh S, Richard S, Richter J, Chari A. Efficacy of Intravenous Immunoglobulin for Preventing Infections in Patients with Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e470-e476. [PMID: 33716054 DOI: 10.1016/j.clml.2020.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Despite many recent advances in the treatment of multiple myeloma (MM), infection remains a major cause of morbidity and mortality. Prior studies have shown mixed results using intravenous immunoglobulin (IVIG) to prevent infections in MM and were conducted prior to most modern MM therapies. PATIENTS AND METHODS We retrospectively reviewed all patients with MM treated with IVIG at our institution from 2010 to 2017. The primary endpoint was the incidence rate ratio (IRR) of infectious events (IEs) per patient-year during IVIG versus observation. RESULTS A total of 68 patients were included; 151 IEs occurred during 918 months of IVIG treatment, whereas 446 IEs occurred during 2484 months of observation. Although the annual rate of IEs was substantially higher during periods of progressive disease (PD) compared with non-PD (4.9 vs. 1.8; P < .001), most IEs occurred during periods of non-PD (75% vs. 25% during PD). There was no overall difference in the annual rate of IEs per patient between IVIG and observation (1.97 vs. 2.16; IRR, 0.92; 95% confidence interval [CI], 0.76-1.10; P = .376). The subgroup of patients with hypogammaglobulinemia and whose myeloma was in a non-PD phase had a significant reduction in all-grade IEs (1.20 vs. 1.92; IRR, 0.63; 95% CI, 0.45-0.88; P = .009) and ≥ grade 3 IEs (0.25 vs. 0.56; IRR, 0.45; 95% CI, 0.22-0.94; P = .041) with IVIG compared with observation. CONCLUSION Although treatment with IVIG did not show benefit in the overall population, there may be subgroups of patients that derive significant benefit. Additional observational studies are needed to confirm these findings and further refine patient selection.
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Affiliation(s)
- Guido Lancman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Nida Athar
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samantha Jacobs
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John Doucette
- Biostatistics, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hearn Jay Cho
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sundar Jagannath
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Deepu Madduri
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Samir Parekh
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shambavi Richard
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Richter
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ajai Chari
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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82
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Abstract
Multiple myeloma is the second most common haematological malignancy in high-income countries, and typically starts as asymptomatic precursor conditions-either monoclonal gammopathy of undetermined significance or smouldering multiple myeloma-in which initiating genetic abnormalities, such as hyperdiploidy and translocations involving the immunoglobulin heavy chain, are already present. The introduction of immunomodulatory drugs, proteasome inhibitors, and CD38-targeting antibodies has extended survival, but ultimately the majority of patients will die from their disease, and some from treatment-related complications. Disease progression and subsequent relapses are characterised by subclonal evolution and increasingly resistant disease. Patients with multiple myeloma usually have hypercalcaemia, renal failure, anaemia, or osteolytic bone lesions-and a detailed diagnostic investigation is needed to differentiate between symptomatic multiple myeloma that requires treatment, and precursor states. Risk stratification using both patient-specific (eg, performance status) and disease-specific (eg, presence of high-risk cytogenetic abnormalities) is important for prognosis and to define the best treatment strategy. Current research strategies include the use of minimal residual disease assays to guide therapy, refining immunotherapeutic approaches, and intercepting disease early in smouldering multiple myeloma.
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Affiliation(s)
- Niels W C J van de Donk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Charlotte Pawlyn
- The Institute of Cancer Research, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Kwee L Yong
- University College London Cancer Institute, London, UK.
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83
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Ahn SY, Park HK, Moon JH, Baek DW, Cho HJ, Sohn SK, Kang SR, Min JJ, Bom HS, Hong CM, Jeong SY, Song GY, Yang DH, Ahn JS, Kim HJ, Jung SH, Lee JJ. Prognostic impact of 18F-FDG PET/CT in patients with multiple myeloma presenting with renal impairment. Int J Hematol 2021; 113:668-674. [PMID: 33475961 DOI: 10.1007/s12185-021-03079-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Abstract
Renal insufficiency (RI) is a frequent manifestation of multiple myeloma (MM) at time of diagnosis but there is no reliable prognostic factor for patients with MM presenting with RI. This study investigated the prognostic impact of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with MM with RI at diagnosis. The records of 209 patients with MM between June 2011 and November 2018 were retrospectively analyzed. PET/CT positivity was defined as the presence of more than three focal lesions or the presence of extramedullary disease. Of 209 patients, 90 (43.1%) had RI and showed similar survival outcomes to patients who had normal renal function. In total, 113 patients (54.0%) were PET/CT-positive, and 46.6% of patients with RI were PET/CT-positive at baseline. In patients with RI, those who were PET/CT-positive showed significantly inferior survival outcomes to those who were PET/CT-negative [progression-free survival (PFS), 12.7 vs. 34.0 months, P < 0.001; overall survival (OS), 42.2 months vs. not reached, P = 0.001]. On multivariate analysis, PET/CT positivity was significantly associated with PFS and OS in patients with RI. In conclusion, PET/CT is a reliable imaging technique for predicting survival outcomes in patients with MM with RI.
