101
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Spatial genomic heterogeneity in multiple myeloma revealed by multi-region sequencing. Nat Commun 2017; 8:268. [PMID: 28814763 PMCID: PMC5559527 DOI: 10.1038/s41467-017-00296-y] [Citation(s) in RCA: 251] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 06/20/2017] [Indexed: 12/27/2022] Open
Abstract
In multiple myeloma malignant plasma cells expand within the bone marrow. Since this site is well-perfused, a rapid dissemination of "fitter" clones may be anticipated. However, an imbalanced distribution of multiple myeloma is frequently observed in medical imaging. Here, we perform multi-region sequencing, including iliac crest and radiology-guided focal lesion specimens from 51 patients to gain insight into the spatial clonal architecture. We demonstrate spatial genomic heterogeneity in more than 75% of patients, including inactivation of CDKN2C and TP53, and mutations affecting mitogen-activated protein kinase genes. We show that the extent of spatial heterogeneity is positively associated with the size of biopsied focal lesions consistent with regional outgrowth of advanced clones. The results support a model for multiple myeloma progression with clonal sweeps in the early phase and regional evolution in advanced disease. We suggest that multi-region investigations are critical to understanding intra-patient heterogeneity and the evolutionary processes in multiple myeloma.In multiple myeloma, malignant cells expand within bone marrow. Here, the authors use multi-region sequencing in patient samples to analyse spatial clonal architecture and heterogeneity, providing novel insight into multiple myeloma progression and evolution.
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102
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Liu Y, Jin L, Lan J. Acute Renal failure caused by plasma cell infiltration in primary plasma cell leukemia. Nephrology (Carlton) 2017; 22:729-730. [PMID: 28792128 DOI: 10.1111/nep.12928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Yueming Liu
- Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Lai Jin
- Department of Hematology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Jianping Lan
- Department of Hematology, Zhejiang Provincial People's Hospital, Hangzhou, China
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103
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Wang G, Zhou P, Chen X, Zhao L, Tan J, Yang Y, Fang Y, Zhou J. The novel autophagy inhibitor elaiophylin exerts antitumor activity against multiple myeloma with mutant TP53 in part through endoplasmic reticulum stress-induced apoptosis. Cancer Biol Ther 2017; 18:584-595. [PMID: 28718729 DOI: 10.1080/15384047.2017.1345386] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Elaiophylin is a natural compound and a novel and potent inhibitor of late stage autophagy with outstanding antitumor activity in human ovarian cancer cells. However, the possible biologic effects and functional linkage between elaiophylin and multiple myeloma (MM) have not been explored. This study aimed to assess the effect of elaiophylin on MM cells with mutant TP53 and the possible molecular mechanism. The results suggested that elaiophylin exerted anti-myeloma activity by inducing apoptosis and proliferation arrest. As expected, elaiophylin blocked autophagy flux in MM cells. Subsequently, persistent activation of endoplasmic reticulum (ER) stress was induced. Moreover, the apoptotic effect was to some extent attenuated by the ER stress inhibitor tauroursodeoxycholic acid (TUDCA). Further studies indicated that elaiophylin effectively suppressed MM cell growth without obvious side effects in zebrafish embryo and mouse xenograft models. Taken together, our data are the first to demonstrate that exposure of human MM cells with mutant TP53 to elaiophylin blocked autophagy flux and thus induced cell death, which partially involved ER stress-associated apoptosis. Targeted disruption of the cellular protein handling system by elaiophylin is therefore a promising therapeutic strategy for overcoming incurable MM, even when TP53 mutations are present.
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Affiliation(s)
- Gaoxiang Wang
- a Department of Hematology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei , China
| | - Pan Zhou
- a Department of Hematology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei , China
| | - Xing Chen
- a Department of Hematology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei , China
| | - Lei Zhao
- a Department of Hematology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei , China
| | - Jiaqi Tan
- a Department of Hematology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei , China
| | - Yang Yang
- a Department of Hematology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei , China
| | - Yong Fang
- b Cancer Biology Center , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei , China
| | - Jianfeng Zhou
- a Department of Hematology , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , Hubei , China
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104
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Joseph NS, Gentili S, Kaufman JL, Lonial S, Nooka AK. High-risk Multiple Myeloma: Definition and Management. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17S:S80-S87. [DOI: 10.1016/j.clml.2017.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/28/2017] [Indexed: 10/19/2022]
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105
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Nahi H, Genell A, Wålinder G, Uttervall K, Juliusson G, Karin F, Hansson M, Svensson R, Linder O, Carlson K, Björkstrand B, Kristinsson SY, Mellqvist UH, Blimark C, Turesson I. Incidence, characteristics, and outcome of solitary plasmacytoma and plasma cell leukemia. Population-based data from the Swedish Myeloma Register. Eur J Haematol 2017; 99:216-222. [PMID: 28544116 DOI: 10.1111/ejh.12907] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 01/16/2023]
Abstract
Solitary plasmacytoma (SP) and plasma cell leukemia (PCL) are uncommon (3-6%) types of plasma cell disease. The risk of progression to symptomatic multiple myeloma (MM) is probably important for the outcome of SP. PCL is rare and has a dismal outcome. In this study, we report on incidence and survival in PCL/SP, and progression to MM in SP, using the prospective observational Swedish Multiple Myeloma Register designed to document all newly diagnosed plasma cell diseases in Sweden since 2008. Both solitary bone plasmacytoma (SBP) (n=124) and extramedullary plasmacytoma (EMP) (n=67) have better overall survival (OS) than MM (n=3549). Progression to MM was higher in SBP than in EMP (35% and 7% at 2 years, respectively), but this did not translate into better survival in EMP. In spite of treatment developments, the OS of primary PCL is still dismal (median of 11 months, 0% at 5 years). Hence, there is a great need for diagnostic and treatment guidelines as well as prospective studies addressing the role for alternative treatment options, such as allogeneic stem cell transplantation and monoclonal antibodies in the treatment of PCL.
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Affiliation(s)
- Hareth Nahi
- Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Genell
- Regional Cancer Centre West, Gothenberg, Sweden
| | | | | | | | | | | | - Ronald Svensson
- Hematology, Linkoping University Hospital, Linkoping, Sweden
| | - Olle Linder
- Hematology, Örebro University Hospital, Örebro, Sweden
| | | | | | | | | | - Cecilie Blimark
- Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
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106
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Jung SH, Lee JJ, Kim K, Suh C, Yoon DH, Min CK, Sohn SK, Choi CW, Lee HS, Kim HJ, Shin HJ, Bang SM, Yoon SS, Park SK, Yhim HY, Kim MK, Jo JC, Mun YC, Lee JH, Kim JS. The role of frontline autologous stem cell transplantation for primary plasma cell leukemia: a retrospective multicenter study (KMM160). Oncotarget 2017; 8:79517-79526. [PMID: 29108331 PMCID: PMC5668064 DOI: 10.18632/oncotarget.18535] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/05/2017] [Indexed: 12/13/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive plasma cell neoplasm, with rapidly progressing clinical course. We evaluated the treatment status and survival outcomes of 69 Korean patients with pPCL. Of them, 59 patients were treated; 15 (25.4%) were treated initially with novel agent-based regimens with upfront autologous stem cell transplantation (ASCT), 7 (11.9%) with conventional chemotherapy with upfront ASCT, 21 (35.6%) with novel agent-based regimens only, and 16 (27.1%) were treated with conventional chemotherapy alone. Overall response rates after initial therapy were significantly higher in patients treated with novel agent-based regimens compared with those treated with conventional chemotherapies (75% vs. 43.4%, P = 0.026). Median progression-free survival (PFS) and overall survival (OS) were 12.2 months and 16.1 months, respectively. The median PFS of the four treatment groups–conventional chemotherapy alone, novel agents alone, conventional chemotherapy with ASCT, and novel agents with ASCT–were 1.2, 9.0, 10.5, and 26.4 months, respectively (P < 0.001); the median OS of the four treatment groups were 2.9, 12.3, 14.1, and 31.1 months, respectively (P < 0.001). The median OS was also significantly better in the patients with novel agents with ASCT versus other patients. In a multivariate analysis, an increased lactate dehydrogenase level, low albumin (< 3.5 g/dL), and non-CR after front-line treatment were independently associated with poor PFS and OS. In conclusion, the use of novel agent-based therapy with ASCT and achieving a deep response to front-line treatment are important in expecting improved PFS and OS in patients with pPCL.
