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Yanamandra U, Khattry N, Kumar S, Raje N, Jain A, Jagannath S, Menon H, Kumar L, Varma N, Varma S, Saikia T, Malhotra P. Consensus in the Management of Multiple Myeloma in India at Myeloma State of the Art 2016 Conference. Indian J Hematol Blood Transfus 2017; 33:15-21. [PMID: 28194051 PMCID: PMC5280871 DOI: 10.1007/s12288-016-0773-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022] Open
Abstract
The science of multiple myeloma (MM) and related plasma cell disorders is rapidly evolving with increased understanding of the disease biology and recent approval of the newer drugs widening the therapeutic armamentarium. Despite multiple international guidelines regarding the management of this disease, the practice of managing MM is not uniform amongst Indian physicians. There are challenges in management which are unique to the Indian patients. This review discusses these challenges and the consensus of the nation-wide experts in dealing with the same. We also briefly highlighted the perspective of international experts as discussed in the Myeloma State of the Art conference held in September 2016 at PGI, Chandigarh. An Indian Myeloma Academic Groupe (IMAGe) group was formed to strengthen the research, create awareness about myeloma and related disorders and form consensus guidelines/ recommendations that can be adapted to the Indian Scenario.
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Affiliation(s)
- Uday Yanamandra
- Department of Internal Medicine, PGIMER, Chandigarh, 160012 India
| | - Navin Khattry
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Noopur Raje
- Massachusetts General Hospital Cancer Center, Boston, USA
| | - Arihant Jain
- Department of Internal Medicine, PGIMER, Chandigarh, 160012 India
| | | | | | - Lalit Kumar
- Department of Medical Oncology, AIIMS, New Delhi, India
| | - Neelam Varma
- Department of Internal Medicine, PGIMER, Chandigarh, 160012 India
| | - Subhash Varma
- Department of Internal Medicine, PGIMER, Chandigarh, 160012 India
| | | | - Pankaj Malhotra
- Department of Internal Medicine, PGIMER, Chandigarh, 160012 India
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Clinical utility of the Revised International Staging System in unselected patients with newly diagnosed and relapsed multiple myeloma. Blood Cancer J 2017; 7:e528. [PMID: 28211889 PMCID: PMC5386331 DOI: 10.1038/bcj.2017.13] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/11/2017] [Indexed: 12/25/2022] Open
Abstract
We analyzed the utility of Revised International staging system (RISS) in an unselected cohort of newly diagnosed multiple myeloma (NDMM; cohort 1), and relapsed/refractory multiple myeloma (RRMM; cohort 2) patients. Cohort 1 included 1900 patients seen within 90 days of diagnosis, from 2005 to 2015, while cohort 2 had 887 patients enrolled in 23 clinical trials at Mayo Clinic. The overall survival (OS) and progression-free survival (PFS) was calculated from the time since diagnosis or trial registration. The median estimated follow up was 5 and 2.3 years for Cohorts 1 and 2, respectively. Among 1067 patients evaluable in Cohort 1, the median OS and PFS was 10 and 2.8 years for RISS stage I, 6 and 2.7 years for RISS stage II and 2.6 and 1.3 years for RISS stage III (P<0.0001). Among 456 patients evaluable in Cohort 2, the median OS and PFS was 4.3 and 1.1 years for RISS stage I, 2 and 0.5 years for RISS stage II and 0.8 and 0.2 years for RISS stage III (P<0.0001). In conclusions, RISS gives a better differentiation of NDMM as well as RRMM patients into three survival subgroups and should be used to stratify patients in future clinical trials.