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Affiliation(s)
- Seo-Yeon Ahn
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Hwa Kyung Park
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Joon Ho Moon
- Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Dong Won Baek
- Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hee-Jeong Cho
- Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang Kyun Sohn
- Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Chae Moon Hong
- Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ga-Young Song
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Deok-Hwan Yang
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Jae-Sook Ahn
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Hyeoung-Joon Kim
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Sung-Hoon Jung
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea.
| | - Je-Jung Lee
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
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84
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Jautz J, Potlukova E, Zeeh F, Osthoff M. More than Meets the Eye: Bacteremic Pneumococcal Pneumonia as the Initial Presentation of Multiple Myeloma. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e927904. [PMID: 33402661 PMCID: PMC7797603 DOI: 10.12659/ajcr.927904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Male, 60-year-old Final Diagnosis: Streptococcus pneumoniae bacteremia • multiple myeloma Symptoms: Chills • cough • fever Medication: — Clinical Procedure: Bone marrow biopsy • CT scan • serology Specialty: Hematology • Infectious Diseases • General and Internal Medicine
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Affiliation(s)
- Jonas Jautz
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Eliska Potlukova
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Franziska Zeeh
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Michael Osthoff
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
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85
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Abstract
PURPOSE OF REVIEW As novel therapies are expanding the life expectancy of patients with multiple myeloma, appropriate supportive care has become critical in the management of these patients. This review aims to outline the key principles of supportive care of patients with myeloma, including management of bone disease, renal disease, anemia, peripheral neuropathy, infections, and venous thromboembolism. RECENT FINDINGS The results from large randomized, controlled trials on the use of high-cutoff hemodialysis in the removal of free light chains in renal disease and the use of levofloxacin in the prevention of infections have recently been published. These results, along with updated guidelines from professional societies on the use of bisphosphonates and erythropoietin stimulating agents, have provided guidance on more effective management strategies for myeloma patients. Integration of these updated guidelines and supportive care strategies into clinical practice will help to ensure quality of life for patients with myeloma.
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Affiliation(s)
- Amy Guzdar
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - Caitlin Costello
- University of California San Diego Department of Blood and Marrow Transplant, Moores Cancer Center, 3855 Health Sciences Dr, La Jolla, San Diego, CA, 92037, USA.
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86
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Szabo AG, Iversen KF, Rosenvinge FS, Möller S, Plesner T. The Incidence and Timing of Blood Cultures in Multiple Myeloma - Results from a Retrospective, Single Center, Real-World Study. Clin Hematol Int 2020; 2:168-172. [PMID: 34595458 PMCID: PMC8432406 DOI: 10.2991/chi.k.200719.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/09/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Agoston Gyula Szabo
- Department of Hematology, Vejle Hospital, Beriderbakken 4, Vejle 7100, Denmark
- University of Southern Denmark, J.B. Winsløws Vej 9 A, Odense C 5000, Denmark
| | - Katrine Fladeland Iversen
- Department of Hematology, Vejle Hospital, Beriderbakken 4, Vejle 7100, Denmark
- University of Southern Denmark, J.B. Winsløws Vej 9 A, Odense C 5000, Denmark
| | | | - Sören Möller
- University of Southern Denmark, J.B. Winsløws Vej 9 A, Odense C 5000, Denmark
- OPEN – Open Patient data Explorative Network, Odense University Hospital and Department of Clinical Research, Odense C 5000, Denmark
| | - Torben Plesner
- Department of Hematology, Vejle Hospital, Beriderbakken 4, Vejle 7100, Denmark
- University of Southern Denmark, J.B. Winsløws Vej 9 A, Odense C 5000, Denmark
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87
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Rana R, Cockwell P, Drayson M, Cook M, Pratt G, Cairns DA, Pawlyn C, Jackson G, Davies F, Morgan G, Pinney JH. Renal outcome in patients with newly diagnosed multiple myeloma: results from the UK NCRI Myeloma XI trial. Blood Adv 2020; 4:5836-5845. [PMID: 33232472 PMCID: PMC7686889 DOI: 10.1182/bloodadvances.2020002872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/16/2020] [Indexed: 12/25/2022] Open
Abstract
Renal injury is a common complication of multiple myeloma (MM) and is associated with adverse outcome. Despite this, the natural history of renal injury in patients with MM remains uncertain especially in the context of intensive therapy and novel therapies. To address the lack of data, we evaluated the renal function of 2334 patients from the UK National Cancer Research Institute Myeloma XI trial at baseline and at 12 months to assess renal function over time and the factors associated with change. Patients who had severe acute kidney injury or a requirement for dialysis were excluded. At 12 months of the 1450 evaluable patients planned for autologous transplantation; 204 (14%) patients had a decline in estimated glomerular filtration rate (eGFR) ≥25% from baseline, 341 (23.5%) had an improvement and 905 (62%) had no significant change in eGFR. Renal outcome at 12 months for the 884 evaluable patients who were not planned for transplant was similar. Improved renal function was more likely if patients were <70 years old, male, had an average eGFR <60 mL per minute per 1.73 m2 and a higher baseline free light chain level >1000 mg/L, and/or a free light chain response of >90%. It did not correlate with monoclonal-protein response, transplantation, or use of a bortezomib-based regimen. We show that with current therapies the proportion of patients who have a significant decline in renal function in the first 12 months is small. The greatest relative improvement in eGFR is seen in patients with high free light chain at baseline and a high light chain response. This trial was registered at http://www.isrctn.com as #49407852.