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Affiliation(s)
- Sung-Hoon Jung
- Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Republic of Korea
| | - Je-Jung Lee
- Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Republic of Korea
| | - Kihyun Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheolwon Suh
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dok Hyun Yoon
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang-Ki Min
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Kyun Sohn
- Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chul Won Choi
- Korea University School of Medicine, Seoul, Republic of Korea
| | - Ho Sup Lee
- Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Hyo Jung Kim
- Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Ho-Jin Shin
- Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Mee Bang
- Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Sung-Soo Yoon
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong Kyu Park
- Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Ho-Young Yhim
- Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Min Kyoung Kim
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jae-Cheol Jo
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - Yeung-Chul Mun
- Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Lee
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jin Seok Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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107
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Dingli D, Ailawadhi S, Bergsagel PL, Buadi FK, Dispenzieri A, Fonseca R, Gertz MA, Gonsalves WI, Hayman SR, Kapoor P, Kourelis T, Kumar SK, Kyle RA, Lacy MQ, Leung N, Lin Y, Lust JA, Mikhael JR, Reeder CB, Roy V, Russell SJ, Sher T, Stewart AK, Warsame R, Zeldenrust SR, Rajkumar SV, Chanan Khan AA. Therapy for Relapsed Multiple Myeloma: Guidelines From the Mayo Stratification for Myeloma and Risk-Adapted Therapy. Mayo Clin Proc 2017; 92:578-598. [PMID: 28291589 PMCID: PMC5554888 DOI: 10.1016/j.mayocp.2017.01.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/12/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Life expectancy in patients with multiple myeloma is increasing because of the availability of an increasing number of novel agents with various mechanisms of action against the disease. However, the disease remains incurable in most patients because of the emergence of resistant clones, leading to repeated relapses of the disease. In 2015, 5 novel agents were approved for therapy for relapsed multiple myeloma. This surfeit of novel agents renders management of relapsed multiple myeloma more complex because of the occurrence of multiple relapses, the risk of cumulative and emergent toxicity from previous therapies, as well as evolution of the disease during therapy. A group of physicians at Mayo Clinic with expertise in the care of patients with multiple myeloma regularly evaluates the evolving literature on the biology and therapy for multiple myeloma and issues guidelines on the optimal care of patients with this disease. In this article, the latest recommendations on the diagnostic evaluation of relapsed multiple myeloma and decision trees on how to treat patients at various stages of their relapse (off study) are provided together with the evidence to support them.
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Affiliation(s)
- David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | | | - P Leif Bergsagel
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Francis K Buadi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Rafael Fonseca
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Morie A Gertz
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Wilson I Gonsalves
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Susan R Hayman
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Shaji K Kumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Robert A Kyle
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Martha Q Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Nelson Leung
- Division of Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - John A Lust
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Joseph R Mikhael
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Craig B Reeder
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Vivek Roy
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Stephen J Russell
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Taimur Sher
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - A Keith Stewart
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ
| | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Stephen R Zeldenrust
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - S Vincent Rajkumar
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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108
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The Role of PI3K Isoforms in Regulating Bone Marrow Microenvironment Signaling Focusing on Acute Myeloid Leukemia and Multiple Myeloma. Cancers (Basel) 2017; 9:cancers9040029. [PMID: 28350342 PMCID: PMC5406704 DOI: 10.3390/cancers9040029] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 01/22/2023] Open
Abstract
Despite the development of novel treatments in the past 15 years, many blood cancers still remain ultimately fatal and difficult to treat, particularly acute myeloid leukaemia (AML) and multiple myeloma (MM). While significant progress has been made characterising small-scale genetic mutations and larger-scale chromosomal translocations that contribute to the development of various blood cancers, less is understood about the complex microenvironment of the bone marrow (BM), which is known to be a key player in the pathogenesis of chronic lymphocytic leukaemia (CLL), AML and MM. This niche acts as a sanctuary for the cancerous cells, protecting them from chemotherapeutics and encouraging clonal cell survival. It does this by upregulating a plethora of signalling cascades within the malignant cell, with the phosphatidylinositol-3-kinase (PI3K) pathway taking a critical role. This review will focus on how the PI3K pathway influences disease progression and the individualised role of the PI3K subunits. We will also summarise the current clinical trials for PI3K inhibitors and how these trials impact the treatment of blood cancers.
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109
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Zatula A, Dikic A, Mulder C, Sharma A, Vågbø CB, Sousa MML, Waage A, Slupphaug G. Proteome alterations associated with transformation of multiple myeloma to secondary plasma cell leukemia. Oncotarget 2017; 8:19427-19442. [PMID: 28038447 PMCID: PMC5386695 DOI: 10.18632/oncotarget.14294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 11/30/2016] [Indexed: 01/22/2023] Open
Abstract
Plasma cell leukemia is a rare and aggressive plasma cell neoplasm that may either originate de novo (primary PCL) or by leukemic transformation of multiple myeloma (MM) to secondary PCL (sPCL). The prognosis of sPCL is very poor, and currently no standard treatment is available due to lack of prospective clinical studies. In an attempt to elucidate factors contributing to transformation, we have performed super-SILAC quantitative proteome profiling of malignant plasma cells collected from the same patient at both the MM and sPCL stages of the disease. 795 proteins were found to be differentially expressed in the MM and sPCL samples. Gene ontology analysis indicated a metabolic shift towards aerobic glycolysis in sPCL as well as marked down-regulation of enzymes involved in glycan synthesis, potentially mediating altered glycosylation of surface receptors. There was no significant change in overall genomic 5-methylcytosine or 5-hydroxymethylcytosine at the two stages, indicating that epigenetic dysregulation was not a major driver of transformation to sPCL. The present study constitutes the first attempt to provide a comprehensive map of the altered protein expression profile accompanying transformation of MM to sPCL in a single patient, identifying several candidate proteins that can be targeted by currently available small molecule drugs. Our dataset furthermore constitutes a reference dataset for further proteomic analysis of sPCL transformation.
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Affiliation(s)
- Alexey Zatula
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Aida Dikic
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Celine Mulder
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Present address: University of Utrecht, Utrecht, Holland
| | - Animesh Sharma
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,PROMEC Core Facility for Proteomics and Metabolomics, Norwegian University of Science and Technology, NTNU, Trondheim, and the Central Norway Regional Health Authority, Stjørdal, Norway
| | - Cathrine B Vågbø
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,PROMEC Core Facility for Proteomics and Metabolomics, Norwegian University of Science and Technology, NTNU, Trondheim, and the Central Norway Regional Health Authority, Stjørdal, Norway
| | - Mirta M L Sousa
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Anders Waage
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Hematology, Department of Medicine, St. Olav's Hospital, Trondheim, Norway
| | - Geir Slupphaug
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,PROMEC Core Facility for Proteomics and Metabolomics, Norwegian University of Science and Technology, NTNU, Trondheim, and the Central Norway Regional Health Authority, Stjørdal, Norway
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110
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Tessoulin B, Eveillard M, Lok A, Chiron D, Moreau P, Amiot M, Moreau-Aubry A, Le Gouill S, Pellat-Deceunynck C. p53 dysregulation in B-cell malignancies: More than a single gene in the pathway to hell. Blood Rev 2017; 31:251-259. [PMID: 28284458 DOI: 10.1016/j.blre.2017.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/02/2017] [Indexed: 12/31/2022]
Abstract
TP53 deletion or mutation is frequent in B-cell malignancies and is associated with a low response rate. We describe here the p53 landscape in B-cell malignancies, from B-Acute Lymphoblastic Leukemia to Plasma Cell Leukemia, by analyzing incidence of gain or loss of function of actors both upstream and within the p53 pathway, namely MYC, RAS, ARF, MDM2, ATM and TP53. Abnormalities are not equally distributed and their incidence is highly variable among malignancies. Deletion and mutation, usually associated, of ATM or TP53 are frequent in Diffuse Large B-Cell Lymphoma and Mantle Cell Lymphoma. MYC gain, absent in post-GC malignancies, is frequent in B-Prolymphocytic-Leukemia, Multiple Myeloma and Plasma Cell Leukemias. RAS mutations are rare except in MM and PCL. Multiple Factorial Analysis notes that MYC deregulation is closely related to TP53 status. Moreover, MYC gain, TP53 deletion and RAS mutations are inversely correlated with survival. Based on this landscape, we further propose targeted therapeutic approaches for the different B-cell malignancies.
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Affiliation(s)
- B Tessoulin
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France; Department of Hematology, Nantes University Hospital, Nantes, France.
| | - M Eveillard
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France; Hematology Biology Department, Nantes University Hospital, Nantes, France
| | - A Lok
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France; Department of Hematology, Nantes University Hospital, Nantes, France
| | - D Chiron
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France
| | - P Moreau
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France; Department of Hematology, Nantes University Hospital, Nantes, France
| | - M Amiot
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France
| | - A Moreau-Aubry
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France
| | - S Le Gouill
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France; Department of Hematology, Nantes University Hospital, Nantes, France
| | - C Pellat-Deceunynck
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France.