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Lambert L, Ourednicek P, Meckova Z, Gavelli G, Straub J, Spicka I. Whole-body low-dose computed tomography in multiple myeloma staging: Superior diagnostic performance in the detection of bone lesions, vertebral compression fractures, rib fractures and extraskeletal findings compared to radiography with similar radiation exposure. Oncol Lett 2017; 13:2490-2494. [PMID: 28454425 DOI: 10.3892/ol.2017.5723] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/17/2016] [Indexed: 11/06/2022] Open
Abstract
The primary objective of the present prospective study was to compare the diagnostic performance of conventional radiography (CR) and whole-body low-dose computed tomography (WBLDCT) with a comparable radiation dose reconstructed using hybrid iterative reconstruction technique, in terms of the detection of bone lesions, skeletal fractures, vertebral compressions and extraskeletal findings. The secondary objective was to evaluate lesion attenuation in relation to its size. A total of 74 patients underwent same-day skeletal survey by CR and WBLDCT. In CR and WBLDCT, two readers assessed the number of osteolytic lesions at each region and stage according to the International Myeloma Working Group (IMWG) criteria. A single reader additionally assessed extraskeletal findings and their significance, the number of vertebral compressions and bone fractures. The radiation exposure was 2.7±0.9 mSv for WBLDCT and 2.5±0.9 mSv for CR (P=0.054). CR detected bone involvement in 127 out of 486 regions (26%; P<0.0001), confirmed by WBLDCT. CR underestimated the disease stage in 16% and overestimated it in 8% of the patients (P=0.0077). WBLDCT detected more rib fractures compared with CR (188 vs. 47; P<0.0001), vertebral compressions (93 vs. 67; P=0.010) and extraskeletal findings (194 vs. 52; P<0.0001). There was no correlation observed between lesion size (≥5 mm) and its attenuation (r=-0.006; P=0.93). The inter-observer agreement for the presence of osteolytic lesions was κ=0.76 for WBLDCT, and κ=0.55 for CR. The present study concluded that WBLDCT with hybrid iterative reconstruction technique demonstrates superiority to CR with an identical radiation dose in the detection of bone lesions, skeletal fractures, vertebral compressions and extraskeletal findings, which results in up- or downstaging in 24% patients according to the IMWG criteria. The attenuation of osteolytic lesions can be measured with the avoidance of the partial volume effect.
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Affiliation(s)
- Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic
| | - Petr Ourednicek
- Department of Imaging Methods, St. Anne's University Hospital in Brno, 656 91 Brno, Czech Republic
| | - Zuzana Meckova
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic
| | - Giampaolo Gavelli
- Radiology Unit, IRCCS-Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), I-47014 Meldola, Italy
| | - Jan Straub
- Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic
| | - Ivan Spicka
- Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic
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105
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Raje NS, Moreau P, Terpos E, Benboubker L, Grząśko N, Holstein SA, Oriol A, Huang SY, Beksac M, Kuliczkowski K, Tai DF, Wooldridge JE, Conti I, Kaiser CJ, Nguyen TS, Cronier DM, Palumbo A. Phase 2 study of tabalumab, a human anti-B-cell activating factor antibody, with bortezomib and dexamethasone in patients with previously treated multiple myeloma. Br J Haematol 2016; 176:783-795. [PMID: 28005265 DOI: 10.1111/bjh.14483] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/10/2016] [Indexed: 01/07/2023]
Abstract
In this double-blind, Phase 2 study, 220 patients with relapsed/refractory multiple myeloma were randomly assigned 1:1:1 to receive placebo (N = 72), tabalumab 100 mg (N = 74), or tabalumab 300 mg (N = 74), each in combination with dexamethasone 20 mg and subcutaneous bortezomib 1·3 mg/m2 on a 21-day cycle. No significant intergroup differences were observed among primary (median progression-free survival [mPFS]) or secondary efficacy outcomes. The mPFS was 6·6, 7·5 and 7·6 months for the tabalumab 100, 300 mg and placebo groups, respectively (tabalumab 100 mg vs. placebo Hazard ratio (HR) [95% confidence interval (CI)] = 1·13 [0·80-1·59], P = 0·480; tabalumab 300 mg vs. placebo HR [95% CI] = 1·03 [0·72-1·45], P = 0·884). The most commonly-reported treatment-emergent adverse events were thrombocytopenia (37%), fatigue (37%), diarrhoea (35%) and constipation (32%). Across treatments, patients with low baseline BAFF (also termed TNFSF13B) expression (n = 162) had significantly longer mPFS than those with high BAFF expression (n = 55), using the 75th percentile cut-off point (mPFS [95% CI] = 8·3 [7·0-9·3] months vs. 5·8 [3·7-6·6] months; HR [95% CI] = 1·59 [1·11-2·29], P = 0·015). Although generally well tolerated, PFS was not improved during treatment with tabalumab compared to placebo. A higher dose of 300 mg tabalumab did not improve efficacy compared to the 100 mg dose. Nonetheless, BAFF appears to have some prognostic value in patients with multiple myeloma.