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Affiliation(s)
- Ritika Rana
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Mark Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Mark Cook
- Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Guy Pratt
- Department of Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - David A Cairns
- Clinical Trials Unit, University of Leeds, Leeds, United Kingdom
| | | | - Graham Jackson
- Department of Haematology, University of Newcastle, Newcastle-upon-Tyne, United Kingdom; and
| | - Faith Davies
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | - Gareth Morgan
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | - Jennifer Helen Pinney
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
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88
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McMasters M, Blair BM, Lazarus HM, Alonso CD. Casting a wider protective net: Anti-infective vaccine strategies for patients with hematologic malignancy and blood and marrow transplantation. Blood Rev 2020; 47:100779. [PMID: 33223246 DOI: 10.1016/j.blre.2020.100779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023]
Abstract
Patients who have hematologic malignancies are at high risk for infections but vaccinations may be effective prophylaxis. The increased infection risk derives from immune defects secondary to malignancy, the classic example being CLL, and chemotherapies and immunotherapy used to treat the malignancies. Therapy of hematologic malignancies is being revolutionized by introduction of novel targeted agents and immunomodulatory medications, improving the survival of patients. At the same time those agents uniquely change the infection risk and response to immunizations. This review will summarize current vaccine recommendations for patients with hematologic malignancies including patients who undergo hematopoietic cell transplant.
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Affiliation(s)
- Malgorzata McMasters
- Division of Hematologic Malignancy and Bone Marrow Transplant, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA
| | - Barbra M Blair
- Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215, USA
| | - Hillard M Lazarus
- Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Carolyn D Alonso
- Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215, USA.
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89
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Evaluating the Relationship of GDF-15 with Clinical Characteristics, Cardinal Features, and Survival in Multiple Myeloma. Mediators Inflamm 2020; 2020:5657864. [PMID: 33144847 PMCID: PMC7596430 DOI: 10.1155/2020/5657864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/17/2020] [Accepted: 10/09/2020] [Indexed: 12/21/2022] Open
Abstract
Growth differentiation factor 15 (GDF-15), a member of the transforming growth factor-β superfamily, participates in processes associated with myeloma development and its end-organ complications. It plays a significant role in both physiological and abnormal erythropoiesis and regulates iron homeostasis through modulation of hepcidin. It is abnormally secreted in marrow stromal cells of patients with multiple myeloma (MM), which may reflect the tumor microenvironment. We analyzed the associations of serum GDF-15 with clinical characteristics of 73 MM patients (including asymptomatic MM) and the laboratory indices of renal function, anemia, and inflammation. Baseline serum GDF-15 was studied as the predictor of two-year survival. We defined five clinically relevant subgroups of patients (symptomatic MM only, patients with and without remission, patients on chemotherapy, and without treatment). Increased GDF-15 concentrations were associated with more advanced MM stage, anemia, renal impairment (lower glomerular filtration and higher markers of tubular injury), and inflammation. Most of the results were confirmed in the subgroup analysis. Serum cystatin C and urine neutrophil gelatinase-associated lipocalin were associated with GDF-15 independently of other variables. In the studied MM patients, GDF-15 did not significantly predict survival (p = 0.06). Our results suggest that serum GDF-15 reflects myeloma burden and shares a relationship with several markers of prognostic significance, as well as major manifestations.
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90
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Chicca IJ, Heaney JLJ, Iqbal G, Dunn JA, Bowcock S, Pratt G, Yong KL, Planche TD, Richter A, Drayson MT. Anti-bacterial antibodies in multiple myeloma patients at disease presentation, in response to therapy and in remission: implications for patient management. Blood Cancer J 2020; 10:114. [PMID: 33149136 PMCID: PMC7642409 DOI: 10.1038/s41408-020-00370-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 11/09/2022] Open
Abstract
Multiple myeloma (MM) is associated with increased risk of infection, but little is known regarding antibody levels against specific bacteria. We assessed levels of polyclonal immunoglobulin and antibacterial antibodies in patients recruited to the TEAMM trial, a randomised trial of antibiotic prophylaxis at the start of anti-myeloma treatment. Polyclonal IgG, IgA and IgM levels were below the reference range in 71%, 83% and 90% of 838 MM patients at diagnosis. Anti-vaccine targeted tetanus toxoid antibodies were protective in 95% of 193 healthy controls but only 41% of myeloma patients. In healthy controls, protective antibodies against 6/12 pneumococcal serotypes, haemophilus and meningococcus A were present in 67%, 41% and 56% compared to just 15%, 21% and 17% of myeloma patients. By 1 year, myeloma patients IgG levels had recovered for 57% of patients whilst the proportion with protective levels of IgG against thymus-dependent protein antigen tetanus toxoid had changed little. In contrast the proportions of patients with protective levels against thymus independent polysaccharide antigens pneumococcus, haemophilus and meningococcus had fallen from 15 to 7%, 21 to 0% and 17 to 11%. Findings highlight the need for strategies to protect patients against bacterial infections during therapy and vaccination programmes during remission.