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111
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Granell M, Calvo X, Garcia-Guiñón A, Escoda L, Abella E, Martínez CM, Teixidó M, Gimenez MT, Senín A, Sanz P, Campoy D, Vicent A, Arenillas L, Rosiñol L, Sierra J, Bladé J, de Larrea CF. Prognostic impact of circulating plasma cells in patients with multiple myeloma: implications for plasma cell leukemia definition. Haematologica 2017; 102:1099-1104. [PMID: 28255016 PMCID: PMC5451342 DOI: 10.3324/haematol.2016.158303] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/17/2017] [Indexed: 12/26/2022] Open
Abstract
The presence of circulating plasma cells in patients with multiple myeloma is considered a marker for highly proliferative disease. In the study herein, the impact of circulating plasma cells assessed by cytology on survival of patients with multiple myeloma was analyzed. Wright-Giemsa stained peripheral blood smears of 482 patients with newly diagnosed myeloma or plasma cell leukemia were reviewed and patients were classified into 4 categories according to the percentage of circulating plasma cells: 0%, 1–4%, 5–20%, and plasma cell leukemia with the following frequencies: 382 (79.2%), 83 (17.2%), 12 (2.5%) and 5 (1.0%), respectively. Median overall survival according to the circulating plasma cells group was 47, 50, 6 and 14 months, respectively. At multivariate analysis, the presence of 5 to 20% circulating plasma cells was associated with a worse overall survival (relative risk 4.9, 95% CI 2.6–9.3) independently of age, creatinine, the Durie-Salmon system stage and the International Staging System (ISS) stage. Patients with ≥5% circulating plasma cells had lower platelet counts (median 86×109/L vs. 214×109/L, P<0.0001) and higher bone marrow plasma cells (median 53% vs. 36%, P=0.004). The presence of ≥5% circulating plasma cells in patients with multiple myeloma has a similar adverse prognostic impact as plasma cell leukemia.
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Affiliation(s)
- Miquel Granell
- Department of Haematology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Josep Carreras Leukemia Research Institutes, Universitat Autònoma de Barcelona, Spain
| | - Xavier Calvo
- Amyloidosis and Myeloma Unit, Department of Haematology, Hospital Clínic and IDIBAPS, Universitat de Barcelona, Spain.,Laboratory of Cytology. Department of Pathology, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Antoni Garcia-Guiñón
- Department of Haematology, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Spain
| | - Lourdes Escoda
- Department of Haematology, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Eugènia Abella
- Department of Haematology. Hospital del Mar-IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clara Mª Martínez
- Department of Haematology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Josep Carreras Leukemia Research Institutes, Universitat Autònoma de Barcelona, Spain
| | - Montserrat Teixidó
- Department of Haematology, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Spain
| | - Mª Teresa Gimenez
- Department of Haematology, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Alicia Senín
- Department of Haematology. Hospital del Mar-IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Sanz
- Department of Haematology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Josep Carreras Leukemia Research Institutes, Universitat Autònoma de Barcelona, Spain
| | - Desirée Campoy
- Department of Haematology, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Spain
| | - Ana Vicent
- Department of Haematology, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Leonor Arenillas
- Laboratory of Cytology. Department of Pathology, GRETNHE, IMIM Hospital del Mar Research Institute, Barcelona, Spain
| | - Laura Rosiñol
- Amyloidosis and Myeloma Unit, Department of Haematology, Hospital Clínic and IDIBAPS, Universitat de Barcelona, Spain
| | - Jorge Sierra
- Department of Haematology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Josep Carreras Leukemia Research Institutes, Universitat Autònoma de Barcelona, Spain
| | - Joan Bladé
- Amyloidosis and Myeloma Unit, Department of Haematology, Hospital Clínic and IDIBAPS, Universitat de Barcelona, Spain
| | - Carlos Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Haematology, Hospital Clínic and IDIBAPS, Universitat de Barcelona, Spain
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112
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Ko PS, Huang YH, Lai CR, Yang CF, Hsiao LT. Diffuse omental cake as an initial presentation of plasma cell leukemia. JOURNAL OF CANCER RESEARCH AND PRACTICE 2017. [DOI: 10.1016/j.jcrpr.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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113
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Yamashita Y, Tamura S, Oiwa T, Kobata H, Kuriyama K, Mushino T, Murata S, Hosoi H, Nishikawa A, Hanaoka N, Sonoki T. Successful Intrathecal Chemotherapy Combined with Radiotherapy Followed by Pomalidomide and Low-Dose Dexamethasone Maintenance Therapy for a Primary Plasma Cell Leukemia Patient. Hematol Rep 2017; 9:6986. [PMID: 28286633 PMCID: PMC5337827 DOI: 10.4081/hr.2017.6986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 01/04/2023] Open
Abstract
Primary plasma cell leukemia (PPCL) is a rare aggressive variant of plasma cell disorder and frequently presents with extramedullary disease. Central nervous system (CNS) involvement with PPCL has an extremely poor prognosis. We describe a 46-year-old man with PPCL treated with a combination of lenalidomide, bortezomib, and dexamethasone as induction therapy following upfront allogeneic stem cell transplantation (allo-SCT). Despite achieving a very good partial response, the patient suffered from an isolated CNS relapse 12 months after allo-SCT. He was immediately started on concurrent intrathecal chemotherapy (IT) and cranial irradiation (RT). Subsequently, pomalidomide and low-dose dexamethasone (Pd) were given as maintenance therapy. He has been without CNS recurrence for more than 18 months. Our case suggests that concurrent IT and RT followed by Pd maintenance therapy may be an effective option to control CNS relapse of PPCL after allo-SCT.
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Affiliation(s)
- Yusuke Yamashita
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Shinobu Tamura
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Takehiro Oiwa
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Hiroshi Kobata
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Kodai Kuriyama
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Toshiki Mushino
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Shogo Murata
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Hiroki Hosoi
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Akinori Nishikawa
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Nobuyoshi Hanaoka
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Takashi Sonoki
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
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114
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Grzasko N, Hajek R, Hus M, Chocholska S, Morawska M, Giannopoulos K, Czarnocki K, Druzd-Sitek A, Pienkowska-Grela B, Rygier J, Usnarska-Zubkiewicz L, Dytfeld D, Kubicki T, Jurczyszyn A, Korpysz M, Dmoszynska A. Chromosome 1 amplification has similar prognostic value to del(17p13) and t(4;14)(p16;q32) in multiple myeloma patients: analysis of real-life data from the Polish Myeloma Study Group. Leuk Lymphoma 2017; 58:1-15. [DOI: 10.1080/10428194.2016.1272684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Norbert Grzasko
- Department of Hematology, St. John’s Cancer Center, Lublin, Poland
- Department of Experimental Hematooncology, Medical University of Lublin, Lublin, Poland
| | - Roman Hajek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Marek Hus
- Department of Experimental Hematooncology, Medical University of Lublin, Lublin, Poland
| | - Sylwia Chocholska
- Department of Experimental Hematooncology, Medical University of Lublin, Lublin, Poland
| | - Marta Morawska
- Department of Hematology, St. John’s Cancer Center, Lublin, Poland
| | - Krzysztof Giannopoulos
- Department of Hematology, St. John’s Cancer Center, Lublin, Poland
- Department of Experimental Hematooncology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Czarnocki
- Department of Hematology, St. John’s Cancer Center, Lublin, Poland
- Department of Ergonomics, Faculty of Management, Lublin University of Technology, Lublin, Poland
| | - Agnieszka Druzd-Sitek
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | - Barbara Pienkowska-Grela
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | - Jolanta Rygier
- Department of Lymphoproliferative Diseases, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | - Lidia Usnarska-Zubkiewicz
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Dominik Dytfeld
- Department of Hematology and Bone Marrow Transplantation Poznan, Poznan University of Medical Sciences, Poland
| | - Tadeusz Kubicki
- Department of Hematology and Bone Marrow Transplantation Poznan, Poznan University of Medical Sciences, Poland
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
| | - Maciej Korpysz
- Department of Biochemical Diagnostics, Medical University of Lublin, Lublin, Poland
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115
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Wong P, Kashtwari D, Nair MK. Radiographic features of plasma cell leukemia in the maxilla: A case report. Imaging Sci Dent 2016; 46:273-278. [PMID: 28035306 PMCID: PMC5192026 DOI: 10.5624/isd.2016.46.4.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/06/2016] [Accepted: 09/20/2016] [Indexed: 12/22/2022] Open
Abstract
Plasma cell leukemia (PCL) is an aggressive form of multiple myeloma where there is hematogenous spread of abnormal plasma cells into the periphery. This is opposed to multiple myeloma, where the abnormal plasma cells stay in the bone marrow. PCL is more common in males than females, and is also more common in African-Americans than Caucasians. Signs and symptoms of PCL include, but are not limited to, renal insufficiency, hypercalcemia, anemia, lytic bone lesions, thrombocytopenia, hepatomegaly, and splenomegaly. Here, we discussed a case of a 71-year-old Caucasian female recently diagnosed with primary PCL with radiographic features of this disease throughout the body, with an emphasis on the maxillofacial skeleton and relevance from a dental standpoint.