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Affiliation(s)
| | | | - Evangelos Terpos
- National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Lotfi Benboubker
- Hôpital Bretonneau, Centre Hospitalier Régional Universitaire (CHRU), Tours, France
| | - Norbert Grząśko
- Medical University of Lublin and Department of Haematology, St. John's Cancer Centre, Lublin, Poland
| | | | - Albert Oriol
- Institut Català d'Oncologia (ICO) and Institut de Recerca contra la Leucèmia Josep Carreras (IJC), Hospital Germans Trias i Pujol, Badalona, Spain
| | - Shang-Yi Huang
- National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Meral Beksac
- Ankara University Ibn Sina Hospital, Ankara, Turkey
| | | | | | | | | | | | | | | | - Antonio Palumbo
- Myeloma Unit, Division of Haematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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106
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van de Velde H, Londhe A, Ataman O, Johns HL, Hill S, Landers E, Berlin JA. Association between complete response and outcomes in transplant-eligible myeloma patients in the era of novel agents. Eur J Haematol 2016; 98:269-279. [PMID: 27859769 DOI: 10.1111/ejh.12829] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Achieving complete response (CR) has been linked to improved progression-free (PFS) and overall (OS) survival in myeloma. A meta-analysis was conducted to investigate whether this holds true in the era of novel agents (bortezomib, lenalidomide, thalidomide). METHODS A total of 24 studies in newly diagnosed patients undergoing autologous stem cell transplantation (ASCT) that reported associations between responses and long-term outcomes (PFS/OS rates post-ASCT by response, or hazard ratios with 95% confidence intervals from Cox models) were identified and analyzed. RESULTS Achievement of CR vs. <CR post-ASCT reduced risk of progression/death by 38% [risk ratio (RR): 0.62, P < 0.0001]; risk of death was 41% lower (RR: 0.59, P < 0.0001). Subgroup meta-analyses showed significant PFS risk reduction with CR post-ASCT with novel (RR: 0.32, P < 0.006) and non-novel (RR: 0.72, P < 0.0001) agents, and corresponding OS risk reduction with novel (RR: 0.33, P = 0.0013) and non-novel (RR: 0.64, P < 0.0001) agents. Risk reduction was greater with novel vs. non-novel agents (PFS: P = 0.047; OS: P = 0.058). CONCLUSIONS Achieving CR during first-line therapy remains important in the novel-agent era; magnitude of association between achieving CR and outcomes appears higher for CR obtained using novel vs. non-novel agents.
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Affiliation(s)
- Helgi van de Velde
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Anil Londhe
- Janssen Research and Development, Horsham, PA, USA
| | - Ozlem Ataman
- Janssen Research & Development, High Wycombe, UK
| | - Helen L Johns
- FireKite, an Ashfield Company, part of UDG Healthcare plc, Maidenhead, UK
| | - Stephen Hill
- FireKite, an Ashfield Company, part of UDG Healthcare plc, Maidenhead, UK
| | - Emma Landers
- FireKite, an Ashfield Company, part of UDG Healthcare plc, Maidenhead, UK
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107
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Chen JH, Chung CH, Wang YC, Hsu SN, Huang WY, Chien WC. Prevalence and Mortality-Related Factors of Multiple Myeloma in Taiwan. PLoS One 2016; 11:e0167227. [PMID: 27907052 PMCID: PMC5132205 DOI: 10.1371/journal.pone.0167227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/10/2016] [Indexed: 11/22/2022] Open
Abstract
In this retrospective cohort study based in Taiwan, we reported the current epidemiology of patients with multiple myeloma and analyzed the factors affecting mortality. We identified 7285 patients with newly diagnosed multiple myeloma (MM) between 1997 and 2013 in Taiwan. Privileges data from the National Health Institute Research Database was used, as it is made readily available to the public in electronic format for research purposes. From 1997 to 2013, the average incidence of MM per 100,000 people was 1.83. The mortality accounted for an average of 0.44 per 100,000 deaths. In all 7285 inpatients with MM, the proportion of male patients was greater than that of female (59.90% vs. 40.10%); the mean age was 68.71 years with the proportion of those >55 years of age was 85.11%; and the proportion of a catastrophic illness was 66.51%. The death risk of the inpatient dialysis group was 3.044 times that of patients without dialysis (P <0.001). Moreover, the risk of death to men in the hospital setting was 1.162 times that of women (P = 0.012), and in the group of patients aged >55 years, the risk of in-hospital death was 1.511 times more than that in those aged ≤55 years (P <0.001). The risk of hospital death due to catastrophic illness was 1.347 times that of a non-catastrophic illness (P <0.001). Male patients and those >55 years of age had the most common prevalence of MM in Taiwan. Hemodialysis treatment, male sex, old age, and catastrophic illness were independent predictors of hospital mortality in patients with MM.