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Affiliation(s)
- Ilaria J Chicca
- Institute of Immunology and Immunotherapy, Clinical Immunology Service, University of Birmingham, Birmingham, UK
| | - Jennifer L J Heaney
- Institute of Immunology and Immunotherapy, Clinical Immunology Service, University of Birmingham, Birmingham, UK
| | - Gulnaz Iqbal
- Warwick Clinical Trial Unit, University of Warwick, Coventry, UK
| | - Janet A Dunn
- Warwick Clinical Trial Unit, University of Warwick, Coventry, UK
| | | | - Guy Pratt
- University Hospital Birmingham NHS Trust, Birmingham, UK
| | - Kwee L Yong
- Department of Haematology, UCL Cancer Institute, London, UK
| | - Timothy D Planche
- St. George's Hospital, University of London, Department of Medical Microbiology, Tooting, London, UK
| | - Alex Richter
- Institute of Immunology and Immunotherapy, Clinical Immunology Service, University of Birmingham, Birmingham, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, Clinical Immunology Service, University of Birmingham, Birmingham, UK.
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91
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Drayson MT, Bowcock S, Planche T, Iqbal G, Pratt G, Yong K, Wood J, Raynes K, Higgins H, Dawkins B, Meads D, Hulme CT, Whittaker AC, Hawkey P, Low E, Dunn JA. Prophylactic levofloxacin to prevent infections in newly diagnosed symptomatic myeloma: the TEAMM RCT. Health Technol Assess 2020; 23:1-94. [PMID: 31690402 DOI: 10.3310/hta23620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Myeloma causes profound immunodeficiency and recurrent serious infections. There are approximately 5500 new UK cases of myeloma per annum, and one-quarter of patients will have a serious infection within 3 months of diagnosis. Newly diagnosed patients may benefit from antibiotic prophylaxis to prevent infection. However, the use of prophylaxis has not been established in myeloma and may be associated with health-care-associated infections (HCAIs), such as Clostridium difficile. There is a need to assess the benefits and cost-effectiveness of the use of antibacterial prophylaxis against any risks in a double-blind, placebo-controlled, randomised clinical trial. OBJECTIVES To assess the risks, benefits and cost-effectiveness of prophylactic levofloxacin in newly diagnosed symptomatic myeloma patients. DESIGN Multicentre, randomised, double-blind, placebo-controlled trial. A central telephone randomisation service used a minimisation computer algorithm to allocate treatments in a 1 : 1 ratio. SETTING A total of 93 NHS hospitals throughout England, Northern Ireland and Wales. PARTICIPANTS A total of 977 patients with newly diagnosed symptomatic myeloma. INTERVENTION Patients were randomised to receive levofloxacin or placebo tablets for 12 weeks at the start of antimyeloma treatment. Treatment allocation was blinded and balanced by centre, estimated glomerular filtration rate and intention to give high-dose chemotherapy with autologous stem cell transplantation. Follow-up was at 4-week intervals up to 16 weeks, with a further follow-up at 1 year. MAIN OUTCOME MEASURES The primary outcome was to assess the number of febrile episodes (or deaths) in the first 12 weeks from randomisation. Secondary outcomes included number of deaths and infection-related deaths, days in hospital, carriage and invasive infections, response to antimyeloma treatment and its relation to infection, quality of life and overall survival within the first 12 weeks and beyond. RESULTS In total, 977 patients were randomised (levofloxacin, n = 489; placebo, n = 488). A total of 134 (27%) events (febrile episodes, n = 119; deaths, n = 15) occurred in the placebo arm and 95 (19%) events (febrile episodes, n = 91; deaths, n = 4) occurred in the levofloxacin arm; the hazard ratio for time to first event (febrile episode or death) within the first 12 weeks was 0.66 (95% confidence interval 0.51 to 0.86; p = 0.002). Levofloxacin also reduced other infections (144 infections from 116 patients) compared with placebo (179 infections from 133 patients; p-trend of 0.06). There was no difference in new acquisitions of C. difficile, methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase Gram-negative organisms when assessed up to 16 weeks. Levofloxacin produced slightly higher quality-adjusted life-year gains over 16 weeks, but had associated higher costs for health resource use. With a median follow-up of 52 weeks, there was no significant difference in overall survival (p = 0.94). LIMITATIONS Short duration of prophylactic antibiotics and cost-effectiveness. CONCLUSIONS During the 12 weeks from new diagnosis, the addition of prophylactic levofloxacin to active myeloma treatment significantly reduced febrile episodes and deaths without increasing HCAIs or carriage. Future work should aim to establish the optimal duration of antibiotic prophylaxis and should involve the laboratory investigation of immunity, inflammation and disease activity on stored samples funded by the TEAMM (Tackling Early Morbidity and Mortality in Myeloma) National Institute for Health Research Efficacy and Mechanism Evaluation grant (reference number 14/24/04). TRIAL REGISTRATION Current Controlled Trials ISRCTN51731976. FUNDING DETAILS This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 62. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Stella Bowcock
- King's College Hospital NHS Foundation Trust, London, UK
| | - Tim Planche