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Affiliation(s)
- Phillip Wong
- Division of Oral and Maxillofacial Radiology, Oral and Maxillofacial Diagnostic Sciences/Radiology, Colleges of Dentistry/Medicine, University of Florida, Gainesville, FL, USA
| | - Deeba Kashtwari
- Division of Oral and Maxillofacial Radiology, Oral and Maxillofacial Diagnostic Sciences/Radiology, Colleges of Dentistry/Medicine, University of Florida, Gainesville, FL, USA
| | - Madhu K Nair
- Division of Oral and Maxillofacial Radiology, Oral and Maxillofacial Diagnostic Sciences/Radiology, Colleges of Dentistry/Medicine, University of Florida, Gainesville, FL, USA
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116
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Loureiro AD, Gonçalves MV, Ikoma MRV, Silva MRR, Colleoni GWB, Chauffaille MDL, Yamamoto M. Plasma cell leukemia with t(11;14)(q13;q32) simulating lymphoplasmacytic lymphoma - a diagnostic challenge solved by flow cytometry. Rev Bras Hematol Hemoter 2016; 39:66-69. [PMID: 28270351 PMCID: PMC5339392 DOI: 10.1016/j.bjhh.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/01/2016] [Accepted: 10/10/2016] [Indexed: 12/27/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Mihoko Yamamoto
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
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117
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Nolte F, Mossner M, Jann JC, Nowak D, Boch T, Müller NZ, Hofmann WK, Metzgeroth G. Concomitant MDS with isolated 5q deletion and MGUS: case report and review of molecular aspects. Eur J Haematol 2016; 98:302-310. [PMID: 27862375 DOI: 10.1111/ejh.12827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 12/23/2022]
Abstract
Patients with monoclonal gammopathy of undetermined significance (MGUS) have a higher risk for the development of concomitant primary cancers such as multiple myeloma (MM) and myelodysplastic syndrome (MDS). We report the case of patient initially suffering from MGUS of the IgG lambda subtype for more than 10 yr, which evolved to MM and MDS with deletion (5q) with severe pancytopenia. Due to pancytopenia, he received dose-reduced treatment with lenalidomide and dexamethasone. He achieved an ongoing transfusion independency after about 1 month of treatment. Bone marrow taken 14 months after start of treatment showed a complete cytogenetic response of the del(5q) clone and a plasma cell infiltration below 5%. In contrast to the development of MM in MGUS patients, the subsequent occurrence of MDS after diagnosis of MGUS is infrequent. Moreover, the biological association of MDS with MGUS is not sufficiently understood, but the non-treatment-related occurrence supports the pathogenetic role of pre-existing alterations of stem cells. Here, we summarize data on concomitant MDS and MGUS/MM with particular emphasis on molecular aspects.
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Affiliation(s)
- Florian Nolte
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Internal Medicine, Hematology and Oncology, St. Hedwig Hospital, Berlin, Germany
| | - Maximilian Mossner
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | | | - Daniel Nowak
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Tobias Boch
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Nadine Zoe Müller
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Wolf-Karsten Hofmann
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Georgia Metzgeroth
- Medical faculty Mannheim of the University of Heidelberg, Mannheim, Germany.,Department of Hematology and Oncology, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
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118
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Mina R, D’Agostino M, Cerrato C, Gay F, Palumbo A. Plasma cell leukemia: update on biology and therapy. Leuk Lymphoma 2016; 58:1538-1547. [DOI: 10.1080/10428194.2016.1250263] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Roberto Mina
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mattia D’Agostino
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Cerrato
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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119
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Miloudi M, Messaoudi N. [Primary plasma cell leukemia: about 3 cases]. Pan Afr Med J 2016; 24:167. [PMID: 27795764 PMCID: PMC5072883 DOI: 10.11604/pamj.2016.24.167.9791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/10/2016] [Indexed: 11/15/2022] Open
Abstract
La leucémie à plasmocytes est une hémopathie maligne rare définie par la présence de plus de 20 % de plasmocytes de la formule leucocytaire ou un nombre de plasmocytes circulants supérieur à 2 × 109/L (2G/L). Elle peut être primitive, dans 60% des cas, et se manifeste d'emblée sur un mode leucémique ou secondaire, dans 40% des cas, compliquant un myélome multiple connu. Vu la rareté de cette affection, seuls quelques cas ont été rapportés dans la littérature. Elle est caractérisée par son agressivité et son mauvais pronostic. A travers 03 cas diagnostiqués au laboratoire d'hématologie de l'hôpital militaire Mohammed V les auteurs présentent les particularités cliniques, biologiques et pronostic de cette affection.
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Affiliation(s)
- Mouhcine Miloudi
- Laboratoire d'Analyses Médicales, 3ème Hôpital Militaire, Laayoune, Maroc
| | - Nezha Messaoudi
- Laboratoire d'Hématologie, Hôpital Militaire d'Instruction Mohammed V, Rabat, Maroc
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120
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Neri A, Todoerti K, Lionetti M, Simeon V, Barbieri M, Nozza F, Vona G, Pompa A, Baldini L, Musto P. Primary plasma cell leukemia 2.0: advances in biology and clinical management. Expert Rev Hematol 2016; 9:1063-1073. [DOI: 10.1080/17474086.2016.1244002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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121
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Gaballa S, Saliba RM, Srour S, Lu G, Brammer JE, Shah N, Bashir Q, Patel K, Bock F, Parmar S, Hosing C, Popat U, Delgado R, Rondon G, Shah JJ, Manasanch EE, Orlowski RZ, Champlin R, Qazilbash MH. Outcomes in patients with multiple myeloma with TP53 deletion after autologous hematopoietic stem cell transplant. Am J Hematol 2016; 91:E442-7. [PMID: 27420405 DOI: 10.1002/ajh.24487] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 12/24/2022]
Abstract
TP53 gene deletion is associated with poor outcomes in multiple myeloma (MM). We report the outcomes of patients with MM with and without TP53 deletion who underwent immunomodulatory drug (IMiD) and/or proteasome inhibitor (PI) induction followed by autologous hematopoietic stem cell transplant (auto-HCT). We identified 34 patients with MM and TP53 deletion who underwent IMiD and/or PI induction followed by auto-HCT at our institution during 2008-2014. We compared their outcomes with those of control patients (n = 111) with MM without TP53 deletion. Median age at auto-HCT was 59 years in the TP53-deletion group and 58 years in the control group (P = 0.4). Twenty-one patients (62%) with TP53 deletion and 69 controls (62%) achieved at least partial remission before auto-HCT (P = 0.97). Twenty-three patients (68%) with TP53 deletion and 47 controls (42%) had relapsed disease at auto-HCT (P = 0.01). Median progression-free survival was 8 months for patients with TP53 deletion and 28 months for controls (P < 0.001). Median overall survival was 21 months for patients with TP53 deletion and 56 months for controls (P < 0.001). On multivariate analysis of both groups, TP53 deletion (hazard ratio 3.4, 95% confidence interval 1.9-5.8, P < 0.001) and relapsed disease at auto-HCT (hazard ratio 2.0, 95% confidence interval 1.2-3.4, P = 0.008) were associated with a higher risk of earlier progression. In MM patients treated with PI and/or IMiD drugs, and auto-HCT, TP53 deletion and relapsed disease at the time of auto-HCT are independent predictors of progression. Novel approaches should be evaluated in this high-risk population. Am. J. Hematol. 91:E442-E447, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sameh Gaballa
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Rima M. Saliba
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Samer Srour
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Gary Lu
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jonathan E. Brammer
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Nina Shah
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Qaiser Bashir
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Krina Patel
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Fabian Bock
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Simrit Parmar
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Chitra Hosing
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Ruby Delgado
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jatin J. Shah
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Elisabet E. Manasanch
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Robert Z. Orlowski
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Richard Champlin
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Muzaffar H. Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston Texas
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122
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Manier S, Salem KZ, Park J, Landau DA, Getz G, Ghobrial IM. Genomic complexity of multiple myeloma and its clinical implications. Nat Rev Clin Oncol 2016; 14:100-113. [DOI: 10.1038/nrclinonc.2016.122] [Citation(s) in RCA: 293] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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123
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Ali A, Paul Y, Nwabudike SM, Ogbonna O, Grantham M, Taddesse-Heath L. Plasma Cell Leukemia Presenting as a Chest Wall Mass: A Case Report. Case Rep Oncol 2016; 9:338-43. [PMID: 27462235 PMCID: PMC4939667 DOI: 10.1159/000447353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 11/19/2022] Open
Abstract
Plasma cell leukemia (PCL) is an uncommon neoplasm of plasma cells, with an aggressive clinical course and poor outcome, even with current standard of care. It can occur either de novo (primary PCL) or as a progression of multiple myeloma (MM). This disease has unique diagnostic criteria but certain genetic markers and clinical features may overlap with MM. Due to the low prevalence of PCL, guidelines on its management are extrapolated from the management of MM and based on small retrospective studies and cases reports/series. We present an interesting case of PCL in a middle-aged African-American male, who was diagnosed incidentally after chest wall imaging for an unrelated complaint. The diagnostic approach, management and outcomes of PCL are discussed.