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Affiliation(s)
- Jia-Hong Chen
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention & Safety Promotion Association, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shun-Neng Hsu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Yen Huang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- National Defense Medical Center, Tri-Service General Hospital, Department of Medical Research, Neihu District, Taipei City, Taiwan
- National Defense Medical Center, School of Public Health, Neihu District, Taipei City, Taiwan
- * E-mail:
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108
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Badar T, Srour S, Bashir Q, Shah N, Al-Atrash G, Hosing C, Popat U, Nieto Y, Orlowski RZ, Champlin R, Qazilbash MH. Predictors of inferior clinical outcome in patients with standard-risk multiple myeloma. Eur J Haematol 2016; 98:263-268. [PMID: 27862330 DOI: 10.1111/ejh.12826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Outcome of patients with standard-risk (SR) multiple myeloma (MM) has improved; however, subsets of patients do worse than expected. We sought to identify the factors associated with inferior outcome. METHODS We evaluated 51 patients with SR MM that received upfront autologous hematopoietic stem cell transplantation (auto-HCT) after induction and had a progression-free survival (PFS) of ≤18 months. RESULTS The median age of patients was 61 yr. Forty-one (80%) patients received induction with immunomodulatory drugs, proteosome inhibitors, or combination of both. The overall response rate (ORR) after auto-HCT was 96% (stringent complete response 23%, complete response 10%, very good partial response 22%, and partial response 39%). The median PFS was 7.8, and median overall survival (OS) was 56.3 months. On univariate analysis, concurrent light-chain amyloidosis (AL) was associated with inferior PFS [hematological response (HR); 2.51, 95% CI; 0.64-10.58, P = 0.03] and occurrence of soft tissue plasmacytoma was associated with a significantly shorter OS (HR: 3.05, 95% CI: 0.57-16.29, P = 0.02). CONCLUSION Our analysis suggests that concurrent AL and soft tissue plasmacytoma were associated with shorter PFS and OS, respectively. Heterogeneity in clinical outcome of SR MM merits better tools for prognostication, such as gene expression profiling and minimal residual disease assessment to identify high-risk patients.
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Affiliation(s)
- Talha Badar
- Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Leukemia, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Samer Srour
- Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nina Shah
- Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gheath Al-Atrash
- Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chitra Hosing
- Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard Champlin
- Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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109
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Zhang L, Cao D, Tang L, Sun C, HU Y. A panel of circulating mi
RNA
s as diagnostic biomarkers for screening multiple myeloma: a systematic review and meta‐analysis. Int J Lab Hematol 2016; 38:589-599. [PMID: 27870469 DOI: 10.1111/ijlh.12560] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/05/2016] [Indexed: 12/13/2022]
Affiliation(s)
- L. Zhang
- Department of Hematology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - D. Cao
- Institute of Cancer Renmin Hospital of Wuhan University Wuhan University WuhanChina
| | - L. Tang
- Department of Hematology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Collaborative Innovation Center of Hematology Huazhong University of Science and Technology Wuhan Hubei China
| | - C. Sun
- Department of Hematology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Collaborative Innovation Center of Hematology Huazhong University of Science and Technology Wuhan Hubei China
| | - Y. HU
- Department of Hematology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Collaborative Innovation Center of Hematology Huazhong University of Science and Technology Wuhan Hubei China
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110
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Jiménez C, Jara-Acevedo M, Corchete LA, Castillo D, Ordóñez GR, Sarasquete ME, Puig N, Martínez-López J, Prieto-Conde MI, García-Álvarez M, Chillón MC, Balanzategui A, Alcoceba M, Oriol A, Rosiñol L, Palomera L, Teruel AI, Lahuerta JJ, Bladé J, Mateos MV, Orfão A, San Miguel JF, González M, Gutiérrez NC, García-Sanz R. A Next-Generation Sequencing Strategy for Evaluating the Most Common Genetic Abnormalities in Multiple Myeloma. J Mol Diagn 2016; 19:99-106. [PMID: 27863261 DOI: 10.1016/j.jmoldx.2016.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/04/2016] [Accepted: 08/12/2016] [Indexed: 12/16/2022] Open
Abstract