- Institute of Infection and Immunity, St George's Hospital, University of London, London, UK
| | - Gulnaz Iqbal
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kwee Yong
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Jill Wood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Kerry Raynes
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Helen Higgins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Claire T Hulme
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Anna C Whittaker
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Peter Hawkey
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Eric Low
- Patient Advocacy, Myeloma UK, Edinburgh, UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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92
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Lin C, Shen H, Zhou S, Liu M, Xu A, Huang S, Shen C, Zhou F. Assessment of infection in newly diagnosed multiple myeloma patients: risk factors and main characteristics. BMC Infect Dis 2020; 20:699. [PMID: 32972385 PMCID: PMC7517606 DOI: 10.1186/s12879-020-05412-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background Infection is a leading cause of morbidity and death in patients with multiple myeloma (MM). The increased susceptibility to infection is complicated and multifactorial. However, no studies have explored the spectrum and risk factors of infections in newly diagnosed MM patients at the first admission. This cross-sectional study aimed to provide ideas for the assessment, prevention and treatment of infection in newly diagnosed MM patients when admitted for the first time. Methods Retrospectively, the data from electronic medical records for 161 patients newly diagnosed with MM from May 2013 to December 2018 were analysed. All the information was collected at the time of admission, and the patients had received no antineoplastic therapy previously. Independent risk factors of infection in multiple myeloma were determined by univariate and multivariate analysis. Results Newly diagnosed patients with MM were highly susceptible to viruses (43.9%), especially Epstein-Barr virus (EBV) (24.4%) and hepatitis B virus (HBV) (17.1%). Advanced stage (ISS stage III, P = 0.040), more severe anaemia (Hb < 90 g/L, P = 0.044) and elevated CRP (> 10 mg/L, P = 0.006) were independent risk factors for infection. Moreover, infections represented a major survival threat to patients with newly diagnosed MM (P = 0.033), and the existence of risk factors for infection was significantly correlated with poor prognosis (P = 0.011), especially ISS stage III (P = 0.008) and lower haemoglobin level (P = 0.039). Conclusions Newly diagnosed MM patients are highly susceptible to viruses. Advanced ISS stage, more severe anaemia and the elevation of CRP are independent risk factors of infection, which also have a strong impact on prognosis. Our results suggest that viral infection should be taken into account if antibacterial drugs are not effective, and the prevention of infection and improvement of prognosis should be paid more attention in newly diagnosed patents with advanced stage and more severe anaemia.
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Affiliation(s)
- Chenyao Lin
- Department of Clinical Laboratory, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, P.R. China.,Genetic Diagnosis Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | - Hui Shen
- Department of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, P.R. China
| | - Shuimei Zhou
- Blood Transfusion Department, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, P.R. China
| | - Minghui Liu
- Department of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, P.R. China
| | - Anjie Xu
- Department of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, P.R. China
| | - Shuang Huang
- Genetic Diagnosis Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | - Changxin Shen
- Blood Transfusion Department, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, P.R. China.
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, P.R. China.
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93
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Zetter DR, Kabir T, Reynolds SB. The Clinical Characteristics of Multiple Myeloma in the Acute Care Setting: Case Presentation and Clinical Recommendations. Cureus 2020; 12:e10463. [PMID: 33083166 PMCID: PMC7566983 DOI: 10.7759/cureus.10463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The acute complications of multiple myeloma can be varied and devastating, including electrolyte derangements, renal failure, and infections amongst others. The varying pathological mechanisms behind these complications make the management of patients presenting with multiple myeloma a complicated and sometimes tenuous process. The patient compliance can further exacerbate these difficulties. The patient discussed in this case initially presented with newly developed altered mental status, fatigue, epistaxis, and an ecchymotic rash. Laboratory testing and imaging would conclude a diagnosis of multiple myeloma, but unfortunately treatment was cut short. Admission at a later date would show rapidly deteriorating condition with new lung consolidations and worsening laboratory findings. Herein the authors discuss the clinical findings of patients with acute manifestations of multiple myeloma, their prognostic value, and the implications of patient compliance and early intervention in the setting of multiple myeloma.