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Affiliation(s)
- Ahmed Ali
- Division of Hematology and Oncology, Howard University Hospital, Washington, D.C., USA
| | - Yonette Paul
- Department of Internal Medicine, Howard University Hospital, Washington, D.C., USA
| | | | - Onyekachi Ogbonna
- Division of Hematology and Oncology, Howard University Hospital, Washington, D.C., USA
| | - Mica Grantham
- Department of Pathology, Howard University Hospital, Washington, D.C., USA
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124
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Våtsveen TK, Børset M, Dikic A, Tian E, Micci F, Lid AHB, Meza-Zepeda LA, Coward E, Waage A, Sundan A, Kuehl WM, Holien T. VOLIN and KJON-Two novel hyperdiploid myeloma cell lines. Genes Chromosomes Cancer 2016; 55:890-901. [PMID: 27311012 DOI: 10.1002/gcc.22388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/12/2016] [Indexed: 12/21/2022] Open
Abstract
Multiple myeloma can be divided into two distinct genetic subgroups: hyperdiploid (HRD) or nonhyperdiploid (NHRD) myeloma. Myeloma cell lines are important tools to study myeloma cell biology and are commonly used for preclinical screening and testing of new drugs. With few exceptions human myeloma cell lines are derived from NHRD patients, even though about half of the patients have HRD myeloma. Thus, there is a need for cell lines of HRD origin to enable more representative preclinical studies. Here, we present two novel myeloma cell lines, VOLIN and KJON. Both of them were derived from patients with HRD disease and shared the same genotype as their corresponding primary tumors. The cell lines' chromosomal content, genetic aberrations, gene expression, immunophenotype as well as some of their growth characteristics are described. Neither of the cell lines was found to harbor immunoglobulin heavy chain translocations. The VOLIN cell line was established from a bone marrow aspirate and KJON from peripheral blood. We propose that these unique cell lines may be used as tools to increase our understanding of myeloma cell biology. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Thea Kristin Våtsveen
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pathology and Medical Genetics, St. Olav's University Hospital, Trondheim, Norway
| | - Magne Børset
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Immunology and Transfusion Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Aida Dikic
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Erming Tian
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Francesca Micci
- Section for Cancer Cytogenetics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ana H B Lid
- Department of Core Facilities, Oslo University Hospital, Oslo, Norway
| | - Leonardo A Meza-Zepeda
- Department of Core Facilities, Oslo University Hospital, Oslo, Norway.,Department of Tumor Biology, Oslo University Hospital, Oslo, Norway
| | - Eivind Coward
- Bioinformatics Core Facility, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Anders Waage
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Hematology, St. Olav's University Hospital, Trondheim, Norway
| | - Anders Sundan
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Centre of Molecular Inflammation Research, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Toril Holien
- K.G. Jebsen Center for Myeloma Research, Department of Cancer Research and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
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125
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Affiliation(s)
- Pellegrino Musto
- Istituto di Ricovero e Cura a Carattere Scientifico, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (Pz), Italy
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126
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Cifola I, Lionetti M, Pinatel E, Todoerti K, Mangano E, Pietrelli A, Fabris S, Mosca L, Simeon V, Petrucci MT, Morabito F, Offidani M, Di Raimondo F, Falcone A, Caravita T, Battaglia C, De Bellis G, Palumbo A, Musto P, Neri A. Whole-exome sequencing of primary plasma cell leukemia discloses heterogeneous mutational patterns. Oncotarget 2016; 6:17543-58. [PMID: 26046463 PMCID: PMC4627327 DOI: 10.18632/oncotarget.4028] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/11/2015] [Indexed: 02/04/2023] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive form of plasma cell dyscrasia and may represent a valid model for high-risk multiple myeloma (MM). To provide novel information concerning the mutational profile of this disease, we performed the whole-exome sequencing of a prospective series of 12 pPCL cases included in a Phase II multicenter clinical trial and previously characterized at clinical and molecular levels. We identified 1, 928 coding somatic non-silent variants on 1, 643 genes, with a mean of 166 variants per sample, and only few variants and genes recurrent in two or more samples. An excess of C > T transitions and the presence of two main mutational signatures (related to APOBEC over-activity and aging) occurring in different translocation groups were observed. We identified 14 candidate cancer driver genes, mainly involved in cell-matrix adhesion, cell cycle, genome stability, RNA metabolism and protein folding. Furthermore, integration of mutation data with copy number alteration profiles evidenced biallelically disrupted genes with potential tumor suppressor functions. Globally, cadherin/Wnt signaling, extracellular matrix and cell cycle checkpoint resulted the most affected functional pathways. Sequencing results were finally combined with gene expression data to better elucidate the biological relevance of mutated genes. This study represents the first whole-exome sequencing screen of pPCL and evidenced a remarkable genetic heterogeneity of mutational patterns. This may provide a contribution to the comprehension of the pathogenetic mechanisms associated with this aggressive form of PC dyscrasia and potentially with high-risk MM.
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Affiliation(s)
- Ingrid Cifola
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Marta Lionetti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eva Pinatel
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Katia Todoerti
- Laboratory of Pre-Clinical and Translational Research, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Eleonora Mangano
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | | | - Sonia Fabris
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vittorio Simeon
- Laboratory of Pre-Clinical and Translational Research, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy
| | | | - Massimo Offidani
- Hematologic Clinic, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesco Di Raimondo
- Department of Biomedical Sciences, Division of Hematology, Ospedale Ferrarotto, University of Catania, Catania, Italy
| | - Antonietta Falcone
- Hematology Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Tommaso Caravita
- Department of Hematology, Ospedale S. Eugenio, Tor Vergata University, Rome, Italy
| | - Cristina Battaglia
- Institute for Biomedical Technologies, National Research Council, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Gianluca De Bellis
- Institute for Biomedical Technologies, National Research Council, Milan, Italy
| | - Antonio Palumbo
- Division of Hematology, University of Torino, A.O.U. San Giovanni Battista, Torino, Italy
| | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | - Antonino Neri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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127
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Braga CG, Rodrigues AR, Alves M, Portela C, Pinto L, Marques H. Plasma cell leukaemia. Porto Biomed J 2016; 1:49-51. [PMID: 32258549 DOI: 10.1016/j.pbj.2016.04.001] [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: 02/03/2015] [Accepted: 09/08/2015] [Indexed: 10/21/2022] Open
Abstract
Plasma cell leukaemia (PCL) is a rare and aggressive disease. Diagnosis is made when there are >2000/#mL circulating plasma cells in peripheral blood or plasmacytosis >20% of total leukocyte count. We report a case of a 51-year old man with generalized bone pain and constitutional symptoms. Blood peripheral smear revealed leukocytosis with 39% plasma cells. Bone marrow biopsy showed plasma cell invasion, which confirmed the diagnosis of PCL. Additionally, the patient had markers of advanced disease. Chemotherapy with vincristine, adriamycin and dexamethasone was started. Despite an initial favourable response, the patient died 2 months later due to an infectious complication. PCL has no established treatment and has a dismal prognosis, requiring the achievement of better data to improve the disease course.
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Affiliation(s)
| | | | - Marina Alves
- Serviço de Medicina Interna, Hospital de Braga, Braga, Portugal
| | | | - Luísa Pinto
- Serviço de Medicina Interna, Hospital de Braga, Braga, Portugal
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128
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Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol 2016; 34:2125-32. [PMID: 27114594 DOI: 10.1200/jco.2015.63.1929] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Primary plasma cell leukemia (pPCL) is a rare and aggressive malignancy with a poor prognosis. With conventional chemotherapy, patients typically die within 1 year. In all but one of the retrospective studies reported to date, bortezomib and lenalidomide seem to improve survival. We conducted a prospective phase II trial in patients with pPCL to assess the efficacy of an alternate regimen that combines standard chemotherapy, a proteasome inhibitor, and high-dose melphalan and autologous stem cell transplantation (HDM/ASCT) followed by either allogeneic transplantation or bortezomib/lenalidomide maintenance. PATIENTS AND METHODS Patients 70 years old and younger with newly diagnosed pPCL received four alternating cycles of bortezomib, dexamethasone plus doxorubicin or cyclophosphamide. Peripheral blood stem cells were collected from responding patients with < 1% of circulating plasma cells before HDM/ASCT. As consolidation, young patients received a reduced-intensity conditioning allograft, whereas the remaining patients underwent a second HDM/ASCT followed by 1 year of bortezomib, lenalidomide, dexamethasone. The primary end point was progression-free survival (PFS). RESULTS Forty patients (median age, 57 years; range, 27 to 71 years) were enrolled. The median follow-up was 28.7 months. In the intention-to-treat analysis, the median PFS and overall survival were 15.1 (95% CI, 8.4; -) and 36.3 (95% CI, 25.6; -) months, respectively. The overall response rate to induction was 69%. One patient underwent a syngeneic allograft and 25 HDM/ASCT (16 of whom subsequently received a reduced-intensity conditioning allograft and seven a second ASCT followed by maintenance). CONCLUSION In this prospective trial in patients with pPCL, we show that bortezomib, dexamethasone plus doxorubicin or cyclophosphamide induction followed by transplantation induces high response rates and appears to significantly improve PFS.