Identification and characterization of genetic alterations are essential for diagnosis of multiple myeloma and may guide therapeutic decisions. Currently, genomic analysis of myeloma to cover the diverse range of alterations with prognostic impact requires fluorescence in situ hybridization (FISH), single nucleotide polymorphism arrays, and sequencing techniques, which are costly and labor intensive and require large numbers of plasma cells. To overcome these limitations, we designed a targeted-capture next-generation sequencing approach for one-step identification of IGH translocations, V(D)J clonal rearrangements, the IgH isotype, and somatic mutations to rapidly identify risk groups and specific targetable molecular lesions. Forty-eight newly diagnosed myeloma patients were tested with the panel, which included IGH and six genes that are recurrently mutated in myeloma: NRAS, KRAS, HRAS, TP53, MYC, and BRAF. We identified 14 of 17 IGH translocations previously detected by FISH and three confirmed translocations not detected by FISH, with the additional advantage of breakpoint identification, which can be used as a target for evaluating minimal residual disease. IgH subclass and V(D)J rearrangements were identified in 77% and 65% of patients, respectively. Mutation analysis revealed the presence of missense protein-coding alterations in at least one of the evaluating genes in 16 of 48 patients (33%). This method may represent a time- and cost-effective diagnostic method for the molecular characterization of multiple myeloma.
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Affiliation(s)
- Cristina Jiménez
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - María Jara-Acevedo
- DNA Sequencing Service, University of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Luis A Corchete
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | | | | | - María E Sarasquete
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Noemí Puig
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Joaquín Martínez-López
- Hematology Department, 12 de Octubre Hospital, Unit of Cancer Research Innovation Spain (CRIS), Spanish National Cancer Research Center (CNIO), University of Madrid, Madrid, Spain
| | - María I Prieto-Conde
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - María García-Álvarez
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - María C Chillón
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Ana Balanzategui
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Miguel Alcoceba
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Albert Oriol
- Catalan Institute of Oncology, Josep Carreras Institute, Germans Trias i Pujol Hospital, Barcelona, Spain
| | - Laura Rosiñol
- Research Biomedical Institute August Pi i Sunyer, Clinical Hospital of Barcelona, Barcelona, Spain
| | | | | | - Juan J Lahuerta
- Hematology Department, 12 de Octubre Hospital, Unit of Cancer Research Innovation Spain (CRIS), Spanish National Cancer Research Center (CNIO), University of Madrid, Madrid, Spain
| | - Joan Bladé
- Research Biomedical Institute August Pi i Sunyer, Clinical Hospital of Barcelona, Barcelona, Spain
| | - María V Mateos
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Alberto Orfão
- DNA Sequencing Service, University of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Jesús F San Miguel
- Center for Applied Medical Research, University of Navarra Hospital, Institute of Health Research of Navarra (IDISNA), Pamplona, Spain
| | - Marcos González
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain.
| | - Norma C Gutiérrez
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Ramón García-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Salamanca, Spain
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Teras LR, DeSantis CE, Cerhan JR, Morton LM, Jemal A, Flowers CR. 2016 US lymphoid malignancy statistics by World Health Organization subtypes. CA Cancer J Clin 2016; 66:443-459. [PMID: 27618563 DOI: 10.3322/caac.21357] [Citation(s) in RCA: 729] [Impact Index Per Article: 91.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 12/15/2022] Open
Abstract
Collectively, lymphoid neoplasms are the fourth most common cancer and the sixth leading cause of cancer death in the United States. The authors provide contemporary lymphoid neoplasm statistics by subtype based on the 2008 World Health Organization classifications, including the most current US incidence and survival data. Presented for the first time are estimates of the total numbers of US lymphoid neoplasm cases by subtype as well as a detailed evaluation of incidence and survival statistics. In 2016, 136,960 new lymphoid neoplasms are expected. Overall lymphoma incidence rates have declined in recent years, but trends vary by subtype. Precursor lymphoid neoplasm incidence rates increased from 2001 to 2012, particularly for B-cell neoplasms. Among the mature lymphoid neoplasms, the fastest increase was for plasma cell neoplasms. Rates also increased for mantle cell lymphoma (males), marginal zone lymphoma, hairy cell leukemia, and mycosis fungoides. Like incidence, survival for both mature T-cell lymphomas and mature B-cell lymphomas varied by subtype and by race. Patients with peripheral T-cell lymphomas had among the worst 5-year relative survival (36%-56%, depending on race/sex), while those with mycosis fungoides had among the best survival (79%-92%). For B-cell lymphomas, 5-year survival ranged from 83% to 91% for patients with marginal zone lymphoma and from 78% to 92% for those with hairy cell leukemia; but the rates were as low as 47% to 63% for patients with Burkitt lymphoma and 44% to 48% for those with plasma cell neoplasms. In general, black men had the lowest survival across lymphoid malignancy subtypes. These contemporary incidence and survival statistics are useful for developing management strategies for these cancers and can offer clues regarding their etiology. CA Cancer J Clin 2016;66:443-459. © 2016 American Cancer Society.