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94
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Firsova MV, Mendeleeva LP, Solovev MV, Rekhtina IG, Pokrovskaya OS, Urnova ES, Soboleva NP, Dvirnyk VN, Klyasova GA, Kuzmina LA, Savchenko VG. [Autologous haematopoietic stem cell transplantation in patients with multiple myeloma complicated by dialysis-dependent renal failure]. TERAPEVT ARKH 2020; 92:70-76. [PMID: 33346447 DOI: 10.26442/00403660.2020.07.000777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 01/02/2023]
Abstract
AIM To assess the safety and efficacy of autologous haematopoietic stem cell transplantation (auto-HSCT) in multiple myeloma (MM) patients with dialysis-dependent renal failure. MATERIALS AND METHODS During a period from May 2010 to December 2016 fourteen MM patients with dialysis-dependent renal failure aged 48 to 65 years underwent auto-HSCT. After the induction therapy complete response, very good partial response, partial response were documented in 64, 29, 7% of patients, respectively. In no case was a renal response achieved. Haematopoietic stem cell mobilization in most patients (13/14) was performed according to the scheme: G-CSF 10 g/kg. Melphalan in 3 dosages was used as pre-transplant conditioning: 100, 140 and 200 mg/m2; 13 patients underwent a single and in one case underwent a tandem auto-HSCT against the background of hemodialysis. Evaluation of the antitumor and renal response was assessed on the 100th day after auto-HSCT. Subsequently, against the background of programmed hemodialysis and in the setting of high-dosed melphalan (100200 mg/m2), 13 patients underwent a single and one patient underwent a tandem auto-HSCT. At +100 days after auto-HSCT, an antitumor response and renal response were assessed. RESULTS The period of agranulocytosis after auto-HSCT was from 5 to 12 days (median 8,5) and was accompanied by infectious complications, cardiac and neurological dysfunctions. At +100 days after auto-HSCT, the complete response was confirmed in 71% patients and very good partial response was confirmed in 29% patients. The minimal renal response was registered in 2 patients (14%), hemodialysis was stopped. The transplant-related mortality was absent. After a median follow-up of 53 months 5-year progression-free survival was 59%, and overall survival was 93%. CONCLUSION Carrying out auto-HSCT in patients with dialysis-dependent renal failure contributed to the achievement of a minimal renal response in 14% of cases, which allowed these patients to stop hemodialysis. Patients whose conditioning regimen was performed using melphalan at a dose of 200 mg/m2showed more frequent complications in the early post-transplant period compared to patients who received a lower dose of melphalan (100140 mg/m2). Auto-HSCT in MM patients with dialysis-dependent renal failure is a feasible and effective treatment method, which in some cases contributes to independence from hemodialysis.
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95
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Djebbari F, Panitsas F, Eyre TA, Prodger C, Davies F, Burton K, Khera A, Vallance G, Moore S, Kothari J, Peniket A, Ramasamy K. Infection-related morbidity in a large study of transplant non-eligible newly diagnosed myeloma patients treated with UK standard of care. Haematologica 2020; 105:e474-479. [PMID: 33054067 PMCID: PMC7556501 DOI: 10.3324/haematol.2019.240762] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Faouzi Djebbari
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Fotios Panitsas
- Department of Haematology, Larissa University Hospital, Larissa, Greece
| | - Toby A Eyre
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Catherine Prodger
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Fearn Davies
- Department of Pharmacy, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kieran Burton
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Akhil Khera
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Grant Vallance
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sally Moore
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jaimal Kothari
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andy Peniket
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Karthik Ramasamy
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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96
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Song GY, Jung SH, Kim K, Kim SJ, Yoon SE, Lee HS, Kim M, Ahn SY, Ahn JS, Yang DH, Kim HJ, Lee JJ. Endothelial activation and stress index (EASIX) is a reliable predictor for overall survival in patients with multiple myeloma. BMC Cancer 2020; 20:803. [PMID: 32831058 PMCID: PMC7446202 DOI: 10.1186/s12885-020-07317-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recently, the endothelial Activation and Stress Index (EASIX) score has been reported to predict overall survival (OS) after allogeneic stem cell transplantation. This study evaluated the prognostic role of EASIX score in patients with newly diagnosed multiple myeloma (MM). METHODS This retrospective study analyzed the records of 1177 patients with newly diagnosed MM between February 2003 and December 2017 from three institutions in the Republic of Korea. Serum lactate dehydrogenase (LDH), creatinine, and platelet count at diagnosis were measured in all included patients. EASIX scores were calculated using the formula-LDH (U/L) × Creatinine (mg/dL) / platelet count (109/L) and were evaluated based on log2 transformed values. RESULTS The median age of patients was 63 years (range, 22-92), and 495 patients (42.1%) underwent autologous stem cell transplantation (ASCT). The median log2 EASIX score at diagnosis was 1.1 (IQR 0.3-2.3). Using maximally selected log-rank statistics, the optimal EASIX cutoff value for OS was 1.87 on the log2 scale (95% CI 0.562-0.619, p < 0.001). After median follow-up for 50.0 months (range, 0.3-184.1), the median OS was 58.2 months (95% CI 53.644-62.674). Overall, 372 patients (31.6%) showed high EASIX scores at diagnosis, and had significantly inferior OS compared to those with low EASIX (log2 EASIX ≤1.87) (39.1 months vs. 67.2 months, p < 0.001). In multivariate Cox analysis, high EASIX was significantly associated with poor OS (HR 1.444, 95% CI 1.170-1.780, p = 0.001). In the subgroup analysis of patients who underwent ASCT, patients with high EASIX showed significantly inferior OS compared to those with low EASIX (52.8 months vs. 87.0 months, p < 0.001). In addition, in each group of ISS I, II, and III, high EASIX was associated with significantly inferior OS (ISS 1, 45.2 months vs. 76.0 months, p = 0.001; ISS 2, 42.3 months vs. 66.5 months, p = 0.002; ISS 3, 36.8 months vs. 55.1 months, p = 0.001). CONCLUSION EASIX score at diagnosis is a simple and strong predictor for OS in patients with newly diagnosed MM.