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Affiliation(s)
- Bruno Royer
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France.
| | - Stéphane Minvielle
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Momar Diouf
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Murielle Roussel
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Lionel Karlin
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Cyrille Hulin
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Bertrand Arnulf
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Margaret Macro
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Sylvie Cailleres
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Annie Brion
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Sabine Brechignac
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Karim Belhadj
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Marie Lorraine Chretien
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Marc Wetterwald
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Carine Chaleteix
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Mourad Tiab
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Xavier Leleu
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Laurent Frenzel
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Laurent Garderet
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Sylvain Choquet
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Jean Gabriel Fuzibet
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Charles Dauriac
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Luc-Matthieu Forneker
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Lotfi Benboubker
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Thierry Facon
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Philippe Moreau
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Hervé Avet-Loiseau
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Jean Pierre Marolleau
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
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Bommannan K, Sachdeva MUS, Malhotra P, Kumar N, Sharma P, Naseem S, Ahluwalia J, Das R, Varma N, Prakash G, Khadwal A, Srinivasan R, Varma S. Plasma cell leukemia in North India: retrospective analysis of a distinct clinicohematological entity from a tertiary care center and review of literature. Blood Res 2016; 51:23-30. [PMID: 27104188 PMCID: PMC4828524 DOI: 10.5045/br.2016.51.1.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 11/23/2022] Open
Abstract
Background Plasma cell leukemia (PCL) is a rare and aggressive plasma cell neoplasm. In PCL, clonal plasma cells comprise ≥20% of the peripheral blood (PB) leukocytes and/or the absolute clonal PB plasma cell count is ≥2×109/L. Primary PCL (PPCL) originates de novo, whereas, secondary PCL (SPCL) evolves from pre-existing multiple myeloma. Methods Clinicohematological features, immunophenotypic profile, and survival of PCL patients were analyzed retrospectively. Results Between January 2007 and December 2014, ten PPCL and four SPCL patients were investigated (8 PPCLs and 3 SPCLs had complete clinical data). All were North Indians, sharing common geography and ethnicity. Our cohort showed less frequent renal failure, more frequent hepatomegaly, and non-secretory type disease. In contrast to western literature, flow cytometric immunophenotyping of our cohort revealed altered expression of CD138 (67%), CD56 (33%), and CD20 (0%). With novel therapeutic agents, these PPCL patients had a median overall survival of 15 months. Conclusion We highlight that our PPCL patients from North India had distinct clinicohematological and immunophenotypic profiles. The significance of our findings must be tested in a larger patient cohort and must be supported by molecular and cytogenetic investigations to unmask possible significant effects on pathogenesis.
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Affiliation(s)
- Karthik Bommannan
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Man Updesh Singh Sachdeva
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narender Kumar
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Sharma
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shano Naseem
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmina Ahluwalia
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Segges P, Braggio E, Minnicelli C, Hassan R, Zalcberg IR, Maiolino A. Genetic aberrations in multiple myeloma characterized by cIg-FISH: a Brazilian context. ACTA ACUST UNITED AC 2016; 49:e5034. [PMID: 27074166 PMCID: PMC4830026 DOI: 10.1590/1414-431x20155034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 12/17/2015] [Indexed: 12/28/2022]
Abstract
Genetic abnormalities are critical prognostic factors for patients diagnosed with multiple myeloma (MM). This retrospective, multicenter study aimed to contribute with the genetic and clinical characterization of MM patients in a country with continental dimensions such as Brazil. Genetic abnormalities were assessed by cIg-fluorescent in situ hybridization (cIg-FISH) in a series of 152 MM patients (median age 55 years, 58.5% men). Overall, genetic abnormalities were detected in 52.7% (80/152) of patients. A 14q32 rearrangement was detected in 33.5% (n=51), including t(11;14), t(4;14) and t(14;16) in 18.4, 14.1, and 1% of cases, respectively. del(13q) was identified in 42.7% (n=65) of patients, of whom 49.2% (32/65) presented a concomitant 14q32 rearrangement. del(17p) had a frequency of 5.2% (n=8). del(13q) was associated with high plasma cell burden (≥50%, P=0.02), and del(17p) with advanced ISS stages (P=0.05) and extramedullary disease (P=0.03). t(4;14) was associated with advanced Durie-Salmon stages (P=0.008), renal insufficiency (P=0.01) and was more common in patients over 60 years old. This study reports similar frequencies of genetic abnormalities to most series worldwide, whereas the t(14;16) and del(17p), two high risk factors for newly diagnosed patients, exhibited lower frequencies. Our results expand the knowledge on the molecular features of MM in Brazil, a country where innovative therapies that could overcome a poor prognosis for some genetic abnormalities are not always available.
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Affiliation(s)
- P Segges
- Centro de Transplante de Medula =ssea, Instituto Nacional de Câncer, RJ, Rio de Janeiro, Brasil
| | - E Braggio
- Department of Hematology and Oncology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - C Minnicelli
- Centro de Transplante de Medula =ssea, Instituto Nacional de Câncer, RJ, Rio de Janeiro, Brasil
| | - R Hassan
- Centro de Transplante de Medula =ssea, Instituto Nacional de Câncer, RJ, Rio de Janeiro, Brasil
| | - I R Zalcberg
- Centro de Transplante de Medula =ssea, Instituto Nacional de Câncer, RJ, Rio de Janeiro, Brasil
| | - A Maiolino
- Departamento de Medicina Interna, Serviço de Hematologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Laboratory testing requirements for diagnosis and follow-up of multiple myeloma and related plasma cell dyscrasias. ACTA ACUST UNITED AC 2016; 54:907-19. [DOI: 10.1515/cclm-2015-0580] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/15/2015] [Indexed: 02/07/2023]
Abstract
AbstractMonoclonal immunoglobulins are markers of plasma cell proliferative diseases and have been described as the first (and perhaps best) serological tumor marker. The unique structure of each monoclonal protein makes them highly specific for each plasma cell clone. The difficulties of using monoclonal proteins for diagnosing and monitoring multiple myeloma, however, stem from the diverse disease presentations and broad range of serum protein concentrations and molecular weights. Because of these challenges, no single test can confidently diagnose or monitor all patients. Panels of tests have been recommended for sensitivity and efficiency. In this review we discuss the various disease presentations and the use of various tests such as protein electrophoresis and immunofixation electrophoresis as well as immunoglobulin quantitation, free light chain quantitation, and heavy-light chain quantitation by immuno-nephelometry. The choice of tests for inclusion in diagnostic and monitoring panels may need to be tailored to each patient, and examples are provided. The panel currently recommended for diagnostic screening is serum protein electrophoresis, immunofixation electrophoresis, and free light chain quantitation.
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Abstract
Multiple myeloma (MM) is a genetically complex disease. The past few years have seen an evolution in cancer research with the emergence of next-generation sequencing (NGS), enabling high throughput sequencing of tumors-including whole exome, whole genome, RNA, and single-cell sequencing as well as genome-wide association study (GWAS). A few inherited variants have been described, counting for some cases of familial disease. Hierarchically, primary events in MM can be divided into hyperdiploid (HDR) and nonhyperdiploid subtypes. HRD tumors are characterized by trisomy of chromosomes 3, 5, 7, 9, 11, 15, 19, and/or 21. Non-HRD tumors harbor IGH translocations, mainly t(4;14), t(6;14), t(11;14), t(14;16), and t(14;20). Secondary events participate to the tumor progression and consist in secondary translocation involving MYC, copy number variations (CNV) and somatic mutations (such as mutations in KRAS, NRAS, BRAF, P53). Moreover, the dissection of clonal heterogeneity helps to understand the evolution of the disease. The following review provides a comprehensive review of the genomic landscape in MM.
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Affiliation(s)
- Salomon Manier
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
- Department of Hematology, Lille Hospital University, Lille, France
| | - Karma Salem
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Siobhan V Glavey
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - Aldo M Roccaro
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
- Department of Hematology, CREA Laboratory, ASST-Spedali Civili di Brescia, Brescia, BS, Italy
| | - Irene M Ghobrial
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
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Response to pomalidomide plus fixed low-dose dexamethasone in a case of secondary plasma cell leukaemia. Leuk Res 2016; 40:30-2. [DOI: 10.1016/j.leukres.2015.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 12/26/2022]
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Hsu P, Lin TW, Gau JP, Yu YB, Hsiao LT, Tzeng CH, Chen PM, Chiou TJ, Liu JH, Liu YC, Liu CJ. Risk of Early Mortality in Patients With Newly Diagnosed Multiple Myeloma. Medicine (Baltimore) 2015; 94:e2305. [PMID: 26683968 PMCID: PMC5058940 DOI: 10.1097/md.0000000000002305] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The overall survival of patients with multiple myeloma (MM) has been improved greatly over the last 2 decades with the broader use of novel drugs and autologous tandem transplantation. However, more than one tenth of myeloma patients still die shortly after diagnosis. We therefore aim to investigate the risk factors of early mortality (death within 60 days after diagnosis) in patients with MM. We included in this study 451 consecutive patients with MM, newly diagnosed at an Asian tertiary medical center between January 1, 2002 and April 30, 2015. A total of 57 subjects who experienced early mortality were identified. Risk factors for early mortality in myeloma patients were collected and analyzed. Early mortality occurred in 57 (12.6%) of the myeloma patients. In the multivariate analysis, being male (adjusted OR 2.93, 95% CI 1.17-7.31), serum albumin < 3.5 g/dL (adjusted OR 2.71, 95% CI 1.09-6.74), primary plasma cell leukemia (adjusted OR 17.61, 95% CI 1.01-306.05), serum albumin (adjusted OR 2.70, 95% CI 1.15-6.38), corrected serum calcium ≥ 12 mg/dL (adjusted OR 2.94, 95% CI 1.21-7.14), and LDH ≥ 250 U/L (adjusted OR 3.07, 95% CI 1.50-6.27) were identified as independent risk factors of early mortality. Pneumonia with other infections contributed most to early mortality (n = 36, 65%), followed by renal failure and cardiac failure. The early mortality rate is high (12.6%) in patients with MM. Patients who are male and those with primary plasma cell leukemia, low serum albumin, high-corrected serum calcium, or LDH are at risk of early mortality. Nearly two thirds of the myeloma patients who experienced early mortality in our study (37 of 57, 65%) died of infection. Once a high-risk group is identified, much effort is required to target new approaches for prevention, early detection, and treatment of infections.