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Affiliation(s)
- Lauren R Teras
- Strategic Director, Hematologic Cancer Research, Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Carol E DeSantis
- Director, Breast and Gynecological Cancer Surveillance, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - James R Cerhan
- Professor and Chair, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Lindsay M Morton
- Senior Investigator, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Christopher R Flowers
- Director, Lymphoma Program, Department of Hematology and Oncology/Winship Cancer Institute, Emory University, Atlanta, GA
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112
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Next-generation multiple myeloma treatment: a pharmacoeconomic perspective. Blood 2016; 128:2757-2764. [PMID: 27742709 DOI: 10.1182/blood-2016-09-692947] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/12/2016] [Indexed: 01/07/2023] Open
Abstract
Advances in the diagnosis and treatment of multiple myeloma have come at a rapid pace, especially with several new drugs entering the market in the last few years. However, access to and affordability of new treatments poses a major challenge, both in the United States and around the world. High costs of life-saving drugs are detrimental to both the personal finances of the individual patient, as well as society which must bear the increasing costs in terms of increased health insurance premiums, taxes, or both. The challenges are not unique to myeloma, but are commonly encountered in several other cancers as well. But to some extent these pharmacoeconomic concerns are amplified in myeloma due to the need for multidrug regimens that combine 2 or more expensive new drugs, continuous therapy, and the prolonged disease course in most patients. We examine current myeloma therapy from a pharmacoeconomic perspective, and discuss the costs involved. We outline the underlying reasons why cancer drugs are so expensive, the measures that are required to lower cost, and propose potential ways in which costs can be reduced while still delivering high-quality care.
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Chalayer E, Chapelle C, Leleu X, Elalamy I, Laporte S, Tardy B. Usual risk factors do not predict venous thromboembolism in newly diagnosed myeloma treated with immunomodulatory drugs. Am J Hematol 2016; 91:E455-6. [PMID: 27341647 DOI: 10.1002/ajh.24454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 06/13/2016] [Accepted: 06/17/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Emilie Chalayer
- Centre d'investigation Clinique CIC 1408; CHU Saint Etienne; France
| | - Céline Chapelle
- Unité de Recherche Clinique, Innovation, Pharmacologie; CHU Saint-Etienne, France
- INSERM UMR 1059, Equipe DVH, Université J Monnet; Saint Etienne France
| | - Xavier Leleu
- Service d'hématologie clinique; CHU de Poitiers; France
| | | | - Silvy Laporte
- Centre d'investigation Clinique CIC 1408; CHU Saint Etienne; France
- Unité de Recherche Clinique, Innovation, Pharmacologie; CHU Saint-Etienne, France
- INSERM UMR 1059, Equipe DVH, Université J Monnet; Saint Etienne France
| | - Bernard Tardy
- Centre d'investigation Clinique CIC 1408; CHU Saint Etienne; France
- Unité de Recherche Clinique, Innovation, Pharmacologie; CHU Saint-Etienne, France
- INSERM UMR 1059, Equipe DVH, Université J Monnet; Saint Etienne France
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114
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Dowling M, Kelly M, Meenaghan T. Multiple myeloma: managing a complex blood cancer. ACTA ACUST UNITED AC 2016; 25:S18-28. [DOI: 10.12968/bjon.2016.25.s18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Mary Kelly
- Advanced Nurse Practitioner (Haematology), Midlands Regional Hospitals, County Offaly, Ireland
| | - Teresa Meenaghan
- Advanced Nurse Practitioner (Haematology) Galway University Hospital, Galway, Ireland
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115
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Affiliation(s)
- Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
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116
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Chakraborty R, Muchtar E, Kumar SK, Buadi FK, Dingli D, Dispenzieri A, Hayman SR, Hogan WJ, Kapoor P, Lacy MQ, Leung N, Gertz MA. Impact of pre-transplant bone marrow plasma cell percentage on post-transplant response and survival in newly diagnosed multiple myeloma. Leuk Lymphoma 2016; 58:308-315. [DOI: 10.1080/10428194.2016.1201572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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117