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Affiliation(s)
- Ga-Young Song
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea.
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea.
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Ho Sup Lee
- Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Mihee Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Seo-Yeon Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Jae-Sook Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Deok-Hwan Yang
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Hyeoung-Joon Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
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97
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Atkin C, Iqbal G, Planche T, Pratt G, Yong K, Wood J, Raynes K, Low E, Higgins H, Neal RD, Dunn J, Drayson MT, Bowcock S. Diagnostic pathways in multiple myeloma and their relationship to end organ damage: an analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) trial. Br J Haematol 2020; 192:997-1005. [PMID: 32798327 DOI: 10.1111/bjh.17044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/26/2020] [Indexed: 11/27/2022]
Abstract
Multiple myeloma is associated with significant early morbidity and mortality, with considerable end organ damage often present at diagnosis. The Tackling EArly Morbidity and Mortality in Multiple Myeloma (TEAMM) trial was used to evaluate routes to diagnosis in patients with myeloma and the relationship between diagnostic pathways, time to diagnosis and disease severity. A total of 915 participants were included in the study. Fifty-one per cent were diagnosed by direct referral from primary care to haematology; 29% were diagnosed via acute services and 20% were referred via other secondary care specialties. Patients diagnosed via other secondary care specialties had a longer diagnostic interval (median 120 days vs. 59 days) without an increase in features of severe disease, suggesting they had a relatively indolent disease. Marked intrahospital delay suggests possible scope for improvement. A quarter of those diagnosed through acute services reported >30 days from initial hospital consultation to haematology assessment. Participants diagnosed through acute services had poorer performance status (P < 0·0001) and higher burden of end organ damage (P < 0·0001) with no difference in the overall length of diagnostic pathway compared to those diagnosed by direct referral (median 59 days). This suggests that advanced disease in patients presenting through acute services predominantly reflects disease aggression.
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Affiliation(s)
- Catherine Atkin
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, UK
| | - Gulnaz Iqbal
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Tim Planche
- St George's University Hospitals NHS Trust, London, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kwee Yong
- UCL Cancer Institute, University College London, London, UK
| | - Jill Wood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Kerry Raynes
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Helen Higgins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Richard D Neal
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, UK
| | - Stella Bowcock
- Department of Haematological Medicine, King's College Hospital NHS Trust, London, UK
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98
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Qureshi A, Tariq MJ, Shah Z, Abu Zar M, Aslam S, Rafae A, Shafqat M, Malik MN, Faisal MS, Anwer F. Evidence-based supportive care in multiple myeloma. J Community Hosp Intern Med Perspect 2020; 10:313-317. [PMID: 32850087 PMCID: PMC7427456 DOI: 10.1080/20009666.2020.1771124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
Multiple myeloma (MM) is a hematological malignancy characterized by an abnormal clone of plasma cells in the bone marrow. MM and its therapy increase the risk of complications like anemia, osteolytic lesions, pain, infections, and renal abnormalities in MM patients. Supportive care for MM patients improves the quality of life. Treatment with bisphosphonates decreases skeletal-related events. Vertebroplasty and kyphoplasty are done in cases of vertebral compression fractures. Prophylactic antibiotics and antivirals can decrease infections related to morbidity. Plasmapheresis in patients with renal dysfunctions decreases dialysis dependency and improve quality of life.