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Affiliation(s)
- Pei Hsu
- From the Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital (PH, J-PG, Y-BY, L-TH, C-HT, P-MC, J-HL, Y-CL, C-JL), School of Medicine, National Yang-Ming University (T-WL, J-PG, Y-BY, L-TH, C-HT, P-MC, T-JC, J-HL, Y-CL, C-JL), Department of Medical Education, Taipei Veterans General Hospital (T-WL), Institute of Public Health, National Yang-Ming University (C-JL); and Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (T-JC); Department of Medicine of Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan (Y-CL)
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Marshall R, Vaughan J, David R, Schapkaitz E, Carmona S, Wiggill T. Primary plasma cell leukaemia in a 22-year-old woman: A case
report. Afr J Lab Med 2015; 4:289. [PMID: 38440312 PMCID: PMC10911651 DOI: 10.4102/ajlm.v4i1.289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 08/18/2015] [Indexed: 03/06/2024] Open
Abstract
Introduction Primary plasma cell leukaemia is a rare and highly aggressive disease that is commonly diagnosed a decade earlier than multiple myeloma, at a median age of 55 years. However, it has also been described in younger patients, as documented in this case report. It often presents with hepatosplenomegaly and lymphadenopathy, whilst the presence of bony lesions are less-commonly seen when compared to multiple myeloma. Case presentation This report describes the case of a young woman who presented with symptoms of anaemia and a history of menorrhagia. On further careful examination, she was found to have additional signs and symptoms and was later diagnosed with primary plasma cell leukaemia. Management and outcome On admission, the patient received supportive care measures, including blood products. At diagnosis, a specific chemotherapy regimen was commenced; however, this failed to induce remission. The decision to continue with supportive care only was made and the patient died seven months later. Discussion This case study is presented because of its rarity, the young age of the patient at presentation and the unusual clinical and laboratory findings. Persistent anaemia unresponsive to standard treatment should raise the index of suspicion and further investigations directed to exclude malignancies should be considered.
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Affiliation(s)
- Robyn Marshall
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
| | - Jenifer Vaughan
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
| | - Ria David
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Internal
Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Elise Schapkaitz
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
| | - Sergio Carmona
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
| | - Tracey Wiggill
- Department of Molecular Medicine and Haematology,
University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South
Africa
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Iriuchishima H, Ozaki S, Konishi J, Matsumoto M, Murayama K, Nakamura F, Yamamoto G, Handa H, Saitoh T, Nagura E, Shimizu K, Nojima Y, Murakami H. Primary Plasma Cell Leukemia in the Era of Novel Agents: A Multicenter Study of the Japanese Society of Myeloma. Acta Haematol 2015; 135:113-21. [PMID: 26505781 DOI: 10.1159/000439424] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/16/2015] [Indexed: 11/19/2022]
Abstract
We investigated the treatment and outcome of Japanese patients with primary plasma cell leukemia (pPCL) in the era of novel agents and analyzed the risk factors affecting survival. Among 3,318 patients with symptomatic multiple myeloma (MM), 38 patients were diagnosed with pPCL. The median overall survival (OS) of the pPCL patients was 2.85 years, which was significantly extended compared with that in previous reports. The proportion of patients treated with novel agents was 61%. The OS of the patients treated with novel agents was significantly extended compared with that of patients treated without novel agents according to the generalized Wilcoxon test (2.85 vs. 1.16 years, p = 0.049). This statistical finding suggests that treatment with novel agents could have prevented early death in the patients with pPCL. Age was the only statistically significant prognostic factor associated with an inferior OS (hazard ratio 4.57). Five patients received maintenance therapy with novel agents, and their OS tended to be longer than that of the other patients without maintenance (4.45 vs. 2.85 years). Unlike MM, OS for pPCL has not been improved significantly over the last decade, especially in elderly patients. Therefore, it is important to establish the treatment strategy, particularly after induction treatment.
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Affiliation(s)
- Hirono Iriuchishima
- Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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Stella F, Pedrazzini E, Agazzoni M, Ballester O, Slavutsky I. Cytogenetic Alterations in Multiple Myeloma: Prognostic Significance and the Choice of Frontline Therapy. Cancer Invest 2015; 33:496-504. [DOI: 10.3109/07357907.2015.1080833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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139
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Molecular Classification and Pharmacogenetics of Primary Plasma Cell Leukemia: An Initial Approach toward Precision Medicine. Int J Mol Sci 2015; 16:17514-34. [PMID: 26263974 PMCID: PMC4581206 DOI: 10.3390/ijms160817514] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive variant of multiple myeloma (MM) which may represent a valid model for high-risk MM. This disease is associated with a very poor prognosis, and unfortunately, it has not significantly improved during the last three decades. New high-throughput technologies have allowed a better understanding of the molecular basis of this disease and moved toward risk stratification, providing insights for targeted therapy studies. This knowledge, added to the pharmacogenetic profile of new and old agents in the analysis of efficacy and safety, could contribute to help clinical decisions move toward a precision medicine and a better clinical outcome for these patients. In this review, we describe the available literature concerning the genomic characterization and pharmacogenetics of plasma cell leukemia (PCL).
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140
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Localized Relapse of Primary Plasma Cell Leukaemia in the Central Nervous System. Case Rep Hematol 2015; 2015:273565. [PMID: 26064713 PMCID: PMC4441999 DOI: 10.1155/2015/273565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/17/2015] [Indexed: 12/14/2022] Open
Abstract
Primary plasma cell leukaemia (pPCL) is a rare and aggressive form of plasma cell malignancies with a very poor prognosis. Compared to other plasma cell malignancies the tendency to extramedullary spread is increased; however central nervous system (CNS) involvement is rare and only reported in few cases. We report the case of a 61-year-old man who was diagnosed with pPCL and achieved a complete remission after autologous stem cell transplantation but had a relapse in the CNS without systemic disease.
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141
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Plasma cell leukemia: Clinicopathologic, immunophenotypic and cytogenetic characteristics of 4 cases. Hematol Oncol Stem Cell Ther 2015; 8:71-7. [PMID: 25929729 DOI: 10.1016/j.hemonc.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/28/2015] [Accepted: 04/04/2015] [Indexed: 12/19/2022] Open
Abstract
Plasma cell leukemia (PCL) is a rare hematologic malignancy with very poor outcome. It is defined by the presence of >2 × 10(9)/L plasma cells or >20% plasmacytosis of the differential white cell count in the peripheral blood. Primary PCL is first diagnosed in the leukemic phase, while secondary PCL corresponds to the leukemic transformation of a previously diagnosed multiple myeloma (MM). The incidence of PCL ranges between 2-4% of patients with MM and 0.9% of patients with acute leukemia. In this case series, we describe the clinicopathologic, immunophenotypic, and cytogenetic findings of four patients diagnosed with PCL within a ten-year period (2002-2012) at King Faisal Specialist Hospital and Research Centre (General Organization), Riyadh, Saudi Arabia.
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142
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Jelinek T, Kryukov F, Rihova L, Hajek R. Plasma cell leukemia: from biology to treatment. Eur J Haematol 2015; 95:16-26. [DOI: 10.1111/ejh.12533] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Tomas Jelinek
- University Hospital Ostrava; Department of Haematooncology; Ostrava Czech Republic
| | - Fedor Kryukov
- University of Ostrava; Faculty of Medicine; Ostrava Czech Republic
| | - Lucie Rihova
- University Hospital Brno; Department of Clinical Haematology; Brno Czech Republic
| | - Roman Hajek
- University Hospital Ostrava; Department of Haematooncology; Ostrava Czech Republic
- University of Ostrava; Faculty of Medicine; Ostrava Czech Republic
- University Hospital Brno; Department of Clinical Haematology; Brno Czech Republic
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143
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Shin HJ, Kim K, Lee JJ, Song MK, Lee EY, Park SH, Kim SH, Jang MA, Kim SJ, Chung JS. The t(11;14)(q13;q32) translocation as a poor prognostic parameter for autologous stem cell transplantation in myeloma patients with extramedullary plasmacytoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 15:227-35. [PMID: 25812994 DOI: 10.1016/j.clml.2014.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/23/2014] [Accepted: 12/06/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Fluorescence in-situ hybridization (FISH)-detected abnormalities, including del(17p), del(13q), and t(4;14), have been associated with inferior prognosis. However, there are few data about the prognostic significance of cytogenetic abnormalities for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients with extramedullary plasmacytoma (EMP). PATIENTS AND METHODS Between April 2004 and December 2012, 290 MM patients underwent ASCT at 3 centers. FISH data for bone marrow samples obtained at diagnosis were available for 58 patients who had EMP at diagnosis or during treatment. RESULTS The t(11;14), t(4;14), del(13q), and 1q gain abnormalities were seen in 14.9%, 6.3%, 25.6%, and 42.9%, respectively. No t(14;16) or del(17p) cytogenetic abnormality was detected in the examined patients. Patients with t(11;14) had a lower response rate compared to patients with other cytogenetic abnormalities. EMP-specific relapse was higher in patients with t(11;14) than in patients with other cytogenetic abnormalities (42.9% vs. 10%-33.3%). Each of the 4 cytogenetic abnormalities predicted shorter median progression-free survival (6-12 months vs. 27-37 months) and shorter overall survival (16-22 months vs. 68 months or not reached) compared to no cytogenetic abnormality. The t(11;14) translocation was an important prognostic factor for both progression-free survival (hazard ratio, 25.154; P < .001) and overall survival (hazard ratio, 7.484; P = .024) in the multivariate analysis. CONCLUSION In the current study, t(11;14), t(4;14), del(13q), and 1q gain were associated with worse survival in MM patients with EMP. The role of t(11;14) as a prognostic parameter for ASCT in MM patients with EMP should be confirmed with a large, well-designed study.