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Lust JA, Lacy MQ, Zeldenrust SR, Witzig TE, Moon-Tasson LL, Dinarello CA, Donovan KA. Reduction in C-reactive protein indicates successful targeting of the IL-1/IL-6 axis resulting in improved survival in early stage multiple myeloma. Am J Hematol 2016; 91:571-4. [PMID: 26945843 DOI: 10.1002/ajh.24352] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/02/2016] [Indexed: 11/08/2022]
Abstract
We report the long-term follow-up results of a phase II trial of IL-1 receptor antagonist and low-dose dexamethasone for early stage multiple myeloma (MM). Patients were eligible if they had smoldering multiple myeloma (SMM) or indolent multiple myeloma (IMM) without the need for immediate therapy. Forty seven patients were enrolled and subsequently treated with IL-1Ra; in 25/47 low-dose dexamethasone (20 mg weekly) was added. The primary endpoint was progression-free survival (PFS). In the clinical trial, three patients achieved a minor response (MR) to IL-1Ra alone; five patients a partial response (PR) and four patients an MR after addition of dexamethasone. Seven patients showed a decrease in the plasma cell labeling index (PCLI) which paralleled a decrease in the high sensitivity C-reactive protein (hs-CRP). The median PFS for the 47 patients was 1116 days (37.2 months). The median PFS for patients without (n = 22) and with (n = 25) a decrease in their baseline hs-CRP was 326 days (11 months) vs. 3139 days (104 months) respectively (P <0.0001). The median overall survival (OS) for the 47 patients was 3482 days (9.5 years). The median OS for patients without and with a decrease in their baseline hs-CRP was 2885 days (7.9 years) vs. median not reached, respectively (P = 0.001). In SMM/IMM patients at risk for progression to active myeloma, reduction in the hs-CRP indicates successful targeting of the IL-1/IL-6 axis resulting in improved PFS and OS. (Clinical Trials.gov Identifier: NCT00635154) Am. J. Hematol. 91:571-574, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- John A. Lust
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Martha Q. Lacy
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | | | - Charles A. Dinarello
- Department of Medicine; University of Colorado; 12700 East 19 Ave, B168 Aurora Colorado 80045
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118
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Dutoit JC, Verstraete KL. MRI in multiple myeloma: a pictorial review of diagnostic and post-treatment findings. Insights Imaging 2016; 7:553-69. [PMID: 27164915 PMCID: PMC4956620 DOI: 10.1007/s13244-016-0492-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/11/2016] [Accepted: 04/20/2016] [Indexed: 01/04/2023] Open
Abstract
Magnetic resonance imaging (MRI) is increasingly being used in the diagnostic work-up of patients with multiple myeloma. Since 2014, MRI findings are included in the new diagnostic criteria proposed by the International Myeloma Working Group. Patients with smouldering myeloma presenting with more than one unequivocal focal lesion in the bone marrow on MRI are considered having symptomatic myeloma requiring treatment, regardless of the presence of lytic bone lesions. However, bone marrow evaluation with MRI offers more than only morphological information regarding the detection of focal lesions in patients with MM. The overall performance of MRI is enhanced by applying dynamic contrast-enhanced MRI and diffusion weighted imaging sequences, providing additional functional information on bone marrow vascularization and cellularity. This pictorial review provides an overview of the most important imaging findings in patients with monoclonal gammopathy of undetermined significance, smouldering myeloma and multiple myeloma, by performing a ‘total’ MRI investigation with implications for the diagnosis, staging and response assessment. Main message • Conventional MRI diagnoses multiple myeloma by assessing the infiltration pattern. • Dynamic contrast-enhanced MRI diagnoses multiple myeloma by assessing vascularization and perfusion. • Diffusion weighted imaging evaluates bone marrow composition and cellularity in multiple myeloma. • Combined morphological and functional MRI provides optimal bone marrow assessment for staging. • Combined morphological and functional MRI is of considerable value in treatment follow-up.