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Affiliation(s)
- Anum Qureshi
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA.,Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA
| | - Muhammad Junaid Tariq
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | - Zunairah Shah
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | - Muhammad Abu Zar
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | - Shehroz Aslam
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | - Abdul Rafae
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | - Madeeha Shafqat
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | - Mustafa Nadeem Malik
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA
| | | | - Faiz Anwer
- Department of Medicine, Division of Hematology Oncology, Blood and Marrow Transplantation, University of Arizona, Tucson, AZ, USA.,Taussig Cancer Center, Cleveland Clinic, Department of Hematology, Medical Oncology, Cleveland, OH, USA
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99
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Rasch S, Lund T, Asmussen JT, Lerberg Nielsen A, Faebo Larsen R, Østerheden Andersen M, Abildgaard N. Multiple Myeloma Associated Bone Disease. Cancers (Basel) 2020; 12:E2113. [PMID: 32751464 PMCID: PMC7465468 DOI: 10.3390/cancers12082113] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 02/08/2023] Open
Abstract
The lytic bone disease is a hallmark of multiple myeloma, being present in about 80% of patients with newly diagnosed MM, and in more during the disease course. The myeloma associated bone disease (MBD) severely affects the morbidity and quality of life of the patients. MBD defines treatment demanding MM. In recent years, knowledge of the underlying pathophysiology has increased, and novel imaging technologies, medical and non-pharmaceutical treatments have improved. In this review, we highlight the major achievements in understanding, diagnosing and treating MBD. For diagnosing MBD, low-dose whole-body CT is now recommended over conventional skeletal survey, but also more advanced functional imaging modalities, such as diffusion-weighted MRI and PET/CT are increasingly important in the assessment and monitoring of MBD. Bisphosphonates have, for many years, played a key role in management of MBD, but denosumab is now an alternative to bisphosphonates, especially in patients with renal impairment. Radiotherapy is used for uncontrolled pain, for impeding fractures and in treatment of impeding or symptomatic spinal cord compression. Cement augmentation has been shown to reduce pain from vertebral compression fractures. Cautious exercise programs are safe and feasible and may have the potential to improve the status of patients with MM.
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Affiliation(s)
- Stine Rasch
- Department of Haematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark; (S.R.); (T.L.); (R.F.L.)
- Department of Internal Medicine, Division of Haematology, Sydvestjysk Sygehus, Finsensgade 35, DK-6700 Esbjerg, Denmark
| | - Thomas Lund
- Department of Haematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark; (S.R.); (T.L.); (R.F.L.)
- Haematology Research Unit, Department of Clinical Research, University of Southern Denmark, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark
| | - Jon Thor Asmussen
- Department of Clinical Radiology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark;
| | - Anne Lerberg Nielsen
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark;
| | - Rikke Faebo Larsen
- Department of Haematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark; (S.R.); (T.L.); (R.F.L.)
| | - Mikkel Østerheden Andersen
- Center for Spine Surgery & Research, Lillebaelt Hospital, Østre Hougvel 55, DK-5500 Middelfart, Denmark;
| | - Niels Abildgaard
- Department of Haematology, Odense University Hospital, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark; (S.R.); (T.L.); (R.F.L.)
- Haematology Research Unit, Department of Clinical Research, University of Southern Denmark, Kloevervaenget 10, 12th Floor, DK-5000 Odense, Denmark
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Chen X, Luo X, Zu Y, Issa HA, Li L, Ye H, Yang T, Hu J, Wei L. Severe renal impairment as an adverse prognostic factor for survival in newly diagnosed multiple myeloma patients. J Clin Lab Anal 2020; 34:e23416. [PMID: 32710448 PMCID: PMC7521223 DOI: 10.1002/jcla.23416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background Renal impairment (RI) is associated with poor survival in newly diagnosed multiple myeloma (MM) patients. Renal function recovery has been one of the main therapeutic goals in those patients. Methods The records from 393 newly diagnosed MM patients in our hospital between January 2012 and December 2016 were retrospectively analyzed. RI was defined as an eGFR < 40 mL/min according to the novel IMWG criteria. RI patients were categorized based on their renal function at diagnosis: severe RI: eGFR < 30 mL/min, and mild RI: 30 mL/min ≤ eGFR <40 mL/min. We explored whether RI, and particularly severe RI, was an adverse prognostic factor for survival, and investigated the impact of renal function recovery on survival. Results Severe RI, hemoglobin <100 g/L, LDH ≥ 245 U/L, hyperuricemia, 1q21 amplification, and lack of novel agent treatment were associated with decreased overall survival (OS). Severe RI patients with renal response had a median OS of 27 months compared with 18 months for those patients without renal response (P = .030), but their median OS was still significantly lower than that for patients without severe RI, which was 51 months. In severe RI patients, the overall renal response rate in bortezomib‐based regimens was significantly higher than that in nonbortezomib‐based regimens. Conclusion Our results suggest that severe RI is an adverse prognostic factor for survival in newly diagnosed MM patients, restoration of renal function may improve survival, and bortezomib‐based regimens may be the preferred treatment in patients with severe RI.
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Affiliation(s)
- Xuduan Chen
- Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaofeng Luo
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yanping Zu
- Department of Nephrology, Fujian Provincial Hospital Jinshan Branch, Fuzhou, China
| | - Hajji Ally Issa
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Linlin Li
- Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hong Ye
- Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ting Yang
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jianda Hu
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lixin Wei
- Department of Nephrology, Fujian Medical University Union Hospital, Fuzhou, China
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