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Affiliation(s)
- Ho-Jin Shin
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Pusan National University, Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Kihyun Kim
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea.
| | - Je-Jung Lee
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun
| | - Moo-Kon Song
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Pusan National University, Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Eun Yup Lee
- Department of Laboratory Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Sang Hyuk Park
- Department of Laboratory Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Sun-Hee Kim
- Department of Laboratory Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Mi-Ae Jang
- Department of Laboratory Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Seok Jin Kim
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Joo Seop Chung
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Pusan National University, Medical Research Institute, Pusan National University Hospital, Busan, South Korea
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144
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Kalff A, Khong T, Wall M, Gorniak M, Mithraprabhu S, Campbell LJ, Spencer A. A rare case of IGH/MYC and IGH/BCL2 double hit primary plasma cell leukemia. Haematologica 2014; 100:e60-2. [PMID: 25381133 DOI: 10.3324/haematol.2014.111385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anna Kalff
- Alfred Hospital, Myeloma Research Group, Australian Centre for Blood Diseases, Monash University, Melbourne
| | - Tiffany Khong
- Alfred Hospital, Myeloma Research Group, Australian Centre for Blood Diseases, Monash University, Melbourne
| | - Meaghan Wall
- Victorian Cancer Cytogenetics Service, St Vincent's Hospital, Melbourne Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Malgorzata Gorniak
- Department of Laboratory Haematology, Alfred Hospital, Melbourne, Australia
| | - Sridurga Mithraprabhu
- Alfred Hospital, Myeloma Research Group, Australian Centre for Blood Diseases, Monash University, Melbourne
| | - Lynda J Campbell
- Victorian Cancer Cytogenetics Service, St Vincent's Hospital, Melbourne Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Andrew Spencer
- Alfred Hospital, Myeloma Research Group, Australian Centre for Blood Diseases, Monash University, Melbourne
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Abstract
Multiple myeloma (MM) is a heterogeneous disease that, over the past 15 years, has seen an increased understanding of its biology and of novel therapeutic options. Distinctive subtypes of the disease have been described, each with different outcomes and clinic-pathological features. Even though a detailed classification of MM into at least seven or eight major subtypes is possible, a more practical clinical approach can classify the disease into high-risk and non-high-risk MM. Such classification has permitted a more personalized approach to the management of the disease. Additionally, risk stratification should be included in outcome discussions with patients, as survival differs significantly by high-risk status. Nowadays, test for risk stratification are widely available and can be routinely used in the clinic. A greater understanding of the genetic abnormalities underlying the biology of MM will allow for the development of novel targeted therapies and better prognostic markers of the disease.
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Affiliation(s)
- Rafael Fonseca
- Department of Medicine, Mayo Clinic in Arizona, Scottsdale, AZ 85259-5494, USA
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147
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An G, Qin X, Acharya C, Xu Y, Deng S, Shi L, Zang M, Sui W, Yi S, Li Z, Hao M, Feng X, Jin F, Zou D, Qi J, Zhao Y, Tai YT, Wang J, Qiu L. Multiple myeloma patients with low proportion of circulating plasma cells had similar survival with primary plasma cell leukemia patients. Ann Hematol 2014; 94:257-64. [DOI: 10.1007/s00277-014-2211-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
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148
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Sekiguchi Y, Shimada A, Wakabayashi M, Sugimoto K, Tomita S, Izumi H, Nakamura N, Sawada T, Ohta Y, Komatsu N, Noguchi M. A case of secondary plasma cell leukemia resistant to novel agents, in which stringent complete remission was achieved and maintained for a long period of time after VAD therapy and tandem autologous transplantation. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:6313-6322. [PMID: 25337285 PMCID: PMC4203256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/20/2014] [Indexed: 06/04/2023]
Abstract
A 61-year-old woman was diagnosed in June 2011 as having immunoglobulin G (IgG) ĸ-type multiple myeloma (MM), stage II, according to the International Staging System (ISS). Chromosome analysis showed a complex karyotype, including t(11;14) and del 13q. Analysis of the cell surface markers revealed that the cells were positive for mature plasma cell-1 (MPC-1), and negative for cluster of differentiation (CD) 45 and CD49e, suggestive of an intermediate level of maturity of the cells. The disease was refractory to bortezomib-dexamethasone (BD) therapy and progressed to plasma cell leukemia despite the treatment. Treatment was therefore switched to lenalidomide-dexamethasone (RD) therapy, however, the condition again proved to be refractory to this therapy. A partial response (PR) was achieved with vincristine-doxorubicin-dexamethasone (VAD) therapy. The residual plasma cells became CD45-positive, suggesting a change of the cells from an intermediate level of maturity to mature cells. In December, autologous peripheral blood stem cell transplantation (Auto-PBSCT) was performed after high-dose melphalan therapy (melphalan 200 mg/m(2)) as pretreatment. PR was observed and a second Auto-PBSCT was performed in July 2012. Stringent complete remission (sCR) has been maintained for 2 years since, without any further treatment. This is the first reported case of secondary plasma cell leukemia (sPCL) resistant to new drugs that was successfully treated by high-dose melphalan in combination with VAD therapy and Auto-PBSCT.
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Affiliation(s)
| | - Asami Shimada
- Department of Hematology, Juntendo University Urayasu HospitalJapan
- Department of Hematology, Juntendo University HospitalJapan
| | | | - Keiji Sugimoto
- Department of Hematology, Juntendo University Urayasu HospitalJapan
| | - Shigeki Tomita
- Department of Pathology, Juntendo University Urayasu HospitalJapan
| | - Hiroshi Izumi
- Department of Pathology, Juntendo University Urayasu HospitalJapan
| | - Noriko Nakamura
- Department of Clinical Laboratory, Juntendo University Urayasu HospitalJapan
| | - Tomohiro Sawada
- Department of Clinical Laboratory, Juntendo University Urayasu HospitalJapan
| | - Yasunori Ohta
- Department of Pathology, Research Hospital, The Institute of Medical Science, The University of TokyoJapan
| | - Norio Komatsu
- Department of Hematology, Juntendo University HospitalJapan
| | - Masaaki Noguchi
- Department of Hematology, Juntendo University Urayasu HospitalJapan
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Trends in survival of patients with primary plasma cell leukemia: a population-based analysis. Blood 2014; 124:907-12. [PMID: 24957143 DOI: 10.1182/blood-2014-03-565051] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare malignancy with an aggressive course and poor outcome. There has been significant improvement in the survival of multiple myeloma patients over the past decade as a result of incorporating autologous stem cell transplantation (ASCT) and novel agents into treatment regimens. However, it is unknown whether these therapies have had a similar impact on the survival of patients with pPCL. We conducted an analysis of the Surveillance, Epidemiology, and End Results database to evaluate the trends in survival of 445 patients with pPCL between 1973 and 2009. The widespread availability of ASCT and use of novel agents in the upfront setting of multiple myeloma and pPCL began after 1995 and 2006, respectively. The median overall survival based on periods of diagnosis were 5, 6, 4, and 12 months for those diagnosed during 1973-1995, 1996-2000, 2001-2005, and 2006-2009, respectively (P = .001). Thus, the current study confirms the recent survival improvement in pPCL within a large US population that may be associated with the use of better therapeutic strategies.
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150
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MicroRNA: important player in the pathobiology of multiple myeloma. BIOMED RESEARCH INTERNATIONAL 2014; 2014:521586. [PMID: 24991558 PMCID: PMC4065722 DOI: 10.1155/2014/521586] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/19/2014] [Indexed: 01/13/2023]
Abstract
Recent studies have revealed a pivotal role played by a class of small, noncoding RNAs, microRNA (miRNA), in multiple myeloma (MM), a plasma cell (PC) malignancy causing significant morbidity and mortality. Deregulated miRNA expression in patient's PCs and plasma has been associated with tumor progression, molecular subtypes, clinical staging, prognosis, and drug response in MM. A number of important oncogenic and tumor suppressor miRNAs have been discovered to regulate important genes and pathways such as p53 and IL6-JAK-STAT signaling. miRNAs may also form complex regulatory circuitry with genetic and epigenetic machineries, the deregulation of which could lead to malignant transformation and progression. The translational potential of miRNAs in the clinic is being increasingly recognized that they could represent novel biomarkers and therapeutic targets. This review comprehensively summarizes current progress in delineating the roles of miRNAs in MM pathobiology and management.
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