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Affiliation(s)
- Julie C Dutoit
- Department of Radiology, MR -1K12, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Koenraad L Verstraete
- Department of Radiology, MR -1K12, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium
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119
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Gentile M, Martino M, Recchia AG, Vigna E, Morabito L, Morabito F. Sorafenib for the treatment of multiple myeloma. Expert Opin Investig Drugs 2016; 25:743-9. [PMID: 26998658 DOI: 10.1517/13543784.2016.1169272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Sorafenib is an orally available compound that acts predominantly by targeting the Ras/Raf/MEK/ERK pathway and by inhibiting the vascular endothelial growth factor (VEGF). Since the Ras/Raf/MEK/ERK pathway is implicated in the proliferation of multiple myeloma (MM) cells and VEGF in bone marrow neovascularization, sorafenib is a drug offering the potential for targeting two important pathogenetic mechanisms involved in MM. Thus, sorafenib is being proposed for use in MM. AREAS COVERED In this review, the authors discuss the rationale for the use of sorafenib in MM. They then summarize the clinical development of sorafenib in MM, from initial Phase I to Phase II studies. A systematic literature review of the trials was performed using PubMed. EXPERT OPINION Preliminary data from phase I/II trials showed that sorafenib had a good safety profile but minimal anti-myeloma activity as a single agent in relapsed/refractory patients. Results of phase II trials, evaluating sorafenib combined with new drugs, such as bortezomib and lenalidomide are eagerly awaited.
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Affiliation(s)
- Massimo Gentile
- a Hematology Unit , Azienda Ospedaliera di Cosenza , Cosenza , Italy
| | - Massimo Martino
- b Hematology and Stem Cell Transplant Unit , Azienda Ospedaliera BMM di Reggio Calabria , Reggio Calabria , Italy
| | - Anna Grazia Recchia
- c Biotechnology Research Unit , Azienda Sanitaria Provinciale di Cosenza , Aprigliano , Italy
| | - Ernesto Vigna
- c Biotechnology Research Unit , Azienda Sanitaria Provinciale di Cosenza , Aprigliano , Italy
| | - Lucio Morabito
- d Medical Oncology & Hematology Unit , Humanitas Cancer Center, Istituto Clinico Humanitas, IRCCS , Milano , Italy
| | - Fortunato Morabito
- a Hematology Unit , Azienda Ospedaliera di Cosenza , Cosenza , Italy.,c Biotechnology Research Unit , Azienda Sanitaria Provinciale di Cosenza , Aprigliano , Italy
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120
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Nishihori T, Song J, Shain KH. Minimal Residual Disease Assessment in the Context of Multiple Myeloma Treatment. Curr Hematol Malig Rep 2016; 11:118-26. [PMID: 26898557 PMCID: PMC4819726 DOI: 10.1007/s11899-016-0308-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With contemporary therapeutic strategies in multiple myeloma, heretofore unseen depth and rate of responses are being achieved. These strategies have paralleled improvements in outcome of multiple myeloma patients. The integration of the next generation of proteasome inhibitors and antibody therapeutics promise continued improvements in therapy with the expectation of consistent depth of response not quantifiable by current clinical methods. As such, there is a growing need to develop adequate tools to evaluate deeper disease response after therapy and to refine the response criteria including the minimal residual disease. Several emerging techniques are being evaluated for these purposes including multi-parameter flow cytometry, allele-specific oligonucleotide polymerase chain reaction, next-generation sequencing, and imaging modalities. In this review, we highlight the recent developments and evaluate advantages and limitations of the current technologies to assess minimal residual disease. We also discuss future applications of these methodologies in potentially guiding multiple myeloma treatment decisions.
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Affiliation(s)
- Taiga Nishihori
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, Moffitt Cancer Center/University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jinming Song
- Department of Oncologic Sciences, Moffitt Cancer Center/University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Hematopathology, Moffitt Cancer Center, Tampa, FL, USA
| | - Kenneth H Shain
- Department of Oncologic Sciences, Moffitt Cancer Center/University of South Florida Morsani College of Medicine, Tampa, FL, USA.
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA.
- Tumor Biology Department, Moffitt Cancer Center, Tampa, FL, USA.
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
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